Shortage of Meningitis Vaccine Forces Triage in Burkina Faso. By Gretchen Vogel

1. Shortage of Meningitis Vaccine Forces Triage in Burkina Faso. By Gretchen Vogel Public health officials are scrambling to halt a mounting epidemic of bacterial meningitis in Burkina Faso. They are now being forced to ration the limited supply in a way that saves as many lives as possible. World Briefing | Africa: Money Needed Quickly For Vaccine By DONALD G. MCNEIL JR. (NYT) The World Health Organization said it was running out of time to raise money for a vaccine to protect people from a vicious new form of meningitis in the so-called meningitis belt that stretches from Senegal to Ethiopia. The agency said $9 million was needed within two weeks to produce enough vaccine before the onset of the meningitis season. GlaxoSmithKline rushed to make a vaccine and is offering it at $1 a dose, which the company says is a quarter of the cost. The W.H.O. is trying to build a stockpile. Donald G. McNeil Jr. (NYT)

2. The User Need • Meningitis vaccination programme • WHO Geneva – William Perea • Needs to plan and implement African vaccination strategy • Assess effectiveness of interventions and overall programme • Cost/Benefit

3. A GEO solution • Use relationships between Earth observations and incidence of meningitis to inform decision-makers as to optimal vaccine and other public health interventions • Transmit real-time observations, forecasts and daily disease risk maps from Europe and US to ACMAD for local Met. knowledge input and onwards to MDSC for interpretation and issuing of decisions on public health interventions at national, regional and district levels

4. The Team • WHO (Two groups in Geneva: Perea and O’Neill) • IRI, Columbia University, CERMES • EU and US Sand and Dust Warning Centres, ECMWF, NASA • ACMAD • MDSC (WHO)

5. Relevant Earth observations and models…

6. Meningococcal Meningitis is a major public health problem with highest epidemics occurrence and burden in the 'Meningitis Belt' in Sub-Saharan Africa. The disease prevalence is associated with environmental conditions, appearing during the dry season and ending with the onset of the monsoon but also shows high year-to-year variability, leading to widespread epidemics. Recent works have linked the seasonality of the disease to the seasonal cycle of atmospheric conditions at national scales (Sultan, 2005, Sultan et al. 2005) and shown potential for epidemics prediction from environmental conditions (Thomson et al. 2006) Need analysis to identify specifically which environmental factors can be used as predictors to Meningitis outbreaks in order to develop in the future an Early Warning System based on forecast and monitoring products of the environmental factors responsible for the outbreak of Meningitis. Association between Earth observations and Meningitis

7. The spatial distribution of epidemics Affected districts (n = 1232 / 3281) Reported to district Reported to province

8. The temporal distribution of epidemics MONTHLY CASES (MENINGITIS) BY DISTRICT Case Surveillance Reported Weekly* BURKINA FASO (Jan’97-Dec’99, 50 districts) NIGER (Jan’93-Dec’99, 38 districts) Field Studies in Health Facilities Presenting Daily* MALI (Jul’89-Jul’98, 7 districts) TOGO (Aug’90-Jul’97, 4 districts) * includes zero reporting

9. The spatial distribution: methodology 1 Derived from data available from the Climate Research Unit, University of East Anglia, UK (http://ipcc-ddc.cru.uea.ac.uk/) 2 Derived from data available from the Centre for Resource and Environmental Studies, Canberra, Australia. 3 Derived from data provided by the US National Aeronautics and Space Administration - Goddard Space Flight Centre 4 Food and Agriculture Organisation (Soil map of the world, FAO-ARTEMIS Image Bank) 5 Derived from data available from the US Geological Survey (http://grid2.cr.usgs.gov).

10. The temporal distribution: methodology 1 Derived from data provided by the US National Aeronautics and Space Administration - Goddard Space Flight Centre, USA 2 Derived from data available from the FEWS community Africa Data Dissemination Service (http://edcintl.cr.usgs.gov/adds/adds.html) 3 Derived from data provided by the Food and Agriculture Organisation, Rome. 4 Derived from data available from the Climate Research Unit, University of East Anglia, UK 5 Derived from data available from the US Geological Survey (http://grid2.cr.usgs.gov).

11. FORECASTING MENINGITIS EPIDEMICS THE FORECASTING PRINCIPLE Early______________Peak__________Late________ -Rain______ +Dust______ -Rain______

12. The problem to be tackled Vaccination starts not preventable Epidemic in Ghana, 1997- Wood et al., Lancet 2000 Without vaccination Actual Vaccination with WHO guidelines 7000 6000 5000 4000 Cases 3000 2000 1000 0 29 5 12 19 26 2 9 16 23 2 9 16 23 30 6 13 20 27 4 11 18 25 February Dec. January March April May Date

13. Current situation • Consortium formed • Long-term project plan being finalised • Long-term funding plan being formulated • General agreement to work with GEO to produce demonstration pilot before Ministerial

14. Outline Plan for Ministerial • Area I: Research (IRI-CERMES-WHO-MDSC, LSTM) • Analyze Burkina Faso, Mali, Niger data on Meningitis to create a spatio-temporal map of the disease which can be used for analyzing the effects of environmental factors (cluster analysis) • Extract environmental data (temperature, relative humidity, changes in wind, small rain, dust, NDVI, land cover classes) • Analyze the Meningitis data in conjunction with environmental data and develop a statistical analysis which will identify the principal environmental factors which influence Meningitis (onset, peak and ending seasons) • Develop this analysis incorporating wider range of information (verify hypothesis with data for Nigeria and other neighboring countries) Ongoing work in parallel with other actions until September, 07

15. Outline Plan for Ministerial • Area II: Operations (WHO-MDSC, ) • Based on the results, develop initial risk assessment processes which can be integrated into vaccine planning and epidemic responses • Analysis of carriage. Mapping population with carriage • Analyze impact of borders (population movement) • Refine risk assessment processes • Prepare countries' National Surveillance systems and National Meteorological services to engage in future development initiatives in climate observations for epidemic forecasting and early warning system Ongoing work in parallel with other actions until September, 07

16. Outline Plan for Ministerial • Area III: Outreach, Capacity Building, Funding. Efforts to fund capacity-building in-country at regional and district level: April - November, 07 Production of short video documentary to show operation of system in pilot phase with end-user testimonials: September - November, 07