Dramatic upscaling of vaccination needed in West Africa

Nigeria, where the first patients were confirmed with diphtheria in December 2022, is experiencing the largest outbreak, with almost 17,000 suspected cases recorded so far. But it’s far from the only country facing the disease: Algeria, Guinea, Mauritania, and Niger have also reported diphtheria cases. Medical teams from MSF in several other West African countries have also seen patients with symptoms that are characteristic of the disease.

Protection against diphtheria, a potentially deadly bacterial infection, is normally offered through routine vaccination programs. However, in many countries routine vaccination programs have suffered greatly from underfunding and de-prioritisation.

“The many outbreaks of measles we’ve been seeing over the last years were a clear warning sign that the routine vaccination hasn’t reached all children,” says Dr Dagemlidet Tesfaye Worku, emergency medical program manager for MSF in Abidjan, Ivory Coast. “And now we see diphtheria emerge, which is even more worrying.”

It is essential to ensure that people are brought up to date on their vaccinations. Yet so far, only Nigeria has started a crucial, large-scale vaccination campaign. Nearly two-thirds (65%) of the diphtheria patients in West African countries have never received a single dose of the vaccine. In parts of Nigeria, vaccination coverage is as low as six per cent, with other places only having between 10 and 18% of people fully vaccinated. As a result, many people, and young children in particular, are extremely vulnerable to the re-emergence of vaccine-preventable diseases.

Thirty to forty per cent of people with diphtheria may die if they don’t get the right treatment. A specific anti-toxin drug, called DAT, is needed to reduce the risk of death in diphtheria patients. There’s currently a global shortage of DAT, partly because manufacturers didn’t expect large outbreaks to occur with vaccination programs in place.

Moreover, the sudden surge in demand for diphtheria vaccines in response to the ongoing outbreaks has created global shortages of the vaccines, too. Manufacturers will need several months to compensate for this surge. If even more countries are going to need similar mass vaccination campaigns, timely access to vaccines may become a significant challenge.

Vaccination is a key tool to bring outbreaks under control, as well as to prevent further re-emergence of other vaccine preventable diseases.

“We’re not seeing vaccination happen. Not at the scale that is needed,” says Dr Tesfaye Worku. “The problem has been slumbering for months now, with hundreds of people dying. What is needed is a truly massive scale-up of vaccination, as soon as possible.”

For this to be achieved, a significant increase in the production diphtheria-containing vaccines is urgently needed.

MSF urges authorities to prioritise outbreak response and seek all necessary support from international stakeholders and donors. International health organisations, such as World Health Organisation, GAVI and UNICEF, must reach out to the affected countries and offer technical and financial support, as well as provide them with enough vaccines. Humanitarian organisations should be included to scale up the response, including mass vaccination campaigns to reach remote and vulnerable communities. Only a huge, collective effort can turn the tide.