Meningococcal vaccine stockpile
The ICG on Vaccine Provision for Epidemic Meningitis Control was established in January 1997, following major outbreaks of meningitis in Africa. The ICG manages security stocks of vaccines, injection materials and antibiotics for emergency use. Working closely with vaccine producers and following regional epidemiological trends, the ICG monitors its security stock levels to ensure they are sufficient to respond to meningitis outbreaks for each epidemic season Since the establishment of Meningitis ICG mechanism until October 2022, almost 64 million doses of vaccines were shipped to 21 countries for outbreak response.
The ICG also improves the coordination of epidemic preparedness and response by providing a forum for technical discussions among partners. Additional issues addressed by the ICG and its networks include the forecasting of epidemics, the evaluation of interventions, and negotiation of vaccine prices.
Accessing ICG Meningococcal vaccine stocks
Although established to deal primarily with the frequent and large scale epidemics in the African ‘meningitis belt’, any country fulfilling the ICG criteria can access the stock when faced with an epidemic.
To request access to Meningococcal ICG stocks, the country should submit an ICG request form for meningococcal vacccine, annexes and other required documents as per the checklist of the request form to the ICG secretariat (WHO Geneva). An ICG member agency (IRFC, MSF, UNICEF, WHO) present in the country can also submit the application on behalf of the Ministry of Health. It is highly recommended that the country submits the request to the ICG secretariat within 7 days after the district crosses the epidemic threshold. The ICG secretariat at WHO then circulates the request to the ICG members (IFRC, MSF, UNICEF, and WHO) for review and assessment within 1 day after receiving the country request. Additional information can be requested to the country, if needed.
Requests are evaluated taking into account the epidemiological situation, vaccination strategy, vaccine availability in the emergency stockpile, pre-existing stocks in the country and operational aspects of the epidemic response.
Following a rapid consultation and evaluation process, the ICG decision to release vaccines and other supplies is communicated to the requesting country within 2 working days, once all necessary information has been provided. If approved, UNICEF organizes the delivery of vaccines to the country, ideally within 7 days.
The ICG mandate is to respond to the outbreak and break the transmission of diseases as soon as possible in order to save as many lives as possible. Therefore, countries should implement the reactive vaccination campaign within 10 days after receiving the vaccines.
Application forms and guidelines
Accessing ICG Ceftriaxone Stockpile
During meningitis outbreaks, countries can submit requests for ceftriaxone as part of their vaccine applications. In this context, the ICG antibiotic stockpile is designed solely for emergency purposes rather than as a replacement of national stocks.
Additionally, the ICG has introduced a dedicated process that aims to streamline and regulate ceftriaxone applications in the absence of concurrent vaccine requests. To this purpose, a standalone submission form is available for countries to request only emergency ceftriaxone supplies. However, this opportunity should not prevent or delay laboratory confirmation efforts or reactive vaccination (where needed).
Ceftriaxone requests will be timely evaluated against available epidemiological information and operational aspects of the outbreak response while also considering the potential risks associated with the inappropriate use of antibiotics and emergence of antimicrobial-resistant pathogens. Upon approval, countries will also be required to fulfill a specific set of reporting requirements during and after the outbreak, sharing relevant information about laboratory confirmation as well as planned and implemented outbreak control measures.
Notably, this process is applicable not only to meningococcal meningitis epidemics but also outbreaks of meningitis caused by Streptococcus pneumoniae, where timely and effective case management plays a crucial role in the overall control strategy.