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Countries of the African meningitis belt continue to experience recurrent meningococcal epidemics. Following the prequalification of the first pentavalent meningococcal ACWYX conjugate vaccine (Men5CV), the World Health Organization (WHO) issued a recommendation for the use of the vaccine in the meningitis belt. It emphasizes the need for each country to conduct a comprehensive meningococcal disease risk assessment to inform Men5CV introduction strategies. In particular, risk assessment is required to determine the need for one‑off mass preventive campaigns at introduction and to define their geographical scope, especially in high‑risk or fragile settings.
To this end, WHO has developed a standardized risk assessment framework combining quantitative and qualitative approaches. This mixed‑methods process results in a structured assessment of meningococcal risk and supports evidence‑informed national decision‑making on Men5CV introduction.
Demand for Men5CV is very high among the countries of the meningitis belt. Between mid‑2024 and mid‑2025, around ten countries have completed such a meningitis risk assessment, and several applied to Gavi support.
However, important challenges threaten timely implementation and the full materialization of the demand. The latest Gavi replenishment has fallen short of its funding target, resulting in a constrained resource envelope for the Gavi 6.0 strategic period. In this context, Gavi has recalibrated its support across vaccine programs, leading to reduced availability of funding for meningococcal vaccines, including the introduction of Men5CV, with a high risk of undermining epidemic prevention objectives. Looking forward, solutions and pathways will need to be explored to ensure that Men5CV can fully benefit the region of the world bearing the highest incidence of meningococcal meningitis.