During the past weeks, teams from Médecins Sans Frontières (MSF) have assisted in the vaccination of more than 860,000 people against meningitis, a contagious and potentially fatal infection of the brain membrane. These mass immunisation campaigns have taken place across large swathes of northern Uganda, southern Sudan and the east of Democratic Republic of Congo (DRC), countries which make up part of what is traditionally known as the 'Meningitis Belt,' an area stretching from Senegal in the west of Africa to Ethiopia in the east. The total population at risk in these countries is approximately 300 million. Without treatment, bacterial meningitis kills up to 50 per cent of those infected. Even if the disease is diagnosed early and treated with appropriate antibiotics, the case fatality rate remains five to 10 per cent. As many as one out of five survivors will suffer from neurological after-effects such as deafness or mental retardation. In southern Sudan, MSF is currently in the process of vaccinating a further 528,000 people, mostly under the age of 30, bringing the total number vaccinated to more than one million. The latest round of vaccinations include around 160,000 people in Juba, the capital of southern Sudan and over a quarter of a million in the north of Bahr-El-Ghazal province. In addition to the planned vaccination of a further 600,000 people in the West African country of Burkina Faso, assessments are being carried out in a number of areas and teams are on alert in other countries where outbreaks are feared. In addition to the vaccinations, MSF is also undertaking case management, as well as epidemiological surveillance. The UN has announced that eight West African countries have been struck by outbreaks of the disease. The worst hit, with 324 deaths recorded by March 5, is Burkina Faso. During the next week, MSF is planning to launch a vaccination campaign for more than 600,000 people around the capital of Burkina Faso, Ouagadougou. According to the World Health Organisation (WHO), in southern Sudan alone, nearly 200 people have died as a result of meningitis and the disease has already hit eight countries, in comparison to only four during the outbreak of 2006. A risk assessment carried out by the WHO identified several factors indicating that a widespread epidemic could occur in 2007 and 2008. In the mid- to late-1990s, waves of epidemics affected several countries in the meningitis belt and caused upwards of 25,000 deaths in three years. Yet today, there are just 25 million doses of A/C vaccine — the A strain being the most common cause of epidemics — available worldwide, of which only 11 million doses have been reserved for epidemic responses. The future prospects for replenishing the vaccine supply are bleak. In May, Sanofi-Pasteur, the sole provider of the A/C vaccine, announced that it was transferring its production to another site. As a result, there will be no capacity to produce additional vaccines this year. This is extremely worrying given that in Nigeria in 1996 more than 13 million people had to be vaccinated over the course of that epidemic. Given these past figures, the potential for a huge number of preventable deaths this year is quite real.