In Reply.—Epidemic meningococcal disease is an important public health problem in the "meningitis belt" of sub-Saharan Africa. Use of satellite images to predict possible areas of future outbreaks so that limited resources can be targeted is an intriguing possibility and warrants further evaluation.
We agree with Dr Treadwell that the occurrence of cases of meningococcal disease can be extremely distressing to affected families and communities. He states that meningococcal vaccine should be available to those who want it—and, presumably, are willing to pay for it. Thus, not all those who may want the vaccine can afford to pay for it, creating a dichotomy between those with resources and those without. The logical extension of the author's argument is that public dollars should be used to provide equal opportunity to all, as is done with other routinely recommended vaccines of childhood. Many issues limit the effectiveness of the current meningococcal vaccine (eg, it does not protect children younger than 2 years, duration of immunity is likely only 3 to 4 years, and it does not protect against serogroup B disease).