ALLENTOWN, Pennsylvania — Ever wonder what the most important issue in global health is? There are a number of competing concerns. The Millennium Development Goals include three related to health: maternal health, lowering child mortality and combating HIV/AID, malaria and other diseases.
Among the three goals, infectious diseases attracts the most attention in the news. They are an important issue to the entire globe and not just the developing countries, so this seems a reasonable choice. Of the aspects related to infectious diseases below, which is most important?
a. vaccine development
b. vaccine delivery
c. vaccine hesitation (fear of vaccines)
d. all of the above
According to the Infectious Disease Research Institute, the answer is b. vaccine delivery. While fear of vaccines has permitted a number of diseases from the past to re-emerge, such as measles and whooping cough, and others to escape eradication, such as polio, the IDRI believes that the delivery of vaccines — “how we actually get vaccines to, and into, people in order to improve global health” — is the crucial issue.
Franklyn G. Prendergast, M.D., Ph.D., a member of the board of directors; Steven G. Reed, Ph.D., founder, president and chief scientific officer working with immunology of intracellular infections and the development of vaccines; and Darrick Carter, Ph.D., vice president of adjuvant technology, state that although vaccinations are increasing both in developed and developing countries, “vaccination coverage still varies widely for different racial and ethnic groups and educational levels, as well as for high-risk populations.” This discrepancy is mostly “a result of less-than-optimal vaccine delivery.”
They highlight two problems that are responsible for this issue: transportation (getting vaccines to people) and injections (getting vaccines into people). In regard to getting vaccines to people, they assert, “We believe you can have the best vaccine in the world, but if it’s damaged during the delivery process, it does no good.” In regard to getting vaccines into people, they note that when just a flu outbreak occurs, for instance, crowds of people converging on health care centers for a flu vaccine create havoc for themselves and for the centers.
The transportation issue exists because many effective vaccines are developed in Europe, the United States or India but are needed most in the Middle East, North Africa and Sub-Saharan Africa. “…These are the places where we are going to see the next generation of catastrophic emerging infections,” according to Peter Jay Hotex, president of the non-profit Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development in Houston.
Damage during transportation occurs due to not only excessive time but also extreme heat or cold during the long shipping process between countries. Stabilizing temperatures to successfully transport a vaccine and increase its shelf life is essential to the delivery process.
This temperature-controlled supply chain is known as the “cold chain.” Doctors Without Borders says that this is most difficult during the last step in the process of delivering a vaccine to the most remote areas.
In order to maintain the potency of a vaccine, it must be kept at 36-46 degrees Fahrenheit — continuously. Some vaccines need to be frozen at minus 112 degrees Fahrenheit. Understandably, keeping vaccines thermostable in transit to and in the Middle East, North Africa and Sub-Saharan Africa is a unique logistic challenge.
As a U.S. Science Envoy of the Department of State, Hotex is working to create vaccine production programs in countries such as Saudi Arabia and Morocco. These countries have a scientific culture and Ph.D.-level scientists.
In addition, IDRI has founded vaccine-formulation centers in South Africa and India. Reed says that by producing vaccines locally, instead of having to import them, helps to reduce the cost as well as the fear of the vaccine.
IDRI is also working on a freeze-drying method, known as lyophilizing, for a tuberculosis vaccine. Lyophilizing was used during World War II for blood serum and is now used for a variety of products that need a temperature-stable shelf life.
This process would be especially useful for next-generation vaccines, the components of which are now often shipped in two separate vials. The two vials need to be mixed in exact portions, which can be inefficient and creates a risk for the patient. If a freeze-dried TB vaccine that had to be mixed with only a little sterile water on site were available, it would help ensure an effective vaccination for millions of people in the most inaccessible regions.
Arecor Ltd. works with pharmaceutical and biotech companies to enhance many different types of proteins in many different applications, such as vaccines. Their technology stabilizes a wide range of vaccines. PATH, a nonprofit organization that works to improve global health through innovation, is one of their partners.
Together they have developed heat-stable vaccines, such as one for hepatitis B. It eliminates the risk of heat and freeze damage in transportation and storage, delivering a potent hepatitis B vaccine in the remotest parts of the world.
Arecor also partners with GlaxoSmithKline to eliminate the need for the cold chain, enabling storage at room temperature while still safeguarding the effectiveness of vaccines. Additionally, for those vaccines that require the deep freezing temperature of minus 112 degrees Fahrenheit, Arecor’s technology is being used to develop a technique that stores these vaccines at the usual 36-46 degrees Fahrenheit.
The second problem in vaccine delivery, injection, is also on the path to improvement. IDRI believes that if people could use a simple patch delivered in the mail they could successfully administer their own vaccination — especially useful during major outbreaks. This would eliminate the need for masses of people to travel to health centers as well as the need for hypodermic needles.
Vaccine patches would be as simple as putting on a Band-Aid, along with being safe and effective. It is accomplished with micro-needles developed by NanoPass Technologies. Micro-needles painlessly inject the medicine directly into the skin. The patch can be placed on the skin in an area where specific cells of the immune system can be targeted. This allows for smaller doses and a quicker immune response.
In TB testing, such a patch is even more innovative. IDRI in partner with researchers at the University of Washington have developed a patch that would be affordable, efficient and convenient. It eliminates the insertion of a hypodermic needle into the skin at a precise depth and angle that often produces inaccurate test results. It is the first time a patch has been used as a diagnostic.
The elimination of diseases now and in the future is dependent on vaccines that are safe and effective due to not only ground-breaking developments but also pioneering delivery systems and devices, according to IDRI. “In the end, the vaccines with the best delivery mechanisms will be accepted and adopted as they become the true difference-makers all over the world.”
– Janet Quinn
Sources: QZ, Arecor, nature.com
Photo: Flickr