Sometimes, a simple technical fix – or techno-fix, as the critics like to say – is exactly what’s needed. It’s getting people, organizations and industry to accept the change that can be the biggest complication.
Seattle-based PATH recently celebrated a techno-fix milestone – reaching the 5 billion mark for the number of vaccine vials distributed worldwide bearing a life-saving, heat-sensitive label.
First developed by the food industry to make sure edibles like frozen fish stayed frozen during transport, when used for immunizations this label is known as the vaccine vial monitor, aka VVM.
Most vaccines need to be kept at a precise temperature under refrigeration; VVMs tell health workers operating in harsh conditions and traveling to remote locations if the vaccines remain protected and viable by the time they are administered. All polio vaccines today have VVMs, as do all vaccines qualified by the World Health Organization, but even after 25 years they are still not uniformly in use.
“We faced great reluctance by the vaccine manufacturers at first,” recalled Debra Kristensen, group leader for vaccine and pharmaceutical technologies at PATH.
Kristensen is one of the old-timers at PATH, having started there back in the days when it was still a small, fairly unknown outfit in Seattle. Since the late 1970s, when Bill Gates was a teenager and the organization was still known as the Program for Appropriate Technology in Health, PATH has been inventing some pretty cool humanitarian gizmos. (Last week, they announced a new use, an injectable contraceptive, for another of their early inventions, the single-use syringe.)
But what may today sound like an obvious solution to a problem – vaccine spoilage – actually took decades to become more widely adopted.
PATH used to be a fairly confusing organization for many in the aid and development world, in part because the Seattle gang of health innovators often sought to work with industry to find profitable solutions for problems that, at the time, were largely viewed as caused by the failure of industry and the marketplace to serve the needs of the poor.
The PATH approach is fairly routine today – sometimes dubbed a public-private partnership or maybe ‘social enterprise’ – but back then such an approach just created suspicion on all sides. Many within the traditional aid and international health community saw PATH as if it was simply operating as industry in disguise – while industry sometimes viewed them as meddling do-gooders.
“This was during a time when donors and industry were abandoning vaccination,” Kristensen said. In the late 1980s and into the early 1990s, child vaccination rates (which had been significantly increased by UNICEF under the leadership of Jim Grant) were beginning to decline globally due to donor fatigue with funding the same old, never-ending immunizations and the lack of much profit margin for the drug industry.
“And so here we were, trying to impose a new demand and an additional step in the manufacturing and delivery process,” Kristensen said. The drug industry argued it would add costs and undermine what little commercial interest they had in vaccines, she said.
But Kristensen, PATH and colleagues at the WHO (who originally came up with the idea) persevered, recognizing that without some method for ensuring vaccine viability many of the world’s biggest global health efforts dependent upon vaccinations – such as the campaign to eradicate polio, or the broader goal of reducing child mortality – were unlikely to succeed.
Working with the food industry, PATH technicians spent years modifying and testing the label to adapt it for vaccine transport in poor conditions. Keeping vaccines properly refrigerated from the manufacturer to the shippers to cooler-toting health workers in poor countries on horseback or bicycle is generally known as the immunization ‘cold chain.’
It would have been nice if the food-preserving technology could have simply been adapted for use in health care, but it took nearly a decade before VVMs were commercially available, starting in 1996.
“It was a lot messier and more difficult than many anticipated,” Kristensen said.
After all was said and done, PATH partnered with a company, Temptime, to make the VVMs – adding only a few pennies to the cost of a polio vaccine. Billions of vaccines have been administered with VVMs, saving an estimated $14 million annually by preserving vaccines that otherwise would have been discarded. Making sure kids, children mostly, get viable vaccines also saves lives, of course.
“That’s true, but I’m not sure how we would ever be able to quantify that,” Kristensen said.