Posts Tagged ‘Innovation’

Published in Forbes on October 13, 2011. Read the article here or below.

Last Tuesday, researchers announced that an experimental malaria vaccine called RTS,S may help reduce the risk of malaria by half. The results – which are preliminary, as the researchers have only analyzed 40% of the study’s 15,000 participants so far – are based on a study being conducted across seven countries in sub-Saharan Africa, which accounts for 90% of worldwide malaria deaths.

RTS,S is being developed jointly by GlaxoSmithKline and the PATH Malaria Vaccine Initiative, a program funded by the Bill and Melinda Gates Foundation. When the study’s preliminary results were announced last week, Bill Gates lauded the research team and said, “A vaccine is the simplest, most cost-effective way to save lives.”

Seth Berkley, CEO of the GAVI Alliance, echoed this sentiment in a recent Huffington Post op-ed. Titled, “Vaccines: The biggest bang for the buck in global health,” Berkley wrote that vaccines offer enormous return on investment because they “cut healthcare and treatment costs, reduce the number of hospital visits, and ensure healthier children, families and communities.” Given their ability to “yield real results,” he encouraged the US to allocate more of its foreign aid to vaccines.

To an extent, Gates and Berkley are right: prevention is generally cheaper than treatment, and among prevention methods, vaccines can be quite cost-effective. Lois Privor-Dumm, the Director of Alliances and Information at Johns Hopkins’ International Vaccine Access Center, also believes that more generally, preventing disease is the right thing to do. “It gives people a better quality of life,” she said, “and it allows [the country’s hospitals] to treat people who really need it.”

If vaccines are so cost-effective and so important for society, why do 20 million children still not get the immunizations they need?

In his op-ed, Berkley pointed primarily to a lack of funding for vaccines. More money, he said, would result in a “transformation in child health and survival.” This is not, however, the whole story. Additional funding would certainly help close the immunization gap, but it would not eliminate it. Even if vaccines were free, there would still be significant obstacles preventing them from being universally accessible.

First, the cost of a vaccine may not reflect its true price to a consumer. Shipping vaccines can be expensive, and many countries pose import duties and taxes on medical supplies. Some vaccines need to be refrigerated, which makes transportation even more expensive, especially in developing countries with limited electricity and cold chain infrastructure.

There are also many indirect costs associated with getting people vaccinated. Patients have to pay, both in money and time, to go to clinics whose hours of operation may not be convenient for them. This is particularly problematic for vaccines that require multiple rounds, including RTS,S. Patients can take the time to go to a clinic once, but it may be difficult to prioritize going on a regular basis.

Compounded to these are non-monetary bottlenecks to getting people vaccinated. Medical professionals are pitifully few and far between in rural areas, and each one can only see a certain number of patients a day. Some communities may have to build demand for vaccinations through time-consuming public awareness campaigns. And regardless of vaccine availability or intention, there will always be some parents who either procrastinate or simply forget to take their children to the doctor.

Surmounting these obstacles may seem daunting, especially since many are indicative of broader failures in countries’ health systems. Luckily, many can be overcome with sustained action and a bit of creativity – and in the case of vaccines, several groups are looking to do just this.


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Photo credit: Economist

Photo credit: Economist

I love free stuff. Who doesn’t? Even if I know I’m never gonna wear that XXL fluorescent green t-shirt, I’ll still take it. And if it’s something I actually can use (free iPod, anyone?)… well, all the better. I may even do something slightly uncharacteristic — say, sing in public — if the reward is good enough.

This is the thinking the folks at MIT’s famed D-Lab (Development Lab) — specifically, at Innovations in International Health — employed when they devised “X out TB. ” They rightly identified lack of patient compliance as one of the biggest obstacles to making tuberculosis treatment effective. Basically, patients need to take their daily course for 6 months in order to prevent nasty drug resistance and relapse. The problem is, people often don’t like taking their medicine, even if there’s a spoonful of sugar involved. Most TB symptoms disappear after month 2-ish, and the medicine can cause unpleasant side effects like nausea, diarrhea, and orange-colored urine.

According to this week’s Economist, MIT’s researchers used the weird orange pee phenomenon to their advantage. They created a device that changes color only if the urine shows traces of certain chemicals (the same ones that make it orange in the first place). And if it does, magic happens: a code appears that the patient can type into their cell phones, to avail of free minutes! Way cooler than anything Mary Poppins could ever offer.

The team is currently working on making the reward applicable to a wider audience (e.g., many women in Pakistan do not use mobile phones, and thus may be better incentivized by free food). I’m pretty impressed, though. If the X out TB team can make this financially sustainable, they could change the face of TB treatment forever.

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