Tuesday, 05 February 2013
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by Raja Rao and Joseph Torres, Bill & Melinda Gates Foundation In November last year, 17 different proposals on how to optimize immunization systems were each awarded $100,000 by the Bill & Melinda Gates Foundation in round nine of its Grand Challenges Explorations initiative. Below, Raja Rao provides an overview of each proposal. Note: Winners in round eight of the Grand Challenges Explorations initiative were announced in May 2012 and were profiled in the July 2012 edition of Op.ti.mize. You can read the article on the TechNet-21.org website or download the July newsletter as a PDF. 4°C simple passive vaccine storage device Keith Bartlett of True Energy in the United Kingdom will work with stakeholders in the immunization community to create a prototype vaccine storage device that uses the properties of water density to maintain vaccines at 4°C during the “last mile”of the cold chain. A water container that maintains the liquid at a steady temperature of 4°C will be in contact with the vaccine storage area, preventing temperature fluctuations that can damage or destroy vaccines. http://www.grandchallenges.org/SiteCollectionImages/rCol_large_explorations.jpg A buddy program for immunization system managers Ben Gilbert and Andrew Brown of the University of Canberra in Australia will develop a regional support network for medical supply managers in Pacific island countries to help them apply the formal training they received to manage vaccine supply systems. By engaging them in a buddy support system, Gilbert and Brown hope to empower these managers to overcome cultural, educational, social, and historical factors that hinder effective management styles and help them operate supply systems that are more responsive to immunization challenges in those developing countries. A passive solar thermal standard for vaccine storage rooms Loriana Dembele of Eau et Vie Ji-Duma in Mali will develop new architectural and construction guidelines for vaccine storage rooms in hot climates that incorporate passive solar thermal technologies to keep vaccines at recommended temperatures. The team will construct and test prototype storage facilities to guide the development of new standards that prevent vaccine spoilage, reduce operating costs, and improve refrigeration capabilities. Assessing environmental impacts of immunization technologies Ruth Stringer and a team at Health Care Without Harm in the United States and colleagues at the Health Care Foundation Nepal will design and test a decision-making tool that compares the costs, benefits,and environmental impacts of centralized autoclaving, recycling, and/or disposing of various types of conventional and safety syringes. This tool will enable decision-makers to choose the most economical and sustainable medical waste management strategy. Creating a decision aid to better forecast vaccine delivery Roger Miller and colleagues at the Logistics Management Institute in the United States will develop a software-based prototype modeling tool that allows vaccine program managers to lower costs by analyzing all of the clinical and logistical factors that determine the cost per viable vaccine dose administered. The prototype could be developed as a fully deployable software product with associated training, reporting, and analysis capability. Cumulative and peak temperature indicators Dawn Smith of Temptime Corporation in the United States will develop a low-cost, vial-level indicator device that provides a signal not only when vaccines have had brief but damaging exposure to high temperatures but also have reached a cumulative heat exposure threshold. The integrated device would provide health care workers a comprehensive indication as to whether a vaccine has been damaged by heat and should, therefore, not be used. Environmental impact minimization for vaccine supply systems Arunprakash Karunanithi of the University of Colorado Denver in the United States seeks to develop vaccine supply chain optimization software that evaluates not only direct costs but also indirect environmental and public health costs, such as those associated with greenhouse gases emitted due to the cold supply chain requirements and the disposal of medical waste. This tool will enable public health programs in low- to middle-income countries to design localized immunization supply systems that have reduced environmental and health impacts. High-performance portable evaporative refrigeration for vaccine delivery Seung M. You of the University of Texas at Arlington in the United States will develop and test an aluminum wicking medium that can be used in an evaporative, passive-cooling refrigeration system for vaccine storage and delivery in dry climates. The wicking medium will be lightweight, low-cost, and include micro- and nano-scale pores for high wickability over a large surface area, providing sustained water evaporation to keep vaccines cool. Hydroelectric power for cold chain Anthony Battersby of River Energy Networks in the United Kingdom will develop and field test a simple inexpensive micro-hydroturbine that can drive a generator to power vaccine refrigerators and other health care facility equipment. Proof-of-concept models will be tested in Nigeria using components designed for simplicity and reliability. Immunization-tracking bracelet for resource-poor mothers Lauren Braun of Alma Sana Inc. in the United States will develop and field test in Peru a simple,inexpensive immunization tracking bracelet that can be worn by babies and that uses numbers and symbols instead of written instructions to track the types and dates of vaccinations required. This bracelet will help remind resource-poor Peruvian mothers of the dates of their babies’ childhood vaccination appointments, remind the health care workers which vaccines are needed, and increase the efficiency and rate of childhood vaccination. Leveraging literacy initiatives to improve vaccine acceptance Mira Johri of the University of Montreal Hospital and colleagues from Pratham Education Foundation in India will develop effective methods for health education in low-literacy communities that enable less educated women and families to understand the purpose of vaccinating children and the benefits of timely and appropriate utilization of immunization services. Low-cost printed vial-level combined TTI-threshold indicator Anastasia Liya Vitkin of Freshpoint Holdings SA of Switzerland will explore new printing technologies for use in the development of a printable label that can be used on vaccines to indicate when contents have surpassed a set temperature threshold or exceeded a cumulative temperature limit. The goal is to create a label that can be printed using low-end, low-cost printing techniques and that will be compatible with other printed temperature indicators. Low-cost vial-level printable low-temperature threshold indicator Yoav Eichen of Freshpoint Holdings SA in Switzerland will explore new technologies for use in the development of a printable label for vaccine vials to indicate when they have been exposed to temperatures below a set threshold which would compromise activity. The label will be printed using low-end, low cost printing techniques and will be compatible with other printed temperature indicators. Mobile immunization tracking and management system Paul Kilgore of Wayne State University in the United States will develop a dynamic immunization tracking system using smart phone and palm scanning technology to create and store vaccination records in cloud computers. Clinics will be able to retrieve and update records anywhere, and program managers will manage vaccine supplies in real time. Mothers to mothers: the vaccine and savings game Anand Narasimhan of the Simha Foundation in the United States will develop a program that encourages immunization and financial planning by using an incentive-based game that engages mothers both in the developed world and in disadvantaged communities. Mothers with financial resources will be encouraged to deposit small amounts of money in an interest-bearing account to create savings accounts for disadvantaged mothers, who will gain access to the accounts when they attend immunization campaign events. By earning money and small prizes at the events, mothers in developing countries are incentivized to immunize their families, and the contributing mothers can track the impact of their contributions. Time-dependent color-changing vaccine reminder ankle bands Noor Sabah Rakhshani of the Trust for Vaccines and Immunization in Pakistan proposes to develop children’s polymer ankle bands incorporating electrochemical indicators that change color at specified time intervals to remind mothers of their childrens’ vaccine due dates. This low-cost technology would work well in areas where SMS/text reminders are not feasible due to limited cell phone coverage and lack of funds for cell phone hardware and accounts. Vaccine wastage sentinel monitoring system (VWSM) K.O. Antwi-Agyei of the Expanded Programme on Immunization (EPI) in Ghana will set up a monitoring system using paper reports and SMS mobile phone technology to assess the management of vaccines at randomly selected storage points throughout the country. Baseline data on vaccine wastage will be established and best practices documented to create measures to reduce wastage at various points in the vaccine supply chain in Ghana.
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