An interview with Lisa Ganley-Leal and Pauline Mwinzi, Epsilon Therapeutics Earlier this year, Lisa Ganley-Leal and Pauline Mwinzi were awarded $100,000 by the Bill & Melinda Gates Foundation through its Grand Challenges Explorations initiative. They hope to demonstrate that selling vaccines in medicine shops across Africa can improve vaccine availability among hard-to-reach populations, and that doing so can be profitable for both vaccine manufacturers and small business owners in disease-endemic regions. They spoke to Op.ti.mize about their proposal and the challenges they face. What are medicine shops? PM: Medicine shops are ubiquitous in developing countries. They sell a wide variety of painkillers, antipyretics, antimalarials, antihelminthics, antihistamines, antiprotozoals, and cough and stomach ache remedies. Up to 80 percent of children in Kenya are treated with health products purchased at medicine shops, which are usually much closer to their homes than government facilities such as community health centers. In coastal Kenya, for example, more than 80 percent of rural households live within one kilometer of a medicine shop, but only about 30 percent live within two kilometers of a government dispensary or private clinic. What gave you the idea for your proposal? LGL: I was listening to a presentation from a student at Boston University on using medicine shops to distribute medical devices. She talked about a pharmaceutical market pyramid where most of the money is spent by the primary consumers at the base of the pyramid. NGOs were in the middle and the Ministry of Health was at the top. It reminded me of the time I was in Kenya and needed to visit a medicine shop—I was in a remote location and had a headache—and I was able to buy some ibuprofen. It struck me that these medicine shops at the foundation of the pyramid could also be used to distribute vaccines and that this might even help to encourage greater investment in vaccine development. As people who visit medicine shops are prepared to pay for their drugs, might they also be prepared to pay for their vaccines as well? If so, might this stimulate investment in vaccine development? Is this a neglected area of study? PM: Using the private sector to distribute vaccines is a neglected idea because vaccines are typically distributed by governments or international organizations for free. In countries with limited resources, vaccinating children under five has been the top priority. But vaccinating adults is important as well, so we need to ask whether the methods that have worked for young children also work for other age groups. This is particularly important when you consider the new vaccines that are in the pipeline. Medicine shops are already an extremely popular way for people to obtain treatment for various diseases (malaria, for example). These types of shops or kiosks have already been wildly successful in bringing cell phones to every corner of Africa. We suspect that vaccine distribution has the potential to become a similarly profitable business in emerging markets through local medicine shops, to the owners of medicine shops as well as vaccine manufacturers and investors. What are the advantages of distributing vaccines in medicine shops? LGL: Because medicine shops are everywhere—most villages have two or three, and they’re usually pretty well stocked—it would be great if we could somehow utilize this huge existing network that so many people are just steps away from. PM: Unlike the vaccines that governments distribute for free to children under five, we can explore ideas where others can benefit as well, that are not just charity. There are employment opportunities here for small-scale businesses throughout the developing world, where large numbers of people who might otherwise be jobless could be employed. How will you test your theory? LGL: For two weeks, ten medicine shops in Western Kenya (in both rural and urban locations) will sell typhoid vaccine for US$1. We will station a trained nurse in each shop, who will educate patrons on the importance of vaccines, collect data on who visits the shop, and administer the vaccine to those who purchase it. The nurse will manage cold storage of the vaccines and safe disposal of needles. If there is any indication that the vaccine suffers degradation during the trial period, distribution at that medicine shop will cease. Afterwards, we will have focus groups to find out why people did or did not purchase the vaccine. The owners of the medicine shops will keep any money from the sale of vaccines. What will be your biggest challenges? PM: The vaccine cannot be administered by medicine shop owners themselves, so for our trial, we will station nurses in every medicine shop selling vaccines. We are testing whether people come to the medicine shop to buy vaccines, not the actual logistics of delivering today’s vaccines in these settings. In the future, it’s possible that some vaccines may have less strict storage requirements or may even be able to be administered by non-clinical personnel, but for now, we will have a nurse in each medicine shop. If your demonstration project is successful, what will you do next? PM: We want to highlight to vaccine manufacturers that their products might eventually end up being sold in medicine shops, and so they should start tailoring their manufacturing practices towards vaccines that can be delivered in such settings. Pharmaceutical companies are often reluctant to spend more on research and development for new vaccines, partly because current vaccines are not great revenue generators. We’d like to change that so we can start seeing manufacturers excited about developing new vaccines and investors wanting to support innovation in vaccine technology—such as increased vaccine stability, for example. LGL: Selling vaccines in medicine shops is a just starting point, in terms of moving vaccines from where they are distributed now—which is at the hospital or on large immunization campaigns—to where they can be more easily distributed, even without a functioning cold chain or reliable electricity. If the demand is created from the bottom up, then other avenues will open. Lisa and Pauline aim to complete their project by November 2012. For more information, please email [firstname.lastname@example.org]Lisa Ganley-Leal [/email] or [email@example.com]Pauline Mwinzi[/email]. 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