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What it takes to get vaccines from the lab to the field
Pfizer's Susan Silbermann explains the superhuman effort involved in getting vaccines to the people who need them most.
SUSAN SILBERMANN: Community health workers play an important role for the health of women and their families. Often they're the connection to the health care system and they educate women about the importance of interventions like vaccines and family planning. They also provide important health care through models like integrated community case management that address nutrition, malaria, diarrhea, and pneumonia.
Now let me tell you a story about a healthcare worker in Ghana that we recently met. She works in a clinic in a small village in the Ho region of Ghana, which is approximately three hours north of the capital. In her clinic there is no electricity, there's no running water. Now these two elements are critical to ensure safe and effective use of medicines.
For example, vaccines need to be stored at a specific temperature to maintain their effectiveness, and therefore they are stored in fridges, which are powered by electricity. Instead of storing the vaccines in her clinic, the healthcare worker travels one hour each way on the bus to get fresh vaccines and transport them for the day in a cooler. She then works all day at the clinic administering these vaccines and seeing mothers, children, and babies. Without the dedication of health care workers like this one in Ghana, it's very likely that communities of children would not have the opportunity to be vaccinated.
As a global company, you'd expect that we'd have a great passion for innovating to discover new vaccines, and we do that. What you might not expect is that we're also truly passionate about innovating on our existing vaccines, both in the vaccine vial and in the packaging they arrive in. We do this based on learnings about the constraints that face the people we are trying so very hard to reach. So what does innovation look like? Well, I brought a vial to show you. This tiny vial is an incredible testament to scientific innovation. Until 2017, it provided one dose to vaccinate one child. But now, this vial provides four doses so we can vaccinate four children. By combining multiple doses into one vial we've reduced the storage space and the shipping requirements. Innovations like this will help make it easier to get vaccines to children everywhere.
Here is a startling fact: Sub-Saharan Africa bears nearly 25 percent of the disease burden in the whole world, and yet they only have three percent of global health care workers. So one of the things we feel is really critical is ensuring that health care workers are trained to administer vaccines. For example, 2017 was the first year that Pfizer's new multi-dose vial became available in Gavi countries. In order to ensure the health care workers were appropriate trained we partnered with AMP and the World Health Organization to develop a pneumococcal conjugate refresher course along with the training program on our multi-dose vial.
In partnership with WHO and our implementing partner AMP, we developed a "train the trainer" model for our new multi-dose vial. The train the trainer model allows country ownership by starting with a small group of health care workers who then become master trainers. Then, in turn, they train the next level of health care workers until the training reaches the most remote villages. The materials are all engaging and easy to understand. The training finishes with a required knowledge test.
We have to make sure that vaccines get to those who need them the most. I've often said that our job doesn't end when we make a vaccine and ship it to a distribution center; what good is a vaccine if it isn't reaching the people who need it the most? Or if the health care workers aren't able to administer a new version of our vaccine, like our multi-dose vial? So when our new multi-dose vial became available in Gavi countries in 2017 we trained 27,000 health care workers across 15 countries. And this year we expanded the program to an additional nine countries with the goal of reaching another 17,000 health care workers by the end of the year.
I firmly believe that strengthening global partnerships between public and private stakeholders is essential to providing a brighter and healthier future for all. It's why I'm so excited to see all the focus and commitment around Sustainable Development Goal number three—good health and wellbeing. One of the most impressive private-public partnerships working toward that goal is being spearheaded by Gavi, the Vaccine Alliance. Now Pfizer is very proud to be a part of this effort, which is working to speed up access to lifesaving vaccines which are delivered by the teams from UNICEF and local ministries of health care working on the ground.
Working with Gavi, we at Pfizer have been supplying millions of doses of our vaccines to help protect the world's most vulnerable children. This partnership opens the door to good health for more children, helping to prevent disease, especially in communities where health care systems are still developing.
- The United Nations Sustainable Development Goals (SDG) are a set of 17 directives to be completed by a 2030 deadline, with the aim of significantly improving quality of life for all people on Earth.
- Pfizer has made a commitment to SDG #3: Good health and well-being for all.
- Africa bears 25% of the world's disease burden yet has just 3% of the world's health workers. So how do you get life-saving vaccines to world's most vulnerable?
- Pfizer partners with several organizations to help strengthen the ability to deliver vaccines in developing countries. By training local healthcare workers we can remove some of the obstacles in getting a child vaccinated.
- Recent innovations in Pfizer's vaccine technology, like the multi-dose vial, have reduced shipping and storage space, which is critical as vaccines need to be transported and stored at very specific temperatures.
A Mercury-bound spacecraft's noisy flyby of our home planet.
- There is no sound in space, but if there was, this is what it might sound like passing by Earth.
- A spacecraft bound for Mercury recorded data while swinging around our planet, and that data was converted into sound.
- Yes, in space no one can hear you scream, but this is still some chill stuff.
First off, let's be clear what we mean by "hear" here. (Here, here!)
Sound, as we know it, requires air. What our ears capture is actually oscillating waves of fluctuating air pressure. Cilia, fibers in our ears, respond to these fluctuations by firing off corresponding clusters of tones at different pitches to our brains. This is what we perceive as sound.
All of which is to say, sound requires air, and space is notoriously void of that. So, in terms of human-perceivable sound, it's silent out there. Nonetheless, there can be cyclical events in space — such as oscillating values in streams of captured data — that can be mapped to pitches, and thus made audible.
Image source: European Space Agency
The European Space Agency's BepiColombo spacecraft took off from Kourou, French Guyana on October 20, 2019, on its way to Mercury. To reduce its speed for the proper trajectory to Mercury, BepiColombo executed a "gravity-assist flyby," slinging itself around the Earth before leaving home. Over the course of its 34-minute flyby, its two data recorders captured five data sets that Italy's National Institute for Astrophysics (INAF) enhanced and converted into sound waves.
Into and out of Earth's shadow
In April, BepiColombo began its closest approach to Earth, ranging from 256,393 kilometers (159,315 miles) to 129,488 kilometers (80,460 miles) away. The audio above starts as BepiColombo begins to sneak into the Earth's shadow facing away from the sun.
The data was captured by BepiColombo's Italian Spring Accelerometer (ISA) instrument. Says Carmelo Magnafico of the ISA team, "When the spacecraft enters the shadow and the force of the Sun disappears, we can hear a slight vibration. The solar panels, previously flexed by the Sun, then find a new balance. Upon exiting the shadow, we can hear the effect again."
In addition to making for some cool sounds, the phenomenon allowed the ISA team to confirm just how sensitive their instrument is. "This is an extraordinary situation," says Carmelo. "Since we started the cruise, we have only been in direct sunshine, so we did not have the possibility to check effectively whether our instrument is measuring the variations of the force of the sunlight."
When the craft arrives at Mercury, the ISA will be tasked with studying the planets gravity.
The second clip is derived from data captured by BepiColombo's MPO-MAG magnetometer, AKA MERMAG, as the craft traveled through Earth's magnetosphere, the area surrounding the planet that's determined by the its magnetic field.
BepiColombo eventually entered the hellish mangentosheath, the region battered by cosmic plasma from the sun before the craft passed into the relatively peaceful magentopause that marks the transition between the magnetosphere and Earth's own magnetic field.
MERMAG will map Mercury's magnetosphere, as well as the magnetic state of the planet's interior. As a secondary objective, it will assess the interaction of the solar wind, Mercury's magnetic field, and the planet, analyzing the dynamics of the magnetosphere and its interaction with Mercury.
Recording session over, BepiColombo is now slipping through space silently with its arrival at Mercury planned for 2025.
Research suggests that aging affects a brain circuit critical for learning and decision-making.
As people age, they often lose their motivation to learn new things or engage in everyday activities. In a study of mice, MIT neuroscientists have now identified a brain circuit that is critical for maintaining this kind of motivation.
Why not just divide the United States in slices of equal population?
- Slicing up the country in 10 strips of equal population produces two bizarre maps.
- Seattle is the biggest city in the emptiest longitudinal band, San Antonio rules the largest north-south slice.
- Curiously, six cities are the 'capitals' of both their horizontal and vertical deciles.
Sweeping re-alignments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTAwOC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMzU3ODA1NH0.u_5xakBvkYwgPtiwLU3z-1e082hBeqwS4Rl1uiJqdF4/img.png?width=980" id="23ff1" class="rm-shortcode" data-rm-shortcode-id="24a5b6ec251a11f3ed7aaefc205dde17" data-rm-shortcode-name="rebelmouse-image" alt="Printed in March 1812, this political cartoon was drawn in reaction to the newly drawn state senate election district of South Essex created by the Massachusetts legislature to favor the Democratic-Republican Party candidates of Governor Elbridge Gerry over the Federalists. The caricature satirizes the bizarre shape of a district in Essex County, Massachusetts, as a dragon-like "monster". Federalist newspaper editors and others at the time likened the district shape to a salamander, and the word gerrymander was a portmanteau of that word and Governor Gerry's last name." />
The original cartoon of the 'Gerry-Mander', published in 1812 in the Boston Centinel.
Image: Elkanah Tisdale (1771-1835), Public Domain.<p>One way for a political party to manipulate the outcome of elections is to 'gerrymander' electoral districts: manipulate their boundaries to increase the likelihood of a favorable outcome (see also #<a href="https://bigthink.com/strange-maps/53-ever-been-ger..." target="_blank">53</a>).</p><p><span></span>The term is almost as old as the United States itself, and the practice continues to disfigure the electoral map to this day. Perhaps these maps can serve as the inspiration for a radical solution. </p><p><span></span>They show the contiguous United States (i.e. without Alaska and Hawaii) sliced latitudinally and longitudinally into ten straight-bordered bands of varying size, so that each contains exactly 10 percent of the population. </p><p><span></span>Although certainly not intended as a reflection on electoral redistricting, it's tempting to see these sweeping re-alignments of the U.S. as a suggestion with some potential in that direction. </p>
United Strips of America<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTA4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzE1MjQ1MX0.WpISo-g15B5O3qXbHXHf-7lQtAainpO7zPuizXWFOGs/img.jpg?width=980" id="d6656" class="rm-shortcode" data-rm-shortcode-id="72ed7c905283f9979ec0f82d451ad261" data-rm-shortcode-name="rebelmouse-image" alt="Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'." />
The contiguous United States, divided into horizontal and vertical deciles.
Image: u/curiouskip, reproduced with kind permission.<p>Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'.</p><p><span></span>Looking at the top map, which divides the U.S. into 10 longitudinal strips, we see</p><ul><li>Seattle rules the northernmost slice of territory. It is the broadest, and therefore also the emptiest one.</li><li>The Chicago, Omaha, New York City and Indianapolis strips complete the northern half of the country. And indeed: 50 percent of the population occupies roughly one half of the country, from north to south.</li><li>The dividing line between the top and bottom halves of the country runs from just north of the San Francisco Bay to halfway across the Delmarva Peninsula.</li><li>Capital cities of the southern strips are San Jose, Charlotte, Los Angeles, San Diego, and Houston.</li><li>The Houston Strip is divided into two non-contiguous areas. Florida maintains its panhandle, albeit much reduced. </li></ul><p>The bottom map shows the U.S. divided latitudinally into 10 bands of equal population. </p><ul><li>San Jose and Los Angeles both retain their capital status, this time of the two westernmost strips.</li><li>San Antonio is the main city of the Big Empty, more than twice as wide as the second-broadest band.</li><li>The dividing line between America's eastern and western half, population-wise, is far off-center: it skirts the eastern edge of Chicago, making the western half much bigger than the eastern one.</li><li>Houston, Chicago, and Indianapolis also remain the largest cities in their respective bands.</li><li>Further east, Jacksonville and Philadelphia get to rule over their strip of America, while Charlotte and New York City keep winning, both vertically and horizontally.</li></ul><p>Redistricting a country into zones of equal population – and that being your only criterium – will create districts that are randomly diverse, and perhaps also, at least in this case, unmanageably large. </p><p>However, mixing up the political map with a bunch of straight lines as the only instrument is something that has been considered before. Usually, the objective is the wholesale removal of age-old divisions. <br></p>
Perfectly square departments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTEzOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwOTQyMzIwOH0.kYuf58g0bjsPL9DGPq5PycZ7PDJMnItT0rfrPonOP3k/img.jpg?width=980" id="89a68" class="rm-shortcode" data-rm-shortcode-id="5b81a43e785997bb1f11f72548659a9f" data-rm-shortcode-name="rebelmouse-image" alt="\u200bCh\u00e2ssis figuratif du territoire de la France partag\u00e9 en divisions \u00e9gales entre elles, proposition annex\u00e9e au rapport du 29 septembre 1789 \u00e0 l'Assembl\u00e9e nationale de la commission dite Siey\u00e8s-Thouret" />
France divided into 80-odd geometrical departments: failed proposal by Jacques-Guillaume Thouret (1790).
Image: Centre historique des Archives nationales – Atelier de photographie; public domain.
European Pie<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTQ0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTE5NDE3OX0.dPcY1tkO7nwkx6IX98Sleh7AmBpDnwlcJLfC_Z-WBlY/img.jpg?width=980" id="b35d7" class="rm-shortcode" data-rm-shortcode-id="84509a9425e13c0dd8fbe00df28a197e" data-rm-shortcode-name="rebelmouse-image" />
In this rather outlandish proposal, continental Europe's 24 cantons center on Vienna.
Image: PJ Mode Collection of Persuasive Maps, Cornell University.<p>And in 1920, an anonymous author – possibly the Austrian P.A. Maas – proposed slicing up Post-World-War-I Europe as a pie, into 24 slices that would center on Vienna's St. Stephen's Cathedral. Each of those slices would be made up of a wide and random variety of linguistic, ethnic, and religious groups – and that would be the point: the better to unite them all into one massive superstate (see also #<a href="https://bigthink.com/strange-maps/a-bizarre-peace-proposal-slice-europe-up-like-a-pie" target="_blank">851</a>).</p><p>Needless to say, both plans never left the drawing board. Would a proposal for the longitudinal and/or latitudinal redistricting of the U.S. have more traction? <br></p>
Coast-to-coast precedents<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTIwOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MDM2OTE0OX0.52UjcA_YD9Y9UB9_hoSctI_xBrRDALZ2DRLkIo9a8RM/img.jpg?width=980" id="10784" class="rm-shortcode" data-rm-shortcode-id="1999808ea21e11162fdb9181c3912753" data-rm-shortcode-name="rebelmouse-image" alt="Illustration of the Connecticut Charter boundary, 1662" />
Putting the 'connect' into Connecticut: the Nutmeg State extending from the Pacific to the Atlantic.
Image: Connecticuthistory.org<p>Well, for one, coast-to-coast polities have some pedigree in America's past: some of the first colonies had claims that extended from the Atlantic all the way to the Pacific. </p><p>If history had gone entirely the way Connecticut would have wanted, the state would include such inland cities as Detroit, Chicago, and Salt Lake City, and extended to what is now the northern part of California.</p><p>Is such geopolitical weirdness reasonable or feasible today? Absolutely not. But in its randomness, would it be it as unfair as gerrymandering? </p><p><em><br></em></p><p><em>Decile maps of the contiguous United States reproduced with kind permission by u/curiouskip; found <a href="https://www.reddit.com/r/dataisbeautiful/comments/ijyn7p/oc_us_population_deciles_by_latitude_and_longitude/" target="_blank">here</a> on <a href="https://www.reddit.com/" target="_blank">Reddit</a>.<br></em></p><p><strong>Strange Maps #1054</strong></p><p><em>Got a strange map? Let me know at </em><a href="mailto:email@example.com">firstname.lastname@example.org</a><em>.</em></p>