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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.
Evolution proves to be just about as ingenious as Nikola Tesla
- For the first time, scientists developed 3D scans of shark intestines to learn how they digest what they eat.
- The scans reveal an intestinal structure that looks awfully familiar — it looks like a Tesla valve.
- The structure may allow sharks to better survive long breaks between feasts.
Considering how much sharks are feared by humans, it is a bit of a surprise that scientists don't know much about the predators. For example, until recently, sharks were thought to be solitary creatures searching the seas for food on their own. Now it appears that some sharks are quite social.
Another mystery is how these prehistoric swimming and eating machines digest food. Although scientists have made 2D sketches of captured sharks' digestive systems based on dissections, there is a limit to what can be learned in this way. Professor Adam Summers at University of Washington's Friday Harbor Labs says:
"Intestines are so complex, with so many overlapping layers, that dissection destroys the context and connectivity of the tissue. It would be like trying to understand what was reported in a newspaper by taking scissors to a rolled-up copy. The story just won't hang together."
Summers is co-author of a new study that has produced the first 3D scans of a shark's intestines, which turns out to have a strange, corkscrew structure. What's even more bizarre is that it resembles the amazing one-way valve designed by inventor Nikola Tesla in 1920. The research is published in the journal Proceedings of the Royal Society B.
What a 3D model reveals
Video: Pacific spiny dogfish intestine youtu.be
According to the study's lead author Samantha Leigh, "It's high time that some modern technology was used to look at these really amazing spiral intestines of sharks. We developed a new method to digitally scan these tissues and now can look at the soft tissues in such great detail without having to slice into them."
"CT scanning is one of the only ways to understand the shape of shark intestines in three dimensions," adds Summers. The researchers scanned the intestines of nearly three dozen different shark species.
It is believed that sharks go for extended periods — days or even weeks — between big meals. The scans reveal that food passes slowly through the intestine, affording sharks' digestive system the time to fully extract its nutrient value. The researchers hypothesize that such a slow digestive process may also require less energy.
It could be that this slow digestion is more susceptible to back flow given that the momentum of digested food through the tract must be minimal. Perhaps that is why sharks evolved something so similar to a Tesla valve.
What is Tesla's valve doing there?
Above, a Tesla valve. Below, a shark intestine.Credit: Samantha Leigh / California State University, Domi
Tesla's "valvular conduit," or what the world now calls a "Tesla valve," is a one-way valve with no moving parts. Its brilliance is based in fluid dynamics and only now coming to be fully appreciated. Essentially, a series of teardrop-shaped loops arranged along the length of the valve allow water to flow easily in one direction but not in the other. Modern tests reveal that at low flow rates, water can travel through the valve either way, but at high flow rates, the design kicks in. According to mathematician Leif Ristroph:
"Crucially, this turn-on comes with the generation of turbulent flows in the reverse direction, which 'plug' the pipe with vortices and disrupting currents. Moreover, the turbulence appears at far lower flow rates than have ever previously been observed for pipes of more standard shapes — up to 20 times lower speed than conventional turbulence in a cylindrical pipe or tube. This shows the power it has to control flows, which could be used in many applications."
A deeper dive
Summers suggests the scans are just the beginning. "The vast majority of shark species, and the majority of their physiology, are completely unknown," says Summers, adding that "every single natural history observation, internal visualization, and anatomical investigation shows us things we could not have guessed at."
To this end, the researchers plan to use 3D printing to produce models through which they can observe the behavior of different substances passing through them — after all, sharks typically eat fish, invertebrates, mammals, and seagrass. They also plan to explore with engineers ways in which the shark intestine design could be used industrially, perhaps for the treatment of wastewater or for filtering microplastics.
It could fairly be said, though, that Nikola Tesla was 100 years ahead of them.
The Inglehart-Welzel World Cultural map replaces geographic accuracy with closeness in terms of values.
- This map replaces geography with another type of closeness: cultural values.
- Although the groups it depicts have familiar names, their shapes are not.
- The map makes for strange bedfellows: Brazil next to South Africa and Belgium neighboring the U.S.
Some countries value self-expression more than others.Credit: Robyn Beck / AFP via Getty Images
Question: On what map is Lithuania a neighbor of China, Poland lies next to Brazil, and Morocco and Yemen touch?
Answer: The Inglehart-Welzel World Cultural Map. To be precise, the 2017 map. Because on the 2020 version, each of those pairs has drifted apart significantly.
These are not, strictly speaking, maps but rather scatterplot diagrams. Each dot represents a country, the position of which is based on how it ranks on two different values (discussed below). The dots are corralled together into geo-cultural groups:
- Catholic Europe, which comprises countries as diverse and far apart as Hungary and Andorra■ Protestant Europe, taking in both Iceland and Germany
- The Orthodox world, from Belarus all the way to Armenia
- The three Baltic states
- The English-speaking world, including both the U.S. and Northern Ireland
- The huge African-Islamic world, ranging from Azerbaijan to South Africa
- Latin America, which goes from Mexico to Argentina
- South Asia, which comprises both India and Cyprus
- The Confucian world, encompassing China and Japan.
The placement of the dots indicates cultural proximity or distance. Some countries from different groups can be more similar than other countries in the same group.
See the examples indicated above: cultural neighbors China and Lithuania belong to the Confucian and Baltic groups, respectively. Poland is part of Catholic Europe; its 2017 neighbor Brazil is in Latin America. Morocco and Yemen are closer culturally to Armenia, in the Orthodox group, than they are to Qatar, despite all belonging to the African-Islamic group.
The 2017 version of the map places Malta deep inside South America and lets Vietnam, Portugal, and Macedonia meet.Credit: World Values Survey, public domain.
Creating a culture map
So, what exactly are the criteria used for plotting these dots in the first place?
These maps are part of the World Values Survey, first conducted by political scientist Ronald Inglehart in the late 1990s. With his colleague Christian Welzel, he produced an update in 2005. The WVS has been revised several times since, most recently in 2020.
The WVS asserts that there are two fundamental dimensions to cross-cultural variation across the world. These are used as the axes to plot the various countries on the diagram.
- The X-axis measures survival versus self-expression values.
Survival values focus on economic and physical security. There is not much room for trust and tolerance of "others." Self-expression values prioritize well-being, quality of life, and self-expression. There is more room for tolerating ethnic, religious, and sexual minorities.
- The Y-axis measures traditional versus secular-rational values.
Traditional values include deference to religion and parental authority as well as traditional social and family values. Societies that score high on traditions typically also are highly nationalistic. In more secular-rational societies, science and bureaucracy replace faith as the basis for authority. Secular-rational values include high tolerance of things like divorce, abortion, euthanasia, and suicide.
As indicated by the significant changes on the 2020 map, the cultural values of nations are not static:
- Countries that move up on the map are shifting from traditional to more secular-rational values.
- Countries that move to the right on the map are shifting from survival values to self-expression values.
- And, of course, vice versa in both cases.
According to the authors of the map, changes in cultural outlook can be the result of socioeconomic changes — increasing levels of wealth, for example. But the religious and cultural heritage of each country also plays a part.
The world's cultural landscape is dynamic — you could even say promiscuous, producing new bedfellows every few years.Credit: World Values Survey, public domain.
Some notable features of the 2020 map:
- The Baltic group has been dissolved; Lithuania is now part of Catholic Europe, Estonia a lone Protestant island in a Catholic sea. More worryingly, Latvia seems to have dissolved completely.
- In general, survival values are strongest in African-Islamic countries, self-expression values in Protestant Europe.
- Traditional values are strongest in African-Islamic countries and Latin America, while secular values dominate in Confucian countries and Protestant Europe.
- The United States is an atypical member of the English-speaking group, scoring much lower on both scales (that is to say, lower and more to the left). In other words, the U.S. is more into traditional and survival values than the group's other members.
- Shifting attitudes don't just separate; they also unite. Belgium and the U.S. are now culture buddies, as are New Zealand and Iceland. Kazakhstan is virtually indistinguishable from Bosnia.
The Inglehart-Welzel map is not without its critics. It has been decried as Eurocentric, simplistic, and culturally essentialist (that is, the assumption that certain cultural characteristics are essential and fixed, and that some are superior to others). Which is, of course, a very self-expressive thing to say.
For more on these maps, on the WVS surveys, and on the methodology used, visit the World Values Survey.
Strange Maps #1098
Got a strange map? Let me know at email@example.com.
A study finds that baby mammals dream about the world they are about to experience to prepare their senses.
- Researchers find that babies of mammals dream about the world they are entering.
- The study focused on neonatal waves in mice before they first opened their eyes.
- Scientists believe human babies also prime their visual motion detection before birth.
Imagine opening your eyes for the first time as a brand new baby. The world is so mysterious, full of obstacles and strange shapes. And yet it does not take babies all that long to get their bearings, to latch on to their parents, and to start interacting. How do they do this so quickly? A new study published in Science proposes that babies of mammals dream about the world they are about to enter before being born, developing important skills.
The team, led by professor Michael Crair, who specializes in neuroscience, ophthalmology, and visual science, wanted to understand why when mammals are born, they are already somewhat prepared to interact with the world.
"At eye opening, mammals are capable of pretty sophisticated behavior," said Craig, "But how do the circuits form that allow us to perceive motion and navigate the world? It turns out we are born capable of many of these behaviors, at least in rudimentary form."
Unusual retinal activity
The scientists observed waves of activity radiating from the retinas of newborn mice before their eyes first open. Imaging shows that soon after birth, this activity disappears. In its place matures a network of neural transmissions that carries visual stimuli to the brain, as explained by a Yale press release. Once it reaches the brain, the information is encoded for storage.
What's particularly unusual about this neonatal activity is that it demonstrates a pattern that would happen if the animal was moving forward somewhere. As the researchers write in the study, "Spontaneous waves of retinal activity flow in the same pattern as would be produced days later by actual movement through the environment."
Crair explained that this "dream-like activity" makes sense from an evolutionary standpoint, as it helps the mouse get ready for what will happen to it after it opens its eyes. It allows the animal to "respond immediately to environmental threats," Crair shared.
Retinal waves in a newborn mouse prepare it for vision www.youtube.com
What is creating the waves?
The scientists also probed what is responsible for creating the retinal waves that mimic the forward motion. They turned on and off the functionality of starburst amacrine cells — retinal cells that release neurotransmitters — and discovered that blocking them stopped the retinal waves from flowing, which hindered the mouse from developing the ability to react to visual motion upon birth. These cells are also important to an adult mouse, affecting how it reacts to environmental stimuli.
Graphic showing the origin and functionality of directional retinal waves.Michael C. Crair et al, Science, 2021.
What about human babies?
While the study focused on mice, human babies also seem to be able to identify objects and motion right after birth. This suggests the presence of a similar phenomenon in babies before they are born.
"These brain circuits are self-organized at birth and some of the early teaching is already done," Crair stated. "It's like dreaming about what you are going to see before you even open your eyes."