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.
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Homo sapiens have been on earth for 200,000 years — give or take a few ten-thousand-year stretches. Much of that time is shrouded in the fog of prehistory. What we do know has been pieced together by deciphering the fossil record through the principles of evolutionary theory. Yet new discoveries contain the potential to refashion that knowledge and lead scientists to new, previously unconsidered conclusions.

A set of 8-million-year-old teeth may have done just that. Researchers recently inspected the upper and lower jaw of an ancient European ape. Their conclusions suggest that humanity's forebearers may have arisen in Europe before migrating to Africa, potentially upending a scientific consensus that has stood since Darwin's day.

Rethinking humanity's origin story

The frontispiece of Thomas Huxley's Evidence as to Man's Place in Nature (1863) sketched by natural history artist Benjamin Waterhouse Hawkins. (Photo: Wikimedia Commons)

As reported in New Scientist, the 8- to 9-million-year-old hominin jaw bones were found at Nikiti, northern Greece, in the '90s. Scientists originally pegged the chompers as belonging to a member of Ouranopithecus, an genus of extinct Eurasian ape.

David Begun, an anthropologist at the University of Toronto, and his team recently reexamined the jaw bones. They argue that the original identification was incorrect. Based on the fossil's hominin-like canines and premolar roots, they identify that the ape belongs to a previously unknown proto-hominin.

The researchers hypothesize that these proto-hominins were the evolutionary ancestors of another European great ape Graecopithecus, which the same team tentatively identified as an early hominin in 2017. Graecopithecus lived in south-east Europe 7.2 million years ago. If the premise is correct, these hominins would have migrated to Africa 7 million years ago, after undergoing much of their evolutionary development in Europe.

Begun points out that south-east Europe was once occupied by the ancestors of animals like the giraffe and rhino, too. "It's widely agreed that this was the found fauna of most of what we see in Africa today," he told New Scientists. "If the antelopes and giraffes could get into Africa 7 million years ago, why not the apes?"

He recently outlined this idea at a conference of the American Association of Physical Anthropologists.

It's worth noting that Begun has made similar hypotheses before. Writing for the Journal of Human Evolution in 2002, Begun and Elmar Heizmann of the Natural history Museum of Stuttgart discussed a great ape fossil found in Germany that they argued could be the ancestor (broadly speaking) of all living great apes and humans.

"Found in Germany 20 years ago, this specimen is about 16.5 million years old, some 1.5 million years older than similar species from East Africa," Begun said in a statement then. "It suggests that the great ape and human lineage first appeared in Eurasia and not Africa."

Migrating out of Africa

In the Descent of Man, Charles Darwin proposed that hominins descended out of Africa. Considering the relatively few fossils available at the time, it is a testament to Darwin's astuteness that his hypothesis remains the leading theory.

Since Darwin's time, we have unearthed many more fossils and discovered new evidence in genetics. As such, our African-origin story has undergone many updates and revisions since 1871. Today, it has splintered into two theories: the "out of Africa" theory and the "multi-regional" theory.

The out of Africa theory suggests that the cradle of all humanity was Africa. Homo sapiens evolved exclusively and recently on that continent. At some point in prehistory, our ancestors migrated from Africa to Eurasia and replaced other subspecies of the genus Homo, such as Neanderthals. This is the dominant theory among scientists, and current evidence seems to support it best — though, say that in some circles and be prepared for a late-night debate that goes well past last call.

The multi-regional theory suggests that humans evolved in parallel across various regions. According to this model, the hominins Homo erectus left Africa to settle across Eurasia and (maybe) Australia. These disparate populations eventually evolved into modern humans thanks to a helping dollop of gene flow.

Of course, there are the broad strokes of very nuanced models, and we're leaving a lot of discussion out. There is, for example, a debate as to whether African Homo erectus fossils should be considered alongside Asian ones or should be labeled as a different subspecies, Homo ergaster.

Proponents of the out-of-Africa model aren't sure whether non-African humans descended from a single migration out of Africa or at least two major waves of migration followed by a lot of interbreeding.

Did we head east or south of Eden?

Not all anthropologists agree with Begun and his team's conclusions. As noted by New Scientist, it is possible that the Nikiti ape is not related to hominins at all. It may have evolved similar features independently, developing teeth to eat similar foods or chew in a similar manner as early hominins.

Ultimately, Nikiti ape alone doesn't offer enough evidence to upend the out of Africa model, which is supported by a more robust fossil record and DNA evidence. But additional evidence may be uncovered to lend further credence to Begun's hypothesis or lead us to yet unconsidered ideas about humanity's evolution.