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The Agilent Technologies Foundation Health Award
Dengue fever is an extremely painful tropical disease that infects 20-40 million people per year globally, killing more than 20,000. There are no vaccines or drugs targeting the virus that causes the fever. Efforts to control the disease are primarily focused on its transmission by a mosquito vector, Aedes aegypti. This mosquito, which also transmits yellow fever, lives happily in urban areas, where the females find plenty of human blood meals, and water in which to lay their eggs. The mosquito’s “talent” for living with humans allowed Aedes aegypti to spread out of
Ecovec was spun off from the
In the past year, MI Dengue has been implemented in several cities in Brazil, and early evidence suggests that it is keeping Aedes aegypti populations and dengue rates low in monitored areas. EcoVec is working to adapt MI Dengue to monitoring programs outside Brazil, in other areas suffering from dengue or yellow fever. Insects have important roles in the spread of many tropical diseases, and MI Dengue can serve as a model for surveillance systems for other disease vectors.
For more information on Ecovec and the MI Dengue project, please see their Web site: www.midengue.com.br.
Medical Missions for Children, Paterson, New Jersey, U.S.
When a doctor in the U.S. is faced with an unusually challenging case, a specialist can be consulted. In less developed countries, physicians often receive more limited training, and thus may have an even greater need for expert assistance on tough cases. Unfortunately, specialists with advanced training are few and far between in these countries. Without expert advice, these doctors find themselves between a rock and a hard place, where either doing nothing or doing the wrong thing, could cause grave harm to the patient. Medical Missions for Children (MMC), and its Global Telemedicine and Teaching Network (GTTN), were founded to get these doctors and patients the help they need.
GTTN operates the Telemedicine Outreach Program (TOP), which coordinates remote videoconference consultations to give real-time advice to doctors dealing with critically ill or injured patients, especially children. By 2005, TOP had videoconferencing and remote diagnostic equipment in exam rooms at hospitals in 36 developing nations, with mentoring physicians at 28 U.S. and European medical centers providing diagnostic and consultation sessions. This year, TOP merged with the World Bank’s Global Development and Learning Network, expanding its reach to more than 100 countries. TOP now coordinates several hundred telemedicine sessions each month, more than 35,000 since the program started, with more than 23,000 patients served. Patients and doctors directly involved in these consultations are not the only ones benefiting. According to Robert Hagerty, CEO of Polycom, who works closely with MMC to provide telecommunications equipment, “I have often noticed that through their efforts to support the treatment needs of a single patient, MMC has been simultaneously educating groups of physicians, nurses, and allied healthcare workers, all of whom elect to observe MMC-orchestrated telemedicine sessions as they take place in their respective healthcare facilities.”
MMC also is trying to upgrade the training of healthcare personnel at institutions with limited financial means by providing free medical education programming. Its Medical Broadcasting Channel (MBC) currently streams educational content 8 hours per day via satellite TV to the western hemisphere, and to healthcare facilities and educational institutions globally via the Internet2 high-speed network. By 2007, MBC will be providing programming free of charge to television networks around the world for rebroadcast to the general public, and their Global Video Library of Medicine will give healthcare professionals online, on-demand access to more than 25,000 hours of training content. Through these efforts, MMC is doing their part to reduce the disparity in healthcare between rich and poor nations.
More information on MMC is contained on their Web site: http://www.mmissions.org.
PointCare Technologies, Marlborough, Massachusetts, U.S.
Most of the 40 million people worldwide who are infected with Human Immunodeficiency Virus (HIV) live in poverty. Although access to anti-retroviral drugs for these people is generally improving, the problem is far from solved. Starting a patient on anti-retroviral drugs is the beginning of an indefinitely-long treatment process that must be carefully monitored to make sure the virus is suppressed, and to minimize the risk of opportunistic infections (which is the direct cause of death for most people with HIV). To determine how well a particular drug regime is working for an HIV patient, a physician has few options in resource-poor settings. “Viral load” measurements, which tell how much virus is present in the blood, are too expensive. Alternatively, the status of the immune system can be monitored by counting Cluster of Differentiation 4 (CD4) white blood cells, the primary target of HIV. Stable or rising CD4 cell counts can indicate a drug treatment is working, while falling CD4 counts may suggest changes need to be made, or additional measures taken to protect the patient from other infections.
The “gold standard” CD4 counting protocol uses a sophisticated, expensive instrument called a flow cytometer. There are often few lab facilities for carrying out CD4 tests in countries heavily impacted by HIV. To remedy this, PointCare Technologies has developed a simple, automated CD4 cell counter (the “AuRICA CD4 Analyzer”) by completely re-engineering the CD4 assay. Standard CD4 counting is based on an antibody (a component of our immune system that recognizes foreign molecules) that binds to the CD4 protein on the surface of certain white blood cells. These antibodies are coupled to fluorescent tags, which the flow cytometer counts as the antibody-bound cells from a blood sample pass by. In the AuRICA analyzer, the CD4-binding antibody is coupled to colloidal gold nanoparticles, instead of fluorescent tags. When the nanoparticles are clustered on the surface of a CD4 cell, it scatters light differently, allowing the cell to be detected by appropriately positioned optical sensors in the flow chamber. Thus, the expensive and delicate fluorescence-detection system was replaced with simpler photodiode optics, dramatically lowering the complexity and price of the AuRICA instrument.
Aside from cost, the AuRICA system has other advantages. The metallic nanoparticles and other reagents can be stored at room temperature, a big advantage in poor locales where the electrical grid experiences frequent outages. Sample handling is largely automated, requiring less operator training and enhancing bio-safety. Finally, the analyzer is small and sturdy, for easy transport. AuRICA will make CD4 testing more widely available in poorer countries by moving it to the point-of-care. Whether therapy is being delivered in urban hospitals or small clinics, doctors will be able to more quickly get the critical data they need to better treat HIV patients, which should lead to longer, healthier lives. PointCare quickly sold out their first batch of 100 AuRICA instruments early in 2006. According to Joyelle Dominique, Laboratory Program Manager in the Clinical Research Division at the Institute for Human Virology (Baltimore, MD), “Our PEPFAR (President’s Emergency Program for AIDS Relief) AIDSRelief and Haiti-CDC programs currently have over 30 (AuRICA) units in place in seven countries in Africa and the Caribbean. This unique instrument has proved to be a wonderful addition to our clinical laboratories… PointCare Technologies, more than any other company that I have worked with, is truly dedicated to laboratories in resource limited settings.”
More information on PointCare Technologies and the AuRICA system is provided at: http://www.pointcare.net.
Riders for Health, Daventry, Northamptonshire, United Kingdom
Much of Africa’s population lives in or near villages lacking permanent healthcare facilities. Limited access to healthcare inexorably leads to poor health outcomes: fewer children vaccinated for preventable diseases, illnesses not diagnosed or treated promptly (if at all), and less access to medication. The founders of Riders for Health, a non-profit organization, recognized that dysfunctional transportation infrastructure is a major factor limiting effective healthcare in rural Africa. Their solution was to develop a workable transportation system for healthcare workers, and then to make sure the system keeps working.
Riders for Health manages a fleet of over 1200 motorized vehicles dedicated to healthcare personnel. Most of these are motorcycles, rather than four-wheeled vehicles. Motorcycles are cheaper to purchase and operate, and can get healthcare workers many places that four-wheeled vehicles cannot, including sites reachable only by “roads” that are barely more than paths. For larger transport needs, Riders for Health also manages cars, trucks, and ambulances. And for situations when something in between is needed, Riders for Health created the “Uhuru” (Swahili for “freedom”), a 200cc off-road motorcycle equipped with a unique sidecar that can function as an emergency ambulance. The Uhuru is extraordinarily versatile. When it is not in use as an ambulance, it can pull a special trailer to take goods to market, power a water pump for irrigation, or serve as an emergency generator.
Riders for Health trains healthcare workers with basic motorcycle operation and maintenance skills. Keeping vehicles running smoothly, though, is an enormous challenge in Africa. Marginal roads and harsh climates conspire with a dearth of mechanics, and limited access to replacement parts, to doom many vehicles to early ends. To overcome this, Riders for Health’s “Transport Resource Management” system trains networks of technicians in repair and preventive maintenance. These mechanics are always available if something goes wrong with a vehicle, and keep all vehicles on a rigorous maintenance schedule. Their efforts are supported by a reliable parts supply chain, which is unusual in much of Africa. Proper maintenance dramatically improves vehicle operability rates and lifetimes, reducing costs and increasing the effectiveness of struggling public health systems.
Communities served by Riders for Health have more visits by healthcare workers, higher vaccination rates, and lower death rates from malaria and other diseases. Riders for Health has programs throughout Zimbabwe and Nigeria, and in 2002 the small West African nation of Gambia contracted with Riders for Health to manage its entire health services vehicle fleet. Although Riders for Health is based in the U.K., all its African programs are locally managed by nationals of the countries involved, and are operated through agreements with local and national governments to be financially self-sustaining.
The Web site http://www.riders.org contains more information on Riders for Health.
Sumitomo Chemical Company, Tokyo, Japan
Malaria is caused by the Plasmodium parasite, which is transmitted by the bite of Anopheles mosquitoes. Thanks to massive vector control efforts, Anopheles mosquitoes have been largely eliminated in wealthier countries in temperate latitudes, but these mosquitoes still thrive in the tropics. The weight of hundreds of millions of malaria cases per year, and up to three million deaths, falls heavily on Africa, where the “big three” infectious disease killers- malaria, AIDS, and tuberculosis- form a harrowing gauntlet. Of these, malaria is by far the most lethal to children.
Effective vaccines still are elusive for both malaria and HIV/AIDS, so prevention remains the least expensive strategy for reining in these diseases. Insecticide-treated bed nets are the anti-malarial equivalent of condoms in the prevention of HIV/AIDS. These nets greatly reduce the risk of mosquito bites at night, when Anopheles primarily feed. Research has shown that widespread usage of treated nets could reduce malaria cases by 20-50%, but less than 10% of children under the age of five in Africa are currently protected by insecticidal bed nets.
Sumitomo Chemical was the first company to develop a mosquito bed net with built-in insecticide. Olyset nets are woven from polyethylene fibers impregnated with permethrin, a powerful insecticide and mosquito repellent. The permethrin continually migrates to the fiber surface, where the insect can contact it. Amazingly, these nets retain insecticidal activity for five years or more, even with periodic washing. Olyset nets were initially marketed to Japanese businessmen who traveled to malarial regions. In Africa, people were soaking their own bed nets in insecticides, if they were fortunate enough to have been educated in this technique and if they had the economic means to afford nets and insecticide. Then in 2001, the World Health Organization made Olyset the first long-lasting, insecticide-embedded mosquito net recommended for malaria prevention. The demand for Olyset nets soared. Sumitomo graciously donated 330,000 Olyset nets to the United Nations’ Millennium Villages Project in Africa, but millions more were needed.
That is when a remarkable public-private consortium came together to push these nets toward their full life-saving potential by establishing an African manufacturing base. Sumitomo donated a royalty-free license for Olyset manufacturing technology to “A to Z” Textile Mills in Arusha, Tanzania. Furthermore, Sumitomo and Exxon Mobil (the polyethylene producer) provided on-site engineering and manufacturing expertise, the Acumen Fund provided $1 million in financing and grants to “A to Z” to develop production capacity, Population Services International donated marketing expertise, and UNICEF guaranteed a market for the initial production runs.
The Olyset project is now a proven success. In two years time, “A to Z” has scaled up production to over seven million nets per year. At least 10 times that many insecticidal nets will be needed in Africa, so “A to Z” has broken ground on a new, larger factory in Kisongo, Tanzania, which should begin production by the end of 2006. Process refinements at “A to Z” also have reduced the cost per net from ten dollars to six dollars, and additional economies of scale may lower that even further. Peripheral benefits from local production of Olyset nets include thousands of new construction and manufacturing jobs, more advanced textile manufacturing technologies and greater capacity, lowered production and distribution costs for the Olyset nets, and faster delivery of this life-saving product. Most of the nets produced so far have been purchased by NGO’s such as UNICEF, but “A to Z” is working to develop sustainable local markets. Given that other long-lasting insecticidal nets are now competing with Olyset, Sumitomo and “A to Z” will need to continue to innovate to retain their position as market leader- but that is good news for the millions of people now less likely to suffer or die from malaria.
More information on Olyset and Sumitomo Chemical Company can be found at: http://www.sumivector.com.
Improving healthcare is essential for underdeveloped nations to reach their full potential. If the projects described here are to contribute to that goal, they must be sustainable. Charitable handouts may be necessary in crisis situations, but long-term development requires real growth and improvement in infrastructure and human capital. Two of our Laureates- Medical Missions for Children, and Riders for Health- are non-profit organizations founded in a spirit of generosity, but both are dedicated to sustainability. Despite its name, Medical Missions for Children does not send teams of physicians on charitable missions to remote, underdeveloped lands, because such efforts often do little to improve local healthcare systems. Instead, they help local physicians through the Telemedicine Outreach Program, and provide globally-accessible training for healthcare workers via the Medical Broadcasting Channel and the Global Video Library of Medicine. Riders for Health does not send out teams of British motorcyclists and mechanics- they design vehicles (the Uhuru), maintenance plans, and training programs for African healthcare workers and mechanics. These organizations thus catalyze sustainable improvements in healthcare services and delivery.
The remaining three Laureates, EcoVec, PointCare Technologies, and Sumitomo Chemical Company, are all for-profit businesses. Can profitability co-exist with humanitarian mission and sustainability in the health sector? EcoVec and PointCare are too early in their corporate lives to reliably answer this question, but Sumitomo Chemical is a large, successful company that explicitly promotes corporate social responsibility: “At Sumitomo Chemical, while we aim to improve our financial performance, we are also committed to contributing to the sustainable development of society through our Responsible Care activities, community activities, and corporate compliance.” (www.sumivector.org). Admittedly, Olyset is just one of many Sumitomo products, and the company’s overall profitability was not substantially dependent on it, which is why they could afford to donate a royalty-free license for producing these nets to “A to Z” Textiles. In contrast, the Tanzanian company’s long-term success will depend on creating a sustainable market for long-lasting insecticidal nets, on a continent where six dollars may still be too expensive for millions of people who could benefit from this lifesaving technology.
We fervidly hope that “A to Z,” EcoVec, and PointCare Technologies can successfully translate their technological innovations into sustainable business models. At the very least, they and the other 2006 Agilent Technologies Foundation Health Laureates have shown that appropriate technologies have enormous potential to improve human health in the poorest parts of the world. The Panel looks forward to hearing about ever more creative technological innovations in 2007!
Craig Stephens, Chair, Associate Professor of Biology, Santa Clara University
Marie Barry, Consultant, ALZA Corporation
Steve Eglash, Principal, Worldview Technology Partners
Leilani Miller, Associate Professor of Biology, Santa Clara University
Russ Sampson, Vice President of Research and Development, Cytyc Surgical Products
Jonathan Showstack, Professor of Medicine and Health Policy, Academic Information Technology Coordinator, Office of the Executive Vice Chancellor, Associate Director, Institute for Health Policy Studies, University of California, San Francisco
Peter Sullivan, Vice President of Emergency Medicine, California Pacific Medical Care