On Delivering Vaccines

Global Reset Series / by Nathan Myhrvold /

Vaccine deployment is a challenge in the third world with its unreliable power grids and roads. We need a self-sufficient device—a super thermos—to surmount this lack of infrastructure.

Most of the world’s focus on developing medicines and vaccines is aimed at rich people. Non-profit medical research is funded mostly by tax dollars—and rich countries prioritize their spending by what matters to them. For-profit medical research is even more focused on servicing the needs of those with higher incomes. Given the huge costs and risks of development, the thinking goes, why target customers with an income of only a few dollars per day?

The global R&D budget is vastly tilted the wrong way. But this is only part of the problem. Even when technologies have the potential to make a difference, deployment in the developing world often stumbles for lack of infrastructure. Therefore, the tricky question when you’re inventing for the developing world is creating the right level of technology.

Delivering vaccines to the developing world poses just such a challenge. The system required to deliver a vaccine is called the “cold chain,” so named for the set of facilities that keep a vaccine cold as it is distributed from the manufacturer to the people who need it. Like any chain, a cold chain is only as strong as its weakest link. In the industrial world, refrigerators work well, the grid is reliable, and hospitals have backup generators. In many parts of Africa and Asia, however, there is no power grid, and those that do exist are highly unreliable. The common method of vaccine delivery is to use a refrigerator or an ice chest. But in the developing world, $10,000 worth of vaccine can go bad because the $50 ice chest or $100 dollar refrigerator fails, perhaps for lack of only a couple dollars worth of electricity. When that happens the loss is worse than monetary: Children fail to get the vaccine and may sicken or die as a result.

So why not fix the power grid and the refrigerators? That’s a bit like asking why the developing world isn’t already developed. It takes a long time and a lot of effort to raise the level of infrastructure everywhere in a country. Other conventional approaches include buying backup generators, or using solar panels to power the refrigerators in clinics. So far these attempts have not worked out—they are too expensive or too fragile: It’s hard to get generators or solar panels serviced in remote areas.

Figuring out which types of technology are appropriate in these regions of the world is difficult. Even the simplest, most robust innovation can fall short if it doesn’t take human behavior and infrastructure issues into account. Some people focus on utter simplicity and low-tech solutions, fearing that anything high tech is too fragile. But those folks have not taken into account how revolutionary cell phones have become in the developing world. Cell phones have been a success because the infrastructure required is pretty modest, and because a cell phone doesn’t require a perfect infrastructure to be useful. If the system is down 10 percent of the time, that is unfortunate, but during the remaining 90 percent of the time, cell phones provide instant communication the likes of which ordinary people in developing nations have never experienced. Cell service in the developing world is not great—they don’t run “can you hear me now?” TV ads—but is still incredibly useful. Unfortunately, the same thing is not true for the cold chain; even 90 percent reliability is nowhere near enough.

To successfully deliver a vaccine to a remote village, relying on infrastructure already in place, we need a cold delivery vehicle that can survive for six months or longer with no power. It needs to be dedicated to vaccine storage, not a good fit for a ham sandwich. And, in order to control costs, it needs to be reusable. This sounds almost impossible, but we have found an answer inspired by three technologies: a thermos, a vending machine, and an AK-47.

A thermos has the appropriate level of technology given the fact that it’s passive: It keeps cold things cold. A conventional thermos isn’t good enough, but a Dewar flask, invented in the 19th century, holds cryogenic fluids like liquid nitrogen at temperatures of -196oC (-321oF) for months at a time. Ordinary ice turns out to be a great battery: The thermal energy absorbed as the ice melts works out to a higher energy density than lithium ion batteries. This is the beginning of an idea but there is one problem: You can’t maintain the temperature if you open the container. The key insight is that you don’t really want to use the container, you just have to get the vaccine out. Just like a vending machine.

So how do you create a vending machine that doesn’t require repair staff tending to it every other week? A machine destined for remote areas with bumpy roads and a host of other calamities? In order to have the vaccine vending machine grab the vials reliably without jamming, we studied the mechanism that has proven reasonably reliable under difficult and gritty mechanisms, the bullet magazine in the AK-47. Assault rifles, kicked and bumped and dropped in mud, still feed ammunition at high rate. Vaccine vials are a bit like bullets, albeit more fragile. We learned from the AK-47 as well as other reliable feed mechanisms. We also learned how to test mechanisms, taking our prototypes into the parking lot and kicking them around to see if they would still feed. So far, so good!

When inventing for the third world, a common criteria is that the invention needs to be cheap. A Dewar flask with an internal vial dispenser is never going to be as cheap as a Styrofoam ice chest.  I think that this may have stopped others from pursuing advanced approaches. The answer here is a matter of perspective—it’s the cost per use that really matters. The capital cost of a device for vaccine storage is less important if the device can be reused many times. A Styrofoam ice chest that breaks often may be more expensive per use, especially when figuring in the cost of losing the vaccine. That doesn’t justify an extremely expensive solution, but it does give innovation some breathing room.

But wouldn’t we be better off just fixing the real problem? Wouldn’t the developing world be better off with good roads, a reliable electrical grid and robust health care? Of course it would, and in the long run, that must happen. Indeed, that is how highly developed countries got where they are today. The United States and Europe were no better off a century or two ago than Africa is today. Given the path to development that has already occurred, poor parts of the world can probably do it faster than Europe and the US did, but even so development is a slow process with many fits and starts. Economic crisis, war, famine, political struggles, and other scourges interact badly with poverty. It is very hard to have confidence that we can quickly solve all of the problems of the developing world.
A better vaccine container may be a band-aid to the real problem of poverty and under development, but it can make a huge difference to millions of children, alleviating the disease burden for entire generations that would otherwise fall sick while waiting for the wheels of progress to develop their society. That seems like plenty of reason to do it.

Nathan Myhrvold, former chief technology officer at Microsoft, is the CEO and co-founder of Intellectual Ventures.

Originally published December 30, 2010

Tags development disease global reset medicine technology

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