Friday, 30 September 2016

Improving Efficiency of Vaccination Systems through Intelligent Vaccine Management

The Ministry of Health and Family Welfare has been working towards reducing morbidity and mortality from vaccine-preventable diseases through its Universal Immunization Programme (UIP). The ministry has introduced numerous initiatives to improve the vaccine coverage in the country but there are still critical gaps in the vaccine logistics management system in the country with issues related to inadequate and poor infrastructure, weak monitoring and management information system, vaccine management and issues related to technical capacities of staff.

Districts around the country have been facing challenges related to vaccine coverage because of frequent equipment breakdowns, overstocking and stock-outs, inadequate monitoring and supervision, high rates of breakdown of equipment, overstocking and stock-outs, inadequate monitoring and supervision, and poor management. To overcome these challenges the Ministry of Health and Family Welfare (MoHFW) in partnership with United Nations Development Programme (UNDP) and GAVI are rolling out Electronic Vaccine Intelligence Network (eVIN) across 12 states in India.

eVIN helps in addressing three critical questions in vaccines logistics management - where vaccines are; whether they are in adequate quantities; and whether they are stored at recommended temperatures?

The eVin system uses a three prompt approach of people, processes and product. The Electronic Vaccine Intelligence Network (eVIN) is a technology system that digitizes vaccine stocks through a smartphone application. The technology uses mobile and web based dashboards to track locations, temperatures and stock levels of vaccines, making sure that the supply is safe and reliable. The system helps in providing real time data that can be viewed on a web and application-based dashboard by programme managers across districts, states and national levels. All the data is uploaded on a cloud based server by trained professionals through a smartphone application.

“Seeing health workers being able to show on their smartphones, real time data and having temperature monitoring that can be monitored externally is a really powerful thing” said Dr Seth Berkley, CEO of GAVI, the Vaccine Alliance.

With the eVIN system recently being rolled out in districts of Assam, Rajasthan, Bihar, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Manipur, Nagaland and Odisha; policymakers will be able to make data-informed decisions in planning for vaccine distribution and improving supply chain. As India is the home to the world’s largest birth cohort, planning a healthy future for every child is very essential at all levels.
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Monday, 5 September 2016

Companies Targeting The Poor Yet Retaining Profits

Innovation is a change that unlocks new value.”
-  Jamie Notter

Innovations in today’s time have paved way for the Multi-National Companies to reach out to people, catering to their needs and making their life simple and easy. It is so phenomenal that companies who sell products targeting customers at the poverty line still manage to make profits despite selling the products at very lower cost.

In order to understand the different facets of such companies’ marketing approach,  Amrit Gill a sophomore, majoring in Business & Finance at the University of South Florida completed a project on a very distinctive area of interest- ‘How companies retain profits while selling goods at a cheap price to consumers at the poverty line’. His initial research showed that such companies face difficulties finding customers in the starting, but after changing their business model and tactics they are able to become profitable. Such companies manoeuvre helps develop a case for other companies to analyze the consumer behavior and compeer their business and marketing approach.

1.       Green Light Planet- Sun King

The product originated in Orissa, is made by two Indian and one American college student in order to improve agricultural productivity, but the villagers later utilised it as a source of electricity. It’s estimated that around two billion population of the world lives in darkness and this product comes as a life-saver by illuminating their lives with bright light. The product is an alternative to the pollution causing kerosene lamps and also reduces the risk of catching fire. The company has sold around 3,000,000 lamps with 6,000 active sellers across India, Kenya and Uganda. The product will be able to add up to 30,000 sellers.

Nearly 20% of the Indian population do not have access to electricity and dwells heavily on kerosene lamps. Kerosene is one of the sources for global warming and also responsible for lung cancer, strokes and other respiratory diseases. With the Green Light Planet’s product Sun King coming into picture will help in reducing such issues. The development of this product took approximately 3 years. The initial investors in this product were from ZS Associates.

 The marketing strategy of Green Light Product was different. They tried to convince important people in the villages such as teachers, police and other officials to gain their trust, as the villagers had a bad experience with the Chinese products of such kind breaking down at a very early level of usage.

After their products were successful among few people, they encouraged their customers to spread its importance by Word of Mouth. In order to gain more trust they partnered with an NGO who helped them in adding more customers to their bucket.

In the near future the company plans to expand with adding more products such as cooking stoves and water filtration systems, once they are able to reach the saturation levels. The company’s projecting a 5-7 year sustainability programme, then depending upon their market they will expand on the product range.

2.       Mpedigree

An organization started by Bright Simmons, an entrepreneur who wanted to terminate counterfeit drug production in Ghana. The company produces labels in order to regulate the sales of counterfeit products. Mpedigree initially worked with pharmaceutical companies, but has now expanded to electrical products, clothing, cosmetics and seeds used in agriculture.

For developing the product, Simmons hired engineers to develop software that creates unique 12 digit codes, which is printed on a label in China costing $0.09 per unit. The software was used to store the codes in a database, in- case when a customer texted the code they were able to receive instant counterfeit verification. It came as valuable tool for manufacturers as they were able to get notifications if the code had been used more than once.

Pharmaceutical companies, venture capitalists, and regulators for future investments/partnerships did not take Mpedigree seriously, because it was a small nonprofit organization and charities were not much successful in Ghana. In 2009 Simmons transformed his organization into a for-profit social enterprise, he made calls until he obtained a meeting with Hewlett Packard to obtain cloud servers for data storage and partnership. HP saw initiative in the rising mobile industry in West Africa and East Asia. In December 2010 HP announced that it would run the data that host Mpedigree’s code, which saved the company 10 million dollars or the infrastructure costs. The pharmaceutical world started taking the company seriously when Nigeria’s food and drug administration endorsed Mpedigree.

Mpedigree is developing a system, in which the customers and the seller can contact each other directly in order to ensure customer satisfaction. They are in the process of presenting the idea to various telecom mobile carriers in India and Nigeria.  The company has expanded to the cosmetic and textile industries and is on the verge of signing 7 new deals, 5 in Ghana and 2 in Nigeria.

What Hilleman Laboratories can do?

Hilleman laboratories can increase the transaction size by using upselling. They can increase the total number products sold to a consumer by selling upgrades or additional accessories. The organization should negotiate long term supply deals in order to buy the products for lower prices and create better terms with the supplier.
The organization can incorporate efficient promotion by effectively using promotion expenses to create as many connections as possible. This will help increase sales volume, which can lead to a larger profit margin.

There is also a need to reduce cost of production which can be done by reducing energy consumption, and taking precautionary steps to prevent accidents. The organization should focus on avoiding overproduction and reducing waste.
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Tuesday, 23 August 2016

Workshop on Nutrition and Immunity for Infant and Child health

MSD-Wellcome Trust Hilleman Laboratories is a first of its kind joint venture between Merck & Co., USA and Wellcome Trust, UK Hilleman Laboratories is dedicated for improvement of child health by developing affordable vaccines for the developing world.

It is well known that appropriate functioning of the human immune system is dependent on nutritional status. There are a lot of insights gathered about interrelationship between nutrition and immunity and its role in reducing childhood morbidity and mortality.
Hilleman Laboratories understands and recognizes this interplaying role of nutrition and immunity in improving child health and its impact on the economic sustainability of our nation. To further our understanding of this key area, Hilleman Laboratories aims to convene a workshop on 21st and 22ndSeptember 2016 in NewDelhi, India. The workshop plans to provide a platform to spur a dialogue between esteemed academicians, researchers, public health experts and policy makers responsible for planning nutrition programs across the country. The workshop will have key-note presentation, theme presentations and discussions.

The workshop scopes to address the two-way association between nutrition with immune parameters in infants and young children. Infancy and early years of a child’s development represents the most nutritionally vulnerable stage of life cycle. Young children pay a lifelong price of undernutrition. Improvement in nutrition status is vital for saving young lives and thereby creating an impact on economic sustainability of a nation. The impact of nutrition is multi-faceted. Nutrition in early years of life is known to make a huge impact on immunity of an individual.

The workshop aims to cover key topics like integrating role of nutrition and immunity and provide insight for the nutrition focal persons/managers on key technical updates on child nutrition and immunity. Some of the key topics to be covered are: Nutrition requirements of children, Nutritional epidemiology for infant and child health,Nutritional deficiency associated Immune disorders in infants and children and Role of nutrition in prevention of disease, environmental eneteropathy, vaccines and nutritional health.

The first segment of this workshop session will throw light on importance of nutrition on immunity in infants and young children. It aims to landscape the trends and determinants in infant and child nutritionacross the country . The second segment aims to appraise and evaluate the nutritional requirements of infants and young children, and consider prenatal nutrition too. The third segment will shed light on ill effects of poor nutrition and its adverse impact on physical and cognitive growth of children.The fourth session will focus on how good nutrition in early years can strengthen immunity or vaccination against a disease can be chosen to prevent disease. It is well known that nutrition status alters response to vaccine and therefore, this session will explore the concept in conjunction with the role of environmental factors for infants and child health. The fifth and final session is planned to focus on the promotion of good health through nutrition and primary prevention of nutrition related illness in infants and young children. Apart from discussions on nutritional education and counseling programs for children, this session is also aimed to address integrated issues such as sanitation and hygiene which could indirectly affect infant and child health.

This workshop thus aims to highlight and resolve the gaps in current scenario while discussing malnutrition, immunity and vaccinesby providing a great opportunity to distinguished professionals to discuss the latest advancement, practices and challenges in the field to achieve the common goal of improving infant and child health. 

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Thursday, 11 August 2016

Undernutrition And Diminished Immunity: Breaking The Lethal Cycle

Healthy children are the bedrock of a healthy society. Good nutrition is the core pillar for healthy and productive communities and nations. The benefits of good nutrition are carried across generations, binding and supporting various facets of nation’s development. Hence it is in a nation’s best interest to safeguard its children’s health. As per UNICEF, around 3 million children die due to undernutrition every year. Asia alone is believed to be home to approximately 70% of the world's malnourished children, while India has the highest percentage of undernourished children in the world. Ironically when the economic development of India is growing at nearly 10% annually, the rate of undernourished children remain very high. As per the third National Family Health Survey (NFHS) India, 48% of children under the age of five are stunted due to chronic undernutrition. Undernutrition, often referred to as “hidden hunger”, is a form of malnutrition. It has long been a sore point for India, adversely impacting the overall social and economic development.

Without aggressive efforts, the undernutrition issue in India is escalating with devastating consequences on children’s development-physical growth retardation, increased susceptibility to diseases, hampered cognitive development.

Undernutrition issues among the age of under-five children is an important concern for the health authorities in India. It is acknowledged widely that infections are as much a cause of malnutrition as they are a consequence. Malnourished children have increased risk of mortality from infectious diseases. Investing in elevating maternal and child nutritional status is a long-term investment that will benefit the present generation and their children as well.
The nutrition of mothers and children is closely linked. When malnutrition starts at conception, most of the damage is already done as the child enters the second year of life. The first 1000 days of a child’s life is a critical window and represents the most vulnerable period to the impact of poor nutrition. Deficits during this period can have irreversible consequences for the child. Other than adversely impacting the cognitive ability, a child’s nutritional status also influences the immune responses in varied and complex ways. A common thread links nutrition, immunity and infections. Nutritional deficiencies are known to affect various components of the immune system putting a child at a greater risk of developing a disease. The severity of malnutrition and the age of onset of nutritional deprivation often decide the extent of immunological impairment. A stunted, undernourished child is at a greater risk of various diseases. Infection and malnutrition overlap and interact; infact they form a vicious cycle. Undernutrition weakens the immune system, putting children at higher risk of more severe, frequent and prolonged bouts of illness. Looking at this from other end of the spectrum, undernutrition appears to be a consequence of repeated infections, which can further worsen the child’s nutritional status. Thus recurrent infections contribute to pathogenesis of malnutrition. This interaction between under nutrition and infection creates a potentially lethal cycle of worsening illness and deteriorating nutritional status. Critical nutrition interventions have the potential to break this cycle and are important for accelerating progress. Scrimshaw et al (1968) first described this vicious cycle of infection and under nutrition. His research stated that infections predispose to malnutrition, through reduced intake and absorption and diversion of nutrients away from growth, while malnutrition reduces immune function and increases the risk and/or severity of infections.

Immunization and improved nutrition are among the key factors in a multi-sectoral package of interventions for reducing childhood mortality and feature prominently in the Gates Grand Challenges in Global Health. Vaccination programs also stand to hugely benefit the malnourished population as well. Vaccination programs are particularly valuable health resource for settings that are in high-disease environment. Reforming children’s health status translates into higher worker productivity promoting economic success and poverty reduction for a nation. Improving nutritional status will further add to the overall success of the multi sectoral interventions that include immunization and vaccination programs undertaken by the government.

It is reassuring that the enormity of the adverse impacts of poor nutrition on a child’s growth and development are being recognized and acted upon aggressively. Entities such as Hilleman Laboratories understand and recognize the interplaying role of nutrition and immunity in improving child health and development and its impact on the economic sustainability of our nation and are looking ahead and promoting actions for transforming lives.
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Friday, 29 July 2016

India: Current Vaccination Scenario

India’s immunization program is one of the largest Universal Immunization Programs (UIP) in the world. In India, the Universal Immunization Program targets 27 million infants and 30 million pregnant women every year. Effective vaccine utilization is an integral component of vaccine security and vaccine wastage is one of the key factors to be considered with regards to vaccine forecasting and need estimation. Heat sensitivity of most vaccines calls for the need of adequate cold-chain system and ensure its maintenance to preserve the potency of the vaccine before it is administered. The World Health Organization (WHO) recommends that all childhood vaccines except the oral polio vaccine be kept at 2–8 °C during their in-country distribution.

In a bid to ensure success of the immunization program, India has a five-level supply chain. It commences at the government medical supply depots (n=4) which supply state vaccine stores (n = 35), which, in turn, supply regional vaccine stores (n = 116). Vaccine is sent from the regional stores to district vaccine stores (n = 626), and thereon the last links in the chain: the primary or community health centers function as the peripheral vaccine stores (n = 26 439).

In spite of all the positive efforts there are ongoing challenges and shortcoming in the program that hamper the coverage rates.Within the entire chain, storage of vaccines at optimum temperature is critical. Most vaccines(except the oral polio vaccine) need to be stored at temperature between 2–8 °C.This is either achieved by building walk-in coolers or ice-lined refrigerators or transported in cold boxes with ice packs that have been allowed to reach 0 °C.Immunization services in the public sector are mostly provided at district hospitals, urban health centers and primary or community health centers. However, outreach vaccination sessions at health subcenters or in remote villages are also conducted, using vaccine transported from the nearest primary or community health center.

A study by Galhotraet al in the year 2007 highlighted incidence of avoidable errors like uninterrupted power supply, in adequate number of exhaust fan, voltage stabilizers, etc. were the identified reasons for the errors and cited a room for improvement.

Use of thermo stable vaccines is on the anvil and is likely to change the dynamics in future.
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Tuesday, 19 July 2016

Need Of The Hour: Heat Stable Vaccines

It is estimated that vaccination programs save about 3 million lives worldwide from the adverse impact of infectious diseases. However it is also reported that about 3 million individuals succumb to vaccine –preventable diseases and the fact that many vaccines not being thermo stable plays a part in this tragedy.

The World Health Organization (WHO) estimates that annually 10-50 percent of vaccines may be wasted globally because of temperature control, logistics and shipment-related issues.
The vaccines currently available need to be kept constantly cold at temperatures between 2°C to 8°C from the point of manufacture until reaching the recipient. Considering the variable stability of vaccines, for a country like India, which experiences a tropical climate, the cold chain remains a highly vulnerable point. Low resource setting areas, which are not only isolated but lack reliable electricity for refrigeration, pose a major obstacle. This impacts the overall immunization rates negatively.

Storage of vaccines at optimum temperature is critical. Inadequate refrigeration systems lead to unintended interruption of the cold chain. Further lack of quality monitoring apparatus, exposure to high heat and damaging exposure to temperatures below 0°C harm the vaccine efficacy. Currently, the requirement for a vaccine to be transported and stored in a constant cold chain, from the time it leaves the manufacturer until it is used at a vaccination point, places huge logistical challenges on vaccination providers who must ensure that the cold chain is maintained each step of the way.
Development of thermo stable vaccines, vaccines that can withstand elevated or fluctuating temperatures is an emerging thought. Use of thermo stable vaccines has the potential to ease such logistical hurdles imposed by the ‘cold chain’. Thermo stable vaccine formulations that would be resistant to damage caused by freezing or excessive heat can reduce the dependence on the cold chain.

Benefits of thermo stable vaccines are huge, including cost savings, preventing vaccine damage, and, most importantly, making it easier to reach children living in remote places who would otherwise remain unvaccinated.

A clinical study published in “Vaccine” in the year 2012; by Lee BY et al has another interesting perspective, “Eliminating the need for refrigerators and freezers should not necessarily be the only benefit and goal of vaccine thermo stability. Rather, making even a single vaccine (or some subset of the vaccines) thermo stable could free up significant cold storage space for other vaccines, and thereby help alleviate supply chain bottlenecks that occur throughout the world.
Nevertheless, making individual vaccines thermo stable could still have benefits if their removal from the cold chain could relieve bottlenecks in the vaccine supply chain.”

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Monday, 27 June 2016

Mission Indradhanush: Spectrum of seven will now be eleven

Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW) on 25th December, 2014. The health ministry’s flagship programme, which provided immunisation against seven life threatening diseases, is all set to be renamed as four new vaccines have been introduced to fight against various life threatening diseases.

Mission Indradhanush, signifies the spectrum of seven colours of the rainbow, which provides vaccination against seven vaccine-preventable diseases including diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and Hepatitis B.

"We have added four new vaccinations - rotavirus, measles rubella, inactivated polio vaccine biavalent and Japanese Encephalitis for adults. In that, very important is rotavirus. 10 lakh children get hospitalised every year suffering from diarrhoea and 80,000 lose their lives every year," said Health Minister JP Nadda.  The four added vaccines had been made a part of the ‘India Newborn’ action plan in January this year.

With an aim to fight against various vaccine preventable diseases and to reach out to the unvaccinated and partially vaccinated children by 2020, the project has additionally brought 1.62 crore children under the ambit of immunization within a year of its launch. India had been facing the problem of low immunization coverage since many years as period between 2009-2013 saw just 1 per cent increase in coverage year-on-year.

"Mission Indradhanush has brought change in the lives of people. We have to keep some other name in place of Indradhanush as the vaccinations have gone up from seven to eleven," added the Union Health Minister.

However regardless of the name, the project has shown improvements in immunization coverage and with the added new four vaccines, a new set of unvaccinated  and partially vaccinated children will be brought under the scope of Immunization.
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Hilleman Laboratories is a global vaccine research & development organization focused on making affordable vaccines using innovation to address gaps that exist in low resource settings. Hilleman Labs acts as a catalyst in bridging the gap between academic research and product development by targeting novel vaccines and increasing the efficiency of existing vaccines. Know More

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