Treatment and Vaccines

Treatment and Vaccines

Encouraging Vaccine Confidence

Communicating with the public may be key to promoting confidence in upcoming COVID-19 vaccines

Given that the World Health Organization declared vaccine hesitancy as a top health threat of 2019, there has been growing attention on the need to encourage vaccine confidence for the upcoming COVID-19 vaccine. The Vaccine Confidence Project, a research group based at the London School of Hygiene & Tropical Medicine established to study and provide guidance on global vaccine trends, have launched the CONVINCE campaign (COVID-19 New Vaccine Information, Communication, and Education) to advance public vaccine literacy and promote widespread acceptance, leveraging a global network of business partners. GAVI, the Vaccine Alliance, an international organization devoted to improving vaccine access to low-income countries, has strongly advocated for the engagement of local communities to rebuild trust and demand for immunization services. Lessons on addressing vaccine hesitancy may also be taken from South Korea, where public trust was re-established by having scientists and public health experts, rather than politicians, lead the way in transparent investigations of misinformation and communications to the public.

Social media has been a particularly important tool, as demonstrated in West Africa, where local health workers are countering vaccine misinformation with the messaging application WhatsApp. U-Report, a digital messaging and data collection tool developed by UNICEF, has been used in places like Indonesia and Uganda to analyze local knowledge and reduce misinformation.

Related Ideas: Massive Media Messaging; Accelerated Vaccine Production

Plasma Therapy and Banks

Convalescent plasma therapy may help in the treatment of some COVID-19 patients.

Convalescent plasma therapy has become a major research area in the search for COVID-19 treatment. The experimental treatment is based on collecting plasma (containing virus-fighting antibodies) from the blood of recovered patients and transfusing it into severe patients.

India has been notable for spearheading the research effort on plasma therapy for COVID-19 patients. In June, the state of Maharashtra launched the world's largest plasma therapy trial project to expand plasma knowledge and infrastructure. The state of Delhi established the country's first plasma bank in July 2020 and a second one days later in a different part of the city. The city's Covid site, https://delhifightscorona.in/, includes instructions on how to donate or apply for plasma. Patients who have recovered from the virus are strongly encouraged to donate; they are reimbursed the cost of traveling to the plasma bank and given a certificate signed by the Delhi chief minister but are not otherwise compensated. “Plasma is available free of cost in government hospitals and government-sponsored plasma banks , its infusion does not require fancy equipment, and it is a cost-effective treatment” says Dr. Nimmi Rastogi, an adviser to the Delhi Government. Amid the growing demand for plasma, a Delhi local developed the website “Dhoondh”, which aims to match donors to recipients. One Indian study based on a small sample (n=30) raises questions about the efficacy of plasma treatment, but others believe that it can help if administered early. 

The potential of plasma therapy is also gaining traction in the United States, where the FDA announced emergency use authorization (EUA) in late August. Before the EUA, the government supported a national expanded-use program led by the Mayo clinic, which provided plasma to more than 72,000 patients. Research from the Mayo Clinic based on a sample of 3,082 patients (but not a randomized control trial and not yet peer-reviewed) suggests that hospitalized patients who get earlier transfusions of blood plasma rich in antibodies to COVID-19 show a lower mortality rate.

Potential Contacts: Dr. Nimmi Rastogi, Coordinator, Health Task Force, Dialogue & Development Commission, Chief Minister's Office, Govt. of NCT of Delhi

Related Ideas: Home-Based Isolation

Rapid Hospital Construction

Expanding hospital capacity rapidly using innovative designs and construction methods

China responded to the outbreak in Wuhan by rapidly constructing two hospitals in less than two weeks, together providing 2,600 new beds. It was staffed with healthcare workers from across China. Innovative design strategies and emerging technologies were employed, informed by previous experience of rapid hospital construction during the 2003 SARS outbreak. Prefabricated building modules, kept in storage, were retrieved to expedite construction and reduce costs. The hospital was designed for use during a pandemic, with each room meant to accommodate one isolated patient, and with as little direct contact between medical staff and patients as possible. A detailed description of how this was done is contained in the 12-minute video below.

Drones can also help with rapid hospital construction, for instance, by conducting quick surveys of terrain or monitoring progress. In Argentina, four hospitals, adding 1200 beds, were planned with the help of drone technology. 2D and 3D images from data collected by drones was quickly available to stakeholders and planners across multiple organizations.

Related Ideas: Leveraging Speed; Pop-Up Mobile Testing Sites

Robot-Based Patient Care

Robots can be used to perform a variety of patient services, improving  safety and productivity

Robots are being used in hospitals worldwide to provide care with minimal patient-doctor interaction and reduced PPE use. In Rwanda, robots assist healthcare workers by checking temperature and monitoring patients, while in China, robots have been designed to perform ultrasounds and mouth swabs. The temporary Wuhan Wuchang Smart Field Hospital in China was staffed entirely by robots and artificial intelligence platforms. Countries such as Vietnam and the United States are also using robots to promote virtual communication with patients. 

Related Ideas: Tech-Based Social Distancing; Robots and Drones for Disinfection

Ultra-Low-Cost Ventilators

Simple ventilator designs using low-cost materials to improve ventilator accessibility in low-resource settings

Companies around the world are racing to ramp up ventilator production in response to the heightened demand from hospitals treating COVID-19 patients and projected ventilator shortages. A new generation of portable ventilators are being designed with low-cost, easy-to-find materials, making them easier to access and employ in low-resource settings. 

The ventilator race is evident in India, where a ventilator shortage was expected given the estimated 48,000 ventilators available at the start of the pandemic for a population of 1.3 billion people. One new model based on an automated bag valve mask, developed by Mahindra & Mahindra, was suggested to be priced at about $100 USD. Nocca Robotics is designing a machine that can work off oxygen cylinders, as opposed to relying on the piped oxygen found only in modern facilities. Another Indian company, InnAccel, created a CPAP oxygen support product following recommendations from experts like the USFDA that CPAP machines could be used as an alternative for non-invasive ventilation support. Intended for low-resource settings, the low-cost CPAP is portable and can work on ambulance power, batteries, or even a hand pump. Since CPAP machines tend to spread contaminated aerosols, an innovative CPAP-helmet was developed to reduce viral exposure to healthcare providers. Designed in collaboration with doctors and public health experts to ensure appropriate air circulation, the helmet is able to dynamically adjust air pressure and flow. InnAccel has also developed VAPCare, a product for Ventilator-Associated-Pneumonia (VAP) which automates VAP prevention protocols with intelligent secretion management and oral hygiene systems. 

In South Africa, ventilator shortages prompted the government to launch the National Ventilator Project. Ventilators were in production by late July, developed and manufactured locally in South Africa. The ventilators are designed to be non-invasive, cost-effective, and simple to operate. The government plans to rapidly produce 20,000 ventilators in order to significantly expand ventilator capacity. 

Young students are also contributing to the design of innovative, affordable ventilators. In Mexico, college students are developing an emergency-use ventilator made almost entirely out of PVC tubing; they plan to publish a manual for global use and estimate the cost to be about $100 USD per machine. An all-girls robotics team in Afghanistan has also received recognition for their low-cost ventilators. Using an open source design developed by MIT and locally-sourced car parts, the “Afghan Dreamers” are attempting to manufacture an automated bag valve mask at a fraction of the cost.

Potential Contacts:

Organizations: Mahindra & Mahindra; Nocca Robotics; Afghan Dreamers

Individuals: A. Vijayarajan (InnAccel founder and CTO)

Related Ideas: Rapid, Ultra-Low-Cost Tests

Accelerated Vaccine Production

Countries in Asia and Africa can help speed up the development and mass production of low-cost vaccines

Several vaccine trackers have been created to report the status of COVID-19 vaccines under development around the world. The London School of Hygiene and Tropical Medicine created a site showing the status of COVID-19 vaccines with a comprehensive review of clinical trial data. The New York Times also developed a tracker providing additional background on how institutions, companies, and governments are involved with each vaccine. As of September 2020, there have been 321 vaccine candidates; at least 32 candidates are being tested in clinical trials, including nine that have reached Phase III clinical trials.

Researchers in low- and middle-income countries (LMICs) are working to establish independent vaccine platforms and pipelines to counter the hoarding of supplies and monopolization of vaccine technology by high-income countries. Vaccine development in Africa is centered around a handful of countries, primarily Egypt and South Africa. There is a justified fear that African populations will be used for clinical testing of new vaccines but will not enjoy early use of vaccines or reap any financial benefits from their development by firms from developed countries.

Countries like China and India can support the mass production of low-cost COVID-19 vaccines. One of the largest and lowest cost producers of vaccines in the world is a privately-owned Indian company, Serum Institute of India (SII). In a preemptive move, SII has set up production lines to make a billion doses of a vaccine developed by Oxford University that is undergoing clinical tests and that has been licensed to AstraZeneca. Another Indian firm, Bharat Biotech, has received approval from the Indian authorities to commence human trials of a Covid-19 vaccine. 

The Coalition for Epidemic Preparedness Innovations (CEPI), World Health Organization, and the GAVI Vaccine Alliance together launched “COVAX“, a vaccine accelerator initiative aiming to equitably distribute 2 billion doses of a COVID-19 vaccine around the world by the end of 2021. In the United States, “Operation Warp Speed” is working to develop 300 million doses of a vaccine by January of 2021.

Potential Contacts: Sinovac; Serum Institute of India (SII); Bharat Biotech

Related Ideas: Rapid, Ultra-Low-Cost Tests