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

Ten Threats to Global Health in 2019, World Health Organization, January 10, 2019

Planning for a COVID-19 Vaccination Program, Journal of American Medical Association, May 18, 2020

Global Business Coalition Launched to Advocate Workforce Use of New COVID-19 Vaccines, Pending Availability, United States Council for International Business, July 30, 2020 

Use of Gavi Support to Maintain, Restore and Strengthen Immunisation in the Context of COVID-19, Gavi the Vaccine Alliance, Updated October 2020 

Maintaining, Restoring, & Strengthening Immunization, Gavi Innovation Catalogue, Gavi the Vaccine Alliance, August 2020 [Section E details innovations relating to community engagement] 

What South Korea Can Teach Us About Vaccine Hesitancy, The New York Times, December 2, 2020

Just 50% of Americans Plan To Get a COVID-19 Vaccine. Here’s How To Win Over the Rest, Science Magazine, June 30, 2020

Spreading Facts, Not Fear, in the Fight Against Coronavirus, UNICEF, March 2, 2020

Ugandan Youth Are Allies For Immunisation, UNICEF, April 24, 2020 

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

How China Built Two Coronavirus Hospitals in Just Over a Week, Wall Street Journal, February 6, 2020

How China’s Industrial Internet Is Fighting COVID-19, World Economic Forum, April 8, 2020

How China Built a Hospital in 10 Days, Wendover Productions, February 11, 2020 [Video, 12 mins]

Covid-19: Drones help build emergency hospitals in Argentina, Urban Air Mobility, April 23, 2020

Additional Links:

China Pledged to Build a New Hospital in 10 Days. It’s Close. The New York Times, February 7, 2020

Coronavirus: How China Built Two Hospitals at Top Speed at the Heart of the Virus Outbreak, South China Morning Post, January 28, 2020 [Video]

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

COVID-19: The Race to Build Coronavirus Ventilators, BBC Future, April 1, 2020 

The World is Scrambling to Buy Ventilators in the COVID-19 Pandemic. One Country Has Only Four of Them — For 12 Million People, CNN, April 18, 2020 

COVID-19 in India: State-Wise Estimates of Current Hospital Beds, ICU Beds, and Ventilators, The Center For Disease Dynamics, Economics & Policy, April 21, 2020 

Mahindra Names Its ‘Coronavirus Warrior’ Low-Cost Ventilators AIR100, Hindustan Times, April 13, 2020

Coronavirus: IIT Kanpur to Develop Low-Cost Portable Ventilators to Aid Medical Infrastructure, The Economic Times, March 26, 2020 

Ventilator Supply Mitigation Strategies: Letter to Health Care Providers, U.S. Food and Drug Administration, March 22, 2020 

Coronavirus- South Africa: Government’s Ventilator Project Enters Production Phase- First Units Expected Soon, AfricaNews, July 17, 2020

From Telescopes to Ventilators, How the Country’s Engineers and Designers Have Retooled for the COVID-19 Crisis, Rhodes University, July 8, 2020

PICS: This Is What the Locally Built, Non-Invasive COVID-19 Ventilator Looks Like, News24, Updated August 4, 2020

South Africa Produces Its First Ventilators to Fight COVID-19, Reuters, July 31, 2020

Mexican Students Design Practical, Inexpensive Ventilators To Face Pandemic, Fronteras Desk, April, 13, 2020

All-Girl Robotics Team In Afghanistan Works On Low-Cost Ventilator … With Car Parts, National Public Radio, May 21, 2020

Can Low-Cost, Open-Source Ventilator Designs Help Save Lives?, MIT Technology Review, March 25, 2020

MIT Emergency Ventilator Project, Massachusetts Institute of Technology, 2020

Afghanistan’s All-Girl Robotics Team is Building Emergency Ventilators Out of Car Parts, Fast Company, May 18, 2020

Additional Links:

COVID-19: Indian-American Couple Develops Low-Cost Ventilator, The Hindu, May 26, 2020

Fast and Frugal Innovations in Response to the COVID-19 Pandemic, Nature Medicine, Nature.com, May 11, 2020 [See Table in this article for some specific ideas]

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

COVID-19 Vaccine Development Pipeline, London School of Hygiene & Tropical Medicine

Coronavirus Vaccine Tracker, The New York Times

Evolution of the COVID-19 Vaccine Development Landscape, Nature Reviews Drug Discovery, September 4, 2020

Latin American Scientists Join the Coronavirus Vaccine Race: ‘No One’s Coming to Rescue Us’, Nature, June 12, 2020

Coronavirus: China Can Help Africa Have a Stake in Race for a Vaccine, The Africa Report, June 8, 2020

Egyptian Researchers Have Begun Developing A Coronavirus Vaccine Set To Enter Human-Testing In 5 Months, MSN, March 9, 2020

South Africa BCG Booster Trials Seek Low-Cost Weapon Against COVID-19, Reuters, May 19, 2020

A Covid-19 Vaccine Will Need Equitable, Global Distribution, Harvard Business Review, April 2, 2020

India Will Play a Key Role in Scaling Up Production of COVID-19 Vaccine: PM Modi, Live Mint, July 9, 2020

Vaccine Giant Promises a Billion Covid Shots for Poor Countries, Wall Street Journal, June 6, 2020

Our Aim Is to Get Millions of Vaccine Doses Out in the Next Six Months: Adar Poonawalla, The Wire, May 24, 2020 [Video interview with CEO of Serum Institute of India]

AstraZeneca and Oxford University Announce Landmark Agreement for COVID-19 Vaccine, AstraZeneca website, April 30, 2020

First COVID-19 Vaccine By Bharat Biotech to Enter Trials in India, Clinical Trials Arena, June 30, 2020

Fact Sheet: Explaining Operation Warp Speed, United States Department of Health and Human Services, June 16, 2020

Dozens of COVID-19 Vaccines Are In Development. Here Are The Ones to Follow, National Geographic, September 3, 2020