New test combats major cause of preventable blindness in Africa

Woman standing outside next to a table where two health workers complete paperwork.

Local health workers register a community member for a river blindness test during a PATH visit to Morogoro, Tanzania. Photo: PATH.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. This is the second day of a blog series: yesterday we explored how river blindness affects communities, today we look at how the diagnostic test works, and tomorrow we’ll cover why diagnostic tools are the next wave in global health innovation.

Part 2: A faster, easy-to-use test to help stamp out a neglected tropical disease

As we described yesterday, onchocerciasis, commonly known as river blindness, is caused by a parasitic worm transmitted to humans through the bite of the blackfly. It causes itching, skin disfiguration, and, with chronic exposure, permanent blindness. Globally, an estimated 120 million people are at risk for river blindness, and 18 million are infected. The disease typically affects poor, rural communities who live near streams and rivers. In the past, entire communities fled their homes to avoid contracting the disease, leaving valuable farmland behind and putting their livelihood at risk.

Elimination in reach

Effective and widespread treatment, control, and surveillance, together with the efforts of international and local community leaders, have put the global elimination of river blindness within reach. In the past two years, the World Health Organization (WHO) has declared two countries in the Americas, Colombia and Ecuador, free of the disease. Achieving the same elimination goals in African countries requires better diagnostic tools. The easy-to-use new rapid test meets this need by supporting fast, effective, and community-wide testing to identify areas where the disease is still active, guide the allocation of limited resources, prevent the disease from reemerging, and confirm elimination. By streamlining testing, it can help expand surveillance activities and accelerate global efforts to stop river blindness for good.

A health worker takes a drop of blood from the finger of a person.

A health worker takes a drop of blood from the finger of a person in Togo during a 2014 PATH field study of the SD BIOLINE Onchocerciasis IgG4 rapid test for river blindness. Photo: PATH/Dunia Faulx.

“The proven technology behind this test makes it a powerful and reliable tool in the multinational collaboration to eliminate river blindness,” said David C. Kaslow, vice president for Product Development at PATH. “The availability of a rapid, point-of-care diagnostic is a harbinger of a world free of the suffering caused by this insidious parasite. What’s needed now is quick action to add this simple test to control and elimination programs.”

An appropriate tool

The new onchocerciasis test is specifically tailored for use in the remote, low-resource settings where it is needed most. It offers a breakthrough alternative to the existing test, which involves an often painful procedure to remove a small portion of skin for examination under a microscope. When faced with this prospect, some communities avoid participating in surveillance testing altogether.

Stamping out NTDs

River blindness and other NTDs exact a devastating toll on vulnerable communities in sub-Saharan Africa, Asia, and Central and South America. Through illness, disability, pain, and suffering, they damage health and economic development and perpetuate cycles of poverty and inequity. Recognizing this threat, the WHO has targeted 17 NTDs, including river blindness, for control, elimination, or eradication by 2020. Developing new diagnostics is one key priority.

Gloved hands hold a prototype of the new SD BIOLINE Onchocerciasis IgG4 rapid test.

A health worker holds a final prototype of the new SD BIOLINE Onchocerciasis IgG4 rapid test, manufactured by Standard Diagnostics, Inc. The test has a line at “C” indicating it is working properly, and no line at “T” indicating a negative test result (the test detected no antibodies to river blindness in the blood sample). Photo: PATH/Dunia Faulx.

The new rapid test is a bold first step for PATH in support of this priority. Over the next several years, PATH will leverage our expertise, innovation, and global partnerships to speed the development of a suite of diagnostic tools to help eliminate several other NTDs. Together, these collaborative efforts will reduce suffering, improve health equity, and help communities thrive.

Illustration of the onchocerciasis rapid test, including air openings, test result windown, blood sample port, and buffer port.

The rapid test has been designed for use in low-resource settings by health workers in the field. Illustration: PATH.

Tomorrow we’ll look at the future of diagnostic tools and the importance they serve in global health innovation.

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The flies have it: river blindness and the communities it affects

Group of people beside river.

Rivers are a water source near many homes in Africa. They’re also home to the blackfly and a parasite they carry that causes river blindness. Photo: PATH/David Jacobs.

Editor’s note: This week PATH is announcing the launch of a new diagnostic test for river blindness with manufacturing partner Standard Diagnostics, Inc. Over three days, our blog series will explore how river blindness affects communities, how the diagnostic test works, and why diagnostic tools are the next wave in global health innovation.

Part 1: The water: a gift and a curse

Let’s say you’re a farmer. What’s the best resource you could hope for next to your land? Water. Right?

Let’s take it deeper: as a farmer, you’d prefer a river, a rapidly flowing water source with no stagnation. Flowing water helps flush impurities downstream, provides fish to eat, and limits breeding opportunities for the mosquito, an insect that can spread illnesses such as malaria and encephalitis. Yes, a river would be ideal. Which is why communities have settled by rivers for thousands of years.

So why is it that having a fast-flowing river near an agricultural area may cause people to abandon productive fields? If you’re thinking floods, think again.

It’s the flies.

A blackfly magnified at 100X actual size.

Adult blackfly magnified 100X using conventional scanning electron microscopy with parasite (Onchocerca volvulus) emerging from the insect’s antenna. The parasite is responsible for the disease known as river blindness. Photo: US Department of Agriculture.

Meet the culprit

Flies do more than pester people—they can spread disease.

Across wide swaths of Africa, one such nasty illness is a parasitic infection called “river blindness” (onchocerciasis). The parasite is found in more than 100,000 communities in 31 African countries, 6 Latin American countries, and Yemen. Estimates of the number of people affected are mind-boggling: 120 million people remain at risk for the disease and 18 million people are infected, typically in poor, rural communities in remote low-resource settings.

The blackfly breeds in the fast-flowing waters of rivers. It’s generally a harmless insect, unless it’s carrying the river blindness parasite. When a fly with the parasite bites a human, it passes along the microscopic parasitic worm which multiplies under the skin of their hosts, causing their skin to become painfully itchy. Without treatment, this condition can become chronic. Eventually the worms can migrate to the cornea of the eyes resulting in scarring and permanent blindness.

This Carter Center video takes you to the Nebbi District in Uganda, where one family has suffered the devastating effects of river blindness. Video length: 3:08 minutes.

And so the lifecycle continues, resulting in blindness among affected people and transmission of the parasite to others.

The lifecycle of river blindness: bite from parasitized blackfly, infection by larvae under the skin, reproduction of worms, proliferation of microfilariae, and transport of microfilariae to the cornea.

This infographic details the lifecycle of river blindness. Illustration: PATH.

Before you think all is lost

There is a medicine called ivermectin that paralyzes and kills the offspring of adult worms in humans, halting their lifecycle. And for nearly 20 years, the African Program for Onchocerciasis Control has helped map transmission zones and treat communities by mobilizing local agencies and networks to identify the disease’s prevalence. Then it’s usually local volunteers who give out the medicine and keep track of who has been treated.

However, it’s hard to know when to stop treating communities with ivermectin. When successful, ivermectin breaks the transmission of river blindness so fewer and fewer people are exposed over years of treatment. But current tests to see if a person has antibodies to the parasite (a sign they’ve been exposed to the disease) often require sending blood samples to a lab, waiting weeks for evaluation by a highly trained technician, and using expensive equipment. And the most common test to see if a person has an active infection is an invasive skin snip. This is a painful test that provides results within 24 hours but exposes people to infection. Because of these challenges testing has been difficult to administer, especially among families with children.

Programs are committed to treating entire communities until they’re sure the disease is gone, and there’s no doubt that this reduces the suffering caused by river blindness. But until they can confirm that transmission has been irreversibly stopped, the overarching problem remains: the disease cannot be eliminated if it risks being reintroduced.

A man watches cows in the river.

A man watching cattle drink from the river. Photo: PATH/Jesse Schubert.

To speed elimination efforts, these programs need a new diagnostic tool that’s less invasive and provides faster results in the field. A test that is easier to use and less expensive. One that won’t dissuade people from being tested.

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Tomorrow: a new, innovative point-of-care test.

Your innovation story for the weekend

Friday Think logoEach week, Claire Hudson, PATH’s media relations extraordinaire, casts her net to look for the week’s hottest stories on innovation to share with everyone at PATH. It’s a thoughtful collection, a little outside the box, and not necessarily focused on global health. It’s always an excellent weekend read.

This got us thinking: Why not share one of these stories with all of you? We’ll call it The Friday Think. Sometimes we’ll tell you what we think is innovative about the weekly pick. Sometimes we’ll let the story speak for itself.

This week, in light of All Hallow’s Eve, a wide range of stories presented themselves, from frightening images of magnified parasites to creative app-driven costumes.

Man hanging from balloon. Photo: J. Martin Harris Photography/Paragon Space Development Corporation.

Alan Eustace ascending to 135,890 feet above Earth.

But when push came to shove, we decided to share a couple of stories from The New York Times about Alan Eustace, a man who took a balloon ride to the edge of space and then fell back to Earth 130,000 ft (a mere 25 miles). Not only did his balloon require a whole lot of helium, but on the way back down, Alan broke the sound barrier before opening his parachute.

“It was amazing,” he said. “It was beautiful. You could see the darkness of space and you could see the layers of atmosphere, which I had never seen before.”

Mr. Eustace cut himself loose from the balloon with the aid of a small explosive device and plummeted toward the earth at speeds that peaked at 822 miles per hour, setting off a small sonic boom heard by people on the ground.

The New York Times followed up later this week with a closer look at the engineering and technical challenges Alan Eustace faced before launch day. It’s worth noting, Alan’s an engineer by trade.

A veteran computer designer, Mr. Eustace approached the technical challenges of finding a new way to reach the edge of space and return safely—without power—with a methodical engineering strategy that has served him well in Silicon Valley.

Advocating better health for Zambia’s newborns

A mother and her child.Health advocates and government groups have made a pact to improve newborn and child health care in Zambia. Photo: PATH/

Health advocates and government groups have made a pact to improve newborn and child health care in Zambia. Photo: PATH.

Today, newborns in Zambia have a better chance for survival and a healthier future thanks, in part, to recent health policy actions that are actively supported by PATH and local health partners.

For nearly 20 years, Zambia has had one of the highest infant death rates in the world. While the country is on track to reduce deaths of children under the age of five (read more about the Millennium Development Goals), it has failed to make similar progress in reducing newborn deaths.

Government policies have been silent on newborn health, and government decision makers have rarely addressed the issue.

Three women holding babies on their laps.

Mothers and their children at a health clinic. Photo: PATH/Wendy Stone.

The lack of policies has “had a very negative bearing on getting resources allocated to newborn health activities,” says Vichael Silavwe, Zambia’s chief integrated management of childhood illnesses officer in the Ministry of Community Development, Mother and Child Health. He adds that without policies, government officials and health workers have not had the necessary support to improve infant health.

A new beginning for Zambia’s children

But the launch earlier this month of two new government health policies signals a major shift in the country’s priority of newborn health. On October 14, 2014, the Honorable Emerine Kabanshi, Minister of Community Development, Mother and Child Health, unveiled two national child health policies: a set of Essential Newborn Care guidelines and the National Integrated Management of Child Illness strategic plan.

Together, these policies provide gold standard guidance for health workers who care for newborns, and they create a foundation for key decision-makers to allocate additional staff and budgets to newborn health services.

Silavwe says the policies are significant because they promise to improve stakeholder coordination for health programs at both the community and national levels.

“This is a great opportunity,” he adds, “to bridge the gap between national policy and local district action to raise coverage of essential interventions, mobilize resources, and measure progress towards reducing infant and newborn deaths.”

Celebrating years of work

This is the successful culmination of years of behind-the-scenes work by newborn health advocates dedicated to making newborn health a political priority.

Three years ago, newborn health advocates in Zambia—including PATH, Save the Children, the Ministry of Health, Zambia Pediatrics Association, the World Health Organization, and UNICEF—created a coalition to secure a newborn health policy framework to increase funding for newborn health, improve health worker training, integrate newborn care with other child health services, and raise political visibility. With these mandates in place, they believed doors would open for new treatments, technologies, and better newborn care by doctors and nurses.

Dr. Nanthalile Mugala, PATH’s country manager for Zambia, says, “This process demonstrates the power of policy advocacy. Through partnerships and close coordination, we support the Zambian government in developing policies that provide for the rapid scale-up of newborn health care in the country.”

Moving forward to save newborn lives

Now that newborn health policies have been created and launched in Zambia, what comes next?

Advocates will continue working with government partners to ensure these policies are implemented in communities.

Government officials must ensure political will remains high and budgets are allocated towards lifesaving interventions and programming.

Health workers and medical professionals will have opportunities for better training in new practices.

Most importantly, babies in Zambia will have the chance for a brighter future.

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We agree: principles are paramount for new digital development

Health worker touching the track pad of a laptop.

A health care worker pilots a health management information system on a laptop in Tanzania. Photo: PATH/Brian Taliesin.

Guest contributor Kate Wilson is the director of Digital Health Solutions, Technology Solutions at PATH.

PATH applauds Dr. Rajiv Shah’s recent IMPACTblog post (October 20, 2014, US Agency for International Development) about how technology is enabling innovative solutions to global problems. As an organization dedicated to driving transformative innovation to save lives, we know the importance of working with governments and key stakeholders to ensure that all products and services are appropriate, scalable, and affordable. Led by our Digital Health Solutions team, we were early supporters and shapers of the Greentree Consensus.

These principles are embodied in many of our projects, though perhaps best exemplified by the Better Immunization Data Initiative, led by PATH and funded by the Bill & Melinda Gates Foundation. This initiative was designed to shine a light on the challenges surrounding the collection, quality, and use of health immunization systems data—and it will identify practical, country-owned, country-led solutions designed to be scaled to other health areas and regions.

PATH agrees that we shouldn’t be “creating technology for technology’s sake” but we also know the day is coming when information and communication technology tools will be as widely used to drive health impact as email is used to drive communication today.

We welcome the endorsement of these principles by major funders and practitioners around the world, codifying best practices in information and communication technology. And we will continue to work with global stakeholders to unleash digital health at scale.

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The art of the lifesaving deal: MenAfriVac team wins award

People lined up to be vaccinated at the MenAfriVac launch in Burkina Faso.

The MenAfriVac vaccine, shown being administered at its launch in Burkina Faso in 2010, has already been used to immunize more than 153 million people, and is expected to prevent more than 1 million cases of meningitis A by 2020. Photo: PATH/Gabe Bienczycki.

On a recent night in San Francisco, an elite group gathered: leaders who orchestrated one of the most creative and innovative intellectual property business transactions recognized this year. Think of it as the Oscars of intellectual licensing, where the top winners are typically titans of their industries celebrating mergers, acquisitions, and joint ventures.

So what brought PATH to the stage at this gala, alongside the likes of Google, Lenova, and ConocoPhillips?

Making a pact to save people’s lives

The event was the prestigious “2014 Deals of Distinction Award” ceremony, organized by the Licensing Executives Society (LES) Inc. As the title suggests, the recipients of these awards were honored for notable deals with their partners.

MenAfriVac "Deals of Distinction" 2014 award winners.

From left to right: Mark Bloom, past chair of the Industry-University-Government Interface (IUGI) Sector of LES – USA and Canada; Peter Soukas, senior licensing and patenting manager, National Institutes of Health (NIH) Office of Technology Transfer; Colleen Ottoson, deputy general counsel, PATH; F. Marc LaForce, director, Technical Services, Serum Institute of India Ltd.; Steven M. Ferguson, deputy director, Licensing and Entrepreneurship, NIH Office of Technology Transfer; Thierry Musy-Verdel, IUGI Deals of Distinction chair. Photo: Design Interface Inc.

In this case, PATH, along with the National Institutes of Health (NIH), US Food and Drug Association (FDA), and Serum Institute of India Ltd. (SIIL), were recognized for an intellectual property licensing deal and technology transfer negotiated about a decade ago. The technology? Development and manufacture of the low-cost MenAfriVac® meningitis vaccine designed for use in sub-Saharan Africa. To date, the deal has helped lead to the vaccination of more than 153 million people. By 2020, the vaccine is expected to protect more than 400 million people, preventing 1 million cases of meningitis A, 150,000 deaths, and 250,000 cases of severe disability.

What made this partnership especially unique was an early pact to make a vaccine affordable and accessible without requiring constant refrigeration. In other words, the vaccine had to have a low production cost and be able to survive hot, long-distance transportation to the remote towns and villages where it was badly needed.

Marc LaForce smiling and talking to a young boy outside his village, with a crowd in the background.

As founding director of the Meningitis Vaccine Project, Dr. Marc LaForce led the successful development, licensure, and introduction of MenAfriVac®. Photo: PATH/Gabe Bienczycki.

The lifecycle gets flipped

Typically, to bring a new vaccine to market, a long set of conventional milestones are reached before a price point is even considered. These milestones include, but aren’t limited to, test trials, product design, manufacturing, shipping, and market promotion. In this model, costs can add up rapidly, and lead to vaccines being marketed at prices that put them out of reach in many economies.

When the World Health Organization (WHO) came to PATH looking for low-cost solutions to address the most common form of bacterial meningitis, serogroup A, it was clear that the traditional manufacturing process would prove challenging. Testing, licensing, and manufacturing a new vaccine with specific cost limits meant new partnerships would have to be developed. And so, the search went global.

An effective vaccine technology had been developed by Dr. Che-Hung Robert Lee and Dr. Carl Frasch of the FDA’s Center for Biologics Evaluation and Research, and through a partnership organized by PATH, the NIH Office of Technology Transfer licensed it for this project. PATH then worked with Serum Institute of India Ltd., a pharmaceutical manufacturer based in in Pune, India, that agreed to scale up the technology in exchange for the technical know-how they would gain during the process.

The result of this remarkable deal? The low-cost MenAfriVac was produced in India, making it affordable to the 26 African countries where serogroup A meningitis is most common.

This short video shows the dramatic lifesaving impact of the MenAfriVac partnership. Run time: 4:20. Copyright 2011, PATH.

Why is licensing so important?

This award calls out a rarely considered aspect of bringing critical lifesaving technologies to scale: the deals that facilitate the exchange of critical intellectual property that can unlock solutions with dramatic lifesaving impact.

“A successful collaboration requires much more than a few agreements. It requires vision, good will, aligned values, diligence, and more,” said Colleen Ottoson, deputy general counsel for Legal Affairs at PATH. “A complex, public-private partnership can only succeed if the technology licenses and related agreements set forth clear and complementary terms and objectives. Upon the achievement of these interdependent agreement objectives, the partnership will realize its larger public health goals.”

To understand the challenges facing PATH, WHO, SIIL, and other partners as they studied the best way to address the development of a new low-cost, easy-to-transport vaccine to fight meningitis in sub-Saharan Africa, it helps to understand the history of the disease.

Timeline of meningitis, from first reports in 1805 to first MenAfriVac vaccinations in 2010.

Timeline of bacterial meningitis and the MenAfriVac vaccine against it. Click to see full-size. Illustration: PATH.

“The license and collaboration have turned out to be an interesting model for vaccine development to address public health needs in developing countries. The vaccine was tailored to a particular population, developed at a modest cost, and structured from the start with provisions to ensure sustainable access,” said NIH Office of Technology Transfer Director Mark L. Rohrbaugh.

Added IUGI Deals of Distinction Chair Thierry Musy-Verdel, “It also demonstrates that it is possible for research organizations such as federal laboratories and universities to license their technologies to organizations other than traditional pharmaceutical and biotech companies and to successfully achieve product commercialization and thus public utilization of their research.”

MenAfriVac was launched in a vaccination campaign in Burkina Faso in December 2010. To date, more than 153 million people in 12 African countries have been vaccinated.

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MenAfriVac is a registered trademark of Serum Institute of India Ltd.

Dancing in the streets: Global Female Condom Day around the world

Two dancers perform in front of Dance4Demand banners.

Female condom supporters show off their choreographed Dance4Demand routine to hundreds of shoppers at the Rosebank Mall in Johannesburg, South Africa. Photo: PATH.

Guest contributor Claire Topalian is a freelance writer who has previously posted on the PATH blog.

Why were women and men around the world dancing on September 16?  For female condoms, of course.

Global Female Condom Day (GFCD), founded in 2012 by the National Female Condom Coalition with support from PATH and other partners, is an annual day of advocacy, education, and awareness for female condoms. Despite its unique standing as the only available woman-initiated protection from unplanned pregnancy and sexually transmitted infections, the female condom remains out of reach for most people—something that GFCD is trying to change.

This year, PATH and its partners celebrated GFCD on September 16 in six countries by supporting an international “Dance for Demand” (Dance4Demand) movement. The event encouraged communities to dance as a visible and fun way to show the world that people want improved access to female condoms.

So how did this look around the world? Let’s check it out.

Kenya

PATH offices in Kenya hosted a brown bag session for more than 50 PATH staff to educate and drive awareness around female condoms, including the Woman’s Condom. Attendees performed a spirited dance routine to celebrate Global Female Condom Day. Janet Shauri, local coordinator for PATH’s Dance4Demand efforts, says: “The female condom puts the power of self-protection in the hands of women and can prevent both sexually transmitted infections and HIV. I got involved in the Global Female Condom Day because I knew that I wanted to be part of a move that would eventually empower Kenyan women.”

China

Meanwhile, women and men at two universities in China became stars of their own choreographed music videos to promote Dance4Demand.

PATH offices in China partnered with Marie Stopes International/China to host local events at Nanjing University and Guangxi University, which continued to run through September 26 (World Contraception Day) for ten full days of awareness for contraceptive options, including female condoms.

A group of young men from Nanjing University of Posts and Telecommunications demonstrate their impressive dancing skills to the song “Rise” by Shaprece:

A group of young women from Guangxi University show off their numbers and colors in support of Dance4Demand:

Zambia

Zambia’s GFCD fun took on a competitive edge in a community essay contest. PATH offices in Zambia and the Zambia Health Education and Communication Trust hosted a ceremony to celebrate essay winners. Local dancers performed at the event and key government officials attended to give speeches and present awards.

Woman writing at a table full of packaged female condoms.

In partnership with the Zambia Health Education and Communication Trust, PATH supported a ceremony for essay contest winners and awareness for Global Female Condom Day. Photo: PATH.

South Africa

In South Africa, PATH offices supported a range of Dance4Demand events at six universities and in public spaces. In addition, PATH partnered with Populations Services International to host a variety of public events as a way of engaging with new community members. For instance, a rooftop salsa dance party in Johannesburg drew over 400 participants, and an advocacy event at the Rosebank Mall drew over 500 attendees who were able to speak with promoters and take product samples.

DJ Yanga Luassa and two supporters holding a Dance4Demand sign.

The Nelson Mandela Metropolitan University GFCD event attracted over 100 students and staff. The audience was livened up by celebrity DJ Yanga Lusasa, who explained during the event why female condoms are important and directed students to the stands to learn more. Photo: PATH.

PATH staff wearing orange Dance4Demand shirts.

Employees at the PATH office in South Africa show their spirit for GFCD 2014. Photo: PATH.

Woman wearing orange Dance4Demand shirt and holding a microphone.

Participants gather at the Rosebank Mall in Johannesburg, South Africa to “Dance for Demand” on Global Female Condom Day. Photo: PATH.

India

Utilizing PATH’s Delhi office as a central point for GFCD, participants danced to show their demand for the female condom, an instrument that they believe to be empowering for women in India.

The dance routine below was performed by choreographer Himanshi Karol and produced by AK$ FILMS to celebrate Global Female Condom Day:

Seattle, Washington

This year, PATH employees and community members gathered to Dance4Demand in a “flash mob” routine in the public space outside of PATH’s headquarters in Seattle, Washington. The flash mob drew a lot of support and attention and was featured in The Seattle Times.

PATH hosts a Dance4Demand flash mob to generate awareness for Global Female Condom Day. Photo: Bettina Hansen/The Seattle Times.

PATH hosts a Dance4Demand flash mob to generate awareness for Global Female Condom Day. Photo: Bettina Hansen/The Seattle Times.

To check out GFCD on social media, look for hashtags #Dance4Demand, GFCD#2014, and #femalecondoms. Thank you to the many communities around the world who Danced for Demand with us this year!

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Getting gold-star nutrition to a million Brazilians

Maricio de Sousa and his daughter Monica holding a cardboard figure of a cartoon mother, her child, and the Vitaminado seal.

Right to left: Arroz Vitaminado champion Mauricio de Sousa with brand ambassador “Turma da Mônica” and de Sousa’s daughter Monica (the inspiration for Turma da Mônica). Photo: PATH/Greg Salibian.

Guest contributor Laura Anderson is an editor at PATH.

In Brazil, where rice is a staple food, shoppers have choices when it’s time to stock up. Increasingly, they’re buying a group of products that look and taste just like the rice they’ve always used—but with a crucial addition: a boost of the vitamins and minerals their families need to thrive.

Standing out by blending in

The products, sold in stores across Brazil under the Arroz Vitaminado (“Vitamin Rice”) quality assurance label, contain a blend of traditionally milled rice and fortified grains manufactured without genetically modified ingredients using PATH’s Ultra Rice® fortification technology. It’s a unique approach that is helping families worldwide get nutrients, including iron, vitamin A, and zinc, that don’t always make it into their diets. By curbing chronic but often invisible nutritional deficiencies, Arroz Vitaminado products have the potential to strengthen Brazil’s families long into the future. As of this year, they have reached more than a million Brazilian consumers—and the number is still growing.

This video explains how fortified rice, Arroz Vitaminado, is made, including which vitamins and minerals are added. Video: Arroz Vitaminado.

The perfect mix

So what does it take to get better nutrition to a million people? Too often, health solutions, especially those designed to reduce hunger and boost nutrition, are manufactured far from the people who need them and then either given away or subsidized through food support programs. That approach has helped many people, but it isn’t always sustainable or efficient. PATH overcame this barrier by helping fortified rice reach consumers a different way: as an affordable and appealing product available on grocery shelves countrywide. Doing so required a wide suite of activities. Together with partners, we bolstered local production of fortified rice, established a quality assurance system, and increased its appeal and visibility countrywide.

Homemade

Consistently and safely manufacturing fortified foods requires the right tools for the job. Iron, for example, is a crucial micronutrient that must be provided in just the right amount. Some methods can also affect the color or texture of fortified grains, which consumers don’t like. To ensure a steady, high-quality supply of fortified rice, we worked with the Global Alliance for Improved Nutrition (GAIN) to enable Brazilian rice millers to produce and distribute the grains. With the right tools and support millers learned to consistently mix the ingredients (primarily rice flour, water, and micronutrients); shape and dry the grains so that they won’t break; and blend them with milled rice at the right proportions. The producers also brought another “ingredient” to the table: their existing rice distribution networks. Together with supportive retailers, those networks help to ensure a consistent and reliable supply of fortified rice throughout Brazil.

Bags of fortified rice stacked on a grocery shelf under a bright yellow price tag.

Consumers can find bags of fortified rice with the Arroz Vitaminado quality assurance label on grocery shelves countrywide. Photo: PATH.

Quality assured

We also collaborated with the Federal University of Viçosa, (a founding member of the Institute for Food Fortification and the Fight Against Hidden Hunger [Instituto de Estudos e Pesquisas em Fortificação de Alimentos e Combate à Fome Oculta, or IPAF]) to create the quality assurance system that gives the Arroz Vitaminado seal its reliability and appeal. Under the system, fortified rice producers go through on-site quality audits and submit samples to IPAF for quality evaluation. When a producer passes the test, the Brazilian rice millers association, Abiarroz, allows it to use the Arroz Vitaminado seal on its product. And to keep that distinction—and the consumer trust that goes with it—millers must continue to meet high standards over time.

Vitaminado seal.

With the Arroz Vitaminado (“Vitamin Rice”) quality assurance label, consumers know they’re giving their families the nourishment to thrive. Photo: PATH.

Familiar

Today, Arroz Vitaminado guarantees consumers that the fortified rice they buy has the quality and nutrients they expect. But generating widespread appeal took insightful marketing, too. PATH partnered with producers and retailers to conduct promotional taste tests and market demonstrations throughout Brazil, and launched a social marketing campaign spotlighting fortified rice through television interviews, promotional videos, a website, and other outlets. Compassionate and inspiring product ambassadors also sparked interest.

For example, soccer star Lucas Moura championed Arroz Vitaminado and the importance of better nutrition. Artist Mauricio de Sousa, Brazil’s most respected cartoonist, also joined the campaign. De Sousa, who calls the product “a magical rice that marks the difference between having a healthier population or a less healthy one,” contributed the support of his “Turma da Mônica” family of characters. Together, these efforts have earned fortified rice a warm and lasting welcome in hundreds of thousands of Brazilian homes—giving children and their families the nutrients they need to learn, play, grow, and thrive.

Ultra Rice is a registered trademark of Bon Dente International, Inc. in the United States.

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Vaccine Resource Library: a new look for PATH’s one-stop-shop for vaccine information

This post’s author, Allison Clifford, is a communications officer for the Vaccine Development Program at PATH.

Screenshot of VRL banner with infant receiving oral vaccine drops.

The popular online Vaccine Resource Library just debuted a brand new look and mobile-friendly design. Photo: PATH/Mike Wang.

One of the top go-to resources for information on vaccines, diseases, and immunizations just got easier to use.

PATH’s online Vaccine Resource Library (VRL) debuted a brand-new look and mobile-friendly design this week. The redesign enhances the site’s accessibility and features engaging new photos. What hasn’t changed is the extensive database of high-quality, scientifically accurate materials on specific diseases, vaccines, and topics in immunization addressed by PATH’s work.

Young girl watches a health worker fill a syringe with vaccine in Khouang Province, Laos.

Health workers around the world can access resources in 11 different languages in the VRL. Photo: PATH/Aaron Joel Santos.

This user-friendly, database-driven site grew out of PATH’s Children’s Vaccine Program, back in 1998. Since then, the VRL has gone through a number of changes and iterations to reach its current status as a well-respected, centralized repository for key global immunization resources.

Today, the site is a WHO-approved source of accurate vaccine information and one of the most popular sections of our website.

Finding resources and exploring topics just got easier

The redesigned VRL features easy-to-find resources and links to information on a wide range of issues and diseases. And there are hefty sections on a variety of topics related to specific illnesses such as rotavirus, the biggest cause of severe diarrhea (for which vaccines already exist), and the top bacterial causes of diarrhea, enterotoxigenic Escherichia coli and Shigella (for which vaccines are still under development).

Icons from PATH's Vaccine Resource Library.

The redesign enhances the site’s accessibility. Photo: PATH.

We also have broader resource sections that aren’t disease-specific on topics related to vaccines, such as advocacy and communications, childhood immunization, vaccine safety and performance, introduction and service delivery, and the major organizations and coalitions working in the vaccine arena.

So, whether you’re looking for something specific or just browsing, we invite you to check out the new VRL.

A version of this post originally ran on the Defeat DD blog.

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Dr. Manjari Lal: an award-winning formula

Portrait of Manjari Lal.

Dr. Manjari Lal. Photo: PATH.

Two of PATH’s leading female scientists were recently honored for their contributions to global health: Tala de los Santos, MBA, MS, as a Washington Global Health Alliance (WGHA) Rising Leader, and Manjari Lal, PhD, with a 2014 William Hunting Award. We’re proud to support the outstanding achievements of our technical teams, who often work “behind the scenes” to develop and advance transformative health care innovations for public health impact.

Part two: Today we feature Dr. Manjari Lal.

Manjari Lal, PhD

Manjari Lal, PhD, one of PATH’s scientists working in vaccine and pharmaceutical technologies, was recently awarded the 2014 William Hunting Award for her and her team’s crucial work to develop a heat-stable fast-dissolving tablet (FDT) formulation of Newcastle disease vaccine.

Each year, Veterinary Record, the prestigious peer-reviewed journal of the British Veterinary Association, bestows the Hunting Award to a research paper considered to have made the most useful contributions to veterinary science. The award-winning paper, “Development of a Low-Dose Fast-Dissolving Tablet Formulation of Newcastle Disease Vaccine for Low-Cost Backyard Poultry Immunisation,” was penned by Manjari, as lead author, in collaboration with authors from the University of Washington, the Southeast Poultry Research Laboratory of the United States Department of Agriculture, and the Global Alliance for Livestock Veterinary Medicine.

Newcastle disease is viral and highly contagious. It is capable of destroying entire chicken populations in a short period of time, and it has been identified as one of the biggest threats to rural poultry and livelihoods globally. It can also be transmitted to humans. The technical work described within Manjari’s paper reflects one of the many ways PATH is helping to build the evidence base for needle-free and thermotolerant vaccine and drug delivery technologies of critical importance to human and animal health in developing countries.

Manjari adjusting a spray dryer, which is drying a container of liquid vaccine.

Manjari uses a spray dryer to convert a liquid vaccine formulation into a powder. Photo: PATH/Scott Areman.

“Vaccines and essential medicines take up a lot of space. They involve many packaging and delivery parts, especially if they need to be refrigerated and/or reconstituted with a diluent prior to administration with a needle and syringe. By simplifying the equation, for example, by formulating vaccines as heat-stable tablets that can be swallowed or dissolved under the tongue, we believe we can achieve even greater public health impact in low-resource settings,” explains Manjari.

Manjari moved to the United States from India in 1995 through an exchange program for young scientists. Although she originally dreamed of being a medical doctor and helping people in a clinical setting, she hit her stride in bench research and stayed in the US to pursue additional opportunities. When Manjari interviewed with PATH in 2008, she says she knew immediately, “this is the place where I want to be.” At PATH, she could leverage her expertise in the biomedical sciences to improve health outcomes.

Manjari and her team have additionally developed fast-dissolving tablet (FDT) formulations for an enteric diarrheal disease vaccine candidate and oxytocin, a WHO-recommended injectable drug for reducing and preventing postpartum hemorrhage. Their heat-stable oxytocin tablet for sublingual delivery will soon be assessed in a first-of-its-kind clinical study set to launch in 2015. The study, a collaboration with the South African Medical Research Council, is part of PATH’s newly formed Global Health Innovation Accelerator—a key first step for expanding access to oxytocin in sub-Saharan Africa, where postpartum hemorrhage remains one of the leading causes of maternal mortality.

FDT formulations hold promise for transforming the means by which vaccines and essential medicines like oxytocin are typically packaged, stored, and delivered. Heat-stable tablets do not require refrigeration to ensure product quality (potency) during transport and storage. The novel product presentation also eliminates the need for safe injection equipment and training—an important feature for patients who may have limited access to skilled health workers or health care facilities.

Box full of blister packs of fast-dissolving tablets.

Manjari and her team have developed fast-dissolving tablet formulations for a veterinary vaccine for Newcastle disease, an enteric diarrheal disease vaccine candidate, and the injectable drug oxytocin. Photo: PATH/Patrick McKern.

We’re honored to have Manjari at PATH. Her transformative work is helping to resolve some of the most vexing challenges associated with health care access and delivery in low-resource settings.

Congratulations to Manjari!

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