Closeup of hands removing cap from Uniject needle.

The Uniject™ injection system provides precise doses, cannot be reused, and reduces waste. Photo: PATH/Patrick McKern.

Rethinking the needle to extend the reach of contraception, medicines, and vaccines

What if syringes were so easy to use that even minimally trained health workers could give injections of lifesaving medicines without the risk of error?

What if they were simple enough that these health workers—or perhaps even women themselves—could administer a safe and effective injectable contraceptive in women’s homes, saving them a potentially long and costly trip to a faraway health center?

What if vaccines for developing countries could be prepacked in low-cost prefilled syringes, vastly reducing the amount of vaccine wasted?

The Uniject™ autodisable injection system (Uniject), born in PATH’s product development shop, is little more than a small bubble of plastic attached to a needle, but it answers these needs and more. It is so simple that health workers can learn to use it after less than two hours of training. It is precisely filled with a single dose, ensuring that the correct amount of drug is delivered and that none is discarded unnecessarily. It cannot be reused, eliminating the possibility of disease transmission. And it reduces the burden on health systems by combining the vaccine, needle, and syringe into a single unit.

PATH developed Uniject—the world’s most inexpensive prefilled syringe with autodisable features—with funding from the US Agency for International Development. We then licensed the system to BD, the largest syringe manufacturer in the world. As part of the licensing agreement, BD supplies the Uniject system to pharmaceutical producers at preferential prices for use in developing-country programs.

Since the development of Uniject in the 1990s, PATH has explored a range of uses for the device, including for the treatment of newborn infection and postpartum hemorrhage. Uniject has extended the reach of essential vaccines for children, and holds the potential to meet the needs of women in remote areas for contraception.

Boosting vaccine coverage

Vaccines protect people around the world from deadly diseases, but they could save even more if there was a way to deliver them safely in areas without highly qualified health workers. That was the original impetus behind Uniject’s development. In 2000, tetanus toxoid became the first vaccine available in Uniject, and it has been achieving our goal of saving lives ever since.

By simplifying injection, Uniject facilitates community-based vaccination by lower-level health workers, which can help boost immunization rates. The single-dose device also eliminates the waste associated with multidose vials. When health workers open a multidose vial to give shots to a few children, the rest of the vaccine may go to waste. Sometimes, health workers may be unwilling to open a vial for just one or two children. In addition, Uniject reduces the burden on supply systems by combining the vaccine and delivery tool into one compact unit. It also takes up less space in waste management systems.

Since 2000, millions of Uniject devices have been used to deliver vaccines against tetanus and hepatitis B. To provide maximum protection from disease, for example, the hepatitis B vaccine needs to be given within 24 hours of birth. In Indonesia, babies are frequently born at home. Uniject is used to reach newborns with the vaccine.

Improving access to contraception

Lack of access to family planning options—especially woman-initiated methods—means that women in poor countries are more likely than others to die from problems related to pregnancy and childbirth. The good news is that about one in three maternal deaths can be avoided by delaying motherhood, spacing births, preventing unintended pregnancy, and avoiding unsafely performed abortions.

Injectable contraceptives—which provide a safe, effective, and discreet method to prevent pregnancy—are increasingly popular with women around the globe. Many women, however, cannot routinely get to clinics that offer this form of contraception, while others start using the method but stop because they cannot return to the clinic.

Sayana® Press, a new lower-dose formulation of the contraceptive Depo-Provera packed in Uniject, was designed to improve women’s access to a family planning method that requires injection only once every three months. Because the prefilled Uniject injection system is easy to use, lower-level health workers may be better able to give injections in convenient community locations or in clients’ homes.

A commitment to women

In July 2012, the London Summit on Family Planning launched a coordinated effort to ensure that voluntary family planning services reach the millions of women and girls in the world’s poorest countries who don’t have access to services. As part of this event, PATH and our partners announced a plan to reach women in sub-Saharan Africa and South Asia with up to 12 million doses of Sayana Press between 2013 and 2016. With the support of major funders, PATH is supporting this pilot introduction in Bangladesh, Burkina Faso, Niger, Senegal, and Uganda.

Adding an injectable contraceptive in Uniject to other family planning methods is expected to increase access to contraceptives and reach new users, ultimately helping PATH achieve one of our goals—giving women more control over the number and timing of their children and a better chance at a healthy life.

Uniject is a trademark of BD. Depo-Provera and Sayana Press are registered trademarks of Pfizers.