Rethinking the needle to improve immunization

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

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

What if syringes used for immunization could not be reused—and we knew for certain that gateway to HIV transmission was closed?

The Uniject® autodisable injection device, born in PATH’s Seattle shop, is little more than a small bubble of plastic attached to a needle, but it answers all these needs. It is so simple that health workers can learn to use it after less than two hours of training. It cannot be reused, which eliminates one route of disease transmission. And it is precisely prefilled by the vaccine producer with a single dose, which ensures that the correct amount of vaccine is delivered and that none is discarded unnecessarily. Vaccinators never have to choose between immunizing the five children standing before them today—wasting the rest of the vaccine in a multidose vial—and immunizing ten children who may need vaccine tomorrow.

PATH developed the Uniject device with funding from the US Agency for International Development and then licensed the device to BD, the largest syringe manufacturer in the world. As part of the licensing agreement, BD supplies Uniject devices to vaccine and pharmaceutical producers at preferential prices for use in developing country programs. Developing the Uniject device and bringing it to market has been a 20-year endeavor that crossed and recrossed the boundary between the public and private sectors.

The large impact of small changes

Two of the greatest successes of the Uniject device have been with tetanus toxoid and hepatitis B vaccines. The hepatitis B virus is 50 to 100 times more infectious than HIV. Most people in developing countries are infected during childhood, and it is childhood infections that are most likely to lead to significant liver disease. In 2003, for the first time, Indonesia launched an immunization program meant to give every newborn in the country a lifesaving first dose of hepatitis B vaccine. Uniject devices, often in the hands of midwives stationed far from hospitals and health care centers, played a large part. The success of the device in Indonesia will be transferred to other nations where physical or cultural barriers stand between newborns and important immunizations.

The United Nations Children’s Fund (UNICEF) is dedicated to eliminating maternal and neonatal tetanus, which strikes both mothers and children in the vulnerable first days after childbirth. Neonatal tetanus is almost unheard of in the United States but kills nearly half a million children each year in developing countries, where tetanus vaccination does not reach all women and where children are often born at home, sometimes in unsanitary conditions. UNICEF is using the Uniject device in campaigns that are delivering nine million doses of tetanus toxoid vaccine to women in Mali, Afghanistan, Ghana, Somalia, Sudan, and Burkina Faso.

The continuing impact of innovation

PATH and its partners are working on additional uses for the Uniject device. For example, it could be used to administer the antibiotic gentamicin to treat neonatal sepsis or to bring injectable contraceptives to women far from a clinic or hospital. The Uniject device may also be an effective tool for administering oxytocin to prevent postpartum hemorrhage, a leading cause of maternal mortality in the developing world.

Uniject is a registered trademark of BD.

Photo: BD (Becton Dickinson).