Charting a path to safer vaccinations

Scientists at a little-known Seattle non-profit firm create practical technologies for immunizing the children of the Third World

Thursday, March 22, 2001

By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER

A Seattle team of technologically talented do-gooders used to have to go to the big boys of international public health to seek support for their innovations.

Today, thanks to Bill Gates, the folks at the Program for Appropriate Technology in Health are the big boys.

Dr. Gordon Perkin, the former president of PATH, is now head of the Global Health Program at the Bill & Melinda Gates Foundation, directing the world's largest health philanthropy at the world's largest private foundation.

PATH manages the foundation's $100 million Children's Vaccine Program, a $50 million Malaria Vaccine Initiative and helped set up the billion-dollar -- and growing -- fund created to pay for getting vaccines to the world's poorest children.

As a result, the modest non-profit organization located in north Queen Anne, a stone's throw from the Lake Washington Ship Canal, has as much influence over the directions taken in international health today as the World Health Organization or UNICEF.

"It's kind of funny," said Dr. Michael Free, PATH's head of research and development. "They were always suspicious of us and our methods."

PATH has long embraced a basic tenet: More lives might be saved or made healthier if it could create products that industry could sell, or even manufacture, in the Third World. PATH doesn't do large-scale manufacturing or sell products. It identifies a need, develops a cost-effective technology to fill it and tries to persuade industry to run with it.

Its successes include an auto-destruct, single-use syringe that prevents the spread of disease by making it impossible to reuse dirty needles, simple diagnostic tests for sexually transmitted diseases and kits to teach safe childbirth techniques in the Third World.

PATH's early work centered on women's health and family planning. That, and proximity, brought the organization to Gates' attention.

Bill Gates Sr., the chairman of his son's charitable foundation, was looking for advice on reproductive health needs in developing countries, one of the foundation's early priorities.

Planned Parenthood suggested he talk to Perkin, whose work had gone largely unnoticed in Seattle.

That didn't last long.

"I was just blown away by the level of technical expertise there," the elder Gates recalled. He arranged for his son to meet with Perkin and the members of the PATH board. They convinced the Microsoft co-founder that the world's greatest health need was rescuing failing childhood immunization systems in the poorest countries.

PATH, with branch offices worldwide, already was a pioneer in the field.

Perhaps the 23-year-old organization's greatest success was the development of the auto-destruct syringe.

"It's estimated that as much as half of all the world's hepatitis B cases come from health care workers reusing dirty needles in poor countries," Free said. UNICEF now uses only auto-destruct syringes. The syringes designed by PATH are manufactured and sold by the giant medical equipment company Becton, Dickenson, among others.

PATH also designed a heat-sensitive label for vaccine vials. Because many vaccines must be kept under constant refrigeration, an inexpensive technology was needed to make sure there was never a break in the "cold chain" trek from Western manufacturer to remote village clinic. The label is in routine use worldwide for all polio vaccine and for many other heat-sensitive vaccines.

And the researchers on Nickerson Street created a low-cost HIV test, the "HIV dipstick," to make blood screening cheaper in poor nations.

The latest project in PATH's workshop and lab is a study of a class of microorganisms known as "cryptobiota."

The research, partially financed by the Gates Foundation, is designed to see whether the desert organisms can be used to produce hardier vaccines capable of surviving backcountry transportation in hot climates without constant refrigeration.

The organism itself offers no immunity boost. The cryptobiota are interesting because they lose all water during a severe desert drought and, even years later, bounce back when rehydrated. Free and his team are exploring how they might use cryptobiotic chemicals to help preserve vaccines in dry form.

A private firm already owns the rights to the use of this technique. Because of PATH's expertise and track record, Free and his colleagues were asked to test it and work with the company to improve it.

"We're trying to stimulate interest among the vaccine makers to try this out," Free said. "Vaccine makers are not very interested in going to the expense of reformulating their manufacturing processes just because it might help people in poor countries. We need to demonstrate that it can be cost-effective, as well."

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