Friday, March 7, 2014

The Next Scheduled Disease and 3D Bio-Printing: Changing Polio Eradication Policy


Poliovirus: photograph: Dennis Kunkel Microscopy,Inc. See:http://www.theguardian.com/books/2013/jul/17/paralysed-fear-polio-williams-review 

In 1979 smallpox was eradicated from the face of the earth. In 1980 the World Health Organization formally announced this. Two repositories were designated the only laboratories in the world to maintain live strains. D.A. Henderson, recognized as one of only a handful of smallpox experts in the world  and who was involved in its eradication, offered this explanation during an interview with regard to polio eradication: "Q: What do you believe the prospects for future eradication programmes such as polio? A. Even towards the end of smallpox eradication, the senior staff never talked about potential eradication of any other disease. There's a reason for this. No other disease had so many of the attributes that made smallpox amenable to eradication. The polio vaccine can be expensive and requires several doses and even then protection is not guaranteed. Protection against smallpox for 10 years or more is possible with a single vaccination. The smallpox vaccine could be kept at 37C for a month, whereas the polio vaccine has to be kept cold up until it is actually administered in the field. This is difficult to do in developing countries. We knew exactly where smallpox was because each infected individual had a distinctive rash. With polio, there are 200 infected children for one paralytic case, so the other 199 are perfectly able to transmit it to others.And they could spread it, undetected, to many different parts of the country. You could not do what we did with smallpox in terms of focusing specifically on an outbreak and on vaccinating the people around that to prevent spread." See: http://who.int/bulletin/volumes/86/12/08-041208/en/index.html

File:An Aerial View of the Za'atri Refugee Camp.jpg
Source: http://www.flickr.com/photos/statephotos/9312291491/sizes/o/in/photostream/


The Syrian outbreak of WPV1 presents an even more challenging dilemma for plans to eradicate it, namely conflict and war, which not only increases the risk that displaced children will spread polio but that those who remain in the conflict zone will face difficulties with access to re-vaccination as well. Currently there are over a million displaced Syrian refugees in camps in bordering states with several camps along the Turkish boarder. The condition in the camps is highly conducive to the spread of disease. Given DA Henderson's statements on the likelihood of eradication of polio, it is imaginable that 3D bio-printing could overcome some of the obstacles he notes above and which of course he correctly identified prior to the promise that 3D bio-printing may deliver. A bio-printed vaccine in a camp in Syria would alleviate factors which inhibit the wider distribution and increase chances at both containment and eradication. In fact refugee camps would be an ideal consumer of 3D bio-printed vaccines and medical counter measures. When we consider on-site vaccine manufacturing and the impact on disease outbreak, just to give an idea of how significant such a breakthrough would be, On February 13, 2014, the Daily Star of Lebanon reported in an article entitled: Syrian Refugee Diseases, Infections on the Rise:  "Lebanese officials have reported several cases o tuberculosis and Hepatitis A in Syrian refugee areas. the aid organization Medecins Sans Frontieres has treated cases of  lice, scabies and the skin disese leishmaniasis, said it's head of Mission Fabio Forgione. 'We have seen an increase in certain diseases related to overcrowding and poor living conditions," he said. Particularly worrisome to the aid workers is leishmaniasis, which currently cannot be treated because the needed drugs are not available. The skin infection usually spreads through a parasite in a sandfly and begins as a small boil that grows several sizes before it bursts, leaving a disfiguring indented scar. The infection initially sparked concerns of leprosy, which caused boils resembling those of the affliction. Forgione said MSF was working on importing the required drugs for the 16 patients the organization was caring for." See: http://www.dailystar.com.lb/News/Local-News/2013/Feb-13/206221-syrian-refugee-diseases-infections-on-the-rise.ashx#axzz2tlK3TjaW


 While significant barriers remain toward actually printing vaccines, the potential to do so is well on the horizon. Companies such as Organovo, certainly are forerunners and of course Craig Venter and his team who do outstanding work in the field. 3D bio-printing for disease containment and eradication is only one application likely to revolutionize global public health security. 
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