TEDGlobal 2013

Mark Kendall: Demo: A needle-free vaccine patch that's safer and way cheaper

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One hundred sixty years after the invention of the needle and syringe, we’re still using them to deliver vaccines; it’s time to evolve. Biomedical engineer Mark Kendall demos the Nanopatch, a one-centimeter-by-one-centimeter square vaccine that can be applied painlessly to the skin. He shows how this tiny piece of silicon can overcome four major shortcomings of the modern needle and syringe, at a fraction of the cost.

- Biomedical engineer
Mark Kendall aims to shake up how vaccines are delivered with the Nanopatch. Full bio

It's a pleasure to be here
00:12
in Edinburgh, Scotland,
00:13
the birthplace of the needle and syringe.
00:15
Less than a mile from here in this direction,
00:18
in 1853 a Scotsman
00:21
filed his very first patent on the needle and syringe.
00:23
His name was Alexander Wood,
00:25
and it was at the Royal College of Physicians.
00:28
This is the patent.
00:31
What blows my mind when I look at it even today
00:34
is that it looks almost identical
00:36
to the needle in use today.
00:39
Yet, it's 160 years old.
00:40
So we turn to the field of vaccines.
00:44
Most vaccines are delivered with
00:46
the needle and syringe,
this 160-year-old technology.
00:49
And credit where it's due -- on many levels,
00:53
vaccines are a successful technology.
00:55
After clean water and sanitation,
00:58
vaccines are the one technology that has increased
01:02
our life span the most.
01:07
That's a pretty hard act to beat.
01:09
But just like any other technology,
01:12
vaccines have their shortcomings,
01:13
and the needle and syringe
01:15
is a key part within that narrative --
01:18
this old technology.
01:20
So let's start with the obvious:
01:23
Many of us don't like the needle and syringe.
01:25
I share that view.
01:29
However, 20 percent of the population
01:31
have a thing called needle phobia.
01:34
That's more than disliking the needle;
01:36
that is actively avoiding being vaccinated
01:38
because of needle phobia.
01:40
And that's problematic in terms
of the rollout of vaccines.
01:42
Now, related to this is another key issue,
01:46
which is needlestick injuries.
01:48
And the WHO has figures
01:51
that suggest about 1.3 million deaths per year
01:53
take place due to cross-contamination
01:57
with needlestick injuries.
01:59
These are early deaths that take place.
02:00
Now, these are two things that
you probably may have heard of,
02:03
but there are two other shortcomings
02:06
of the needle and syringe you
may not have heard about.
02:08
One is it could be holding back
02:10
the next generation of vaccines
02:12
in terms of their immune responses.
02:14
And the second is that it could be responsible
02:16
for the problem of the cold chain
that I'll tell you about as well.
02:19
I'm going to tell you about some work
02:24
that my team and I are doing in Australia
02:25
at the University of Queensland
02:27
on a technology designed to
tackle those four problems.
02:29
And that technology is called the Nanopatch.
02:33
Now, this is a specimen of the Nanopatch.
02:38
To the naked eye
02:44
it just looks like a square
02:46
smaller than a postage stamp,
02:48
but under a microscope
02:51
what you see are thousands of tiny projections
02:54
that are invisible to the human eye.
02:56
And there's about 4,000 projections
02:58
on this particular square compared to the needle.
03:00
And I've designed those projections
03:03
to serve a key role, which is to
work with the skin's immune system.
03:06
So that's a very important function
03:10
tied in with the Nanopatch.
03:12
Now we make the Nanopatch
03:14
with a technique
03:16
called deep reactive ion etching.
03:19
And this particular technique
is one that's been borrowed
03:21
from the semiconductor industry,
03:23
and therefore is low cost
03:25
and can be rolled out in large numbers.
03:26
Now we dry-coat vaccines to
the projections of the Nanopatch
03:29
and apply it to the skin.
03:34
Now, the simplest form of application
03:36
is using our finger,
03:40
but our finger has some limitations,
03:42
so we've devised an applicator.
03:45
And it's a very simple device --
03:47
you could call it a sophisticated finger.
03:48
It's a spring-operated device.
03:50
What we do is when we apply
the Nanopatch to the skin as so --
03:53
(Click) --
03:57
immediately a few things happen.
03:59
So firstly, the projections on the Nanopatch
04:02
breach through the tough outer layer
04:06
and the vaccine is very quickly released --
04:08
within less than a minute, in fact.
04:10
Then we can take the Nanopatch off
04:12
and discard it.
04:15
And indeed we can make
a reuse of the applicator itself.
04:17
So that gives you an idea of the Nanopatch,
04:23
and immediately you can see some key advantages.
04:25
We've talked about it being needle-free --
04:28
these are projections that you can't even see --
04:30
and, of course, we get around
04:32
the needle phobia issue as well.
04:34
Now, if we take a step back and think about
04:37
these other two really important advantages:
04:39
One is improved immune
responses through delivery,
04:42
and the second is getting rid of the cold chain.
04:46
So let's start with the first one,
this immunogenicity idea.
04:50
It takes a little while to get our heads around,
04:52
but I'll try to explain it in simple terms.
04:54
So I'll take a step back and explain to you
04:58
how vaccines work in a simple way.
05:00
So vaccines work by introducing into our body
05:03
a thing called an antigen
05:06
which is a safe form of a germ.
05:08
Now that safe germ, that antigen,
05:11
tricks our body into mounting an immune response,
05:13
learning and remembering
how to deal with intruders.
05:17
When the real intruder comes along
05:21
the body quickly mounts an immune response
05:23
to deal with that vaccine
05:25
and neutralizes the infection.
05:26
So it does that well.
05:28
Now, the way it's done today
with the needle and syringe,
05:30
most vaccines are delivered that way --
05:32
with this old technology and the needle.
05:35
But it could be argued that the needle
is holding back our immune responses;
05:36
it's missing our immune sweet spot in the skin.
05:42
To describe this idea,
05:45
we need to take a journey through the skin,
05:48
starting with one of those projections
05:51
and applying the Nanopatch to the skin.
05:53
And we see this kind of data.
05:56
Now, this is real data --
05:58
that thing that we can see there is one projection
06:00
from the Nanopatch that's been applied to the skin
06:02
and those colors are different layers.
06:05
Now, to give you an idea of scale,
06:07
if the needle was shown here, it would be too big.
06:08
It would be 10 times bigger
06:10
than the size of that screen,
going 10 times deeper as well.
06:11
It's off the grid entirely.
06:14
You can see immediately that we
have those projections in the skin.
06:16
That red layer is a tough outer layer of dead skin,
06:20
but the brown layer and the magenta layer
06:23
are jammed full of immune cells.
06:25
As one example, in the brown layer
06:28
there's a certain type of cell
called a Langerhans cell --
06:30
every square millimeter of our body
06:33
is jammed full of those Langerhans cells,
06:35
those immune cells, and
there's others shown as well
06:38
that we haven't stained in this image.
06:40
But you can immediately see that the Nanopatch
06:42
achieves that penetration indeed.
06:44
We target thousands upon thousands
of these particular cells
06:46
just residing within a hair's width
06:49
of the surface of the skin.
06:51
Now, as the guy that's invented
this thing and designed it to do that,
06:55
I found that exciting. But so what?
06:58
So what if you've targeted cells?
07:02
In the world of vaccines, what does that mean?
07:04
The world of vaccines is getting better.
07:07
It's getting more systematic.
07:09
However, you still don't really know
07:11
if a vaccine is going to work
07:13
until you roll your sleeves up
07:15
and vaccinate and wait.
07:16
It's a gambler's game even today.
07:18
So, we had to do that gamble.
07:21
We obtained an influenza vaccine,
07:23
we applied it to our Nanopatches
07:26
and we applied the Nanopatches to the skin,
07:28
and we waited --
07:30
and this is in the live animal.
07:32
We waited a month,
07:34
and this is what we found out.
07:35
This is a data slide showing the immune responses
07:37
that we've generated with a Nanopatch
07:40
compared to the needle and syringe into muscle.
07:42
So on the horizontal axis we have
the dose shown in nanograms.
07:46
On the vertical axis we have
the immune response generated,
07:49
and that dashed line indicates
the protection threshold.
07:52
If we're above that line it's considered protective;
07:58
if we're below that line it's not.
08:00
So the red line is mostly below that curve
08:03
and indeed there's only one point that
is achieved with the needle that's protective,
08:05
and that's with a high dose of 6,000 nanograms.
08:09
But notice immediately the distinctly different curve
08:12
that we achieve with the blue line.
08:15
That's what's achieved with the Nanopatch;
08:18
the delivered dose of the Nanopatch is
08:20
a completely different immunogenicity curve.
08:21
That's a real fresh opportunity.
08:25
Suddenly we have a brand new lever
08:27
in the world of vaccines.
08:29
We can push it one way,
08:31
where we can take a vaccine
that works but is too expensive
08:32
and can get protection
08:35
with a hundredth of the dose
compared to the needle.
08:36
That can take a vaccine that's suddenly
10 dollars down to 10 cents,
08:39
and that's particularly important
within the developing world.
08:43
But there's another angle to this as well --
08:46
you can take vaccines that currently don't work
08:48
and get them over that line
08:51
and get them protective.
08:52
And certainly in the world of vaccines
08:54
that can be important.
08:57
Let's consider the big three:
08:58
HIV, malaria, tuberculosis.
08:59
They're responsible for about
7 million deaths per year,
09:02
and there is no adequate vaccination
method for any of those.
09:05
So potentially, with this new lever
that we have with the Nanopatch,
09:08
we can help make that happen.
09:10
We can push that lever to help get those
candidate vaccines over the line.
09:12
Now, of course, we've worked within my lab
09:17
with many other vaccines that have attained
09:19
similar responses and similar curves to this,
09:21
what we've achieved with influenza.
09:24
I'd like to now switch to talk about
09:27
another key shortcoming of today's vaccines,
09:29
and that is the need to maintain the cold chain.
09:33
As the name suggests -- the cold chain --
09:36
it's the requirements of keeping
a vaccine right from production
09:39
all the way through to when the vaccine is applied,
09:42
to keep it refrigerated.
09:44
Now, that presents some logistical challenges
09:48
but we have ways to do it.
09:51
This is a slightly extreme case in point
09:54
but it helps illustrate the logistical challenges,
09:58
in particular in resource-poor settings,
10:01
of what's required to get vaccines
10:03
refrigerated and maintain the cold chain.
10:07
If the vaccine is too warm the vaccine breaks down,
10:08
but interestingly it can be too cold
10:12
and the vaccine can break down as well.
10:14
Now, the stakes are very high.
10:17
The WHO estimates that within Africa,
10:20
up to half the vaccines used there
10:23
are considered to not be working properly
10:25
because at some point the
cold chain has fallen over.
10:27
So it's a big problem, and it's tied
in with the needle and syringe
10:30
because it's a liquid form vaccine, and
when it's liquid it needs the refrigeration.
10:33
A key attribute of our Nanopatch
10:38
is that the vaccine is dry,
10:41
and when it's dry it doesn't need refrigeration.
10:43
Within my lab we've shown that we can keep
10:45
the vaccine stored at 23 degrees Celsius
10:48
for more than a year without
any loss in activity at all.
10:50
That's an important improvement.
10:54
(Applause)
10:56
We're delighted about it as well.
11:03
And the thing about it is that
we have well and truly proven
11:06
the Nanopatch within the laboratory setting.
11:10
And as a scientist, I love that and I love science.
11:13
However, as an engineer,
11:16
as a biomedical engineer
11:19
and also as a human being,
11:21
I'm not going to be satisfied
11:23
until we've rolled this thing
out, taken it out of the lab
11:24
and got it to people in large numbers
11:27
and particularly the people that need it the most.
11:29
So we've commenced this particular journey,
11:33
and we've commenced this
journey in an unusual way.
11:36
We've started with Papua New Guinea.
11:38
Now, Papua New Guinea is an example
of a developing world country.
11:41
It's about the same size as France,
11:47
but it suffers from many of the key barriers
11:50
existing within the world of today's vaccines.
11:53
There's the logistics:
11:57
Within this country there are only 800
refrigerators to keep vaccines chilled.
11:59
Many of them are old, like this one in Port Moresby,
many of them are breaking down
12:03
and many are not in the Highlands
where they are required.
12:07
That's a challenge.
12:10
But also, Papua New Guinea has the
world's highest incidence of HPV,
12:12
human papillomavirus, the
cervical cancer [risk factor].
12:17
Yet, that vaccine is not available in large numbers
12:21
because it's too expensive.
12:24
So for those two reasons, with
the attributes of the Nanopatch,
12:26
we've got into the field and
worked with the Nanopatch,
12:28
and taken it to Papua New Guinea
12:31
and we'll be following that up shortly.
12:33
Now, doing this kind of work is not easy.
12:37
It's challenging,
12:41
but there's nothing else in
the world I'd rather be doing.
12:42
And as we look ahead
12:46
I'd like to share with you a thought:
12:48
It's the thought of a future where
12:51
the 17 million deaths per year
12:55
that we currently have due to infectious disease
12:57
is a historical footnote.
13:00
And it's a historical footnote that has been achieved
13:02
by improved, radically improved vaccines.
13:04
Now standing here today in front of you
13:08
at the birthplace of the needle and syringe,
13:10
a device that's 160 years old,
13:12
I'm presenting to you an alternative approach
13:15
that could really help make that happen --
13:17
and it's the Nanopatch with its attributes
of being needle-free, pain-free,
13:19
the ability for removing the cold chain
and improving the immunogenicity.
13:23
Thank you.
13:28
(Applause)
13:30

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About the Speaker:

Mark Kendall - Biomedical engineer
Mark Kendall aims to shake up how vaccines are delivered with the Nanopatch.

Why you should listen

Looking a bit like a fuzzy computer chip, the Nanopatch uses tiny powder-coated spikes to deliver a small dose of vaccine just under the skin, immunizing a person in about a minute. Made for less than $1, it uses only a fraction of a vaccine dose delivered by traditional syringe method (which was invented in 1853), at the same time eliminating the risk of needle injuries. What’s more, a Nanopatch infused with vaccine is designed to be heat-stable, so it can be transported without refrigeration. And the process doesn't draw blood, reducing the risk of infections.

Mark Kendall, an Australian biomedical engineer, was part of a team at the University of Queensland that advanced the Nanopatch by vaccinating animals. Now his company, Vaxxas, is on a mission to commercialize the device for human use. He plans to run an international trial using the Nanopatch, starting with the human papilloma virus (HPV) vaccine to protect against cervical cancer.