How air pollution affects homeless populations

When air quality worsens, either from the smoke and ozone of summer or the inversion of winter, most of us stay indoors. But for individuals experiencing homelessness, that’s not always an option. In a new study, researchers from the University of Utah document the effect of air pollution on people experiencing homelessness, finding that nearly all notice and are impacted by air pollution, whether or not they reside in shelters.

The study, funded by the Interdisciplinary Exchange for Utah Science (NEXUS) at the University of Utah, is published in the International Journal of Environmental Research and Public Health.

Life lived outdoors

People experiencing homelessness, particularly those who sleep outdoors at night, are the most vulnerable and exposed population to environmental hazards, says Daniel Mendoza, a research assistant professor in the Department of Atmospheric Sciences and visiting assistant professor in the Department of City & Metropolitan Planning. Mendoza also holds appointments as an adjunct assistant professor in the Pulmonary Division in the School of Medicine and as a senior scientist at NEXUS. “Many individuals sleep near a road or under a bridge,” he says, “which leads to exposure to high levels of traffic related emissions. Further compounding the issue is the fact that during sleep, many people breathe through their mouth and breathe more deeply.”

This life lived outdoors makes homelessness an environmental justice issue, says Jeff Rose, assistant professor in the Department of Parks, Recreation and Tourism.

“People experiencing unsheltered homelessness often live, eat, sleep, socialize, use the bathroom, and other basic human functions outdoors, with close and regular interaction with the environment,” he says. Environmental justice research looks at uneven exposures to pollution and other environmental risks. “Increasingly, scholars are considering people experiencing unsheltered homelessness as fitting in this framework.”

While other researchers have looked at how people experiencing homelessness experience environmental injustice in the form of access to safe drinking water or parks, the U team says it is among the first to look at how people experiencing homelessness also experience the intermittent poor air quality of Salt Lake County.

Gathering experiences

To collect people’s stories, Angelina DeMarco, a doctoral student in anthropology and Rebecca Hardenbrook, a doctoral student in mathematics, went to several Salt Lake City resource centers to meet with people experiencing sheltered homelessness.

“We sat in the dining hall of each center and invited all residents that came by to interview,” DeMarco says. In partnership with the Volunteers of America outreach team, they also interviewed people at the Salt Lake City library, on downtown streets, outside the St. Vincent de Paul dining hall and at local parks. Outdoor interviews took place often during harsh winter conditions, DeMarco says.

They interviewed everyone they encountered, 138 people total, and asked them open-ended questions about when and how they knew the air was polluted, and how air pollution make them feel. With the interviewees’ permission, the researchers also examined health records kept by the state Homeless Management Information System.

Sheltered and unsheltered

More than half of the participants reported having physical reactions to air pollution including headaches and difficulty breathing, and more than a third reported emotional stress associated with air pollution. 89% reported seeking medical treatment for their symptoms.

But the researchers also wanted to look at whether the duration of homelessness or residing within a shelter would affect individuals’ experiences with air pollution. Surprisingly, they found no significant differences in heart and lung health outcomes between sheltered and unsheltered individuals, as well as between people experiencing chronic (more than a year) or non-chronic homelessness.

“These results indicate that sheltered and unsheltered, short-term and long-term homeless populations experience negative health outcomes that are associated with air pollution,” DeMarco says. The mental health impacts of air pollution exposure, she says, merit additional study.

The message for governmental leaders, the researchers say, is that shelters and day centers that protect people from the elements may not be shielding them from air pollution and other environmental impacts, which can have a significant effect on their health. Affordable housing policies and efforts to place people experiencing homelessness in housing, they say, may do much more to protect a vulnerable population from an environmental hazard.

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Parasitic worms offer ‘the missing link’ on the dual nature of a key immune regulator

De’Broski Herbert has a philosophy that’s guided his career researching helminths, or parasitic worms, and their interaction with their hosts’ immune systems: “Follow the worm.”

“The mantra of my lab since its inception has been that parasitic worms manipulate their hosts in very interesting ways to maintain their survival,” says Herbert, an associate professor of pathobiology in Penn’s School of Veterinary Medicine. “SARS-CoV-2 doesn’t care about staying in your body very long because it is transmitted so easily. Worms aren’t spread so easily, so they have to figure out how to persist.”

That focus has revealed a key insight about an immune signaling molecule, the cytokine IL-33, that is important not only in parasite infections, but in a range of other health conditions, such as asthma, obesity, and eczema. In a new study published in Science Immunology, Herbert and colleagues made insights that explain how IL-33 can both help defend the body against parasite infection, but also suppress chronic inflammation in diseases where the immune system is activated inappropriately and causes harmful pathology. A key discovery was that the activity of IL-33 depends upon which cell type is releasing it.

“Lots of people have been interested in IL-33 ever since two big genomic association studies implicated it and its receptor in the pathogenesis of asthma,” Herbert says. “Other researchers have looked at it in the context of infections and others in the context of the brain and development. And everyone knew this protein was in the nucleus, but no one understood how it got out of the cell to accomplish all of these things.

“I’m excited for this work because not only do we find this cytokine in a cell type that nobody was expecting, but we also present a mechanism that no one was expecting for how it could come out.”

IL-33 has been of major interest to immunologists focused on what are known as type 2 immune responses, typically associated with parasite infections or asthma and allergies. On the parasite front, researchers knew that IL-33 acted in part to “wake up” the immune system to the presence of a worm infection. In a mouse model, animals lacking IL-33 sustain worm infections much longer than those with IL-33 intact.

To find out whether it mattered which cell type was releasing the IL-33 signaling molecule, Herbert and colleagues used special mouse model in which only myeloid antigen-presenting cells (immune cells), or epithelial cells (those that line mucosal surfaces), failed to release IL-33.

“Sure enough, we found that when animals lacking the myeloid-derived IL-33 experienced a hookworm infection, they eliminated those hookworms quite fast,” Herbert says. Mice lacking IL-33 in the epithelial cells, however, were not able to readily clear the infection. The same results held up in another rodent model, this one of roundworm infection.

Dendritic cells, a type of myeloid antigen-presenting cell, produce IL-33, and further experiments showed that the cytokine produced by these cells supported a specific population of regulatory T cells (Tregs), which are cells “whose whole purpose is to suppress the immune response,” Herbert says.

Now understanding that dendritic cells were key to supporting Tregs, the researchers wanted to understand how the dendritic cells were delivering the IL-33. The team screened dendritic cells from mice with and without IL-33, identifying a protein called perforin-2 to be suppressed in expression from myeloid cells lacking IL-33.

Perforin-2, as its name suggests, forms a pore that spans the cell membrane, like a tunnel in a hillside, allowing the transport of proteins in and out. The find made complete sense to the researchers, providing an explanation for how dendritic cells could promote the release of IL-33 into the tissues to interact with Tregs. And when Herbert and colleagues experimentally eliminated perforin-2 from dendritic cells, they saw a subsequent lack of Treg growth.

To connect the findings in their animal model and lab dishes to humans, the team utilized patient samples from Penn otolaryngologist Noam Cohen. They found perforin-2 at the plasma membrane of cells from polyps removed from patients with chronic rhinosinusitis, suggesting that the significance of the findings extends to human health.

The study paves the way for even more translational work in immunology — and worms are to thank. “It’s kind of the missing link,” Herbert says. “It opens up a whole new direction for understanding how this cytokine could be involved in obesty, inflammatory bowel disease, Crohn’s, asthma, and development.”

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The Popovich of floral nectar spurs

When it came to naming a gene that could lead to new insights on a crucial feature of evolution, the Harvard Organismic and Evolutionary Biology alumna leading the project aimed for something rather tongue in cheek. She called it POPOVICH, after San Antonio Spurs coach and president Gregg Popovich.

Evangeline Ballerini, Ph.D. ’10, an assistant professor of biological sciences at California State University, Sacramento, said she and her collaborators — including Harvard’s Elena Kramer — settled on the name because the newly discovered gene calls the shots for floral nectar spurs the way Popovich does for his NBA team.

“I ended up choosing to name it after Gregg Popovich, in part, because the gene plays a regulatory role in spur development, kind of like a coach controls the development of their team,” said Ballerini, who is a long-time Golden State Warriors fan and a part-time Celtics fan because of her time in the Boston area, but respects the Spurs and admires Popovich’s leadership.

The work is described in a recently published study in PNAS.

Nectar spurs are the hollow tubes that bulge out from a number of flowers and are crucial to increasing biodiversity among flowering plants that have them. In many cases, species with nectar spurs are much more diverse than their close relative without this novel trait.

In the paper, the scientists identify the gene critical to controlling the development of these spurs in the common columbine, or Aquilegia. They found it acts as a master regulator that appears to control the creation of the spurs by regulating the activity of other genes, the way a coach decides who plays and when.

Aside from the quirky NBA reference, what really has evolutionary biologists excited about the discovery is that the findings have the potential to help them understand how organisms get their vast array of shapes and traits, and then how those traits evolve.

Nectar spurs are considered a key innovation in flowers, meaning they are considered a novel feature — one that helps organisms make the greatest use of their environment and leads to a diversity boom. Animals that evolved to have wings, for instance, have spun off into number of different species over millions of years. Other key innovations are eyes or the backbone in mammals.

Most key innovations happened deep in the past, making identifying their origin increasingly difficult. In the group of plants the researchers studied, however, floral nectar spurs have only been around for about 5 to 7 million years.

“Given that the Aquilegia nectar spur evolved relatively recently and is formed by modifications to a single floral organ, it provides a unique opportunity to begin to dissect the developmental and genetic basis of a key innovation, which, in turn, will provide insight into its origin,” the researchers wrote.

The researchers believe the gene is among the first key innovations for which scientists have identified the critical gene, opening the door to a number of areas in understanding how form and morphology are achieved in flowers and other living things.

“We’re particularly interested in novel features that seem to be very important for promoting speciation events,” said Kramer, Bussey Professor of Organismic and Evolutionary Biology and chair of the Department of Organismic and Evolutionary Biology. “In terms of a morphological trait, like the nectar spur, we’re asking: How did development [of the species] change? … It gives us, essentially, a handle, a starting place to try to start understanding this genetic network.”

Researchers made the discovery using a combination of techniques that included genetic sequencing and crossing species, and gene expression analyses. One of the keys was using a species of the Aquilegia native to China and known to be the only member of that genus, out of 60 to 70 species, to lack nectar spurs.

The team started by repeating a 1960 study by the Russian geneticist W. Pra?mo that crossed the spurless flower with a spurred species and suggested that a single, recessive gene was responsible for spur loss. Unlike Pra?mo, they had the genetic tools to finish the job, and sequenced the genome of about 300 offspring. That narrowed the search to just over 1,000 genes. Further genetic sleuthing led them to POPOVICH, which they call POP for short, and confirmed it using a genetically modified virus that knocks down, or suppresses, targeted genes.

“We took a species that has spurs and normally has POP expression, and we downregulated the expression of POP,” Kramer said. “We showed that it lost its spurs, and that result was the thing that ties it all together. Not only is this a gene that’s specifically expressed in spurs, but when you knock it down, it loses its spurs.”

While this is all strong evidence, more work is needed to confirm their findings.

“There are several directions that we’d like to go in, including trying to figure out how POP expression is controlled, which genes POP regulates the expression of, and what the POP gene is doing in the spurless relatives of Aquilegia,” Ballerini said.

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Ultracompact metalens microscopy breaks FOV constraints

The pursuit of ever-higher imaging resolution in microscopy is coupled with growing demands for compact portability and high throughput. While imaging performance has improved, conventional microscopes still suffer from the bulky, heavy elements and architectures associated with refractive optics. Metalenses offer a solution: they’re ultrathin, ultralight, and flat, and benefit from lots of recent research that has improved their efficiency, FOV, and polarization functionalities.

According to Tao Li, professor of engineering and applied sciences at Nanjing University, “An ultra-compact metalens for imaging will miniaturize and even revolutionize conventional optical devices.” Despite all the ongoing work to improve metalenses, most research groups are using them as a substitute for conventional refractive lenses in conventional optical settings. For metalenses to move toward real-world application, it’s important to learn how to integrate metalenses into ultracompact optical devices.

In pursuit of a compact integrated microscope system, Li’s team mounted a metalens on a CMOS image sensor to create a prototype of a coin-sized imaging device. As reported in Advanced Photonics, their metalens-integrated imaging device (MIID) exhibits an ultracompact architecture with a working imaging distance in the hundreds of micrometers. Using a simple image-stitching process, they are able to obtain wide-field microscope imaging with large FOV and high resolution.

Pocket microscope system

The MIID prototype involves a millimeter-sized silicon metalens in a well-designed array of 6×6. Despite the integration of multiple lenses, imaging distance remains relatively small (~500 ?m) because each single lens is sized about 200 ?m. According to the authors, it can be extended to centimeter scale to cover the whole CMOS sensor.

The metalens array, which is a polarization multiplexer, has two different phase profiles corresponding to two circular light polarizations. According to Li, this arrangement ensures the elimination of blind areas.

The authors hope that the new MIID prototype heralds a new era of the pocket microscope system. They acknowledge that the imaging performance needs improvement and suggest a variety of approaches, such as adopting low-loss materials like GaN and SiN. They anticipate continuing advances in microscopy based on meta-technology in the future.

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Materials provided by SPIE–International Society for Optics and Photonics. Note: Content may be edited for style and length.

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Be mindful: Study shows mindfulness might not work as you expect

If dispositional mindfulness can teach us anything about how we react to stress, it might be an unexpected lesson on its ineffectiveness at managing stress as it’s happening, according to new research from the University at Buffalo.

When the goal is “not to sweat the small stuff,” mindfulness appears to offer little toward achieving that end.

The findings, published in the journal Personality and Social Psychology Bulletin, which measured the cardiovascular responses of 1,001 participants during stressful performance tasks, run contrary to previous research and pop culture assertions of how being mindful offers stress relief and coping benefits.

Where earlier work in this area suggests how mindfulness may help people manage active stressors, the current paper finds evidence for an opposite response. In the midst of stress, mindful participants demonstrated cardiovascular responses consistent with greater care and engagement. Put another way, they actually were “sweating the small stuff.”

Even more curiously, although the study’s participants demonstrated no physiological signs associated with positive stress responses, they did report having a positive experience afterward.

“What’s surprising, and particularly striking about our results, is that mindfulness didn’t seem to affect whether people had a more positive stress response in the moment,” said Thomas Saltsman, a researcher in UB’s psychology department and the paper’s lead author. “Did more mindful people actually feel confident, comfortable and capable while engaged in a stressful task? We didn’t see evidence of that, despite them reporting feeling better about the task afterward.”

Mindfulness does have benefits, but appears to be limited in what it can accomplish while people are actively engaged in stressful tasks, like taking a test, giving a speech or sitting for a job interview. Instead, being mindful may only benefit people’s perception of their stress experience after it has ended.

“Although our findings seem to go against a wholesome holy grail of stress and coping benefits associated with dispositional mindfulness, we believe that they instead point to its possible limitations,” says Saltsman. “Like an alleged holy grail of anything, its fruits are likely finite.”

Saltsman describes dispositional mindfulness as having a focused attention on the present. It’s a mindset that tries to avoid ruminating on past realities or considering future possibilities or consequences. It’s about being non-judgmental and relaxing critical interpretations. Mindfulness can be approached with formal training, but people can also be dispositionally higher or lower in mindfulness, which was the focus of their study.

Those high in dispositional mindfulness report greater well-being. They tend not to dwell on past events, and claim to manage stress well.

“Although those benefits seem unambiguous, the specific ways in which mindfulness should impact people’s psychological experiences during stress remain unclear,” says Saltsman. “So we used cardiovascular responses to capture what people were experiencing in a moment of stress, when they’re more or less dispositionally mindful.”

By measuring cardiovascular responses, Saltsman and the other researchers, including Mark Seery, an associate professor of psychology at UB, can tap into participants’ experiences during moments of stress — in this case, giving a speech or taking a reasoning-ability test.

Those responses include heart rate and how hard the heart is pumping. When people care more about the task they are completing, Seery says, their heart rate increases and beats harder. Other measures, like how much blood the heart is pumping and the degree to which blood vessels dilate, indicate how confident or capable one feels during the task.

“One thing these results say to me, in terms of what the average person is expecting when they casually get into mindfulness, is that what it’s actually doing for them could very well be mismatched from their expectations going in,” says Seery. “And this is an impressively large sample of more than a thousand participants, which makes the results particularly convincing.”

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Materials provided by University at Buffalo. Original written by Bert Gambini. Note: Content may be edited for style and length.

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Light shed on the atomic resolution structure of phage DNA tube

Given that phages are able to destroy bacteria, they are of particular interest to science. Basic researchers from the Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) in Berlin are especially interested in the tube used by phages to implant their DNA into bacteria. In collaboration with colleagues from Forschungszentrum Jülich and Jena University Hospital, they have now revealed the 3D structure of this crucial phage component in atomic resolution. The key to success was combining two methods — solid-state NMR and cryo-electron microscopy. The study has just been published in the journal Nature Communications.

With growing antibiotic resistance, phages have increasingly become the focus of research. Phages are naturally occurring viruses with a very useful property: they implant their DNA into bacteria and proliferate there until the bacterial cell is ultimately destroyed. This is why they are also referred to as bacteriophages (bacteria eaters).

This approach has already been shown to fight multidrug-resistant bacteria. Last year, the case of a girl from England hit the headlines, when she was cured from a serious antibiotic-resistant infection using engineered phages.

However, the widespread use of phage therapy is still a long way off. Many of the underlying principles that are key to advancing this therapy are not yet understood. For example, little was previously known about the appearance of the exact architecture of the tube used by phages to implant their DNA into bacteria. Now scientists from the Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) in Berlin, together with colleagues from Forschungszentrum Jülich and Jena University Hospital, have managed to reveal the 3D structure of this crucial phage component in atomic resolution.

Designed for transporting DNA

“The structure and flexibility of the DNA tube attached to the icosahedron-shaped capsid is somewhat reminiscent of a spinal column,” stated FMP’s Professor Adam Lange, describing one of the new findings. “It seems to be perfectly designed for transporting DNA.”

The researchers were able to gain fascinating insights into the structure and function of this sophisticated DNA transport pathway — in this case, from a variant of phage SPP1 — by innovatively combining solid-state NMR with cryo-electron microscopy (cryo-EM). Lange’s research group further developed nuclear magnetic resonance spectroscopy (NMR) especially for this task under an ERC Grant; cryo-EM expert Professor Gunnar Schröder from Forschungszentrum Jülich performed the electron-microscopic investigations. In addition, new modeling algorithms were required for the computer-based combination of the two data sets for structure determination. These algorithms were developed by Professor Michael Habeck from Jena University Hospital. “The key to success was combining the two methods, representing a methodological milestone,” commented Professor Lange.

While solid-state NMR is ideal for visualizing flexible structures and tiny details, cryo-EM provides insight into the overall architecture. The resulting image shows that six gp17.1 proteins organize into stacked rings, forming a hollow tube. The rings are connected by flexible linkers, making the tube very bendable. “We are now able to understand how negatively charged DNA is repelled from the likewise negatively charged interior wall of the flexible tube, passing through it smoothly,” explained FMP’s Maximilian Zinke, lead author of the study now published in Nature Communications. “The bacteria are ultimately destroyed via this pathway.”

Milestone for integrated structural biology

According to group leader Adam Lange, besides representing a quantum leap forward in phage research, the work will also advance “integrated structural biology,” the term for the combination of these two complementary methods.

Thanks to the recent installation of a new high-resolution Titan Krios electron microscope, the infrastructure required to achieve this is now available on Campus Berlin-Buch. Moreover, a 1.2 gigahertz device will soon be added to the existing NMR spectrometers. “Equipped with cryo-EM and the most sensitive NMR spectrometer in the world, we will be very present in integrative structural biology in the future,” enthused Adam Lange. “This offers bright prospects for the campus and for the research location of Berlin.”

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Materials provided by Forschungsverbund Berlin. Note: Content may be edited for style and length.

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The unique hydraulics in the Barbegal water mills, the world’s first industrial plant

The Barbegal watermills in southern France are a unique complex dating back to the 2nd century AD. The construction with 16 waterwheels is, as far as is known, the first attempt in Europe to build a machine complex on an industrial scale. The complex was created when the Roman Empire was at the height of its power. However, little is known about technological advances, particularly in the field of hydraulics, and the spread of knowledge at the time. A team of scientists led by Professor Cees Passchier from Johannes Gutenberg University Mainz (JGU) has now gained new knowledge about the construction and principle of the water supply to the mills in Barbegal. The research results were published in Scientific Reports.

A mill complex consisting of a total of 16 water wheels in two parallel rows

Watermills were one of the first sources of energy that did not depend on the muscle strength of humans or animals. In the Roman Empire they were used to make flour and sawing stone and wood. As one of the first industrial complexes in European history, the Barbegal watermills are an outstanding example of the development at that time. The mill complex consisted of 16 water wheels in a parallel arrangement of eight wheels each, separated by central buildings and fed by an aqueduct. The upper parts of the complex were destroyed and no traces of the wooden structures have been preserved, which is why the type of mill wheels and how they worked remained a mystery for a long time.

However, carbonate deposits that had formed from the flowing water on the wooden components remained. These were stored in the archaeological museum in Arles and only recently examined in detail. The researchers found an imprint of an unusual, elbow-shaped flume that must have been part of the mill construction. “We combined measurements of the water basins with hydraulic calculations and were able to show that the flume to which this elbow-shaped piece belonged very likely supplied the mill wheels in the lower basins of the complex with water,” said Professor Cees Passchier. “The shape of this flume was unknown from other watermills, either from Roman or more recent times. We were therefore puzzled as to why the flume was designed this way and what it was used for.”

An elbow-shaped flume as a unique adaptation for the Barbegal mills

At first glance, the team found such a flume unnecessary and even disadvantageous, because it shortens the height from which the water falls onto the mill wheel. “However, our calculations show that the oddly shaped flume is a unique adaptation for the Barbegal mills,” explained Passchier. The distribution of the carbonate deposits in the elbow-shaped flume shows that it was inclined slightly backwards against the direction of the current. This created a maximum flow rate in the first, steep leg of the flume, and at the same time the water jet to the mill wheel obtained the correct angle and speed. In the complicated mill system, with small water basins, this unique solution was more efficient than using a traditional, straight water channel. “That shows us the ingenuity of the Roman engineers who built the complex,” emphasized Passchier.

“Another discovery was that the wood of the flume was probably cut with a mechanical, water-powered saw, which is possibly the first documented mechanical wood saw — again evidence of industrial activity in ancient times.” The research was carried out by a multidisciplinary team of experts in geology, geochemistry, hydraulics, dendrochronology, and archaeology.

The carbonate deposits that formed on the ancient hydraulic structures are an important tool for the researchers for archaeological reconstructions. In an earlier project, the team led by Professor Cees Passchier was able to show that the flour from the Barbegal mills was probably used to make ship biscuits. “The carbonate deposits give us extremely exciting insights into the skills of Roman technicians at a time that can be seen as the direct predecessor of our civilization,” added Passchier, Professor of Tectonic Physics and Structural Geology at the JGU Institute of Geosciences from 1993 to 2019, now Senior Research Professor in Geoarchaeology.

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Materials provided by Johannes Gutenberg Universitaet Mainz. Note: Content may be edited for style and length.

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Covid: Children more likely to be infected in second wave

Evidence presented to government confirmed rising infections as schools reopened.

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R number for UK has fallen to between 1 and 1.2

ONS data also says the number of people infected with coronavirus is slowing down.

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Health24.com | Cold truth: South Africa won’t be able to store Pfizer’s Covid vaccine. Here’s why.

  • The first results for a Covid vaccine are out, with Pfizer and BioNTech reporting 90% efficacy based on early data
  • Despite its promise, cold chain requirements mean this jab wouldn’t be the first choice for countries like South Africa
  • The vaccine needs to be kept at minus 70 degrees Celsius, well below other vaccines used in South Africa, which poses a huge challenge to its delivery and storage

The world’s first hope for a Covid-19 vaccine – the jab developed by drug companies Pfizer and BioNTech, showing 90% efficacy in preventing Covid-19 in early results – is highly unlikely to become widely available in South Africa.

This is because the vaccine needs to be stored below freezing temperatures – at minus 70 degrees Celsius – that the country doesn’t have the capacity to do on a large scale. If the shots are kept at temperatures too high or too low, they can spoil and become less effective. 

In the United States, large city hospitals are already “rushing to buy the expensive ultra-cold freezers” that cost between R150 000 and R235 000 each, to store the shots, for which Pfizer and BioNTech will apply for an emergency license from the US regulator, the Food and Drug Administration (FDA), later this month, Statnews reports.

And just three days after the announcement of the BNT162b2 vaccine’s first interim results, the European Union signed an agreement with the manufacturers to supply it with 200 million doses and an option to request an additional 100 million doses, “with deliveries anticipated to start by the end of 2020, subject to regulatory approval”.

But South Africa doesn’t have the required ultra-cold freezers to store the vaccine – except for a few at large research institutions such as the National Institute for Communicable Diseases, says director of Vaccines for Africa at the University of Cape Town, Gregory Hussey.

And, along with less well-off rural hospitals in developed countries, the country is unlikely to be able to afford to buy enough of the freezers to be able to make the vaccine available at community health centres or clinics, or pay for the cold chain systems that are necessary to maintain the vaccines.

Most vaccines that are part of South Africa’s immunisation programme have to be kept at temperatures between two and eight degrees Celsius. The country’s system – including vaccine transportation, storage, and monitoring – is therefore not suitable for vaccines that need to be kept below freezing temperatures.

And the Pfizer/BioNTech vaccine is not the only Covid-19 frontrunner that is likely to pose a problem to South Africa. The pharmaceutical company, Moderna’s mRNA-1273 jab, of which the first results are likely to be released before the end of the year, needs to be stored at minus 20 degrees Celsius.

Pfizer/BioNTech and Moderna’s vaccine both use mRNA technology. Such vaccines use pieces of man-made genetic material known as messenger ribonucleic acid, or mRNA, that instructs our bodies to produce proteins, in the form of antibodies and killer cells, to fight off SARS-CoV-2, the virus that causes Covid-19.

But the snag is that these two mRNA vaccines need to be kept at extremely low temperatures, or they risk becoming damaged. 

And to complicate things even further, mRNA vaccine technology is new – not a single vaccine using mRNA messengers has been licensed for human use up to date.

“I don’t know if we could really even contemplate an mRNA vaccine with our present setup,”  explains Barry Schoub, chair of South Africa’s ministerial advisory committee on coronavirus vaccines. “Things may change, but with our present setup, the places where we could actually utilise it would be so limited that it would be a major challenge.”

South Africa’s challenge of keeping vaccines cool    

Maintaining a cold chain — where a product must be consistently stored at a low temperature – is important to ensure that vaccines don’t degrade or lose their efficacy. A 2018 paper in the journal Vaccine, showed that although this deterioration did not pose a safety risk to people receiving the vaccine, the jabs offered less protection after being stored at the wrong temperature.

This is a major risk for rural hospitals and clinics or those facilities that lack adequate infrastructure to properly store doses when a Covid vaccine becomes available, according to Hussey, who also serves on the Covid vaccines ministerial advisory committee.

Schoub, who is also a virologist and former director of the National Institute for Communicable Diseases, agrees: “You can’t really store vaccines reliably and sustainably at minus 20 degrees Celsius anywhere outside the bigger cities. Especially if you’re looking at places with a hotter climate, like the Northern Cape or KwaZulu-Natal, even maintaining a freezer at minus 20 is going to be a question mark.”

According to Schoub, Pfizer/BioNTech are considering freeze-dried vaccines – in the form of frozen powders to which liquid is later added – which could potentially ease cold chain requirements for the jab, because they can be stored between two and eight degrees Celsius. But the timeline for this, he says, is still unclear.  

But even without taking into account the additional obstacles that will arise with maintaining a vaccine at well below 0 degrees Celsius, just regulating the temperature for our existing vaccines is already a challenge.

An assessment of vaccine management in 18 countries done by the World Health Organisation Regional Office for Africa in 2001 found that “only 47% of the indicators were satisfactorily met for buildings, cold chain equipment, and transport at the national level”.

In the Western Cape, a 2015 study published in Vaccine found that government-managed vaccine supply chains were often unable to manage the temperatures at which vaccines need to be stored, adequately. 

The average temperature of health centre fridges in the study ranged from 0.9 to 9.2 degrees Celsius, meaning that the jabs could have potentially been stored at temperatures both too low or too high and been damaged.

Why does 90% efficacy matter? 

Despite the delivery challenges of the Pfizer/BioNTech vaccine, its 90% potential efficacy has physicians and scientists, who mostly expected a much lower efficiency, excited.

Although it is only initial data that could still change as the trial progresses, this kind of efficacy puts the jab in the same category as the world’s most effective vaccines, such as the measles shot.  

Schoub explains: “If it does turn out to be true then that is a major, giant step forward, but at this stage it’s very difficult to assess how accurate that figure is because it’s still early in the trial.”

A higher efficacy rate means that the jab is able to offer more protection to a population. This is important when it comes to the role of a vaccine in offering immunity to a community.

If only half the people receiving a vaccine are going to be protected, you need to vaccinate a much larger portion of the population in order for it to make a difference and properly contain an outbreak.

With herd immunity as the end goal – where enough of the population is protected or resistant to the virus that it stops spreading – the measles vaccine, which is 97% effective at preventing measles, is often held up as the ideal.

But until now, scientists have been skeptical that we would be able to reach the same level when it came to Covid-19.

As Schoub explains, it was speculated that a Covid vaccine would be unlikely to offer the same level of protection as the measles shot because of the differences between the two diseases. While both are spread in a similar manner, through coughs or sneezes, they fundamentally differ in how they affect a person’s body.

Measles is a systemic disease, meaning it affects the whole body, while Covid is initally a pulmonary disease that mainly targets the lungs. In that respect, Covid is more similar to influenza, which is what has been used as the sort of benchmark when it comes to vaccine efficacy, says Schoub.

The distinction in how the disease works matters, because it influences the type of immune response – with measles requiring the production of antibodies in the blood to fight off the measles virus and influenza needing a more complicated immune response through antibodies in respiratory secretions.

The type of immune response needed to fight off influenza is hard to get through vaccinations, with most flu jabs only offering around a 60% chance of protection from the infection.

Most Covid vaccine trials are therefore designed to pick up around 60% efficacy in a vaccine candidate, the director of the American government’s National Institute of Allergy and Infectious Diseases, Anthony Fauci, explained in a Medical Brief webinar in October.  

But regardless of whether the Pfizer/BioNTech candidate is suitable for South Africa, the issue of delivering a vaccine is something we need to begin working on now, says Hussey.

He concludes: “There is a huge cost involved in delivering a vaccine, the World Health Organisation has estimated that cost of delivery of vaccines could be up to two or three-fold greater than the cost of the vaccines alone.

“There is also the additional operational costs of conducting immunization campaigns during the Covid-19 pandemic. We have to ensure that the facilities, the staff administering vaccines and the recipients of vaccines are kept ‘Covid safe’. That’s something we need to factor into our planning.”

And even though South Africa is only expecting to get enough Covid vaccines for around 5% of its population by next year, and a large rollout to the general public will likely only come in the next two years, Hussey cautions: “I think getting the vaccine is a simple thing. Getting the vaccine out to the people who need it is the challenge and we don’t have a great track record in even getting routine vaccines to the communities that need them most.”

*This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

Image credit: Getty Images

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