MONDAY, FEBRUARY 2, 2015 H E A LT H & S C I E N C E In pursuit of next-generation Ebola stockpile vaccines Vaccines could be ready for future outbreaks OREGON: In this Wednesday, Dec 3, 2014 photo, a nurse prepares liver cancer patient Crispin Lopez Serrano for an endoscopy at a Clackamas, Ore hospital. — AP Culturally sensitive palliative care represents new approach WEST LINN: When doctors diagnosed Pilar Alcantara with advanced breast cancer, she felt lost and intimidated. Growing up in Mexico, she learned to deal with illnesses using home remedies and prayer. She was taught that doctors weren’t to be questioned, and she preferred not to know the details of her illnesses or treatment plans. She felt hopeless, but that was before she connected with a Portland, Oregon-based nonprofit that takes cultural habits and beliefs into account while focusing on comfort and quality of life for patients with serious or terminal illnesses. She said the approach saved her. “A few years ago, because of the pain and uncertainty, I wanted to bail on life,” Alcantara said. “Palliative care gave me more control over my cancer.” Palliative care, which focuses on the well-being of patients with serious illnesses by improving doctor-patient communication and treating pain and side effects, has gained traction across the nation, but the culturally sensitive model embraced by Familias en Accion, the treatment center that has helped Alcantara, represents a new approach. Medical crises The method has taken root in Portland and Seattle, and it’s being taught to nursing students in California for its potential to improve care and reduce costs. Dr Woody English, former medical director of palliative care at Providence Health and Services in Portland, said the multi-faceted approach “has the ability to transform the usual health care system.” Studies show palliative care decreases emotional and medical crises and cuts down on unnecessary emergency room trips and hospitalizations, leading to cost savings sought under the Affordable Care Act. “A patient who is not having a crisis does not call 911,” Dr Diane Meier, director of the Center to Advance Palliative Care, said. By adding a cultural emphasis, health care professionals aim to address patient needs that would otherwise be overlooked. “Until we understand a patient’s drivers and concerns - the social, emotional, religious and historical contexts - we can’t begin to help the person,” and help them, Meier said. Familias started its program in 2011 with a $260,000 grant from the Portland-based Cambia Health Foundation. The system involves patient navigators who help chronically ill Latinos access doctors, fill out insurance forms and find financial assistance. Familias also offers support groups and health literacy sessions to help ease stress, stabilize emotions and address cultural factors that might hinder care. At the outset, the group tracked 90 seri- ously ill patients for two years and showed a 62 percent reduction in inpatient, outpatient and ER costs. Among those who received help from Familias was Crispin Lopez Serrano, a liver cancer patient who had resigned himself to fate and faith. The 58-year-old suburban Portland resident had lost his private health insurance when his illness made him unable to work construction. “I was just going to get by with the grace of God, eating aloe and drinking herbal teas,” Lopez Serrano said. A Familias navigator, however, helped him sign up for Medicaid and retain his same doctors. The support groups restored his hope and let him know he wasn’t alone. Getting to know other Latinos who were fighting serious illnesses “motivated me to live,” he said. Advocates want such programs expanded to help the increasing population of aging minorities, and the approach has popped up in spots around the US At Harborview Medical Center in Seattle, where the foreign-born population has increased 40 percent over the past decade, culturally specific palliative care programs have been created for immigrants from Mexico, Somalia, Vietnam and elsewhere. And, citing a need for growth, California State University’s Institute for Palliative Care has begun offering an online course that hones in on the needs of Latino patients. Radically changed The programs help break down barriers that traditional care models miss, gaps that can lead to improper diagnoses and poor treatment. “Being culturally competent means you know where people come from, their values, and you take an extra step to go toward where they are,” Olga Gerberg, director of patient navigators at Familias, said. “You need to address the mentality of the person’s approach to illness.” In Alcantara’s case, the organization radically changed her approach by encouraging her to educate herself about different types of treatments and teaching her how to discuss them with her doctor. With the help of her patient navigator, the 45-year-old found a new oncologist and decided against chemotherapy, instead choosing a less taxing treatment that allows more time with her two children. She now volunteers as a patient navigator, helping other Latinos. She says there’s a need, since others likely face treatment barriers similar to her own. Growing up, “health was just not so important,” she said, explaining an obstacle that she once faced. “It wasn’t something you discussed openly. If there were problems, you fixed it yourself.” — AP LONDON: As West Africa’s devastating Ebola outbreak begins to dwindle, scientists are looking beyond the endgame at the kind of nextgeneration vaccines needed for a vital stockpile to hit another epidemic hard and fast. Determined not to lose scientific momentum that could make the world’s first effective Ebola interventions a reality, researchers say the shots, as well as being proven to work, must be cheap, easy to handle in Africa and able to hit multiple virus strains. That may mean shifting focus from the stripped-down, fast-tracked vaccine development ideas that have dominated the past six months, but it mustn’t mean the field gets bogged down in complexities. “We need a stockpile because there will be other outbreaks,” said Seth Berkley, chief executive of the GAVI global immunization alliance, which helps bulk-buy vaccines for poor countries. The experimental vaccines now moving into large clinical trials in West Africa target the current Ebola Zaire virus strain, but the next outbreak may be different. “We need to work with the pharmaceutical industry to create secondgeneration vaccines that would cover not just Ebola Zaire but also Ebola Sudan and perhaps Marburg, perhaps Lassa. The idea is to have vaccines that will work across different places,” Berkley said. Right now, scientists are grappling with several tricky issues-partly due to success in cutting new infections in the vast Ebola outbreak. With relatively few new cases, big trials in Liberia and Sierra Leone to test the first generation singledose one strain vaccines may not have the statistical power needed to show whether the shots work. And already, early data from safety trials in humans suggest a single-dose vaccination with the most advanced vaccine, from GlaxoSmithKline, may not provoke an immune response strong enough to protect people exposed to the virus. “We now know you get around 10 times fewer antibodies in humans (than in monkeys) and probably five times fewer T-cells,” said Adrian Hill of Oxford’s Jenner Institute, referring to two key elements of the immune system. This strongly suggests that a two-dose regime, or a so-called “prime-boost” approach, is the one likely to prove effective, Hill said. Sizeable challenge These and other issues add up to a sizeable to do list for scientists focusing on vaccines for future stockpiles. Producing multi-strain, or multivalent, vaccines that could protect against different types of Ebola and other haemorrhagic fevers will be more time consuming than making today’s monovalent shots, but it is by no means impossible. In fact, several of the candidate Ebola vaccines being fast-tracked through testing started out as multivalents before being stripped back to deal with the current outbreak. Another challenge is ensuring vaccines have a long shelf-life and can be easily transported in the tropics. At the moment, test shots are kept at -70 or -80 degrees Celsius, although Johnson & Johnson says its Ebola vaccine can be stored at normal fridge temperature for many weeks. Producing adequate volumes, however, looks manageable. Hopefully, the next time Ebola emerges from Africa’s forests it will be spotted earlier and immunization will be needed for perhaps tens of thousands of people-nothing like the tens of millions who would need vaccines in a worldwide flu pandemic. Finally companies still need a regulatory green light, which gets tricky if large-scale trials fail to produce clear proof that the shots are both safe and effective in people. Researchers and drugmakers say, however, that regulators have made clear stockpile Ebola vaccines could be approved on efficacy data from tests in monkeys or other non-human primates plus proof of safety and immune response in humans, reflecting contingency plans for vaccines designed for bioterror attacks. Pursuing tomorrow’s vaccines is not to say one of today’s monovalent shots from GSK, Merck or J&J might not yet have a role in ringfencing lingering pockets of infection in the current epidemic, and perhaps finally stamping it out. “I’m pretty optimistic there’s still a role for vaccination in ending this outbreak,” said Hill. “And I’m certainly optimistic that we’ll learn for the next outbreak which of these vaccine approaches is the most likely to work, and be ready to tackle it early on.” — Reuters Scientist considered father of birth control pill dies SAN FRANCISCO: Carl Djerassi, the chemist widely considered the father of the birth control pill, has died. Djerrasi died of complications of cancer Friday in his San Francisco home, Stanford University spokesman Dan Stober said. He was 91. Djerassi, a professor emeritus of chemistry at Stanford, was most famous for leading a research team in Mexico City that in 1951 developed norethindrone, a synthetic molecule that became a key component of the first birth control pill. “The pill” as it came to be known radically transformed sexual practices and women’s lives. The pill gave women more control over their fertility than they had ever had before and permanently put doctors - who previously didn’t see contraceptives as part of their job - in the birth control picture. In his book, “This Man’s Pill,” Djerassi said the invention also changed his life, making him more interested in how science affects society. In 1969, he submitted a public policy article about the global implications of US contraceptive research, according to the Stanford News Service. In 1970, he published another article about the feasibility of a birth control pill for men. “The thoughts behind these two public policy articles had convinced me that politics, rather than science, would play the dominant role in shaping the future of human birth control,” he wrote. Later in life, Djerassi, a native of Austria who came to the US in 1939 with his mother, wrote poems, short stories and plays. He used stock earnings from the company that made the pill to help collect Paul Klee art work, which he donated to the San Francisco Museum of Modern Art, the San Francisco Chronicle reported. AUSTRIA: In this Oct 20, 2009 file photo, Carl Djerassi talks to Austrian Chancellor Werner Faymann, not seen, at the federal chancellery in Vienna. — AP “Carl Djerassi is probably the greatest chemist our department ever had,” Richard N Zare, the Marguerite Blake Wilbur Professor in Natural Science at Stanford, said in an obituary released by the university. “I know of no person in the world who combined the mastery of science with literary talent as Carl Djerassi.” “He also is the only person, to my knowledge, to receive from President Nixon the National Medal of Science and to be named on Nixon’s blacklist in the same year,” Zare added. Djerassi told the Chronicle last year he was tired of talking about the pill. “Carl did many things in his life - he was a true Renaissance man and scholar,” Philip Darney, a contraceptive scientist and director of the University of California, San Francisco’s Bixby Center for Global Reproductive Health, told the Chronicle. He is survived by a son, Dale Djerassi; a stepdaughter, Leah Middlebrook; and a grandson, Alexander M Djerassi. — AP