By Melissa Dribben, Inquirer Staff Writer
POSTED: May 25, 2014
On May 6, 2010, a 15-year-old boy named Oriel died of diphtheria in Haiti.
Normally, the world would not have noticed. But the boy was living in a refugee camp managed by the actor Sean Penn. With the listless teenager in his sinewy arms, Penn had spent hours, rushing from hospital to hospital in the capital of Port-au-Prince, searching for the antitoxin that would save Oriel's life.
It was found too late. Shortly after the boy was taken off life support, Penn appeared on CNN, expressing outrage about the many factors that led to his death.
At home in Philadelphia, actor David Morse turned on CNN that night and saw his friend, distraught over the tragic absurdity that children were still dying of a preventable disease like diphtheria that had been nearly eradicated decades ago in the United States and Europe, where children are vaccinated.
Morse called Penn. "I told him how moved I was and asked if there was anything I could do to help."
Regarding the immediate crisis in Haiti, the answer would turn out to be "not much."
But in his attempt, Morse set off a chain reaction that led to a simple idea about how to save the lives of millions of children.
If, that is, it could be made to work.
One of Morse's next calls was to another friend, this one a star in the field of medicine.
Harvey Rubin, an infectious-disease doctor at the University of Pennsylvania, does research on tuberculosis and the mathematical modeling of complex biological systems. His vast professional and personal network has made him a kind of human power grid.
If anyone could figure out a way to deal with the mess in Haiti, Morse figured Rubin was the one.
But Rubin had bad news.
The public-health nightmare that led to Oriel's death could not be fixed by merely airlifting in more vaccines and antitoxin. And it was not just confined to the ragged edges of Haiti's refugee camps.
"The problem," he said, "is that the cold chain is woefully inadequate."
The cold chain, Rubin explained, is the network of transportation and electricity that keeps vaccines at the proper temperature.
Most vaccines are exquisitely delicate, he said. From the moment they are manufactured to the instant they are injected, they must be kept at a constant low temperature. There is little room for error. Chilled to below 35 degrees or warmed above 45 degrees, they lose potency and become useless.
Over the last 30 years at the University of Pennsylvania, where ambition and intellectual prowess are as embedded as the brick on Locust Walk, Rubin has earned a reputation as the rare hyper-achiever who is generous about sharing glory and a genuinely nice person.
A 65-year-old triathlete with a bushy silver mustache and thick wavy hair, he speaks with the high velocity and curly vowels of a native New Yorker.
"Every year, 2.5 million children die from preventable diseases," mostly because they live in places where refrigeration is unreliable, he told Morse.
"When sera freezes," he said, "microcrystals form, breaking the bonds of the biological molecules in lipids and proteins. Heat creates too much energy, which also breaks bonds."
With such low tolerance for temperature changes, Rubin said, shipments cannot be left on pallets in the airport. Even if they survive the transfer to trucks and central storage, each successive segment - onto the back of a bicycle or a donkey, or into the backpack of a health-care worker who has to trek miles to a clinic - puts them at risk.
Morse mulled over the technological disparities.
"Why is it possible that I can be talking to Sean on his cellphone, using his L.A. number, while he's standing in the middle of the rubble in Haiti - that there are cellphones everywhere, completely off the grid in India and Africa - but you can't refrigerate vaccines?"
Good question, Rubin agreed.
"Go solve the cold chain," said Morse, glib but serious. "I'll call you in the morning."
A source of power
As much as he appreciated his friend's faith in him, Rubin knew it was a long shot. For decades, others had been trying. But Morse was right. In this day and age, there must be a way. But how?
Progress had been made. In 1974, only 5 percent of children under age 1 in developing nations were vaccinated against the six main childhood killers - diphtheria, pertussis, tetanus, measles, polio, and tuberculosis.
That year the World Health Organization launched a program to expand immunization coverage. Doctors and aid workers mobilized, said Ralph Henderson, a Harvard-trained epidemiologist and the program's first full-time director.
They improved infrastructure, coordinated efforts, and invented better refrigerators that stay cold for hours without power, Henderson said.
By 1990, the immunization rate had soared to 80 percent. Efforts to reach the remaining 20 percent, however, have largely failed.
WHO reports that one-fifth of the world's children - about 22.4 million infants - still are not immunized against the main killer diseases.
The cold chain.
In the back of his mind, Rubin had stored a factoid picked up years before from a cloud-computing expert.
"He told me that there were more cellphones than toilets in the world."
The talks with Morse stirred Rubin's thinking.
"If you have cellphones, there must be energy nearby, every mile or two. Signals are continuously transferred, tower to tower. Their power is everywhere."
On May 17, 2010, he had an epiphany.
As chairman of a committee that selects recipients for honorary degrees, Rubin had donned academic robes and taken his place on stage in Franklin Field for the school's 254th commencement.
One of the honorees was Paul Farmer, founder of Partners in Health, which brings high-quality health care, including vaccinations, to poor nations.
Also on stage was David L. Cohen, chairman of Penn's board of trustees and Comcast mahoff.
Waiting for the ceremony to begin, Rubin looked at the two men.
"In that moment - boom!" he recalled.
A possible solution, hiding in plain sight. Could it be he had found a way to fix the cold chain?
Cellphone towers require reliable sources of power. So in developing nations, where electricity is balky and blackouts can last for days, telecom companies supply their own, primarily with diesel generators. These sites are secure, because they have a financial incentive to maintain and protect them.
And because they are always anticipating growth, they probably produce more energy than they need to serve their current customers.
What if, Rubin thought, some of that excess power could be harnessed to run refrigerators for vaccines?
It made sense.
But was it doable?
A few days later, at the Starbucks on Walnut and 34th Streets, Rubin ran into his colleague Ali Jadbabaie, an electrical engineer and applied mathematician.
While Jadbabaie threw back a nonfat mocha, Rubin laid out his proposal. Technologically, he asked, did Jadbabaie think it would work?
Off the top of his head, Jadbabaie could not be sure, so he called a former classmate in Iran whose company installs cellphone towers in remote villages.
Towers have electrical outlets for testing equipment, his friend said. Refrigerators could be plugged in, no problem.
On May 20, Jadbabaie sent Rubin an e-mail.
"This is totally doable."
Chain of connectivity
Rubin was encouraged. But ideas, even promising ones, do not translate into reality without money. He reached out to a friend at Wharton for help developing a business model.
Meanwhile, Rubin could not afford to neglect his multiple day jobs. He needed to delegate, and knew just the right person.
Alice Conant was looking for a summer job.
Conant, a freshman at Harvey Mudd College in Claremont, Calif., was an engineering and math whiz who had spent most of her vacations since ninth grade working in research labs at Penn.
When Rubin told her the plan, she said, "I thought it was the most brilliant, innovative project you could ever work on."
On her first day, Rubin told her: "I'm a hands-off kind of guy. Show me what you can do."
Conant, sweet-faced, soft-spoken, and porcelain fair, proved fearless. She spent the summer poring over rural medical journals, technical papers, and global health reports.
She examined the electrical layout of cellphone towers, taught herself geographic information system mapping, worked with Jadbabaie's engineering students and Wharton M.B.A.s, and gathered reports that showed how many vaccine-related deaths were directly linked to a breakdown in the cold chain.
Then she and Rubin wrote a paper outlining the plan. In September 2010, their article, " 'Off-grid' cellphone towers could save lives," ran in the technical magazine New Scientist.
Within days, Rubin's inbox was flooded. Experts in business, technology, and public health called, offering help.
Meanwhile, the article had made its way into the Johannesburg office of Strive Masiyiwa, founder and chairman of the global telecommunications group Econet Wireless.
This idea for refrigerating vaccines had merit, Masiyiwa thought, which, in the world of African telecom, was tantamount to a papal blessing.
A canny, charismatic businessman, Masiyiwa launched his career in 1986 by challenging the national monopoly in telecommunications. One of the wealthiest men in Africa, he is a born-again Christian who devotes a great deal of his time and money to humanitarian causes and sits on the boards of organizations ranging from the Rockefeller Foundation to Morehouse College in Atlanta.
In short, the man whose business is connectivity is powerfully connected himself.
Masiyiwa tucked Rubin's idea away for a few months.
Back in Philadelphia, Rubin assembled a staff. They contacted local governments in India, ministries of health and private firms, looking for ways to put the idea into action. Consultants volunteered to refine plans and help Rubin spread the word.
Conant transferred to Penn, so she could devote more time to the project that now had a name - Energize the Chain - and official status as a nonprofit organization. (Since then, she has been awarded a Fulbright to research the intersection of health-care accessibility and cellphone coverage in India.)
"Everything sped up so fast after that first summer," she said.
In March 2011, Masiyiwa asked his chief technical officer to attend the annual meeting of the Global System Mobile Association in Mombasa, Kenya.
Rubin was one of the speakers.
Impressed by his presentation, the officer reported back to Masiyiwa that the project had merit. Two weeks later, at a meeting in Johannesburg, Econet committed funds for a pilot project.
A concept proven sound
Within a year, children in 10 villages in Zimbabwe were receiving vaccinations through Econet and Energize the Chain.
There are now 110 working sites, with 100 more set to go by December, and plans to expand into Lesotho and Burundi.
So far, 250,000 children have been vaccinated, said Precious Lunga, who runs the Econet project.
Rubin's concept has proven sound. Not only are base stations powering refrigerators, but Econet is using remote sensors to monitor how long the doors remain open and how many degrees temperatures rise when vaccines are taken out.
The project has also run into obstacles. Many of the cellphone towers are built on high ground to optimize reception and security, making it hard for some health-care workers to trek to refrigerators at the base stations.
It will take a few more years to serve the most remote areas, Rubin said. For villages closer to the grid and many that cannot yet access the towers, Econet has become a rallying point, providing refrigerators that stay cold for 10 days without power.
In April, Lunga, Rubin, Conant, and other colleagues participated in a conference at the United Nations. The purpose was to raise the project's profile, and highlight what remains the biggest challenge: getting private industry, government, and nonprofits to cooperate.
Ultimately, Rubin said, the most critical links in the cold chain are those forged among people.
Which may seem obvious, but as Lunga said:
"Simple solutions can change so many lives."