Team:Shanghai Metropolis/Human Practices

Questionnaire Survey

The research, development and launch of a product requires more background research and social market consultation. In order to investigate the public's awareness of Hand-Foot-and-Mouth Disease(HFMD), we put a questionnaire of 19 questions on public communication platforms (such as WeChat).


First of all, we received 248 results from different age groups. Most of them were under 18 years old and middle-aged people in their 30s and 40s. Among them, more than 98 percent were from cities and towns, and the average person was a parent who participated in the results survey. However, to our surprise, 94.35% of the respondents haven’t sufferedfrom hand, foot and mouth disease. Only 1/3 of them had experienced or witnessed HFMD. 74% of people chose the option that the susceptible population is more likely to be under the age of five, which is still a general perception.

In terms of symptoms and risks of Hand- Foot-and-Mouth Disease, more than 77% of people identified fever as the main symptom. Also, more than half of the respondents identified loss of appetite and blisters and ulcers throughout the body as symptoms of HFMD.

We also looked at HFMD transmission and found that 75% of people opt for the conception that HFMD was spread through nose or throat secretions. Salivary transmission along with fecal and hygiene effects is also considered by many one of the routes of HFMD transmission.

As for the severity of Hand- Foot-and-Mouth Disease, half asserted that it was serious but did not cause death, while a quarter said it posed a death threat and another quarter said it wasn’t a serious disease. Most people thought that keeping skin and mouth clean is the best way to prevent Hand- Foot-and-Mouth Disease, while relatively few people thought that it’s vaccination that can be convincible. To our surprise, the ratio of participants who recognized that HFMD was vaccine-preventable to those who didn't is 3:2. In addition, when faced with a choice between the traditional vaccine and the oral vaccine, more people preferred the oral vaccine than the injectable one, while a third of them were neutral. It's worth emphasizing that 70 percent of people's biggest concern about oral HFMD vaccine was its safety. When asked about the advantages of oral vaccines, most people were aware that they were easy to take and easy for children to accept. Interestingly, although oral vaccines can also ease people's financial burden in terms of health insurance and costs, this advantage has not been particularly highlighted.

Through the online questionnaire, the following conclusions can be drawn. The population itself has a good understanding of the symptoms of HFMD, and can accurately identify HFMD in most cases, as well as understand the transmission route. The potential effects of Hand-Foot-and-Mouth Disease are somewhat less well understood, with only a small number of people is fully aware of the deadly consequences of HFMD.As the HFMD vaccine has not been mandatory, the public is not fully aware of the significance of HFMD vaccine. Besides, since oral vaccine is a new product in this field, the promotion of Enterovirus 71 oral vaccine is still facing social resistance. In view of the above situations, we realize that we should increase the publicity of the effectiveness and affordability of oral vaccine, so that more people can know about its advantages, in order to maximize the promotion of vaccine and fully utilize it.

Street Investigation

When the Research & Development of new products is completed, analyzing the market positioning, audience characteristics and stakeholders of products is also an important link related to the success of products. By understanding the social background, producers can adjust and optimize product quality and product performance in time. Enterovirus 71 oral vaccine, as the first oral vaccine of Hand-Foot-and-Mouth Disease, has incomparable advantages over traditional injectable vaccines.

In order to better understand the customer need of our product in order to better promote the oral vaccine in the future, our team members took to the streets and conducted offline field visits.

We interviewed 24 people in public areas. The respondents ranged in age from 18 to 60. The range of education is very wide, ranging from elementary, middle and high school to undergraduate students. We examined the causes, prevention of HFMD, and public opinion about its oral vaccines. We’ve got a lot of different results. First of all, most people believe that the cause of Hand-Foot-Mouth virus is weakened immunity caused by neglection of health care. Based on what they have seen in life, some interviewees believe that the susceptible population is distributed among children. A small number of people does not know enough about the causes of HFMD. According to statistics, more than 80 percent of people believe that frequent hand washing is the best way to prevent illness. In addition, oral vaccines have unfortunately been adopted by only a small number of people, and some are skeptical about the oral vaccine’s future. We found that the low acceptance of oral vaccine resulted from people’s doubts about its efficiency.

With the continuous development and breakthrough in the field of biotechnology in recent years, the research level and technology in the field of vaccine have been constantly strengthening. This social research aims to explore the public's cognition and views on HFMD and its oral vaccine, which are essential background and basis for us to promote the project research. The above research shows that the research content of our team has unlimited development prospects in the future. We hope that with our efforts, people can have a certain knowledge and understanding of biomedical such as Hand-Foot-Mouth Disease and oral vaccines. In the near future, I believe our oral vaccine could be more widely accepted and thus serve to prevent more people from this terrible diease.

Interview

Up to now, for the sake of researching more opinions about the oral vaccine of HFMD, we have interviewed three professionals, including an HFMD's doctor, a professor in the vaccine industry, and a consultant in biotechnology technology field. These professors have provided their insights about our products by answering our questions, which are helpful to us, and we appreciate these suggestions. Additionally, we have also made some questionnaires online and interviewed some residents in the streets. We think that these opinions from street investigatin are also important to us, especially in terms of market selling. Thus, after taking opinions from both professionals and our fellows, we are confident in the prospects of this oral vaccine.

Interview with Dr. Li

We interviewed Dr. Li Aifang, Director of Pediatrics at Hebei Yangyuan People's Hospital, about the direction of HFMD, so as to better promote the progress of our HFMD oral vaccine program. The interview results were divided into two parts: analysis of symptoms and prevention of Hand-Foot-Mouth Disease.

The high incidence season of HFMD is from May to July. According to Dr. Li's statistics, among the more than 100 patients treated by the pediatrics department every day, about half are HFMD patients.

Although HFMD is severe, the incidence of severe cases is not high, and they only saw one case of HFMD in a year. But if the symptoms are mild, you can wait forits self-cure, and needs no treatment. In addition, there is possibilities of recurrence of Hand-Foot-Mouth Disease. It is not caused by a single virus, but by more than 20 enteroviruses. However, the vaccine only targets at one of the viruses (EV71), so there may be a recurrence. And the vaccine is inactivated vaccine, the protective effect is limited, which provides no guarantee for lifelong immunity.

Hand-Foot-Mouth Disease and other related conditions do not have a specific antiviral response. According to Li, the onset of such diseases is acute, with severe cases usually worsening in one to five days, so antiviral drugs are not recommended for treatment worldwide. As for the treatment method, Dr. Li introduced that it is generally symptomatic treatment, direct treatment of complications (such as fever, vomiting, diarrhea, etc.), both traditional chinese medicines and western medicines are used, and some vitamins or proprietary Chinese medicines are used to assist. Dr. Li said, for the prevention of Hand-Foot-Mouth Disease, we need to pay attention to hygiene, avoid contact with patients. Timely medical treatment is also very important, Hand-Foot-Mouth Diseaseis very Acute when it suddenly occurs, whose belated attention would render the disease harder to eradicate.

For the Hand-Foot-Mouth Disease vaccination,Dr.Li said children between 6 months and 3 years are most suitable for getting vaccinated. Also, vaccination is not 100% preventable for Hand-Foot-Mouth Disease, children vaccinated would still caught this virus. However, the symdrone would be much milder. Dr. Li believes the idea of an oral vaccine forHand-Foot-Mouth Disease is very advanced, and thinks a sugar pill version would be more acceptable to young children. Currently, only the inactivated vaccine of EV71 has been marketed in China, and it is a self-funded vaccine. Dr. Li said that although many parents understand the symptoms of Hand-Foot-Mouth Disease, they will ask to be hospitalized to observe and prevent sudden symptoms, but they are not willing to let their children be vaccinated against Hand-Foot-Mouth Disease. Vaccination is not widely practiced, partly because of complications (the side effects of vaccination) and partly because of economic problems. The country did not invest enough in such a vaccine, which doctors recognized as the reason for low incidence of EV71. Dr. Lee and his team took samples from several patients, and none of them were EV71. But hospitals are still indefatigably promoting the HFMD vaccine. Doctors gather that the low incidence of getting vaccinated can be accounted for by poor publicity rather than the vaccine quality.

Interview with Professor Han

To obtain a comprehensive understanding of the vaccine, EV71 terminator interviewed Mr. Han Zhenggang, who holds a master degree in virolgoy from the Chinese Academy of Sciences and Ph.D degree in Natural Science from Lubeck University in Germany. Professor Han, an expert on virology, is currently an associate professor in Wuhan Polytechnic University.

For starters, Professor Han analyzed the vaccine itself. We first consulted Professor Han about vaccination. Some vaccinations, taking the COVID-19 vaccine as an example, need to be vaccinated for three times. Moreover, the three doses of vaccine may come from different manufacturers, so the choice of vaccine producers has also become a concern of vaccinators. Professor Han explained that choosing vaccines from same manufacturer leads to higher safety and weaker immune response, becausethe inactivation processes vary from different manufacturers, the antigen structures produced are different. In addition, many people will have some side effects after vaccination, and are convinced that the side effects after vaccination are the consequences of the vaccine effect. In fact, this is a normal immune response after vaccination, exemplifies as fever, pain, etc. Therefore, we consulted the association on the severity of immune response and vaccine effectiveness. Professor Han pointed out that a strong immune response results from a strong personal immunity system rather than the effect of the vaccine. Generally speaking, the immune response to oral vaccine is greater than that of injection vaccine, because oral vaccine is activated vaccine and injection vaccine is inactivated vaccine. From the perspective of safety, oral vaccine carries more risks than injection vaccine, because it is more toxic so as to lead to a small probability of the revival of the virus. Owning to the relatively higher efficiency, oral vaccine can be taken just for once. In comparison, injective vaccination requires two to three shots to produce antibodies against the disease.

Additionally, when referring to the social background of oral vaccines, Professor Han pointed out that the social resistance faced by the oral vaccine is closely related to the incidence rate of one area and the cost of vaccination. The smaller the injected population, the higher the cost of vaccination. As a non-statutory vaccine, people's elasticity of vaccination is relatively more flexible. Therefore, factors such as the convenience of vaccination and the social publicity of the vaccine themselves will play a more essential role upon whether certain people would get vaccinated. For city with low incidence rate, such as Shanghai most families will choose to vaccinate their children, since they consider it affordable and worth inoculating. For cities with high incidence rate, which refers to those with warmer temperature and higher humidity, the demand for Hand-Foot-Mouth Disease, vaccine is surprisingly smaller, which is in converse with their proper approach of prevention.In this context, there is be a small number of families unable to afford the cost of vaccination, resulting in the consequence that the transmission of the virus can’t be completely cut off. As long as the virus is still spreading among people, the disease cannot be eliminated. In this context, oral HFMD vaccine has obvious advantages and future room for further improvement. On the one hand, because it is easy to carry and syringe pollution is more likely to be avoided, the oral version solves the problem of inconvenience concerning time and place, and also dispels parents of their qualms about the security of the vaccine.. On the other hand, in order to promote the vaccine in a larger dimension, it is necessary to strengthen the social publicity and popular science education of thevirus as well as the vaccine. The popularity of oral vaccine for HFMD has yet to be improved, so as to expand the vaccination population and reduce the vaccination cost.

Moreover, we consulted the professor on the technical issues of oral vaccine and the future development. The professor said that there is no oral vaccine for HFMD currently. But fortunately, as an enterovirus, HFMD is believed to be suitable for making oral vaccine. The coming-out of a new vaccine is on the premise of weakening the independence of the virus and breaking its defense. This also shows that oral vaccine has a long way to go on the scientific conquer. The professor says this process for oral vaccines is much harder than injectable vaccines to kill the virus. On the road of oral vaccine research and development, scientists will spend more time exploring this frontier field.

Finally, the professor explained that the above process has great randomness and uncertainty. Louis Pasteur tried this method as early as 100 years ago in the research of rabies virus. He was a brave and innovative scientist. He deduced that the rabies virus should be concentrated in the nervous system, so he boldly took a small piece of spinal cord from the dead rabbit and opened up a new field of live vaccine. In the long history, the development of live vaccine not only needs time, but also needs the support of a combination of multiple factors. Courage, innovation and opportunity are indispensable factors for scientific success. However, the professor believed that the long-term exploration of live viruses was no longer suitable for the current pace of scientific development. Nevertheless, people should continue to explore and make breakthroughs in the active vaccine, because once the research and development is successful, the efficiency will be improvedand more people's health can be guaranteed.

Interview with Mr.Andong Zhang, Senior Manager, Risk Management (Medical Industry Focus), COSCO Leasing,Co.,Ltd

We interviewed Mr. Zhang,on how to push our project forward. The first part is about the vaccine market in China. The Chinese Vaccine market is a multiple market with many segments, which is our target field, in which the field of Oral Hand-Foot-Mouth Disease Vaccine has a relatively low threshold, making it a golden opportunity for us to grasp. However, according to the Chinese laws of vaccine production, we have to get franchise rights, technical support, financial investment, clinical trial reports, etc. in order to successfully get the vaccine legally launched and come into service. Following Mr. Zhang's suggestion, as an independent research and development team, we established the route of focusing on research and development in the early stage, signing technical service agreements with established large companies to backup our resources. And we will focus on purchasing and acquiring patents in the later stage. Because the laboratory cannot mass-produce, we focus more on patents and use the company's platform to develop and promote our products. Mr. Zhang introduced that China's biotechnology market has a promising prospect. Because of the increase of aging population, the pursuit of health stability,and the strong government policy support, which provides a good background for our product investment and financing, the vaccine market is less likely to fluctuate.

The second part is about government policy in China. Hand-Foot-and-Mouth Disease vaccine is now aiming at the market in China. The Chinese government’s supervision, management and legislation had a big loophole before 2018. From 2019 to 2021, the governments been strengthening the supervision.Thus, policy constraints of our business promotion environment became fair, transparent and conducive to improving public recognition of products. As a public vaccine, HFMD vaccine plays a very important role in ensuring public safety. Although it is still a self-funded vaccine at the present stage, Mr. Zhang and our team believe that the promotion rate of HFMD vaccine will be greatly increased in the future. Therefore, the introduction of oral vaccine, which is easier for children to receive, will greatly help the market share in the future. Mr. Zhang introduced that in the promotion stage of our products, we can cooperate with government officials, local hospitals and local associations to promote the products. In addition, since the oral HFMD vaccine is a new product which will expand overseas market, attention should be paid to the cooperation with governments of various countries. As for the vaccine industry, there is a possibility for countries to carry out a certain amount of trade protection, so we should actively promote cooperation with those governments. Finally, regarding the appearance of our products in market, according to Mr. Zhang's analysis, we should take several issues into consideration, including the competitive advantage over other large companies, the quality assurance of products, the safety of storage and transportation, the administrative issues in promoting vaccines, and the sustainability of the capital chain.