Last week, the Wall Street Journal reported that a Nepalese man detained at the U.S.-Mexico border has extremely drug-resistant tuberculosis, XDR-TB. Tuberculosis, a potentially fatal disease that can be passed through the air, has historically been curable with appropriate treatment. However, new strains of TB that are resistant to available drugs have recently emerged and pose a significant public health threat. Some strains are resistant to only a few drugs (multi-drug resistant TB) while other strains, such as the one carried by the man in this story, are resistant to nearly all existing drugs. Because of this, XDR-TB is extremely difficult to treat and experts warn that new drugs will be necessary to treat growing numbers of patients with this disease.
In addition to the need for new drugs to combat XDR-TB, this case underscores the need for improved TB diagnostics. Because this man was tested in the U.S., his samples were sent to an advanced laboratory that had the equipment necessary to detect the drug-resistant strain. However, many developing countries where TB poses the largest burden do not have the technological or health infrastructure to accurately diagnose XDR-TB cases. Therefore, patients may not receive appropriate treatment, which is detrimental to their own health and means that they can continue to pass drug-resistant TB onto others. Research to develop simple, efficient and low-cost TB diagnostics is urgently needed.
Unfortunately, this story is not an isolated case. Prior to entering the U.S., the man had made his way through 13 countries and had likely come into close contact with hundreds of people, many of whom may have been infected. In this era of globalization, diseases will continue to cross international borders and it is imperative that public funding for new tools and for this type of research is sustained.
–Morgan McCloskey, global health intern
An article in the most recent issue of The Scientist highlighted the importance of affordable diagnostics for global health. Although scientific advances have improved treatment options for many global diseases, a lack of effective, low-cost diagnostics hinders the health of many in the developing world. For example, medicines to treat HIV and tuberculosis have been life-saving for many individuals, but they can cause liver damage and patients on these medications must be monitored. However, the primary test for liver damage requires expensive equipment that is simply not available in low-income countries. To solve this problem, a Massachusetts biotech company, Diagnostics For All, developed a 10 cent paper-based test that can diagnose liver damage with a single drop of blood.
Other U.S.-based companies are working on similar low-cost diagnostics. In Texas, Global BioDiagnostics Corp is developing a more effective test for tuberculosis that will cost just $5. Both of these projects are excellent models for incorporating the idea of access into the research process and designing products that can actually be utilized in low-resource settings. However, there is often not enough money for companies to develop these kinds of products. In fact, a principal investigator at PATH says that “the problem [with low-cost diagnostics] is almost always funding.” Therefore, it is crucial to increase funding for affordable diagnostics. Not only would increased investment support these U.S.-based companies, but the end products could truly transform health care in the developing world.
Update: Another article, published in The Scientist on January 10, also addresses the urgent need for better diagnostics in resource-limited countries. In addition to making diagnostics more affordable, truly successful new diagnostics must also be “sensitive, specific, user-friendly, rapid, equipment-free and deliverable” and these considerations must be built into the R&D process. Overcoming these research challenges hinges not only on additional funding, but collaboration between research companies, the healthcare industry and local governments. Several Product Development Partnerships (PDPs) are leading the charge in these kinds of innovative collaborations. For example, the Foundation for Innovative New Diagnostics (FIND), a PDP based in Geneva, Switzerland, is working with manufacturers, health organizations and ministries of health and developing diagnostics from the initial design to the operational research phase to determine the diagnostic’s efficacy in a low resource setting. The importance of these kinds of new tests, which will result in more appropriate treatment plans that can save lives and money, cannot be overlooked.
-Morgan McCloskey, global health intern