Contributed Commentary by Jonathan O’Halloran
September 17, 2018 | In a few days, I’ll be flying to New York to take part in the first ever United Nations High Level Meeting on tuberculosis. This should be a game-changer, with attendees including heads of state, international NGOs, and select private sector companies, all participating in the hope of eradicating this dreadful disease.
I feel like Neil Armstrong sitting in the rocket, just about to take off. It’s frightening and exhilarating all at the same time. It is definitely, in my industry, our moon shot for sure. If we’re ever going to beat this thing, we need global agreement on actions and the political will and funding to make it happen, and this meeting is our best chance to do that.
The stakes are high: there are an estimated 10.4 million new cases of TB every year, the vast majority in low and middle income countries, and it is believed that 4.3 million of these go undiagnosed and untreated.
For the “lucky” ones whose infection is picked up, they will most likely be given a standard six-month regimen of chemotherapy; these blanket poisons can have awful side effects: losing hair, hearing, sight, and weight. Patients feel sick all the time, and the chemotherapy may not even work because TB is a living organism that mutates and acquires resistance to drugs readily. In order to treat TB effectively, we don’t just need to know whether people have TB, we need to know what kind of TB they have, and which drugs they will respond to. This is where better diagnostics come in.
Next generation diagnostics will provide the ability to diagnose people near their homes, in the community, and give results in less than twenty minutes. A speedy diagnosis is critical; when people live far from testing centers and have to give up a day of work to visit a doctor, they often never return for their test results. In fact up to 38% of tested patients are lost to follow-up before treatment even begins. Drug susceptibility tests will also mean right-first-time prescribing so that patients are not needlessly medicated, but instead given treatment they can be confident will work.
I’ve been passionate about TB ever since I went to South Africa nine years ago to establish QuantuMDx, the molecular diagnostics company I co-founded with former nurse Elaine Warburton. South Africa then, as now, had a huge TB problem, and wanted to invest in solutions.
We put our lab right next to the WHO’s reference center for multi-drug resistant TB at Tygerberg hospital and I spent a lot of time chatting with scientists and healthcare workers there. They took me out into townships around Cape Town and Stellenbosch, and to see the devastation caused by TB first-hand was shocking.
I will challenge anyone not to want to dedicate their life to ending TB once they’ve seen a child have to suffer a bronchoalveolar lavage, the only current way to diagnose children who can’t produce enough sputum. Essentially their lungs are flooded with saline solution which is then collected when they regurgitate it—I will never forget that image.
In the past decade, tens of millions of dollars have been pumped into diagnostics from generous donors into big companies in an attempt to improve sensitivity or assay speeds, but these have not been as successful as hoped. Companies seem to be working on what they believe the market needs, rather than what the patients actually need. The resulting new technologies are too expensive, time-consuming, and they don’t multiplex – the ability to do lots of different tests on a single sample.
I think it’s the smaller companies who are really getting to grips with what is needed on the ground through novel innovation—and that’s why I believe QuantuMDx has been accredited to attend to the UN meeting.
When I visit countries like South Africa, India, and Uganda, healthcare providers tell me they want more options: speedy results to reduce loss to follow-up; the ability to test for other bacterial infections such as non-tuberculous microbacteria (NTM) at the same time; and quick results on drug resistance so the patient is prescribed the right TB treatment.
And it’s not just the individual healthcare providers and patients who will benefit from these results. New diagnostic devices will allow geotagging of anonymized patient data into the cloud. By aggregating that data electronically, you can have a real-time picture of the prevalent drug resistance mutations in any one population country-wide.
This would allow a health provider to direct the correct drugs to those populations, from a central repository. So, you can have a treatment algorithm for Cape Town that’s different to the treatment algorithm for Durban, specifically based on the drug resistant status of those populations.
I hope to hear many other compelling ideas on September 26. At the meeting I want to garner further recognition of the need for better TB diagnostics, to ensure that the politicians and the funders fully understand the realistic costs of developing new diagnostic tools. I want them to start thinking about innovative patient-centric solutions, not just individual technologies.
We know how to beat TB, we’re developing the tools to do so, we just need the political will to form a cohesive global plan, and the money to fund it.
If that doesn’t happen, the cycle of missed cases and blanket-treating sick individuals is going to create the perfect storm; this disease will continue to kill millions of people year after year, mainly kids and people in low resource settings.
If it succeeds, we will have promises from governments to put together the plan to allow us to implement what we know will work. We can look forward to a future where individuals will be able to get the correct treatment first time and TB will, finally, be eradicated.
Jonathan O’Halloran is Chief Scientific Officer and co-founder of QuantuMDx. QuantuMDx has been accredited to attend the United Nations General Assembly’s high-level meeting on the fight to end tuberculosis on 26 September 2018 in New York with the overall theme “United to end tuberculosis: an urgent global response to a global epidemic”. He can be reached at firstname.lastname@example.org.