The annual Diagnostics for Global Health Workshop, held on the 1st and 2nd August 2023, and chaired by Professor Jacqueline Linnes of Purdue University, Professor Debjani Paul of IIT Bombay, and Dr. Samantha Byrnes of Diagnostics R&D at Amazon, brought together over 50 researchers and engineers, epidemiologists, microfluidics experts, and public health and clinical professionals in virtual format to share and discuss the latest research, developments, and innovations in global health diagnostics. The presentations, panels, and posters convened by the workshop brought into sharp focus the significant gaps and responsive solutions that continue to define the sector in the wake of the Covid-19 pandemic. Shannon Branigin from the Global Frugal Dx Network attended the event and reports here on the main debates and takeaway points
Professor Madhukar Pai of McGill University set the stage for the two-day workshop by highlighting the Lancet Commission on Diagnostics’ 2021 findings: globally, there remains a consistent scarcity of diagnostic capacity and capability across continuums of care. One of the biggest healthcare lessons learned from the Covid-19 pandemic is the need for timely, accurate, and widely-accessible diagnostics. The global lack of diagnostics, observed across disease burdens, demonstrates a critical juncture in Covid-informed healthcare reform, making visible a global gap that urgently requires solutions. Professor Pai stated that now, more than ever, it is vital to leverage the knowledge, innovations, infrastructures, and public engagement built during Covid-19 to transform access to diagnostics for all diseases, co-produced with users and localized to specific contexts.
Following this dynamic call to action, two panel sessions invited speakers to further bring into dialogue their experiences and expertise in the diagnostic landscape. Two rounds of lightning talks and interactive poster sessions emphasized the impactful work being done to develop applications, devices, and techniques that work to close the gap for specific communities and disease burdens. Innovations included CandyCollect, a lollipop-inspired saliva collection device for noninvasive diagnostics targeting children, portable point-of-care digital cancer diagnostics for accurate and rapid results trialed in Botswana, and point-of-care electronic biosensing for onchocerciasis, or river blindness, transmitted by female blackflies. The virtual format of the conference facilitated accessibility across geographies and time zones, emphasizing the benefits of global collaboration for productive dialogue.
Lessons from Tuberculosis (TB) Diagnostics
Unfortunately, attention to TB diagnostics has fallen since Covid-19 became a priority in global health agendas. This has left a current global TB diagnostic gap of roughly four million missed cases. In response, Professor Pai outlined seven critical transitions needed to close the TB diagnostics gap, several of which are representative of wider goals in global health diagnostics. He emphasized elevating molecular testing as the new diagnostic standard and decentralizing testing to primary or point-of-care (POC) facilities as two major goals in the agenda. To effectively integrate diagnostics in primary healthcare, Professor Pai discussed how the adoption of nationally-specific Essential Diagnostic Lists (EDLs), embedded in health insurance plans, will move forward a new frontier for widespread accessibility to TB and other diagnostics.
Chemical engineer and co-founder of Papyrus Diagnostic, Professor Bhushan Toley of the Indian Institute of Science shared challenges and lessons learned in TB diagnostics at the stages of research, development, and commercialization. He dissected innovations from his Laboratory for Ubiquitous Medical Diagnostic Technologies to unpack emerging priorities in diagnostics research and development: among them, the need to design innovations with manufacturing feasibility in mind, the need to work within national political priorities to overcome regulatory hurdles, and the need to indigenize manufacturing. Indigenization calls for investment in medium and small enterprises local to a place of research or implementation. This enables a local supply of materials, increasing the availability and affordability of diagnostics technologies in the contexts in and for which they are developed.
Fostering Community Engagement
The final speaker of the workshop’s first day, Professor of Engineering Umut Gurkan of Case Western Reserve University, highlighted the importance of researching and developing diagnostic technology in a community engaged way. Community engagement requires diversifying and funding technological developments across the mega-diverse Global South, especially as current investment flows concentrate on scaling up solutions developed in high income countries (HIC) and resource-rich settings, often disconnected from end-user contexts. Professor Gurkan outlined an invention and translation approach that reengineers the commercialization of diagnostic technologies for targeted populations, especially those typically underserved by larger companies. Invention and translation connects stakeholders across geographies and knowledge bases, expanding the big-picture innovation team to include local experts and on-site customers for a better understanding and adapted response to the root-cause of a disease burden.
Confronting Sustainability and Equity
The second day of the workshop began with a presentation by Professor in Microfluidic Engineering Maïwenn Kersaudy-Kerhoas of Heriot-Watt University that unpacked issues of environmental sustainability and financial equity in global health diagnostics. Covid-19 showcased the environmental detriments of point-of-care diagnostics, such as the proliferation of plastic and single-use tests. As such, Covid-19 diagnostics has led to escalated chemical, biological, and electronic waste across the globe, ultimately heightening waste management issues. Since environmental sustainability in diagnostics is rooted in the design stage, scientists and manufacturers can work to implement sustainable changes, such as by reducing reliance on single-use testing and developing manufacturer take-back schemes to upcycle and reuse materials. In conversation with speakers of the previous day, Professor Kersaudy-Kerhoas also addressed the financial inequities in diagnostics innovation. Highlighting financial inequities alongside health and knowledge inequities in diagnostics makes visible the need to diversify the concentration of IP and revenue in the Global North, such as by spurring global investment initiatives and situating priority-setting in the Global South.
Expanding and Improving Diagnostics Literacy
Professor of Diagnostics Research Tivani Mashamba-Thompson of the University of Pretoria discussed diagnostics literacy as an obstacle to implementation, especially in low-resource settings. Diagnostics literacy is critical for strengthening public awareness of healthcare services, informing health-seeking behavior and providing context for disease screenings and linkages to care. In response to this gap, Professor Mashamba-Thompson presented an innovative multi-level diagnostics literacy advocacy model. The model’s macro-level calls for the development of global advocacy, such as by conducting stakeholder workshops, establishing diagnostics advocacy groups, and developing localized testing and linkage-to-care programmes. Meso-levels involve developing social mobilization, such as with the creation of publicly-accessible information platforms and collaborations with religious leaders. The micro-level entails developing knowledge capacity, such as by educating healthcare workers and incorporating diagnostics literacy into schools, arts-based, and community-based programs. The model is adaptable to different contexts, reinforcing efforts to localize knowledge-building and uptake.
Panel Discussions: The Dx Valleys of Death and Sustainability
Two panel sessions facilitated conversations around prevalent priorities in global health diagnostics. The first day’s panel, with speakers Professor Bhushan Toley, Dr. Mikashmi Kohli of FIND, and Mr. Michael Campbell of the Clinton Health Access Initiative, Inc. (CHAI), discussed the two major Valleys of Death for diagnostics innovation identified by Professor Pai: the first to be found in the research and design stage, the second in the deployment stage. The second day’s panel invited Professor Kersaudy-Kerhoas, Professor Mudrika Khandelwal at the IIT Hyderabad, and Mr. Harry Akligoh of Yemaachi Biotech to further explore the challenge of sustainability in the context of a push toward greater availability and use of single-use point-of-care tests. Professor Kersuady-Kerhoas and Mr. Akligoh are two of the co-founders of the Global Frugal Diagnostics Network, a platform working to build a diagnostics ecosystem that prioritizes sustainability, equitability, and decentralized co-production.
Challenges and Lessons Learned from Covid-19 Testing
The final speaker of the workshop, Professor Catherine Klapperich of Boston University, described the process of implementing rapid and high throughput Covid-19 testing at BU over the period of May to August 2020. Professor Klapperich’s work enabled on-campus learning by BU’s 2020 fall semester when most campuses remained closed, showcasing the potential for rapid innovation and implementation of point-of-care testing in an unprecedented and complex emergency scenario. Covid-19 throughput testing also significantly advanced social and technical pillars of diagnostics in the surrounding community, such as by strengthening public diagnostics literacy and promoting the commercialization of molecular testing.
The workshop was closed by Dr. Adriana Velazquez, the World Health Organization’s Team Lead for Medical Diagnostics, who spoke on the recent approval of the World Health Assembly’s Resolution on Strengthening Diagnostics Capacity in May 2023. The Resolution is a significant step forward for prioritizing diagnostics in member states’ public health agendas, and it is an important sign of endorsement for action, for the research and work shared in this workshop, to close the global diagnostics gap.
A big congratulations to the winners of the Lab on a Chip poster awards, Vanessa Ho for her poster “A microfluidic platform to quantify single microRNA molecules in primary human samples at a single cell level,” and Oshin Sharma for her poster “Point-of-care detection of sickle-cell disease and trait, through microscopic determination of red blood cell shapes induced by differential hypoxia.”
The Diagnostics for Global Health Workshop was sponsored by the Chemical and Biological Microsystems Society (CBMS). Benefactors included the Global Engineering Program at Purdue University and the Shah Family Innovation Lab.
This blog post was supported by the Global Frugal Diagnostics Network, with support from Heriot-Watt University, the Royal Academy of Engineering (Frontiers Champion Award), the University of Edinburgh, the European Research Council (grant number 715450), and the Kühne Foundation.
Founding members include Maïwenn Kersaudy-Kerhoas (Heriot-Watt University), Harry Akligoh (Yemaachi Biotech), Zibusiso Ndlovu (MSF), Alice Street (University of Edinburgh), Ayokunle Olanrewaju (University of Washington), and Elena Rosca (Ashesi University). Shannon Branigin is the Global Frugal Diagnostics Network Media and Communications Officer. For more information about the Network, join the Slack space https://join.slack.com/t/globalfrugaldxnetwork/shared_invite/zt-20wnzwwl3-sWpr~XGaEILA5SBLcpG8~Q and follow @GlobalFrugalDx on twitter/X.