Why malaria diagnosis needs to move into the 21st century.
« Great companies start because the founders want to change the world… not make a fast buck. » – Guy Kawasaki
The term « disruption » often conjures a negative image. A disease disrupts the ordinary process of things on both a micro and a macro level; individuals experience disruption in their lives through losing their ability to work or attend school and through the medical costs that come with disease. On a larger scale, businesses, governments and entire societies suffer the inevitable interference that comes with being placed in a disease endemic area. The direct cost of malaria has been estimated to be the equivalent of $12 billion per year, with damage to economic growth projected to be far more.
In the business and innovation community, the term has a more positive spin. « Disruption » is the lifeblood of start-up business. Interfering with the status quo by offering different solutions to old problems is often the pillar upon which young companies rest. It may be that disruptive companies have a part to play in shaking up the current techniques of malaria diagnosis; disrupting the disruption could be the way forward.
Prompt diagnosis and effective treatment are the cornerstones of malaria case management. Patients who are diagnosed early recover quickly and require less anti-malarials to treat. However, if the disease is not correctly diagnosed or the diagnosis is delayed the disease can quickly progress, increasing the severity of symptoms and the risk of death. The current methods leave too much room for error and logistical complication both from an individual and disease control perspective.
« The main problem with malaria detection is that dipsticks are unreliable, they’ve got poor shelf life and they’re quite expensive » – Professor David Mendels, xRapid inventor
It is also vital that malaria diagnosis is extremely accurate. Any tool used as a diagnostic needs to be consistently reliable. Avoiding misdiagnosis and uncertainty has several positive ramifications. Because malaria symptoms cross over with several other diseases, there have been instances of people being treated for malaria when they have contracted something else. For this reason, only an accurate test can truly diagnose malaria. The overtreating caused by symptomatic diagnosis and unreliable testing not only misplaces the supply of antimalarials, but also skews the picture of an outbreak.
Reliable data for malaria outbreaks can only be created and used as a method of control if the diagnostic tool is incredibly consistent and reported quickly. Diagnostic tests already play a large role in malaria surveillance activities, but one issue with current rapid diagnostic tests is that they rely on accurate outbreak statistics in order to be used at the sensitivity needed for pin point diagnosis. This creates a cycle of inconsistency.
Besides speed and accuracy, the main obstacle current diagnostic technology presents is cost. Malaria does most of its damage within the developing world, particularly in rural areas with little access to healthcare and less access to the money needed for transport and medicine. Rapid diagnostic tests in their current form are a step forward in this regard. The labour costs of employing a microscopist to analyse thousands of samples combined with the logistics of collecting and transporting them are heavy. However, current RDTs have financial drawbacks due to the sheer volume they are required in, and the costs of storing them. Children in sub-saharan Africa can be infected almost one thousand times per year, and it takes roughly three years to build an immunity. That is a lot of testing. RDTs also need to be stored below 30 degrees centigrade, which in almost all endemic zones requires expensive refrigeration.
A key fact to consider is that under the status quo, malaria deaths and cases have dropped. Malaria deaths peaked in 2004, with over 1,817,000 casualties globally. In 2013, the figure had reduced to 584,000. The question is, is this good enough?
Dr. Nick White says that the disease will persist even if 99% of the parasites that carry malaria are wiped out. – Wall Street Journal – 09/02/2015
Considering the threats that drug resistance bring, fighting malaria harder than ever is vastly important for the state of global public health. Alongside research into new treatments, improving the speed, accuracy and cost of diagnosis is of paramount importance.
Something as innocuous as the phone in your pocket may hold the key. The advances in smartphone technology over the last decade mean that we all carry computers that have similar processing power to the advanced workstations of ten years ago. Using smartphones to diagnose malaria has shown an astounding improvement on accuracy and speed. The xRapid algorithm has managed to achieve 98% accuracy consistently, whilst also being able to detect the level of infection to a precise extent.
Furthermore, diagnosis on a smartphone increases the speed in which patients can be diagnosed and the transmission of important outbreak data. xRapid can diagnose a patient within 3 seconds of analysis, whilst a full procedure takes under five minutes. With access to such rapid diagnosis, severe disease progression and death can be avoided because patients can be treated within that critical 48 hour window with certainty.
There are also several reasons why smartphone diagnosis can reduce cost. The digital nature of the testing cuts out the labour costs of the microscopist, and the material cost of traditional RDTs. Using facial recognition software, smartphones can cut the disintermediary and bureaucratic costs for rural areas with little access to medical records. The portability and interconnectivity of smartphone devices not only cut transport costs, but can relay information quickly to central databases, helping create a real time picture of any outbreak. Access to a rapid, accurate diagnosis for malaria also reduces the amount of antimalarials needed to treat the disease, avoiding overtreatment and reducing the risk of drug resistance whilst simultaneously saving large amounts of money.
The xRapid app incorporates all of these improvements, and can help carve a new path for malaria case management. The efforts to combat malaria over the past ten years have been highly successful, but a new gear is needed if the disease is ever to be eradicated. Moving forward starts with revolutionising diagnosis, and the tools that 21st century technology has provided us with can take us there.