The sudden fever that a Ugandan farmer fell ill with could have been a death sentence, as Beth Bell of the Centers for Disease Control and Prevention, described it at a Capitol Hill briefing last week. That’s because in rural Uganda, which Bell referred to as a “hot zone for emerging infectious diseases,” you can’t treat what you don’t know, and by the time samples taken to diagnose patients’ illnesses reach urban labs they can die untreated. This farmer, however, was treated, cured, and back to work in three days. He owes his life to an affordable dipstick diagnostic test developed by the CDC, which didn’t need to be refrigerated to stay effective, cost less than $1, and yielded results in less than 15 minutes. The farmer, it turned out, was infected with an ancient disease the likes of which hasn’t been seen in the developed world in centuries: bubonic plague.
This was just one example given at the briefing sponsored by the CDC and AdvaMedDx, on how progress in diagnostic technology is accelerating progress against HIV, TB, malaria, and other emerging infectious diseases.
“Diagnostics are the backbone of global health,” Thomas Kenyon of the CDC said, but they are often overlooked in policy and advocacy discussions focusing on therapeutics and vaccines.
“Diagnostics are a largely under appreciated cornerstone of health care,” added Andy Fisher, executive director of AdvaMedDx.
Todd Summers of the Center for Strategic and International Studies who moderated the event weighed in adding that United States investment in diagnostic technology comes home in a globalized world, where global health threats can become domestic health threats.
“The threat posed by emerging and reemerging diseases is very real,” said Bell. “Infectious diseases have the potential to spread faster than ever before, narrowing the gap between what’s domestic and what’s global health.”
“Not a lot of people remember the dark days when we didn’t have [HIV] diagnostics. Fast forward thirty years and we have an array of tests, from dipsticks to mouth swabs.” Kenyon said. Now, he added, “I can test this room for HIV in 20 minutes.”
The CDC is getting ready to ramp up diagnostics research thanks to a $40 million allocation in the 2014 budget to develop an advanced molecular detection program, an area in which the CDC is “woefully behind,” Bell said.
The program will help the CDC more accurately and rapidly diagnose infectious diseases, investigate and control outbreaks, understand disease transmission patterns, and develop and target prevention measures. The program also will help determine antimicrobial resistance, which according to Bell, is a “growing problem.” “We’re quite worried about antibiotic resistance, and we’re really not that confident we have a handle over it,” she said.
“Forty million dollars over five years is a rounding error in other budget areas,” Summers said, to drive home to Capitol Hill staffers that although “the thirst for diagnostics is very clear,” developing the needed tools still requires much more funding than currently available.
The scale up of GeneXpert in countries with high TB burdens could make the diagnosis of more than 700,000 TB cases a year possible and save low and middle income countries more than $18 million in direct health costs, Kenyon said. He noted that a decade ago when the President’s Malaria Initiative began, and there weren’t accurate malaria tests, everyone in malaria endemic areas who complained of a headache and fever were given malaria drugs, regardless of whether or not they really had malaria because there were few ways to test for it in resource limited settings. Molecular tests like RealAmp that can diagnose malaria in those settings have saved money in the long term and immediately, by saving treatment for people who need it.