The Longitude Challenge - Developing a Diagnostic Test To Fight Antimicrobial Resistance

Since their discovery, antimicrobials have enabled vast improvements in healthcare and longevity. However, inappropriate use over the years has contributed to antimicrobial resistance, leading to the development of untreatable microbes. Antimicrobial resistance is a growing concern to public health, threatening to make surgery, chemotherapy, and treatment to many infections no longer viable. While the development of new antibiotics remains important, working towards more appropriate use of current treatments is perhaps more urgent.

An improvement in point-of-care diagnostic testing could play a critical role in the global effort to tackle antimicrobial resistance, providing clinicians with rapid and effective tools to help guide their treatment decisions, enabling more targeted use of antibiotics and reducing misdiagnosis. However, progress in this area has so far been fairly limited, with more opportunities for investment and funding needed. We recently spoke with Daniel Berman, Global Health Lead at Nesta Challenges to learn about the Longitude Prize, a £10 million prize fund with an £8 million pay-out, which will be awarded to a team that invents an affordable, accurate, fast and easy-to-use test for bacterial infections.

Anna MacDonald (AM): Can you give us an overview of the importance that diagnostic tests can play in the fight against antimicrobial resistance? Why is their use currently fairly limited in clinical practice?

Daniel Berman (DB): It's important to start with the fact that we simply cannot outpace microbial evolution. Even if a new broad-spectrum antibiotic was invented tomorrow, if we were to carry on as we are, that drug would eventually meet new forms of resistance. The overall solution involves a long-term path towards a more intelligent use of antibiotics and a point-of-care test kit is an essential component of this. It will empower a more targeted use of antibiotics and, crucially, an overall reduction in misdiagnosis and unnecessary prescriptions. Today, the best evidence for guiding antibiotic choices is based on testing bacterial culture in a lab, but this process can take two to three days to produce a result. We need to get to a point where testing can be done in the doctor’s surgery or a pharmacy and results given in minutes rather than days.

AM: In Chatham House’s recently published Review of Progress on Antimicrobial Resistance, Jim O’Neill describes “that of the 10 broad areas of policy relevance highlighted in the Review … there has been some progress on seven of them, and in three areas (diagnostics, vaccines and the market for new drugs) there has been virtually none, despite endless talk.” Why has the progress in diagnostics not kept up with that seen in other areas? What can be done to address this?

DB: The scale of this challenge requires government mandates and public and private investment at the global level. Although there are exciting new diagnostic technologies in the field, many of these are not useable in frontline settings like that of the pharmacy. We need to see a sea change in the economic model that underpins how diagnostics are developed, tested and manufactured. Unfortunately, this failure to explore and jumpstart other ways of funding innovation is on par with continued disinvestment in antibiotic R&D among big pharma and leading biotechs.

AM: The Longitude Prize is one initiative aiming to help spur research and development into tests that can help tackle antimicrobial resistance. Can you tell us more about the prize and its origins?

DB: The origins of today’s challenge prize stretch back to summer 2013. Astronomer Royal, Lord Martin Rees, led a roundtable consultation with over 40 of the country’s leading scientists, engineers, and politicians at 10 Downing Street to identify, and group, a number of global challenges suitable for the Longitude Prize. Following multiple rounds of critical analysis and deliberation, the Longitude Committee shortlisted six challenges and then the British public voted via BBC Two's Horizon programme for the one they thought should become the focus. As we know, they selected antibiotic resistance. The name, however, comes from 1714 when the “longitude rewards” were established -- these inducement prizes were offered by the British government in order to find a simple and practical method for the precise determination of a ship's longitude at sea. 

AM: How can a team apply for the prize? What are you looking for, and what will it take to win?

DB: The Longitude Prize is open for anyone in the world to compete and we are still accepting applications through the website. We’re looking for a test that is accurate, rapid, affordable, easy-to-use and available to anyone, anywhere in the world. It will identify when antibiotics are needed and, if they are, which ones to use. To win, the competitor must meet all the criteria in the Prize rules, this requires a range of assets from a prototype to evidence of testing and impact.
If you would like to apply, please click here.

AM: Can you give us some examples of tests currently applying for the prize?

DB: There are 69 teams in the race to win and they come from all around the world. In the UK, for example, there is a group of scientists in Strathclyde University who are developing a low cost, rapid diagnostic sensor test which aims to show the susceptibility of bacteria to antibiotics within 45 minutes. Then, there’s AI Imaging in Canada -- this team are currently developing devices that use multiple wavelengths of light, backed by advanced Artificial Intelligence, to determine the presence or absence of streptococcal throat infections. In India, Module Innovations has invented a rapid credit card sized test that detects bacteria causing urinary tract infections (UTI) to help guide effective treatment.

AM: What are some of the hurdles that teams face when trying to develop a diagnostic test that could tackle antimicrobial resistance?

DB: Alongside the need for investment and financing, typically, the biggest technical challenge facing those trying to develop a diagnostic is to ensure that it is truly “point-of-care.” Today’s tests still need some basic laboratory equipment or ancillary support to perform and deliver results.

Daniel Berman was speaking to Anna MacDonald, Science Writer for Technology Networks.