Things could get really serious if we don’t deal with the growing threat of antibiotic resistance. Around the world, millions of people might die from easily treatable diseases. Child birth and routine operations could become more risky. Health care costs might rise sharply because infections become harder to treat. Without steps to safeguard antibiotic effectiveness, estimates point to $100 trillion in economic damages per year by 2050, and perhaps as many as 10 million additional deaths.
The Longitude Prize is focused on one area of potential solutions: tests “to show when antibiotics are needed and, if they are, which ones to use.” The $15 million British challenge is giving an incentive to universities, companies, and individuals to come up with tools showing when a particular antibiotic is likely to be effective in patients, or when other treatments might be better.
Most of all, the tools have to diagnose resistance at point-of-care, when it can inform medical decision-making. “Traditionally, you have to take a swab from the threat and then grow the bugs up in the lab,” says Roger Highfield, a member of the prize committee, explaining the laborious process. “If you’re sitting in front of your doctor with a really raw throat, we haven’t got something that can give you an immediate answer there and then.”
The Longitude Prize gets its name from a challenge called by the British government in 1714 to solve the “longitude problem.” At the time, Britain was losing many ships at sea because navigators couldn’t plot the longitude accurately. The prize was meant to incentivize navigational innovation (which it did, though not particularly successfully; the full award was never awarded).
Three hundred years later, there’s been a renaissance in public innovation contests, with multimillion challenges like the X Prize. The Longitude Prize, organized by Nesta, a non-profit innovation group, is set to run over five years, with prizes awarded every few months. Seventy-five teams have come forward so far. Below are some approaches suggested by committee members–“general ideas for the kinds of things we are looking for,” as Highfield puts it.
Inspired by the Star Trek tricorder, this device would use infrared lasers to “interrogate blood chemistry” to expose the “immune fingerprints of certain bacteria,” Highfield says. It would analyze our vital signs, requiring only that it touch a patient’s skin, then send data back to a separate computer. There are already a host of tricorder-like devices on the market or in development, including this “noninvasive” glucose monitor, though nothing for drug resistance.
Similarly, you could imagine a detection device in the form of a smartphone attachment. The device itself would be low-powered with little onboard processing; the phone would do the necessary analysis and data storage. “There is real potential that a breakthrough in the field of cheap novel diagnostics will be facilitated through the adaptation of mobile devices,” the committee says.
Highfield’s personal favorite is as simple as it comes. It’s a test for strep throat in the form of a lollipop that changes color in the presence of Streptococcus bacteria. Why? Because millions of people go to the doctor every year with sore throats, some of which are the result of bacteria and some the result of other causes. Being able to quickly judge when actual strep bacteria is involved would lessen the chances of doctors prescribing antibiotics for something they’re not effective against, like a virus.
Like a pregnancy test, this kit would take a urine, blood, or saliva sample and, through capillary action, drag it into a central chamber where it would come in contact with a detection agent, like an antibody. If the target molecule was present, a line would appear, giving doctors a quick sense of what infection is present. “It could look for specific genetic markers, such as those for antibiotic resistance,” Highfield says.
Most speculatively, nanobots–tiny swimming machines–could roam inside our bodies, reporting back on the state of our bacteria. “Nanobots could have both basic and advanced functional knowledge and measurement apparatus to monitor the body’s health. For example, they could assess for signs of inflammation, which is a well-known indicator of infection,” the committee says. There are several bots in development, but, as yet, nothing ready for primetime.
Finally, a diagnostic device could come in the form of a “mini lab” that tests multiple samples simultaneously (or tests one sample for many things). “The device has the potential to test for ten different types of infection and the corresponding possible resistances to the most common antibiotics used to treat them,” the submission says. There are already USB stick-sized tests for on-the-spot gene sequencing, which could be used in this device.
Of course, diagnosing resistance is only one way we can deal with the larger problem. We could also use less drugs, particularly in agriculture, find better ways to track drug use, particularly in countries with lax controls, and create bigger incentives for new drug development. Currently, say experts, there’s little encouraging Big Pharma to get into antibiotics, despite all the worries about their over-use.