The power of knowing | Violette Defourt | TEDxBoerhaavedistrictStudio
Transcriber: İlayda Gökgöz Reviewer: IF I KNEW THEN This year, 241 million people will suffer from a malaria infection. 10 million from tuberculosis. 3 to 5 million from the seasonal flu. And worldwide, more than 1 million sexually transmitted infections are acquired every single day. Humanity is also facing some major challenges. Since the start of 2022. The W.H.O. has already recorded 47 outbreaks worldwide. Outbreaks of pathogens with pandemic potential are becoming increasingly frequent. Antimicrobial resistance is on the rise. While there's a lack of novel antibiotics. But how do we know which disease someone has or know what pathogen is causing an epidemic? For this, we use diagnostic tests like PCR. Good diagnostic tests are the starting points for each medical journey. Even though these current diagnostic tests have a high quality, they fail to address an important medical need. Let me give you an example. Sasha is 30 years old. He's had multiple partners in the last two weeks, and he thinks he may have showed some risky behaviors. So his friends tell him he should get checked preventively for an STI. He finally decides to visit a sexual health clinic to get tested. He attends the clinic where they discuss his profile in history and take a sample. The sample was sent to a lab to run a PCR test. While Sasha waits for his results, he wasn't too concerned about engaging in sexual activity. Two days later, Sasha starts to feel symptoms related to an SCA. He experiences burning pain and discomfort, and he's not too sure what to do next. He also feels ashamed and nervous about telling his sexual partners. It’s been a week since his test and Sasha phoned the clinic for the results. Unfortunately, the results were positive and he needs to attend the clinic again for treatments. Sasha is terribly embarrassed. Such a situation is far from unique for most infectious diseases today. Patients have to wait days before they receive the results. For some patients, this delay can have much more severe consequences, like a sudden deterioration of their symptoms. Missing the window for giving effective treatments or even spreading the infections to loved ones. What if instead Sasha could have gone to the clinic, taken a sample, gotten tested and gone home within 30 minutes with a prescription for the adequate antibiotics. It would have spared him a lot of unnecessary discomfort. Perhaps if the whole procedure had been more relaxing, it would have encouraged Sasha to get tested more often. This concept is called Points of Care, our decentralized testing. It was first introduced in the 1960s, but its meaning has evolved and new technologies have enabled point of care testing to be used even closer to the patients and further removed from a medical setting. Point of care diagnostics have improved over time, making it possible to detect protein biomarkers, antibodies but also for more novel applications. In this way, bringing DNA testing, technology or molecular diagnostics directly closer to the patient's. Molecular diagnostic technologies allow us to cuts the central diagnostic lab from the patient journey. Now a patient can enter the clinic and within 30 minutes leave with the results and their treatments without having to outsource samples. Sasha’s example, shows that the decentralized molecular diagnostics of infectious diseases have tremendous value for patients. Patients are immediately relieved and they could benefit from a more comfortable and convenient procedure. Making this type of testing more accessible. It gives doctors the information they need to make the right decision for their patients while they're still sitting in the chair and the patient doesn't have to come back for a follow up. Implementation of point of care tests is also better for public health. Molecular point of cone of care tests give doctors concrete information to make decisions. This way we can avoid over or under treatments and prevent antimicrobial resistance. More recent developments in this field make it even possible to predict whether bacteria are resistant to a certain treatment. New molecular point of care tests also enable us to prevent further spread of the disease, particularly if the disease is very contagious. In the case of an outbreak, these tests would allow us to be better prepared as they are easier to develop for novel diseases compared to antigen or antibody tests. I truly believe that in a near future, we'll be able to bring diagnostics another step further. Patients will be able to conduct high technology diagnostic tests from the place where they feel most comfortable at home. Sasha may not even have to go to a clinic anymore for STI testing, but instead request tests at his doorstep. At home tests also hold potential for patients to reclaim control over their own health and also to keep patients with smaller infections from overcrowding essential health care services. This is how a truly able to break down the barriers to tests and make preventive testing more accessible. So if these tests are so great, then why are we getting a point of care tests every time we visit the doctor? Point of care tests have been developed in many shapes and forms. Molecular point of care tests today are almost, if not just as accurate as lab based PCR tests and have been developed for a wide range of diseases. The bottleneck is not necessarily strictly the development of these tests. They're already great tests out there and many more in the pipeline. They're getting faster, more performance and easier to use. But there's so many technical, regulatory and market barriers for better adoption of molecular point of care testing. The first is that some doctors feel hesitant about these decentralized tests because they fear diagnostics will become a free for all uncontrolled, unregulated and unaffordable. But decentralization is a trend that's moving forward in many medical domains and fast. So how can we ensure this transition occurs better? When it comes to when it comes to point of care tests, there's rarely a one size fits all. Many doctors delegate the implementation to decision makers, but instead, the medical community is an essential player to validate control and guide usage of these tests to ensure they get implemented at the right place in the care chain. Besides, this cost is also a crucial factor and often a bottleneck to reimburse these tests. Molecular point of care tests are often technologically advanced and low throughput. Developers then have to compete on price with large scale centralized testing where costs have been lowered thanks to high throughput automation. This last problem has two solutions. First, developers should keep the pricetag in mind while developing the molecular point of care testing application to integrate it into the in the design of their technology. For example, an expensive machine in a doctor's office might not make the cuts as it would increase the price per test and not be cost efficient. Design thinking could therefore be a determinant factor for final market access. Secondly, we need to acknowledge the power and value of well implemented point of care testing on a public level. Currently the estimated antimicrobial resistance costs amount €9 billion yearly in Europe, and they're on the rise. Good molecular point of care testing could decrease these costs significantly. If we consider the long term and added value of point of care testing, the cost of coverage could outweigh the direct added cost of a test. In certain cases, we need to trade short term thinking for longer term thinking and agree to invest the cost difference into these novel applications. These considerations are essential to ensure the advantages of molecular points of care testing can be maximized and sustainably integrated in our health care systems. This is why in 2021 we founded Rep Mimic ,a startup company, working to improve the way molecular tests are done today. We're developing a technology for fast and accurate diagnosis of infections. Our first solution will be a contribution to more accessible STI testing to help Sasha, along with the millions of people affected with an STI every single year. There's a long way to go to track and prevent outbreaks of emerging infectious diseases and reducing resistance, but also to create a developmental and regulatory pipeline for quickly adaptable diagnostic tools. Let's acknowledge and recognize the power these tools have and the central place they occupy in safeguarding our health care systems. We need to continue supporting the development and implementation of new diagnostics. The COVID pandemic has demonstrated what a small antigen tests could do for a person. Imagine if we could apply this and better to many more infectious diseases. What if we could help Sasha and so many more? And what if the next time we would actually be ready for future outbreaks? Let's make sure we invest where it matters in the power of knowing.