Announcing Ramanan Laxminarayan as the newest adviser to join the Longitude Prize

New technologies: from development to impact

Ramanan Laxminarayan & Molly Miller-Petrie

The Longitude Prize was originally awarded in 1756 to John Harrison for his portable chronometer, the first device capable of accurately measuring distance traveled by sea. His invention instantly changed the face of marine navigation. Will antibiotic resistance be the next front for a sea change?

First, let us stipulate that every use of an antibiotic “uses up” some of its effectiveness. It’s worth it if the small loss is balanced by a benefit to the patient, but not if there is no benefit. The most widespread uses of antibiotics that have no benefit to human health are to treat acute respiratory infections, most (but not all) of which are head colds caused by viruses, and childhood diarrhea, appropriately treated by oral rehydration. The hitch is that these diseases also remain the top two causes of death for children under five worldwide, and when they are caused by bacteria these deaths could easily be prevented by an effective antibiotic. How can we do a better job of knowing who needs treatment and who does not?

A lot of pieces must be in place to fit the right antibiotic to the patient, but a major barrier is the lack of a clear indicator for when an infection is bacterial—and can be successfully treated with an antibiotic—versus caused by some other organism, most often a virus.

Because there are so many different bacterial and viral pathogens, it may not be practical to try to identify each one individually. A diagnostic that distinguishes between bacterial and viral infections could be the key to preventing the unnecessary use of antibiotics. Overuse could also be reduced by a test that can distinguish between severe infections that might be life threatening and infections that are not serious. The possibilities are limited only by human ingenuity, and we will, no doubt, be surprised and delighted by what emerges from this challenge.

The diagnostic itself is just the first step, of course. Even if it’s easy to use and affordable, it won’t change behavior over night. Just as the now decade-old malaria rapid diagnostic tests changed some minds quickly, there still are practitioners who prescribe antimalarials despite negative test results. Patient and provider expectations and lack of alternatives drives some overuse, and only improved healthcare access and infrastructure will fix those problems.

The challenge of developing a technology that is effective, deployable and scalable is part of what makes the task so daunting – but the potential rewards are also great. The quantity of antibiotics currently used without benefiting health is vast. A diagnostic test is not sufficient to remedy the problem, but it will make a remedy possible.