The TB epidemic: are global networks the missing key to driving innovative solutions?

Every year, the WHO marks March 24th as World TB Day to raise public awareness about the devastating consequences of tuberculosis (TB). TB is often overlooked but remains to be the second-largest infectious killer (after COVID-19), affecting an estimated 10 million people yearly. The United Nations has listed ending the TB epidemic by 2030 as a Sustainable Development Goal (SDG), but with only a 2% drop in incidence rate over the last 5 years, how close are we to this goal?

“As people around the globe come together to commemorate World TB Day, WHO is calling on governments… health-care providers, donors, partners, and the industry to unite forces and step up the TB response – notably for TB preventive treatment – to ensure no one is left behind,” said Dr. Tereza Kasaeva, Director of WHO’s Global TB Programme.

This week, we explore how the healthtech industry has responded to this call. With 86% of new TB cases clustered around only 30 high-TB burden countries, how can we collate expertise on a global level to ‘unite forces’ for this initiative? To ensure that new health technology is embraced by patient- and professional-communities, we also explore how vital it is for healthcare professionals to actively participate in the development of these technologies. 

Innovations From Across the Globe 

From preventive vaccines to diagnostics to treatment, several innovative solutions have been in the works over the last few years. Here are a few ways in which companies, academic institutions, and organizations from around the world are using AI and digital health to tackle the epidemic. 

Utilizing Resources in Radiology  

Vietnamese AI software company, Vinbrain, announced in 2021 that their AI model was able to detect TB in chest x-rays with 86% sensitivity and 96.1% specificity. They have since integrated this model into their platform, which not only reads chest x-rays but can also auto-generate x-ray reports. 

The current average diagnostic error rate in radiology is estimated to be between 3-5% and accounts for nearly 75% of malpractice suits against radiologists. These AI tools not only assist clinicians in reducing error and ultimately contribute to better health outcomes, but also save previous clinician time by omitting time needed to type up entire reports. Furthermore, Tuberculosis is not a first-world disease, and in resource-poor settings, where there may be a shortage of radiology specialists, AI tools could be used in screening programs to fill this gap. 
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Simple Digital Health Solutions for Medications

TB is almost always curable if patients are compliant with taking their medicines, usually daily over a period of 6 months or more. However, many patients stop taking their medications once they start to feel better. Based in India, Everwell improves patient adherence to anti-TB drugs using simple technology - a basic mobile phone. Their product, 99DOTS, encodes pill-packets with specially-generated numbers. Upon popping the pill packet, the number is revealed and patients can send this via an SMS to a toll-free number. This low-cost product allows for technology to be used even in resource-poor settings or by patients with little digital literacy.  

Machine Learning for Predicting Tuberculosis Mutations 

Drug resistance has become a major obstacle in the initiative to end the epidemic of TB. With the emergence of ‘multi-drug resistance TB’, followed by ‘extensively drug resistance TB’, the TB bacteria is becoming more and more resistant to our last line of defenses. 

Researchers in India have been using machine learning tools to predict TB gene mutations, with an 85% accuracy rate. The potentials from this are massive - new vaccines, or even drugs can be developed to get ahead of the race. The understanding of how the TB bacteria mutates could also lead to new drug developments that target this mechanism. Susceptible populations could also be identified this way, changing the surveillance of TB. 
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An Old Disease, A New Vaccine 

The BCG vaccine, the only vaccine currently licensed for TB, is over 100 years old. Over this time, the vaccine has played a vital role in saving young lives by providing moderate protection against severe forms of TB in infants and children. However, the BCG vaccine does not offer long-term immunity and also offers little protection to adults against TB. 

The WHO is currently monitoring a few candidates for a new TB vaccine - these range from vaccines to prevent TB in all ages, to BCG boosters, vaccines to prevent reoccurrence (in those recovered), or as an adjunct to speed up treatment. In particular, one vaccine candidate developed by GSK and tested in Kenya, South Africa, and Zambia, was found to be protective against developing the TB disease in those with dormant TB. 
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Collaboration

While the prospects of the above solutions are exciting, TB and its associated projects, remain at large a problem for low-income countries. Responses need to be tailor-made depending on the resources available, as well as with the health and digital literacy of the population in mind. With much of our current technology and health experts situated in high-resource countries, there is a gap between the disease and its technological solution. Communication and a shared space for expertise are essential to ensure that products are being developed with maximal technological potential while remaining user-friendly for the communities they are designed to serve.

A common platform is needed, where on-the-ground clinicians from these 30 different high-burden countries can communicate the product or research need, while both technology and health experts from further afield can share their skills. Furthermore, health solutions should always address the ever-changing needs of populations and should include a continuous cycle of user feedback and developments. In this common space, information should be allowed to flow freely both ways to ensure that these technologies are continuing to be utilized with maximum potential. 

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Medcase is the world’s largest network of remote and on-demand access to medical expertise.  We allow enterprises and healthcare companies to have access to medical expertise throughout the development of their product to increase its usability. Our online professional platform also enables medical experts to connect, share ideas and collaborate, removing geography as a barrier to accelerating health solutions.

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