Opinion: The promise of precision in global health

A rapid diagnostic test shows negative result. Photo by: Lilia Gerberg / President's Malaria Initiative

In the United States, “precision health” — the concept of treating patients based on their individualized genes, environment, and lifestyle — is revolutionizing medicine. But worldwide, the emerging concept of "precision global health," driven by data, is changing the way we combat and ultimately eradicate diseases, including malaria.

Malaria is one of the world's oldest, deadliest diseases. Defeating it will require a new approach that allows us to find and map the parasite using diagnostics and real-time data to develop highly tailored solutions that respond to local conditions.

Until recently, fighting malaria has been a guessing game. Without practical, point-of-care diagnostics, in many countries, malaria treatment was given to patients based solely on presentation of clinical symptoms — such as fever during a malaria epidemic — and without any test confirming whether or not the patient actually had the disease.

In 2010, the World Health Organization recommended using innovative rapid diagnostic tests or traditional microscopy to confirm all suspected malaria cases before treatment. 

Unlike microscopy, where samples need to be sent to a lab and results are often unavailable for several days and even weeks, rapid diagnostic tests are portable and can be administered by frontline health workers in the most remote of locations. Results are available within minutes.

“Governments, global funders, and foundations, together with industry, must provide the underlying investments required to support these new innovations and get them into the hands of health workers on the frontlines of the fight against malaria.”

Suddenly, it was possible, and practical, to test before administering treatment.

For those who test positive, the benefits of an accurate diagnosis are clear and they can begin treatment immediately, which also helps stem the disease from spreading to others.  

Quick, accurate negative diagnoses are just as important. They allow health workers to address other ailments and reserve treatment for those who actually need it. This can help reduce the chances of the malaria parasite developing resistance to antimalarial drugs.

RDTs, along with other life-saving interventions such as bed nets and antimalarial drugs, have helped contribute to one of the best global health success stories to date – 7 million lives saved and more than 1.3 billion malaria cases prevented since 2000.

Sujata Karan, an accredited social health activist health worker, or ASHA, in India, recently explained to Abbott —  a health care technology company —  the RDTs revolutionary impact: “It used to take 15 days to complete the test. Using a rapid diagnostic test, we get the test results in 15 minutes. These days, people don't die because of malaria like in the past.”

Karan is one of 47,000 ASHAs in Odisha, the Indian state with the highest malaria burden. Between 2017-2018, Odisha reduced its malaria burden by more than 80%. That's largely thanks to the efforts of ASHAs like Karan, who conduct village-wide testing for malaria using RDTs and provide immediate treatment to people who need it.

New generation RDTs can accelerate the end of malaria

With the advent of new, more sensitive RDTs, we can be even more precise in combating this disease. The earlier generation of RDTs detected malaria in people who showed symptoms, but often failed to do so in people who were asymptomatic. New generation RDTs are up to 10 times more sensitive than standard RDTs.

New RDTs can also digitally connect data to central health databases. Using smartphone-based technologies, health workers can log test results, patient demographic information, place, time, and other data.

Armed with this information, health officials can then identify malaria hotspots in near real-time and respond accordingly. They can cross-reference that data with other information — for example with weather or human mobility patterns — to predict where the disease may spread next.

In Uganda, Abbott is supporting an extensive pilot program deploying a high-sensitivity RDT with these new smartphone-based capabilities. The technology will log location details for patients who show malaria symptoms and test positive. Then, health workers will visit and test everyone in the household link all individuals who test positive to treatment. This combination of real-time surveillance and high-sensitivity tests is an exciting prospect for malaria programs worldwide.

If successful, the pilot could provide a template for clinicians and public health workers battling other infectious diseases, including HIV/AIDS and typhoid fever.

Governments, global funders, and foundations, together with industry, must provide the underlying investments required to support these new innovations and get them into the hands of health workers on the frontlines of the fight against malaria.

This “precision” approach, coupled with other innovations such as next-generation treatments and vector-control technologies, represents a new model for disease elimination and helps support the mission of WHO and Malaria No More that no one has to die from a mosquito bite.

It’s a model that countries ought to consider on this World Malaria Day.

About the authors

  • Headshot

    Damian Halloran

    Damian Halloran is Abbott’s vice president of infectious disease in emerging markets and rapid diagnostics. Halloran has worked in all the major business units in Abbott, starting his career in Ireland in 1986 where he joined the Hospital Products Plant as a graduate engineer.
  • Martin gatesfoundation

    Martin Edlund

    Martin Edlund is a founding member and chief executive officer of Malaria No More, a globally recognized nonprofit organization with the visionary mission to end the world’s oldest, deadliest disease in our lifetimes. During his tenure at Malaria No More, he has built a world-class board of directors and teams in the U.S., Africa, and India with affiliates in the U.K. and Japan. He has led strategies to mobilize political will, global influencers, and executives of leading media, mobile, and medical companies to deliver the resources and innovations to end malaria.