An interview with Daniel Berman on the Longitude Prize

KEYWORDS:

• Longitude Prize
• antimicrobial resistance
• antibiotics
• rapid diagnostic testing
• One Health

1. What led you to become lead of the global health team at Nesta Challenges?

I joined Nesta Challenges from the World Health Organization. I was working on a project supporting the Ethiopian government in their efforts to expand production and improve the quality of medicines in their local factories. Before that I was in South Africa with Doctors Without Borders (MSF).

Earlier in my career, the big issue was the lack of access to AIDS drugs – MSF was part of a global movement to fight for access to medicines. In terms of what is going on now in the health space, one of the most important issues is making sure that we overcome the challenge of resistance to antibiotics.

2. Why is the development of rapid diagnostic products to address antimicrobial resistance so important?

The role of diagnostics is to tell us whether antibiotics are needed or not by distinguishing between whether an infection is viral or bacterial. Rapid, point-of-care diagnostic tests would drive the better and more rational use of antibiotics, which would significantly help us tackle antimicrobial resistance (AMR) around the world.

Recent new data from the Centre for Disease Control Report [1] found that around 30% of all antibiotic prescriptions in the US are unnecessary. We urgently need tests to disrupt the status quo in AMR and to ensure that people get the right antibiotic the first time they present in a medical facility.

If we had such a rapid, accurate diagnostic test, that would immediately tell us which antibiotic we should use, then many patients that are sadly getting the wrong first treatment would be getting the right treatment straight away.

From a UK perspective, the importance of getting the right antibiotic the first time around is exemplified in the treatment of urinary tract infections (UTIs). The majority of UTIs are due to Escherichia coli (E. coli) and if we treat E. coli infections badly, over-prescribing first-line antibiotics when a patient presents with symptoms, we will effectively create a superbug; that is an infection that is particularly dangerous in many circumstances, especially in the hospital.

Of course, there will always be a need for new antibiotics and vaccines; in many ways they are the holy grail. However, there is no panacea to the challenges we face. We must tackle AMR on multiple fronts simultaneously.

3. What is the challenge of the Longitude Prize and what are its main goals?

The Longitude Prize is a £10 million prize fund, with an £8 million payout. The aim is to design a rapid diagnostic test that is accurate, affordable and easy to use anywhere in the world. Today there about 55 teams competing from 14 different countries. The teams range from academic groups, start-ups, small or medium-sized enterprises, and larger companies; there will be one winner of the £8 million prize.

The competition was launched in 2014 and has been running for 5 years. We’re at a point where we’re seeing the competition tightening.

The types of diagnostics in development include a test for UTIs, a test that differentiates between viral and bacterial infection, tests for pathogen identification, blood infection, and susceptibility. We are seeing different technologies deployed, some are new innovations, some are new uses of older technologies.

4. What are the opportunities and challenges when it comes to developing new diagnostics and other solutions to antimicrobial resistance?

Of course, there are many technical challenges. For example, to know which antibiotics are working against a particular pathogen, the pathogen has to grow and that takes time. One of our criteria is that the time between taking the sample and the result is a maximum of 30 min, and that is really challenging for susceptibility tests.

Given that we are asking for a point-of-care test, another challenge is miniaturization, not unlike a pregnancy test or rapid malaria test. It needs to be put to use at bedside or in a clinic, so you don’t have to send the sample to the lab to get the result.

As you might expect, another challenge is financial. We are looking for a test that is affordable, so it can be sold around the world, including in lower- and middle-income countries.

Some companies are struggling to get investment, because the venture capital investors are interested in products with higher returns. They would rather invest in a company that is making the product for the US because the price point is higher.

We have been able to provide grants to 32 teams. There are three new grants that are being disbursed (for approximately £100k each) to Indian competitors. However, in general, the companies have to self-fund or acquire their own funding for their projects.

Finding investment can be a large obstacle to progress, that’s why we are calling for more resources to be put into the development side of rapid diagnostic tests for AMR.

5. What are some examples of some innovations in the race to win the Longitude Prize?

The tests in development are diverse and run the gamut of ingenuity.

There is one test that uses imaging for diagnosing strep throat. It involves taking an image of a suspected infection which is then compared against an extensive AI-enabled database for quick and affordable diagnosis.

Another example is a test for viral vs bacterial infection, which is based on three combined biomarkers to determine host response to viral and bacterial infections. This test is designed like an HIV rapid test; the needle to prick a finger to draw blood is integrated into this single-use device, and the result is easy to read.

A third one, which is really innovative, involves the diagnosis of UTIs. You could almost think of the company’s device as a modern reimagining of the microscope. It is a camera, which is paired with a significant database which they have built over the past few years. The test can identify the pathogen and its antibiotic susceptibility by analyzing the motility of the pathogen when exposed to a range of antibiotics.

We have some tests that use microfluidic technology, some that are genetic tests and some completely novel technologies.

6. What are the benefits of challenge prizes over grant programmes?

Nesta Challenges run a wide range of challenge prizes. One of the main reasons to use a challenge prize is to focus minds on a specific issue and draw new people into solving that challenge.

Unlike upfront grants, the challenge prize model de-risks investment in new, untested businesses by rewarding teams only after they meet predefined goals at predetermined stage-gates. This opens up underserved markets and sectors to disruptors and start-ups who may otherwise struggle to get a foothold to compete against incumbents or may never have considered playing in that space themselves.

Another large advantage of a challenge prize for funders is that they are high profile; there is a lot of media and social media attention. Throwing a spotlight on the issue you hope to overcome in this way brings it to the attention of investors, policymakers and a wider populace.

7. What is the importance of a ‘One Health’ approach to tackle antimicrobial resistance?

One Health is a multifactorial challenge; we need to work very carefully from all different angles. The UN report calls it a tripartite agreement, because it involves three different agencies at the UN – the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE).

Looking at a couple of different One Health angles, in the UK there has been a successful effort to reduce the use of antibiotics in livestock with more than a 50% reduction in use. There is an antibiotic of last resort called Colistin, and in some countries they have banned the use of this antibiotic in livestock. The UK has not yet banned it, but they have challenged the agricultural sector to dramatically reduce its use. In the last year, there was only 7 kg of the drug used in livestock – that is a massive reduction.

Looking at arable agriculture too, a practice that has wider environmental costs is spraying crops with antibiotics. In the US, orange trees are regularly sprayed with antibiotics to kill a pest that can destroy the tree. The antibiotics aren’t confined to the trees, they get into the soil, can be carried on the wind and seep into the watercourse, impacting the wider eco-system and promoting wider drug resistance. This is the type of thing on the environmental side that we are fighting against, because it is a short-sighted misuse of antibiotics.

8. What can we learn from other countries in their approaches to tackling antimicrobial resistance?

There is no question that the UK is a global leader in terms of fighting AMR, however there are some countries that are doing even better in terms of reducing the use of unnecessary antibiotics. The Nordic countries allocate more funds for diagnostic testing in their respective health systems, however there is more time allocated for patient consultations, which is something that will be difficult to achieve in the UK. Therefore, we need to be even smarter about how we use diagnostics to support the decisions in the diagnosis and treatment with antibiotics.

9. What do you think the next 5 years holds for the future of antibiotics and resistance?

I think the picture is mixed. In terms of technologies for diagnostics, there are a lot of new technologies that are getting close to market, however, the market is dysfunctional. You may have a good idea and a good prototype, however attracting the financing to actually turn it into a product and get it authorized for sale is difficult.

There is a lot of progress in terms of the early stages of antibiotic development, the research to identify new potential targets for antibiotics that had stopped has been restarted with significant funding from Carb-X, a project by the US NIH and the Wellcome Trust.

The part that is really worrying is that the most recent antibiotic that was introduced in the UK only had sales of £200,000 for the year, and that sends a signal to the pharmaceutical industry that antibiotics are not highly valued.

The NHS is responding to this challenge by initiating a new ‘subscription model’ by which they will negotiate service contracts with suppliers of new antibiotics and will pay considerably higher rates based on the total impact to the health system of the antibiotic, not just the direct impact for the individual patient. These service contracts will not be based on the number of pills consumed but rather an agreement to cover the needs of the population. This will create a disincentive for overuse.

The global antibiotic market is currently so weak that we have recently seen biotech companies that had antibiotics in development go bankrupt despite the fact that their products looked promising in terms of efficacy.

We are actively calling for a new funding mechanism [2]. We already have effective institutions that fund research for vaccines, TB, HIV, and malaria. We need an international institution for Global Health to tackle AMR too. It would provide the initial funds to make these markets attractive, and specifically money to subsidize or purchase innovative products.

Disclaimer

The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Taylor & Francis.

Declaration of interest

The interviewee has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.

Notes on contributors

Daniel Berman

Daniel Berman is Head of Global Health at Nesta Challenges. He leads the Longitude Prize, a £10m prize fund, with an £8m payout, that will reward a team of researchers who develop a point–of–care diagnostic test that will conserve antibiotics for future generations and revolutionize the delivery of global healthcare. In this interview, he highlights the importance of diagnostic testing, and the opportunities and challenges we face when it comes to developing new diagnostics to address the challenge of antimicrobial resistance.