Innovation in Diagnostics for Infectious Diseases and Antimicrobial Resistance - Opportunities to learn from the COVID-19 pandemic

Till T. Bachmann, Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, UK

The COVID-19 pandemic has been ravaging the world since early 2020. By September, over 30 million cases have been counted and the global death toll was rapidly approaching 1 million. Not all age groups were found to be impacted in the same way and the highest risk by COVID-19 appeared for elderly patients. Diagnostics was rapidly identified as crucial for the response to the pandemic playing a vital role in public health and individual patient care. Once SARS-CoV-2 was tracked down as etiologic pathogen, its genome sequence could be determined and structure described. This kicked off an unprecedented race for diagnostic tests around the world with two main directions dominating the field, viral RNA detection using qPCR for acute infection diagnosis and antibody detection using immunoassays to measure prior exposure to the virus and the immune status of a patient. The latter quickly gained widespread interest to grant individuals free movement in case of a positive result. Reinfections were hoped to be unlikely and immunity to be lasting. Many variations of diagnostic approaches quickly emerged ranging from full blown chest imaging combined with artificial intelligence to repurposed fitness trackers for home care. Today, over 800 commercial tests are known and the trend continues. From the start, diagnostic innovators were facing a dilemma between the need for short time to market and continuously evolving scientific understanding of the disease. As a consequence, a lot of repurposing of existing diagnostic tools and target product profiles was done followed by more innovative technical approaches fuelled by a surge of research funding and exceptionally high public emergency budgets. Today, innovative infectious disease diagnostics has found its place in the awareness of policy makers and general public alike. Great successes in managing of the COVID-19 pandemic have been achieved by widespread testing creating a further demand for more testing. While COVID-19 came over the world in a tsunami like fashion, antimicrobial resistance (AMR) is set to have similar if not by far exceeding consequences arriving in slow motion. If not tackled, predictions were made for 50 million deaths globally by 2050 due to AMR. Similar to COVID-19, rapid diagnostics is identified as key in the fight against AMR. However, despite exceptional technological achievements, the implementation and adoption of advanced diagnostics to tackle AMR is still facing considerable barriers for example around regulation, health economics and behaviour change. The COVID-19 pandemic exerts additional pressure by a rising empiric consumption of antibiotics for COVID-19 patients likely to drive AMR even further. The presentation will discuss the landscape and emerging opportunities for diagnostics innovation - including our own - through cross fertilisation and convergence in the field of COVID-19 and AMR diagnostics for research, development and innovation.

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