Strengthening diagnostics capacity to reduce premature deaths

The term "diagnostics" is typically used to mean determining what the cause of a particular problem is. You run "diagnostics" on a computer to find out why it is not performing correctly for example. The topic of diagnosis of disease is similar and suggests conducting a series of tests to determine why a person is not well. Hippocrates, arguably the best-known physician in history, suspected that bodily fluids influenced our health and was the first to test urine as a key indicator for diagnosis of disease in humans. The 19th century was a golden era for sensational scientific discoveries especially in diagnostics. Wilhelm Conrad R?ntgen discovered X-rays in 1895 and advances in clinical chemistry during this period led to the first testing of blood glucose.

In today’s modern world, without diagnostics, there is no option for timely and accurate treatment.?At this year’s 76th World Health Assembly (WHA), we welcomed the resolution on Strengthening diagnostics capacity by World Health Organization (WHO). The resolution points out that increasing access to diagnostics from current levels can help reduce annual premature deaths. This is particularly relevant for low- and middle-income countries (LMICs). Every year, nearly 85% of non-communicable disease (NCD) related premature deaths occur in LMICs<1>. NCDs like cancers, cardiovascular disorders, and diabetes can only be well-managed when diagnosed early.

Offering both laboratory diagnosis and imaging solutions, Siemens Healthineers is able to provide comprehensive end-to-end solutions in managing the most threatening diseases. There are many conditions where this is important, but here I will cite just two examples of how multi-dimensional diagnostics play a critical role in early disease management.

In 2021, an estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, which is the second leading infectious disease killer after COVID-19. The largest number of new TB cases occurred in the WHO’s South-East Asian Region which includes India with the highest number of new cases. <2> TB, which mostly affects the lungs, is a preventable and curable disease. However, challenges like latent TB infection, multi-drug resistant TB and very recently COVID-19 impact, is increasingly affecting the health target of the United Nations Sustainable Development Goals (SDGs) of ending the TB epidemic by 2030. <3>

Reducing the TB mortality rate requires understanding the symptoms, ensuring accurate diagnosis and treatment, and a robust program for quarantine of infected persons as quickly as possible due to the rapid spread of the disease through air.?A rapid molecular diagnostic test that enables early diagnosis is recommended for those indicating TB symptoms. This test result, when used in combination of a chest X-ray especially for severe cases, provides the physician with precise information on the damage incurred to the lungs as well as staging of the TB disease progression.

Over 80% of TB cases and deaths are in LMICs. Subsequently, there is a need to accelerate the availability and accessibility of basic diagnostics testing, including both molecular diagnostics tests and X-ray, that will considerably help LMICs in the accurate and early diagnosis of TB and improve patient outcomes.?

The second example of deploying multi-dimensional diagnostics is in the case of Hepatitis C. Hepatitis C, which is an inflammation of the liver and can cause liver cirrhosis and cancer, requires multi-dimensional diagnostics to understand the symptoms and assist with planning suitable care. Globally, an estimated 58 million people have chronic hepatitis C virus infection. There is no vaccine for hepatitis C, but antiviral medicines can cure more than 95% of people with the infection.?However, access to diagnosis and treatment is low.<4>

The Enhanced Liver Fibrosis (ELF) blood test indicates active fibrosis and can be used to predict the risk of progression to cirrhosis. The Ultrasound Derived Fat Fraction (UDFF) is used, along with the ELF blood test, to examine further damages to the liver. The combination of a blood test and the ultrasound exam help indicate the risk of fibrosis, as well as its progression and location, which is critical in managing liver disease.?

In both communicable and non-communicable diseases, a combination of more than one diagnostic test allows for early intervention to prevent disease progression and leads to better patient outcomes. Furthermore, to implement a multi-dimensional diagnostics approach, strengthening of diagnostics capacity is fundamental to reducing the disease burden in LMICs. Particularly for patients with NCDs, an early diagnosis is essential to both reduce costs and reduce mortality rates.

The diagnostics resolution announced by WHO further requests Member States to introduce national diagnostic strategies that combine all levels of care for communicable and non-communicable diseases.?These strategies should include government funding as well as reimbursement schemes to ensure equitable access for everyone. Siemens Healthineers supports this resolution and emphasizes that collaboration at multiple levels is required to create optimized, integrated diagnostic networks and services that are well supported with digitalization. At the same time, a strong focus on patient awareness and education is also essential to ensure diagnostic testing reaches those who need it the most.

What Hippocrates suspected 2,400 years ago is a reality today – staying healthy requires understanding the diagnostic parameters and actively monitoring key indicators of health. There has been tremendous clinical and technical progress – a multitude of laboratory and imaging tests exist that help physicians accurately identify diseases at the earliest stages when most economically and clinically viable to treat. In order to improve healthcare for the most vulnerable populations, it is important to ensure these diagnostic tests, and the subsequent treatment options, are accessible and affordable for all.

Sources:

1 WHO

2 WHO TB Fact Sheet

3 WHO END of TB Strategy

4 WHO Hepatitis C Key Facts