Going to India was truly a first for me, in every aspect; first visit to India, first tuberculosis (TB) vaccine conference, and first interaction – even remotely - with the patient aspect of infectious diseases. I have been a “lab rat” my entire scientific life, with a focus on HIV/AIDS. With the prospect of visiting Operation ASHA (OpASHA), a nonprofit organization that brings high quality, cost-effective TB treatment and health services to underserved populations in Indian’s urban slums and rural villages, I was excited to finally get a glimpse of the human impact of our TB research and development work and really make this “first” count.
I knew very little about India, other than what I’d gleaned from pop culture and a few high school history classes: Siddhartha, The Namesake, Slumdog Millionaire. I had some images and impressions: the gold and magnificence of the palaces, the poverty and the overcrowded cities, the wisdom of Mahatma Gandhi. A vast land of incredible contrasts, with immense potential and challenges.
TB is one of those many challenges. Before joining a TB vaccine research organization a little over a year ago, I was under the impression that TB was a disease of the past. I was shocked to learn that the World Health Organization declared a global health emergency in 1993, and that TB is now the top infectious disease killer worldwide. The latest WHO data shows that TB kills 480,000 to 500,000 Indians every year. The only vaccine available is almost 100 years old and hasn’t been successful in stopping the TB epidemic.
Our visit to OpASHA was scheduled after three intense days of scientific presentations and work discussions on TB vaccine research. A bus picked us up at the hotel and after an hour drive we reached the Delhi slum where one of the clinics was located. The streets were narrow, too small for even a smart car. People were friendly and curious as we walked, following our guide to the tiny clinic building. There, in the street, our guide started explaining that OpASHA was founded in 2006 to reach communities of patients with limited hospital access. They employ community health workers that are involved in and often from those same communities, and understand the needs of the population. Each health worker goes through a standardized training covering TB prevention and treatment, as well as dealing with the stigma associated with TB.
Health workers also get a tablet equipped with software developed to monitor TB patients, such as eCompliance, an app that works in conjunction with a fingerprint reader or an eye scanner to help track when a patient takes TB medication or alert health workers when a dose is missed. Or the eDetection system, an algorithmic questionnaire designed to track down and diagnose people who may have been exposed to someone already diagnosed with TB. By arming locally trusted health workers with the latest technology, OpASHA can reach patients that would otherwise go undiagnosed, untreated, and ultimately forgotten.
It was there in the crowded streets that I really started to understand just how critical innovation is to the more than 10 million people who will get TB every year. The work my colleagues and I are doing in TB research and development has tremendous impact on the ground, in communities where people need it most. But funding for critical new tools, especially a new, more effective vaccine, is astoundingly inadequate. Without continued investment in the “lab rats” who dream up and test better drugs, diagnostics and vaccines, we will not be able to reach the millions suffering from TB, and we will not stop this disease.
As we arrived back at the hotel, exhausted and nauseous from the hair-raising bus ride through Delhi traffic, I felt so overwhelmed by the immense challenges ahead in the fight against TB. But I also felt hopeful: OpASHA is just one small example of the potential impact of the next big idea. I hope the world does everything it can to keep those big ideas coming.
Agnes Chenine is a Senior Scientist at Aeras.