Team:Wageningen UR/HP/Gold Integrated

Integrated Human Practices

The project as it is presented on this Wiki has evolved from our initial ideas. In the past half-year a lot has happened. To get the best out of our project, we actively engaged with stakeholders and experts and combined creativity with expertise. This has shaped our project into the way it is now. Below, a timeline can be found of how our project was shaped by the input we received. This starts out with the initial idea we had, looking at previous iGEM projects, and many hours of reading literature. Within iGEM, and definitely within our team, we find it very important to take the opinions of experts and stakeholders into account. Hearing the personal stories has had a great impact on us, giving us even more motivation to succeed in our project.

Below we will consider: Is there even a need for a new diagnostic device? Which requirements have to be fulfilled, where are the current bottlenecks? Are there other situations that we did not think of beforehand, where our device might be needed? How should this device look?

By talking to many people these questions and much more have been answered. This shaped our project to be the way it is now. Below an overview of the most important conversations can be found, including the main findings and pieces of advice.

Our idea

We are making a diagnostic device to test for tropical diseases in remote areas. However, it is not clear how we can best implement our diagnostic. We have multiple diseases for which we can screen; both viral diseases, like Zika and chikungunya (CHIKV), as well as African Sleeping Sickness (Human African Trypanosomiasis, HAT). How do we integrate these different aspects? How can we visualize our ideas best? How should our device look like? Is this even the best approach? We talked to several experts and integrated their expertise into our project.

Integration of our prototypes

From the very beginning of our project, we have been working on the prototypes of our diagnostic device. We received feedback from several experts and have adapted our device accordingly.

This includes general comments on our device having to be robust and applicable to be used in the field with minimal facilities, but also specific comments. For example, we added an LED-screen to get a quantitative output after our talk with dr. Philippe Büscher. After collaboration with the students from the Quantified Self course and our talk with dr. ir. Arnold van Vliet, we added a GPS signal and data storage unit. Finally, one of our latest prototypes was shown to dr. Erwan Piriou, who confirmed that it was easy and straight-forward to use.

Wondering why we made these adaptations? Read more about this in the timeline on this page!

We wanted to know more about the situation in Africa. Do they need a new diagnostic? Which requirements should this meet?

Prof. Joseph Ndung'u

Programme Head at FINDdx, expert on HAT

We talked to prof. Ndung'u early on in the project. We found out that there are several bottlenecks that exist in making and implementing new diagnostic tests in Africa. Some cannot be changed by the power we have, like political situations. For us, it is most important to develop our diagnostic test to be used with minimal facilities.

We wanted to get the complete overview of the HAT situation in the field in Africa, make sure that the ideas we had were realistic and that there is a real need for it. Currently, field teams drive hours into the countryside to test possible patients with dipstick tests, which have many downsides. A test should be rapid, cheap and easy to use. Tested people are often skeptical about the results as they do not feel ill, thinking they don't need treatment. The availability of the tests and field teams is highly dependent on the current political situation in the country.

March 16

The story so far

Our device is going to be implemented for individual testing on tropical diseases. We have considered three different scenarios that illustrate the modularity of our device: a neglected, long-known epidemic (HAT), a recent outbreak (Zika virus) and a relatively new disease which might cause an outbreak in the future.

But how can we approach these three scenarios the best? Should we focus on one, or is it possible to tackle all three of them at the same time?

Experts at Rathenau Institute

Guide to the Integrated Human Practices

We talked to several experts at the Rathenau Institute about our project. They advised us to get into contact with end-users, as well as NGOs, and to take advantage of the expertise present at the Wageningen University & Research (WUR). Moreover, they suggested we specify the disease we are tackling and which population is most affected. Other experts agreed that a clear, coherent idea is needed for people to understand the aim of the project. This way, we can combine both specificity and modularity of the device.

Within the Rathenau institute we talked to dr. Dirk Stemerding, assistant professor at University of Twente, expert in biotechnology and society.

  • Wieke Betten, PhD student at Athena Institute (Vrije Universiteit Amsterdam), expert in bioethics and the sociology of science and technique.
  • Marjoleine van der Meij, PhD student at Athena Institute (VU Amsterdam), expert in science education, bioengineering and communication design.
  • Dr. Cécile van der Vlugt and Korienke Smit, scientific employees at RIVM (the Dutch National Institute for Public Health and the Environment). Experts in biosafety aspects and safety assessments in laboratory.
  • Virgil Rerimassie, former researcher technology assessment at Rathenau Institute, expert in policy and legal applications of biotechnology.

April 19

Dr. Bob Mulder

Strategic communication at WUR, advisor of iGEM

We talked about an approach to work out our story and talk to stakeholders. On his advice, we will first focus on working out one disease case, and then apply it to other cases.

Our advisor dr. Bob Mulder gave us some extensive advice on how to approach different scenarios. He advised to focus on and show the modularity of the device and to find a way to describe all three cases (HAT, Zika and Mayaro). The implementation of the device will be different for each case. Moreover, we have to find the weakest link in the diagnosis process. For now, we should fully develop one case first and then compare it to the next case and adapt the application. We did that by making a roll-out plan for African Sleeping Sickness in Congo and then compared it to the case of Zika virus in Brazil. Also, we could try to develop future scenarios: a best case scenario, in which everything works out well, or one in which everything is performed badly.

May 18

Implementation

We looked at the future perspectives of our device via SynBio scenarios. Here, we focused on the drawbacks of an open-source iGEM project.

Prof. dr. ir. Marcel Zwietering, prof. dr. Wim van de Poel, dr. Martin Scholten

Experts in emerging infectious diseases, One Health, Wageningen University & Research

They endorsed our project and suggested us to look into patents. This includes both existing patents as well as the possibility of patenting Mantis. Moreover, they questioned the robustness of a whole-cell biosensor compared to cell-free. Following this conversation we talked to an intellectual property (IP) expert and looked further into the robustness.

One Health is an initiative which entails a number of Dutch universities and institutes which aim to improve the health in various ways all over the Earth; one of their subjects is the battling of emerging infectious diseases. We discussed our project with three experts. They liked the setup of our project, but also had some concerns: normally antigens and antibodies are screened next to each other. With Mantis, we do not test for antibodies, which might influence the reliability of the test. Furthermore, they thought that bacteria are not always robust enough, and felt like a cell-free system could be of interest for us. They suggested that we look into patents and patenting our new diagnostic test.

► We looked at patents by talking to ir. Paul van Helvert (Intellectual Property manager of Wageningen University & Research). After this conversation we decided that patenting our device would not be feasible at this point due to costs and the open-source mindset of the iGEM competition. Also, we looked into the robustness of a whole-cell biosensor compared to cell-free systems. More can be read in the roll-out plan.

June 7

We attach great value to biosafety and we would like to discuss our plans and general approach for biosafety and ethics with an expert. What should we focus on? Is our approach the best one?

Dr. Zoë Robaey

Postdoctoral researcher at Delft University of Technology, former researcher at Rathenau Institute, working on ethical issues in synthetic biology

Zoë endorsed our approach for biosafety and gave us some nice tips on how to improve this and how to approach expert interview and integrate these into the design of the project.

Dr. Zoë Robaey is our contact point within the Rathenau Institute. Although she switched jobs soon after we met her, she remained willing to advise us on ethics-related questions about our project and about the iGEM Jamboree. She endorsed our plans for biosafety: an infographic and interviews. She advised us to define the target of our application more precisely. Another point she mentioned was 'connect the disconnect': find the bottleneck in the whole diagnosis process and try to connect it using our project. She also advised us on preventing the feeling of being overwhelmed by the competition: reconsider your approach after every new bit of information. Moreover, to use the expert's point of view to get more specific info on the topic, and to set goals prior to interviewing. Finally, try to show it in a storyline. As a result of this interview our approach to interviewing experts greatly improved.

June 8

Implementation

Following the interview with dr. Robaey, we made a storyline about our project.

Moreover, we elaborated greatly on our biosafety and ethics. To make our biosafety page, we got into contact with several experts in the field of biosafety, ethics, and risks. For example prof. dr. Marcel Verweij, head of the department of philosophy of the Wageningen University & Research, an expert in bioethics.

Are the alternative applications for Mantis more relevant?

Instead of individual diagnostics in humans, we might be able to apply our diagnostic device on the detection of viral diseases in mosquitoes. Vector control plays an important role in the containment and eradication of infectious diseases. Is there a need for a new diagnostic device in this field? Is this a better application than screening disease in humans, since for most diseases no treatment is available?

Dr. ir. Niels Verhulst and dr. Sander Koenraadt

Entomologists vector-borne diseases, WUR

Both dr. Sander Koenraadt and dr. Niels Verhulst see the benefit in focusing on both human diagnostic and mosquitoes. In mosquitoes there is no problem with the presence of viruses in the blood or issues with treatment availabilities. However, there is currently not a great need for a new field test for viral diseases in blood fed mosquitoes. It only becomes a necessity after a disease is transmitted from animals to humans.

We talked to dr. Sander Koenraadt, Assistant professor at the Laboratory of Entomology (Wageningen University & Research), expert in medical entomology and vector-borne diseases, about the application of our device on mosquitoes and he referred us to dr. ir. Niels Verhulst. Dr. Niels Verhulst developed an odor compound combination which attracts blood fed mosquitoes. He also developed traps which have already been used in the field.

June 20

Decision

From the opinion of the experts, we decided that vector control will not be our main focus but will be explored as a side-project.

We continue with the human-based testing and gather more opinions of experts in the field of infectious diseases. Does it make sense to diagnose people if treatment is not always available? How is the situation in Africa compared to other tropical regions?

Jeanine Loonen MSc.

Medical Entomologist at Médecins Sans Frontières (MSF), Amsterdam

Jeanine has hands-on experience with the situations in tropical areas in Africa with regards to health care and diagnosing since she has worked in Congo for MSF. We learned that education of the local population is very important to gain the trust of the population and prevent miscommunication. Moreover, Jeanine gave lots of information about the local situation in Congo, which we can take into account in our roll-out plan. Furthermore, she confirmed that diagnostics are still important even when treatment options are not available, as they give information about the diseases present in the area and play a major role in preventing epidemics. This means our device is more relevant at large-scale screening than on individual-based testing.

Via the expert talk with dr. Sander Koenraadt, we were referred to her for more inside information. She told us that there are often sudden explosions in the number of infected people, that may be caused by mosquitoes that get resistant against pesticides.

The control of, for example, malaria is challenging because of the political status of Congo: setting up and maintaining a functional health system is very difficult. This was also emphasized earlier during our talk with prof. Joseph Ndung'u. MSF negotiates with both the governmental military and rebel groups. They achieved building a hospital that acts as a base camp to prepare for fieldwork. It attracts the local population that now goes to this hospital instead of local government health centers. This hospital employs both foreign specialists and locals, in which the former educate the latter. The goal is to create an independent health system, run by experienced locals, without the interference of MSF. Furthermore, MSF also has to rely on the help of locals for the delivery of medicine and equipment in case their shipments cannot be delivered to the hospital due to dangerous situations caused by the country’s conflicts.

MSF outreach teams are active in screening for malaria in mosquitoes as well as in the population, but also by educating locals about the work they do. The latter is very important to gain the trust of the population and prevent miscommunications. The current rapid malaria diagnostics give a readout in 15 minutes. If positive, the patient will be taken along to the MSF hospital. Introduction of a new diagnostic in countries such as Congo requires trust by the government, as they always need to give permission. Therefore, it is best to do this via established NGOs such as MSF. On the topic of diagnostics for diseases without a cure or treatment, Jeanine mentioned that these are still very important, as they give information about the diseases present in the area, as well as their role in preventing epidemics.

July 4

Prof. dr. Wim van de Poel, dr. Jeroen Kortekaas

Emerging infectious diseases, One Health, CVI, Wageningen University & Research

They mentioned several drawbacks of both current diagnostics, and our diagnostic. Moreover, we got more confirmation that focusing on human screening is more relevant than vector control.

The Central Veterinary Institute (CVI) is the bioveterinary research institute of the Wageningen University & Research. Located in Lelystad, it is commissioned by the Dutch authorities and carries out research related to vaccine development, diagnostics and animal health in general. On the 10th of July, we gave an elaborate presentation on our project, during which we discussed the setup and story with the people at CVI.

They mentioned that the Zika virus can slumber in the placenta, which might be an interesting side-topic for our application. They also said that the current antibody dipstick tests for HAT are of bad quality since confirmation tests are always needed. Furthermore, the interpretation of the result is subjective and depends on the researcher, hence there is a high chance of false positives or false negatives. One way to solve this is to quantify our results, making it more objective. In addition, a cold chain is currently needed while delivering the tests, and tests that can avoid the need for a cold-chain would be very beneficial. The delivery on site is very important, so the on-site test is definitely of value. A drawback in detecting antigens instead of antibodies is that we need to test for viruses in blood, which is difficult but not impossible. This is not so much a problem for HAT. An alternative application that they mentioned was sheep, where a virus (Cache Valley virus, CVV) causes abortion of the lamb. This can spread to humans so a new diagnostic would be valuable. Moreover, Trypanosoma is also a problem in cattle, which might also be an interesting side-story.

We also asked them about vector monitoring, regarding our previous decision of not making it our main story. They told us that for vector monitoring the rapid characteristics of our device is not needed. Furthermore, with PCR you can detect any virus you want whereas our system is specific for one virus. Hence, we made the right choice in focusing on human screening.

July 10

Dr. Philippe Büscher

Head of the Unit of Parasite Diagnostics, Institute of Tropical Medicine, Antwerp.

HAT has been a problem in Africa for many decades. Even though this disease is long known, researchers have still not been able to develop a good diagnostic tool. However, alternatives are available, meaning viral diagnostics have higher priority. As a lot is known about HAT, it is a good example to prove that our device can be used in fighting parasitic diseases. In his opinion, our device should contain a positive control, and an LED-screen for quantitation of the result would be a good addition.

Dr. Philippe Büscher is an expert on Trypanosomiasis and part of the WHO Collaborating Center for Research and Training on Human African Trypanosomiasis Diagnostics; OIE Reference Laboratory for Surra. He told an in-depth story about the history of HAT in Africa. After the colonizers left Africa, e.g. after the independence of Congo from Belgium, the health system collapsed and Sleeping Sickness re-emerged. This shows that these countries largely rely on western NGOs. To this day, the WHO, other NGOs, and companies are providing free diagnostics and treatment for HAT patients in Congo. This is expensive and costs US$ 100-200 per patient.

Currently mobile teams leave from a central point, after which they travel up to 20 days a month to remote villages on motorbikes or 4x4s. The tests they are carrying is either the Card Agglutination Test, with a high false positive rate, or an antibody dipstick test, without positive control. It is important that our device does not need much equipment, is stable at 40 degrees Celsius and has a positive control.

Moreover, he gave some technical details on the detection limit of current devices, and on HAT protein production. He showed us the current tests and explained how they are exactly performed. Finally, some suggestions for alternative use of our device were made. For example to test antibiotic resistance or to be used in reference laboratories. Here, sensitivity of detection is more important than speed of producing a result.

He endorsed our 3D-printed device prototype and was surprised by the ease of use and to observe the fluorescence. He thought it would be a nice addition to quantify the fluorescent signal and to add an LED-screen. This is in line with the opinions of prof. dr. Wim van de Poel and dr. Jeroen Kortekaas in previous talks. Finally, he suggested to increase the readability of the text on the device, and to indicate the place to insert the controls and the samples.

He mentioned that a lot of research has already been done on HAT and a new diagnostic device is needed but does not have a high priority. However, because of the high research levels, it is an excellent way to prove that our device can be used in combatting parasitic diseases as HAT is a suitable placeholder and proof-of-concept.

Figure 1: Two different dipstick tests for Sleeping Sickness, and their manual.
July 14

See how we implemented this in our roll-out plan!

In our roll-out plan, we focused on educating the local population and took the infrastructure into account.

See how we adapted our device!

We added sensors to measure the intensity of the fluorescent signal and to visualize it on the LED-screen. More can be read on the device page.

Although we have spoken to several HAT experts, we were missing the inside information on viral diseases. Is the situation with health care and diagnostics the same as in HAT? What are the current issues in diagnosing viral infectious diseases?

Dr. Pascale Ondoa

Senior viro-immunologist, AIGHD Amsterdam

Because of the talk with dr. Ondoa we realized that cell culturing might be a bottleneck when performed in the field. Moreover, in her opinions screening large populations for viral diseases is important for monitoring.

Dr. Pascale Ondoa is a viro-immunologist with expertise in HIV at the Amsterdam Institute for Global Health and Development (AIGHD). She also conducts research on laboratory systems, with a specific focus on alleviating barriers to the laboratory workforce in sub-Saharan Africa. In the opinion of dr. Ondoa, the cell culturing step will be one of the bottlenecks of our proposal, as expertise and bioreactors etc. are needed and the level of training in the field is low. The most important thing at the moment is that we find out which need we can fulfill: we need to look into the available technology, logistics, and education. We should consider the complete health system and find out how our diagnostic would fit in there.

She felt that HAT is not the best example for a new diagnostic device, as the disease has been combated quite successfully already. However, this changed after we explained that we would like to compare our diagnostic to current methods. Since HAT is a long known disease, it is suitable for comparison.

In case of viral diseases where no distinct symptoms are present, the need of the diagnostic changes completely. In this case, it would be of more use for screening the presence and development of a disease in the population and to place positively screened individuals in quarantine. Thus, the focus is on prevention of spread rather than specific treatment of infected individuals. If the device is used in such a way, the effect of vaccination on the spread of disease can also be seen.

Dr. Pascale Ondoa emphasized that we should look more into biosafety. Moreover, we should not forget that research and development costs are high. This needs to be considered when calculating the estimated cost of our diagnostic.

Aug 3

Dr. ir. Arnold van Vliet

Biologist at Wageningen University & Research, expert in citizen science networks

Although he developed a mosquito-radar, dr. ir. Arnold van Vliet confirmed we made the right choice to focus on human screening instead of mosquitoes. Moreover, his citizen science networks might be a nice addition to our project, monitoring the spread and occurrence of the diseases in a specific region.

Dr. ir. Arnold van Vliet has set up several citizen science networks, like the global mosquito alert and is an expert in communicating science to society. In citizen science, stakeholders, citizens, and mass media work together on scientific projects. This might be a nice future perspective of our device, where test results are saved and put online. In this way, a map and graph can be created that shows where and when the disease has spread or the mosquitoes are most active. This can be used to warn people at the right time and determine which measures should be taken.

Aug 11

Dr. Robert-Jan Hassing

Internist-infectiologist, Rijnstate Hospital Velp

This Dutch internist has experience in diagnosing tropical infectious diseases, including the only case of Mayaro virus in the Netherlands. Availability of diagnostics for obscure infectious diseases is a problem, even in western countries like the Netherlands, especially for diseases harboring cross-reactivity with similar diseases. Although no specific treatment is available for Mayaro, correct diagnosis is important on global scale. Due to globalisation and climate change tropical infectious diseases will spread to the western world more and more often.

In 2008, a Dutch couple came back ill from Surinam and went to the hospital of Rotterdam where they were investigated. They showed very common symptoms for viral infections and most likely they were infected with either dengue or chikungunya, both of which are very similar viruses. However, serological tests proved that this was not the case. Taking into account the areas where similar but obscure viruses are present, Mayaro proved to be the most logical candidate and after obtaining assays against Mayaro, this suspicion was proven to be right. Dr. Robert-Jan Hassing was involved in this progress, being it the only case of Mayaro in the Netherlands up to now. He wrote a paper on this particular case: “Imported Mayaro Virus infection in the Netherlands (2010)” [1].

Mayaro Virus (MAYV) causes long persisting symptoms, which is the most crippling feature of the disease. In developed countries patients run into problems regarding disability insurance as MAYV is not an officially recognized disease. Currently, no specific treatment is known. This means that for the patient it does not matter if the disease is correctly diagnosed. However, on a global health scale this is significant for monitoring the disease.

Dr. Robert-Jan Hassing mentioned that assays against obscure diseases are difficult to obtain. Most of them are stored in only a couple of locations in Europe, most notably in Marseille, France. Due to cross-reactivity with other viral diseases, antibody-based tests are not convincing enough. The current “golden standard” is the Serum Dilution Test.

Several small outbreaks of Alphaviruses have been found in Europe, mostly chikungunya in France and Italy. This has to do with increasing globalization and climate change. CHIKV shows many similarities with MAYV. It can be lethal to newborns and elderly (encephalitis) and this disease has already been found in the Netherlands. Mayaro can become dangerous when it changes vector to the Aedes mosquito which is urban dwelling and can thus reach more people. This seems unlikely at the moment but it has occurred before with similar viruses. Finally, the lack of immunity in Europe to diseases like Mayaro and chikungunya can improve likeliness of an outbreak.

  1. Hassing, Robert-Jan, et al. "Imported Mayaro virus infection in the Netherlands." Journal of Infection 61.4 (2010): 343-345.
Aug 18

From earlier conversations, we were advised to implement our device in large-scale screening during epidemic outbreaks. Is this more applicable before, during or after the outbreak? We wanted to discuss this with an epidemiologist.

Dr. Marianne van der Sande

Head of the center for Epidemiology and Surveillance, RIVM Centre for Infectious Disease Control

We found out that, depending on the disease, a diagnostic is applicable both during and after the peak of the epidemic. Predicting epidemics is hard, hence a robust diagnostic is needed to identify and monitor the spread, and to make evidence-based interventions.

We are now certain that Mantis can be applied in new epidemic situations!

Dr. Marianne van der Sande is an expert in epidemiology. She told us about the successful use of diagnostics during an epidemic. Diagnostics are continuously used throughout the progress of the epidemic. It is required to assess how it spreads and to decide on the appropriate measures that have to be taken, like treatment and monitoring. Also after the largest peak of the epidemic, when the number of cases starts to drop, diagnostics are still relevant to test for most pathogens. However, now not everyone will be tested, only risk groups are screened.

The cost of the device is not the most important factor, due to donors and investments by the Western world. A test should have reproducible and specific results. Furthermore, it should be robust in tropical settings such as high temperature, light intensity, and humidity. The ease of use plays a big role too.

The prevalence of a disease only becomes clear by applying a diagnostic. Predicting where a disease might emerge is unfeasible since it is a chance scenario. Moreover, the difference in genetic makeup of the target population and the corresponding resistances also plays an important role in the disease segregation. A modular tool sees use when there is an outbreak of a pathogen where no convenient diagnostic already exists.

Collaboration between different stakeholders to tackle the infectious problem is one of the most important factors to consider. Groups that will have to work together, are for example social scientists, clinicians and epidemiologists. To set up laboratories in the area of operation and acquire licenses to do so, may pose difficulties due to the fact that third-world countries cannot pay for these themselves. Negotiations with the private companies should solve this in case of a global problem.

Aug 18

The last missing links

We now have a clear image on how the situation in different areas is with regards to infectious diseases. However, we felt like we still missed some real inside-information. Moreover, we wanted to discuss our latest prototype with an expert.

Dr. Erwan Piriou

Laboratory advisor at Médecins Sans Frontières (MSF)

Dr. Erwan Piriou has expertise in international and humanitarian medicine, clinical immunology and infectious diseases. He discussed with us the bottlenecks in current diagnostics. Most were in line with previous conversations. However, he mentioned funding could be a big problem as obtaining funding for diagnostics is not centralized and developers can make only a small profit.

The advantage of our test is the modularity. He believes the prototype is easy to use and requires minimal training.

Dr. Erwan Piriou started by describing what is currently the main problems for new diagnostics. According to him the funding of diagnostic tools is very difficult to get due to the low profit margins developers can make on these tools. Funding for diagnostics is not centralized like it is for vaccines. As an example, he mentioned the current situation of malaria diagnostics, where 95% of all diagnostics are produced by only two companies. Moreover, it can be very difficult to actually implement the tool due to regulations and bureaucracy, especially if there already exists a diagnostic for the target disease, even if the new one is better in multiple aspects.

On the positive side, he mentioned that our project has the advantage of being flexible, due to its modularity, and efficient, due to the basic level of training required. Another advantage we could look into is making the diagnostic quantitative, as this would allow for identifying the severity of the disease. This would result in better decision making of personnel in terms of sending patients to the hospital.

On the topic of outbreak prevention dr. Erwan Piriou told us that developing diagnostics for these targets is often difficult, but our system has the advantage of being modular and easy to scale-up. Preventing recurrence comes down to screening in the field with diagnostics, which means that these need to be available with long shelf life, as well as data communication to central labs. However, money nor personnel is available for these practices, leading to a lot of examples of disease recurrence in the recent decades. The WHO is attempting to centralize funding for diagnostics somewhat by making an ‘essential diagnostic list’. By coming to an agreement, worldwide funding for these diagnostics might be sped up.

We showed our device and let him ‘experience’ it without any instructions about its functioning. He quickly understood how everything was supposed to work and said: people would definitely be able to use this device in the field and also mentioned how he didn’t see a need for extensive training of personnel. He asked us if we thought about multiplexing for different diseases and carrying out multiple tests for multiple patients at the same time. He mentioned how tests for the 5-10 most common diseases would reduce the amount of nonspecific antibiotic prescriptions to patients. He also mentioned how our device could benefit from being open-source as it could easily be modified due to its modularity. However, this would lead to problems with attracting investors.

Aug 29

iGEM USP Brazil 2017

iGEM team in Brazil

Since we were unable to contact experts that have been in the field in South America, we contacted iGEM USP Brazil. Who else knows the local situation better than Brazilian inhabitants? Their insights into the measures being taken by the government and the locals to prevent infection by mosquito-borne diseases are a valuable addition to our project. Moreover, they got into contact with Dr. Tatiana Mingote Ferreira de Azara, Health Surveillance Secretary of the Brazilian Ministry of Health, providing us with even more details. More can be read on the collaborations page.

Sept 20

Dr. Tatiana Mingote Ferreira de Azara

Health Surveillance Secretary of the Brazilian Ministry of Health

Via iGEM USP-Brazil, we got the opinions of dr. Tatiana Mingote from the Brazilian Ministry of Health. According to her, the Brazilian government faces lots of issues dealing with infectious diseases. The main bottleneck of diagnostic tests is not the costs but the limited production capacity. Moreover, the reliability of current diagnostic field tests is insufficient. Also, the Brazilian government does not recommend the use of current vaccines. Lastly, the fight against mosquitoes is difficult because of the bad water distribution system and the rainy seasons.

Implementation

We now obtained enough in-depth information about viral diseases in South America. There are many similarities between epidemics, but also a lot of differences. We have to take this into account when implementing our diagnostic test. This is why we explain the situation in Africa and South America as separate cases in our roll-out plan.

What will be our future scenario?

Previously, we have been advised at the Rathenau Institute to work out a techno-moral scenario for our device. This will be a future perspective for our diagnostic test. Here we answer the question: how would our world change if health care would become open source? We wanted to discuss this with an expert.

Dr. Henk van den Belt

Philosophy teacher at Wageningen University & Research, iGEM Human Practices judge 2011

We discussed this techno-moral scenario with dr. Henk van den Belt. While the current patent-based market has its flaws, it doesn’t seem likely that there will be a major change soon. Money is a major driver of innovation and by using patents companies can protect their claim. Furthermore it seems unlikely that an open source based market could be installed or effectively sustain itself alongside a patent-based market.

Oct 12

On our Future Perspectives page, the outcome of the interview with dr. Henk van den Belt can be found.

Final conclusions

This all resulted in the project as it is presented on the Wiki right now!

What started out as a device capable of diagnosing people went through a vector monitoring phase and resulted in a robust device that can be used for large-scale screening during epidemic situations. We gained insight into the situation in both Africa as well as in South America and found out that there are many similarities but also many differences and difficulties. Finally, our prototypes got a nice upgrade, and we have considered a roll-out plan of our final device.

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