How can data and technology improve stock control and/or reduce the use of substandard and falsified oral antibiotics for community use in low- and middle-income countries?

Antibiotic resistance (often referred to as antimicrobial resistance or AMR) is a One Health crisis and an increasing threat to our health, food, and environmental security.

It is estimated that antibiotic resistance will cause 39 million deaths in the next 25 years. Without action, the majority of deaths will occur within low- and middle-income countries (LMICs).

People and animals in LMICs lack access to common antibiotics. Of the 7.75 million people who die of bacterial sepsis each year, almost 3 million have infections that could be treated with commonly used oral antibiotics such as penicillin and amoxicillin, which are generally low risk, low cost, and widely available. Children under 5 years of age in LMICs are especially affected.

Lack of access to effective antibiotics causes both mild and severe infections, increased antibiotic resistance, and death in both human and animal populations. There are many contributing factors: from upstream manufacturing quality control, to downstream availability of health care services.

The Trinity Challenge on Community Access to Effective Antibiotics is seeking innovative, low-cost data and technology solutions in LMICs that address:

1. Lack of stock control at the sub-national/local level in community settings.

   AND/OR

2. Substandard and falsified oral antibiotics, which are estimated to make up 10% of antimicrobials used by humans in LMICs and 6.5% of veterinary medicines.

The use and/or generation of community-level data should be integral to solutions. Solutions may relate to human and/or animal health.

Solutions might respond to this Challenge by, for example:

• Leveraging citizen-related data (such as mobility or health metrics) to improve sustainable access to effective antibiotics for human and/or animal use.

• Applying technology to improve the tracking of antibiotics along the journey from manufacture to patient, tracking community demand, and reporting on shortages and/or predicting stockouts.

• Innovation in data capture and/or data analysis relating to stock control or substandard and falsified antibiotics.

• Developing (or updating) more accurate estimates of the prevalence of substandard and falsified antibiotics in a specific community or in a specific part of the supply chain.

• Developing new or improved ways to authenticate antibiotics at the point of sale.

• Developing technology to monitor the effect of climate factors on antibiotic quality.

• Applying existing technology from other sectors to this issue.

See full eligibility criteria here.

Glossary of Key Terms

• Antimicrobial resistance: For the purpose of this Challenge, this refers specifically to the resistance of bacteria to antibiotics.

• Commonly-used oral antibiotics: These antibiotics have a narrow spectrum of action, generally with fewer side-effects, a lower potential for the selection of antimicrobial resistance and of lower cost. The majority are categorised as ‘Access’ antibiotics as per the three classes of antibiotics defined by the WHO Essential Medicines List. They are recommended for first line treatment of most common community-acquired infections at the community level and should be widely available.

• Community-level data: Data that is collected from the community, outside of hospitals and other formal healthcare facilities and large-scale industry such as food production plants.

• Low- and middle-income countries (LMICs): Countries with a Gross National Income (GNI) less than $14,005 per capita as defined by the World Bank. These include low-income, lower middle-income countries, middle-income countries, and upper middle-income countries.

• One Health: Human, animal, and environmental health.

• Substandard and falsified antibiotics (Challenge Categories):

  • Substandard antibiotics: Authorised medicines that fail to meet either their quality standards, their specifications, or both.

  • Falsified antibiotics: Deliberately or fraudulently misrepresent their identity, composition, or source. The term counterfeit is also commonly used and refers more specifically to trademark infringement.

• Stock control: The provision of goods, which for the purpose of this application relates to antibiotics in LMICs at sub-national/local level, where interruptions may occur anywhere along the continuum from manufacture to dispensing of antibiotics.

• Stockout: A situation where there is no available supply of a specific antibiotic within the community, preventing it from being dispensed or administered when needed.

• Technology: The application of science and evidence-based knowledge to the practical aims of human life. We welcome solutions that are using apps, SMS technology, software, AI, robots, drones, blockchain, and virtual reality. We also welcome solutions that are leveraging traditional, ancestral, and natural technologies and knowledge systems.

A prize fund of up to £1,000,000 will be awarded, with an aim to award a grand prize of £500,000 in each category of the Challenge (Stock Control and Substandard and Falsified Antibiotics). Other prizes may be made at the discretion of the Judges e.g. runner-up prizes or honourable mentions for solutions outstandingly meeting some criteria.

The exact amount of the prize for each winner will depend on the solution’s needs for development, deployment, and scaling over the next two years.

The Trinity Challenge reserves the right to increase or decrease prize values at their discretion. 

Prize funding will be contractually binding between applicants and The Trinity Challenge and must be used to develop the solutions and further the aims of the Challenge.

In addition to prize funding, The Trinity Challenge will look to leverage support from its network of Members to enhance winning solutions, through opportunities such as networking, mentorship, or collaborations.

Applicants from all over the world are encouraged to apply. This Challenge particularly encourages solutions from teams based in low- and middle-income countries (LMICs) and multi-disciplinary teams. Previous Trinity Challenge applicants are able to apply. 

Solutions must:

• Focus on interventions in LMICs
  • A minimum of 60% prize funding must be spent in LMICs
  • Utilise or generate community-level data in LMICs i.e outside of hospital/formal healthcare settings and industry (see FAQs)
  • Demonstrate the potential to scale to positively impact the lives of LMIC populations
• Focus on stock control AND/OR substandard and falsified oral antibiotics
  
  • If focus is human health, it should be on oral antibiotics in the community setting.
  • If focus is animal health, it should be on antibiotics in feed or water for food production animals, or oral antibiotics for companion animals.
  • We welcome existing solutions focused on community-level health, agricultural, or other relevant data and analytics that can be adapted as long as there is a justification for how it could be applied to stock control and/or substandard and falsified antibiotics.
• Utilise data and/or technology in an innovative way
• Be at least at the proof of concept stage (see FAQs)
• Have clear deliverables that can be achieved in two years
• Provide a public benefit that would be globally accessible under fair, reasonable and non-discriminatory terms

Challenge Teams must:

• Have an Organization that is legally registered in its home jurisdiction with a bank account in its name, which will be liable for the Award Agreement.
  
  • Teams can be individual organisations or a consortium of Partner Organizations with one acting as the Lead Organization.
• If the Organization is based in a high-income country (HIC), include bona fide partnerships with researchers or organizations in LMICs. Additionally, data must be relevant to, or collected from, LMICs, and not HICs.
• Submit only one application per Challenge Team

Challenge Teams may not include:

• Government agencies or their foundations (see FAQs).
• Pharmaceutical companies.
• Organizations operating in a sanctioned country (see Terms of Service).
• For-profit companies that fulfil (or are controlled by a for-profit group that fulfils) any two of the following conditions:
  
  • Annual revenue/turnover in excess of £50 million per year
  • Balance sheet net assets in excess of £20 million
  • Average monthly FTE employees in excess of 250
• Donors that have made a financial contribution to the Challenge prize fund.
• Members of the Judging Panel.

Due Diligence

• The solution and Challenge Team must pass all due diligence checks, and adhere to the generative AI policy.

The Trinity Challenge supports the FAIR principles, CARE principles, and the principle of open-access data and encourages applications from Challenge teams that reflect a wide range of perspectives and life experiences. 

Judges

• Dr. Divleen Jeji - India Lead at Google Health
• Erick Venant - Founder at Roll Back Antimicrobial Resistance Initiative
• Dr. Céline Caillet, PhD - Medicine Quality Research Group at University of Oxford
• Dr. Anna Farra, MD, PhD - Coordinator of the Middle East Medical Unit, Antimicrobial Stewardship Referent at Doctors Without Borders (MSF OCB)
• Prof. Diane Ashiru-Oredope, PhD, FRPharmS - Lead Pharmacist, AMR and Co-Lead AMR PROGRESS Team at UK Health Security Agency 
• Dr. Simone Weyand, PhD - Independent Scientist at University of Cambridge and EMBL-EBI
• Prof. Anna Gales, MD, PhD - Professor, Infectious Diseases at Universidade Federal de São Paulo
• Amit Khruana - Director, Sustainable Food Systems at Centre for Science and Environment
• Dr. Lane Lwoyero - Technical Officer-AMR and Food Safety at World Organisation for Animal Health (WOAH)
• Dr. Toby Leslie - Global Technical Lead at Fleming Fund / Mott MacDonald
• Prof. H. Rogier van Doorn, MD, PhD - Director at Oxford University Clinical Research Unit - Hanoi
• Dr. Christopher Butler, BA, MBChB, DCH, CCH, MD, FRCGP (Hon), FFPH, FMedSci, Doctor Honoris Causa in Medicine and Healthcare - Professor of Primary Care, Clinical Director at University of Oxford
• Dr. Megan Neary - Senior Research Manager at Wellcome Trust
• Winnie Nambatya - Lecturer, Clinical Pharmacy at Makerere University College of Health Science, Pharmacy Department
• Prof. Natalie Schellack - Professor and Head of Pharmacology, School of Medicine, Faculty of Health Sciences at University of Pretoria
• Dr. Otto Cars - Professor, Infectious Diseases at Uppsala University Sweden
• Dr. Hala Zaid - Regional Director, MENA at Access Health International
• Dr. Evelyn Wesangula - Senior Antimicrobial Resistance Control Specialist at East Central and Southern Africa Health Community
• Dr. Nhu Nguyen - Program Director, Epidemic Preparedness & Response, and Malaria Control at PATH
• Prof. Patricia Kingori, PhD - Professor of Global Health Ethics at Ethox Center, University of Oxford

Judging Criteria

Solve’s unique selection methodology is a multi-phase process that includes screening, review, and judging. Expert panels of judges utilize evaluation criteria to assign quantitative scores to each solution. These scores, coupled with qualitative deliberation discussion, determine the selection of winning teams.

Solve’s standard scoring rubric uses the below criteria to assess solutions: 

1. Challenge Alignment: The solution uses data, digital tools, and/or analytics to address one or more Challenge categories.
2. Potential for Impact: The planned solution implementation has the potential to impact the intended population.
3. Feasibility: The team has a realistic, practical plan for implementing the solution, it is feasible in the given context, and the team has a reasonable plan for operational sustainability and measurable results that can be proven to work.
4. Innovative Approach: The solution includes a new technology, a new application of data, digital tools and/or analytics, a new policy model, or a new process for solving the Challenge.
5. Inclusive Human-Centered Design: Inclusive and equitable outcomes are considered in the design, implementation, and internal operations of the solution.
6. Scalability: The solution has a plan for financial viability and the potential to be scaled to affect the lives of more people in low- and middle-income countries.
7. Proximate Leadership: The solution is led by a visionary entrepreneur, innovator, or team who has deep understanding of the communities they serve and the problem they are trying to solve, expertise to develop and implement solutions, and the ability to adapt and respond to feedback, along with the necessary skills and track record to improve, expand, or replicate their solution.
8. Technical Feasibility: If the digital tools and/or analytics are novel, the applicant has provided convincing evidence that they have been built and function as they claim, even if only at proof-of-concept stage.

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About the Challenge

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