EcoFab Health+

An accessible, effective device for the automated and real-time analysis of pathogen content for policy and epidemiological modelling.

Wenqi Zhao, Eton College

Jacqueline Shih, Horace Mann School

Michele Jiang, Downe House School

Zekai Fu, YK Pao School

The abuse of antibiotics - thought of as efficacious against all diseases - perpetuates one of the most pertinent health concerns of our time: the rise of antibiotic-resistant bacteria, directly killing 1.27 million people in 2019. Too often, that abuse stems from a lack of knowledge and data: antibiotics are administered for viral infections, for minor conditions and for the wrong bacterial strain, allowing bacteria to develop resistance through natural selection. 

The current methods of disease identification are time-consuming, requiring laboratory techniques inaccessible to developing communities. The specific problems are twofold. First, given similar symptoms, the common antibiotics, penicillin and methicillin, are administered for both viral and antibiotic-resistant pathogens, leading to the rise of bacteria such as MRSA, VRE, MDR-TB. Second, antibiotic-resistant outbreaks are detected far too late, at which point treatment  becomes impossible to administer and the resistant bacteria is allowed to propagate.

 Currently, we are trailing behind our microscopic nemesis; they evolve faster than we produce; they spread faster than we contain. EcoFab Health+ provides the platform to detect the presence of bacteria and monitor their levels. We fill in the knowledge gap that forms the basis of policy, stopping the disease before it becomes a pandemic.

Local governments are our immediate customers: they control the spread of bacteria in public buildings. Governments are uniquely able to act when the presence of antibiotic-resistant bacteria are detected by our product. We expect them to deploy it to vulnerable rural regions, where new pathogens could arise from human-animal contact.

In addition, there are commercial customers in cities: from crowded places such as restaurants, malls and residential places. They have a vested interested in preventing outbreaks as early as possible. Specifically, hospitals are important. Here, due to the large dosage of antibiotics, resistant bacteria are likely to develop and spread, and an early warning system mitigates the brunt of the damage. Simultaneously, we prevent dosage of unnecessary antibiotics (for viral infections for example) in hospitals, slowing down the development of resistance. We have investigated the different needs of local areas - both rural and urban. We take into account the population and the existing health infrastructures to tailor the product to individual places.

Our beneficiaries are multifaceted. Authorities are granted access to more data on the spread and development of antibiotic-resistant bacteria; businesses are provided an early-warning system for dangerous outbreaks; lives of individuals are saved.

The quest to combat antimicrobial resistance is twofold: to give rise to increased awareness and importance to the cause for both governments and the people; to develop sustainable and effective methods of both detection and treatment. EcoFab Health+'s sensory and warning technology fulfils this.  

First, we provide the most important data: the quantity of antibiotic resistant bacteria in the air that may cause disease and death. The benefit of this real-time data is paramount and indiscriminate, in helping researchers within the genetics and epidemiological spread of disease and in advising governments and scientists while implementing legislation. As a disruptive technology with low cost and high simplicity in using, we bring a public good to developing communities that would otherwise be blind against the onslaught of antibiotic resistant bacteria. Further, these are provided without discrimination to any area deemed vulnerable.

Beyond that, we increase global awareness in antimicrobial resistance. The technology is simple to use: a completely free installation of our app allows users to connect to nearby devices and see the levels of pathogens in the air. This allows them to make more informed decisions about their health, one that we value with great importance.

EcoFab Health+ biosensors are installed in hospitals, public places, intensive breeding farms, medical waste treatment centers and other places. The biosensors upload the detected results of drug-resistant bacteria to the cloud, and the cloud processes the data and transmits it to the customer's app. Anyone interested in drug-resistant bacteria can see relevant information about drug-resistant bacteria for free through the app. We've conducted interviews with hospitals, farms, and other institutions in the rural areas around Shanghai, China; the equipment price of US$500 and the individual cost of using consumables (US$12 each time) are perceived to be reasonable to the service we provide. 

 The profit made from commercial sales in developed countries allows more outreach into vulnerable communities. Subsidised and discounted costs are provided, in addition to on-site help with technology, such as installing the devices and connecting to the cloud algorithm. Even in areas with limited WiFi, the device can upload the results in the cloud to be accessed by parties with the capabilities (such as local authorities).

We plan to combine the surveillance of drug-resistant bacteria with the surveillance of infectious disease pathogenic microorganisms. The surveillance of infectious diseases is more urgent to avoid emergencies and easier to obtain commercial funding support. We will select three communities this year to install EcoFab Health+ biosensors in hospitals, public places, farms, and garbage treatment centers in the communities, and let more people download the EcoFab Health app through publicity. After the community pilot is successful, this model will be promoted globally through the World Health Organization or other institutions in the future to establish a unified monitoring network for antibiotic resistant bacteria.

The first is the technical index, reflecting the performance of the biosensor. Specifically, we want to measure the sensitivity of monitoring and the minimum number of copies of drug-resistant bacteria that the system can detect. Our current sensitivity is around 20-100 copies/reaction. This indicator is already higher than the sensitivity of traditional air sampling and qPCR amplification. We will continue to optimise this through testing concurrently as the product is rolled out. The scientific rigour ensures that our primary aim - protecting and providing information to the public - is adhered to.

The second is the metric measuring the promotion of the product. This is reflected in the use of the device, both in the number in use in a given time, but also the number of consumables used. We'll track the sales for this. More broadly, we examine the number of industries our system serves and the geographical areas the system has been promoted to - measuring the diversity and applicability of our system to different environments. These metrics are key factors in measuring the effectiveness of our outreach efforts, supporting our secondary aim of increasing awareness in the rise of antimicrobial resistance.

Although we envisage a worldwide adoption of the product, there are two major barriers in place. First, in many societies, health data - antimicrobial resistance and bacteria content in the air - is sensitive data. Governments and health organisations may not allow access and usage of such data and special permission must be granted. To ensure this, we would have to demonstrate strong hardware and software capabilities such that the data can only be accessed by wanted parties - ourselves and those licensed to use it. 

Second, many developing countries may not have the financial resources to procure the product: in initial acquisition and in operation. We will do our best to subsidise costs for areas demonstrating that need based on profits from commercial customers (whom we have partnered with in China). Furthermore, strategic partnership with authorities (the customer segment we focus most on in poorer regions) can help make costs reasonable

The first barrier we identified was the risks associated with data. Successful application to the Trinity Challenge not only helps validate the idea such that novel organisations are more likely to approve grants and collaborations, but more importantly, can help us connect with health organisations and authorities to bring the project into reality. Furthermore, to fulfil our impact goals of expansion into other countries, connection with the British Society of Antimicrobial Chemotherapy and the South African Medical Research Council could facilitate that.

The second major barrier involves the cost of the product. Grants and funds from the Trinity Challenge are a crucial addition to our technology - a novel one with huge scope for growth and improvement with further R&D. Moreover, this can be paramount in subsidising costs for underprivileged regions and providing them with the health monitoring they need.

We hope to connect with the Ineos Oxford Institute for Antimicrobial Research. Their interests aligns with our core biomedical technology and could have advice on how to further develop and optimise the solution. 

For the computational segment of the product - the Machine Learning for colour recognition and the epidemiological monitoring processes - we hope to partner with Amazon Web Services for their insight and advice on the technological side. Furthermore, they are experienced in maintaining data security, which is crucial as one of the risks we identified previously. 

Finally, to scale the product globally, we believe the Tony Blair Institute for Global Change has the capacity to facilitate this growth and development.