Can Offering A $12 Million Prize Make a Difference to Drug Resistance?

Last night, at a gathering in Boston, a crew of scientists and altruists offered a prize for achieving a technology so novel, no one can yet imagine it.

The last time this was tried, it took almost 50 years for someone to win.

This time, the organizers hope it will take only five. The Boston gathering was a reception at Harvard Business School to introduce American inventors to the Longitude Prize, a British initiative to stimulate innovation in order to reduce antibiotic resistance. The Prize is fairly well-known in England—it is backed by the UK’s National Endowment for Science, Technology and the Arts and was broadly publicized by the BBC—but has gotten little attention in the US. Which meant that, before last night’s session, US-based teams might have been missing out on its juicy incentives: £8 million in winner-take-all prize money (currently about $12.3 million), in addition to £2 million (about $3.075 million) in early-stage discovery awards.

The aim of the prize competition, which opened in the UK last November and will run until 2019, is very specific. It wants to entice inventors to create something that the fight against antibiotic resistance lacks and critically needs: a point-of-care rapid diagnostic test. The prize’s organizers hope for a device that can distinguish among bacteria, and among the various resistance factors that bacteria may carry, and do it inexpensively, within 30 minutes, with minimal additional technology, anywhere in the world.

Such a device doesn’t now exist—and no one yet has proposed a reasonable way of achieving one. Hence the competition, which harks back to an earlier era when a technology was badly needed but could not be envisioned by the scientific establishment of its day. The current contest is named for the original Longitude Prize, offered by an Act of Parliament in 1714. That prize aimed to solve the most pressing scientific problem of that era: how to determine accurate time at sea—not only local time, but the time at a reference point such as Greenwich—in order to calculate longitude and derive a ship’s precise location. The eventual winner, Joseph Harrison, built multiple iterations of a finely engineered timepiece that looked like an oversize pocket watch; he did not receive his first payout until 1765. (The story is told in Dava Sobel’s best-selling book Longitudebest-selling book Longitude.)

The goal of the new prize was chosen by a nationwide vote in Britain in June 2014. Combatting antibiotic resistance won the most public support, over five other topics: creating zero-carbon aviation; ensuring access to nutritious food; reversing paralysis; guaranteeing clean water; and improving independent living for dementia patients.

“Rapid diagnostics are an essential part of the fight against resistant organisms,” Professor Dame Sally Davies, Britain’s chief medical officer and co-chair of the prize advisory panel, told me by email. “They have the potential to not only influence clinical practice, but also prescribing behaviour. I hope the prize will get innovators across the globe working on this problem.”

The panel, called the Longitude Committee, chose a diagnostic device as the process’s goal because it could change both whether physicians give drugs inappropriately—choosing the wrong drug, or giving an unneeded one—and also whether patients understand that they may not need an antibiotic at all. Taking or giving unneeded drugs contributes to antibiotic resistance, and despite decades of public health campaigns, it has been very hard to make people stop.

“It should give a result within 30 minutes, it should not be a sophisticated test, in terms of needing lots of expensive equipment, and it should be able to be used anywhere in the world,” Dr. Laura Piddock, a professor of microbiology at the University of Birmingham and one of the prize’s technical advisors, told me by phone. “That is a very tall order. Even whole genome sequencing can’t come near that, at the moment.”

Some rapid tests that can be used in low-income areas do exist now, she pointed out—an Ebola rapid test was developed during the recent West African epidemic, and a Harvard research group has achieved tests for diabetes and some infections using paper incorporating microscopic channels—but each of those aims to detect just one organism or condition. A successful resistance diagnostic would have to handle “lots of bacterial species, lots of resistance factors,” Piddock said.

Since submissions opened, 101 teams have registered with the site: 28 who plan to submit entries, and another 73 who are volunteering to be collaborators. Entries will be assessed every few months. The competition ends when one entry looks like a clear winner, but that has not happened yet. Organizers hope that ideas will come not just from the usual suspects of microbiology and drug/device development, but from engineers, tech geeks and civilians as well.

“There have been a large number of high quality groups who have either submitted or registered,” Kevin Outterson, a professor of law at Boston University who studies incentives for antibiotic development, and is also a technical advisor, said by phone. “I have every indication we will continue to get really good submissions.”

But, he cautioned, just coming up with good technology won’t be enough to win. “A fair amount of this challenge is not technical, it is behavioral,” he said. “The prize doesn’t want to see just something that works on the lab bench. The prize requires that people can demonstrate how this will be used in practice. Will a provider use this before prescribing? Will an informal drug seller in the developing world be willing to use it?

“There is a greater emphasis here than people realize on real-world experience. We can achieve this device, but if it is not used every day, in every setting, then we have wasted an opportunity.”

To learn more about the Longitude Prize, the rules for enrolling, and the teams who have entered so far, visit LongitudePrize.org and @longitude_prize.