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Spirit of ‘reverse innovation’ drives new digital health technologies at the Geneva Health Forum 

A doctor checks an x-ray of the lungs of a hospitalised boy with Covid-19. Credit: Keystone/ EPA / Emanuele Valeri

What if every household in the world could diagnose coronavirus-triggered pneumonia from their home with a cheap handheld device?

We are not at this stage yet. But the Swiss-made Pneumoscope, an intelligent stethoscope that can diagnose pneumonia in seven minutes, is bringing this dream closer to reality, says Benissa Mohamed-Rida from the Pneumoscope initiative.

The device is one among a series of new portable and low-cost innovations that will be featured at the Geneva Health Forum which opens Monday, 16-18 November.

Why it’s important. The three-day Forum brings together Swiss and European expertise with that of researchers and practitioners from low- and middle-income countries to explore problems on the cutting edge of global health, as well as innovative solutions.

While an overarching theme of the first-ever virtual of the Forum will naturally be COVID-19, the conference is covering a wide range of other topics - from big picture themes such as climate change and decolonising global health to nuts-and-bolts approaches to tackling cervical cancer or neglected tropical diseases.

The event is co-sponsored by the Geneva University Hospitals and the University of Geneva, in collaboration with Geneva International, WHO, UNAIDs and UNITAR.  It is expected to draw some 1,600 participants from 80 countries worldwide.

Virtual Innovation Fair. In addition, some 120 new health technologies will be showcased at a special GHF Innovation Fair, including the Pneumoscope. People registered to the GHF will be able to visit the online “exhibit” spaces at certain times every day to meet with the innovators and chat with them about their products.

A pneumonia diagnosis in just seven minutes. The current Pneumoscope prototype can diagnose in just seven minutes common forms of pneumonia, one of the leading causes of death for children under five in low-income countries.  Although this diagnosis isn’t sufficiently fine-tuned [yet] to identify only Covid-19, it’s a hint at the direction such new technologies are heading.

“In times of a pandemic, public health professionals are on the lookout for cost-effective strategies to promote diagnosis and disease prevention, not only in low-resource settings,” notes Mohamed-Rida, a Paris-based medical doctor who is working with the Swiss-based Pneumoscope Initiative. “If we can be precise in the laterality of pneumonia, there is no need to do an x-ray, so insurance companies will want to pay for the Pneumoscope, even in high-income countries.”

The Pneumoscope Initiative is being led by Geneva University Hospitals and the University of Geneva, in collaboration with the Swiss Ecole Polytechnique Federale Lausanne (EPFL) and Terre des Hommes, a global NGO.

Among the many other innovations on display will be the Indian-designed Smart Scope, an award-winning portable device that can detect cervical cancer, the second largest killer of women in India after breast cancer.

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The Smart Scope, an Indian invention that can detect cervical cancer in under 10 minutes. Source: Periwinkle Technologies.

They are just two examples of the many low-cost health technologies that are emerging out of the “reverse innovation” spirit of entrepreneurs looking to turn resource scarcity into a virtue.

Such devices are potential deal breakers in low- and middle-income countries, where a lack of more sophisticated x-ray and laboratory infrastructure and trained healthcare workers, means that many preventable diseases, including pneumonia and cervical cancer, slip past our radar.

Just Like Shazam - How it Works. Just like a song that can be recognised through apps like Shazam, respiratory diseases also have their own acoustic “signature”. And they can be recognised by artificial intelligence (AI), with the help of a smartphone or tablet, at a surprisingly high accuracy.

Working from this principle, the Pneumoscope can tease apart a healthy lung from a diseased one at a sensitivity of almost 100%, according to a preliminary case-control study that compared children under 5 years of age with pneumonia to healthy children.

In comparison to commonly used tools to diagnose pneumonia like the WHO/UNICEF case management algorithm, the Pneumoscope is twice as accurate, says Mohammed-Rida. Currently, the algorithm developed by UNICEF/WHO misses every second child with pneumonia, which is ‘simply not good enough’, he adds.

But there’s more. The Pneumoscope can also tease apart viral pneumonia from bacterial pneumonia almost 90 per cent of the time.

That means that it could help address another important issue - unnecessary prescription of antibiotics. In low-income countries, given the scarcity of effective diagnostics, antibiotics are often prescribed when a child is sick with pneumonia - even though they may have a viral infection - and this contributes over time to drug resistance.

In addition, the device can potentially diagnose severe bouts of asthma, the leading chronic disease in children that affects almost 340 million people worldwide. Preliminary results are ‘quite promising’, says Mohammed-Rida, noting that the Pneumoscope picks up asthma's acoustic signatures 90% of the time, according to preliminary trials that are still unpublished.

The device is currently being field tested in Burkina Faso, Morocco, Brazil, Cameroon and Senegal.

Not a Rolex. The Pneumoscope is designed to withstand a range of extreme conditions, including deserts with scorching temperatures as hot as 50 °C, as well as humid environments and rain.

“The Pneumoscope can’t be a Rolex,” says Mohamed-Rida. “It has to withstand extreme conditions, especially heat and humidity, as well as sand, which clogs up electronics and renders them unusable.”

Although its price remains to be determined, its cost-effectiveness ratio is likely to be “quite interesting”, says Mohammed-Rida. The group is working to manufacture it locally in low- and middle-income countries through 3D printing.

Reverse innovation. Because it doesn't need lots of technical training to use, it's particularly well-suited for low- and middle- income countries, where pneumonia is five times more common than in rich countries.

But there may be appetite for the Pneumoscope in high-income countries as well, especially during the pandemic, says Mohammed-Rida. Precisely because such devices save time and money - and may even be more accurate - they often infiltrate upward into more affluent countries - a process some call “reverse innovation.”

Notably, since the Pneumosocope can also detect which side of the lungs is infected, more formally known as the ‘laterality of disease’. it may be able to overcome the need for pricey x-rays.

“This could save overwhelmed healthcare systems tremendous amounts of money,”” says Mohammed-Rida.

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