For people like me who have devoted their entire medical careers to the fight against tuberculosis, there are finally some reasons to be optimistic about the fight against this scourge. This week, tuberculosis experts from 125 countries are gathering in Amsterdam, surrounded by a buzz of optimism that political leaders will finally come through on their commitments to fight the world’s most deadly infectious disease.
Making progress against tuberculosis hasn’t been easy. Over the 35 years of my professional career, I have seen brilliant people dedicate their lives to reducing the spread of the disease. Yet progress has been slow and incremental: Tuberculosis kills someone every 18 seconds — more than any other infectious disease, including HIV. For more than two decades, tuberculosis infections around the world have decreased by less than 2 percent a year. And each of the 18 million people living with tuberculosis today will infect about a dozen friends or family members.
Most people suffering from tuberculosis live in places where access to health information is limited, disease data are sparse and rarely acted upon, and incentives that drive providers’ behaviors are often at odds with the delivery of quality care. So it’s not surprising that progress against tuberculosis has been slow and linear.
What makes this year’s tuberculosis meeting different than the one 10 years ago? Virtually everyone at this week’s meeting will have a powerful weapon against tuberculosis lurking in their purses or pockets: the smartphone.
Mobile technology is changing the world at an exponential pace. WhatsApp creates massive global communities, Yelp gives every customer a voice, shopping apps manipulate consumer incentives and collect actionable data in real time, Uber uses digital behavioral economics to improve service delivery, and blockchains empower individuals to control their own data and transactions.
Nearly 2 out of 3 people alive today are mobile phone subscribers, and more than half of them use smartphones. Although the numbers are smaller in developing countries where tuberculosis is most problematic, most of the 1.75 billion mobile users who will come online by 2025 will live in countries or regions with the highest tuberculosis burden: China, India, Pakistan, Indonesia, and sub-Saharan Africa.
Investments by governments, international organizations, and the private sector over the past few decades have improved health systems in even the poorest countries. But individuals do not experience health care as functional systems. Instead, they experience it as complicated and fragmented health markets in which they struggle to gain access to useful information, services, and products.
In the same manner that phone-based mobile banking has increased access to useful and affordable financial products and services, phones can help tuberculosis patients find their way to the care they deserve, in both the public and private sectors. While we await game-changing new diagnostics, drugs, and vaccines, we can make far better use of smartphones today to connect people with tuberculosis with the care they need.
Smartphones are already being used for other medical conditions. In South Africa, MomConnect has partnered with WhatsApp to connect nearly 2 million pregnant women and new mothers to vital services and information. In India, Together For Her has established a Yelp-like system that empowers new mothers to provide feedback on the quality of the hospitals in which they gave birth, giving expecting mothers information to choose the best maternity hospitals. In 11 developing countries, Triggerise is using phones to reward people for doing the right thing while simultaneously collecting and analyzing data to increase their impact. Proof of Impact is using blockchain-based smart contracts to verify events that make an impact and pay for them with cryptocurrencies or funds from impact investors.
And now there are sparks of smartphone innovation for tuberculosis. Most promising are apps made by SureAdhere, Emocha Mobile Health, AiCure, 99Dots, and others that have been shown to help patients take the required six months of antibiotics. Others are being developed to address other challenges of tuberculosis care and control, such as disseminating information about the disease and improving its diagnosis. But the burning question is how to stitch together such efforts and make them widely available so that poor people are empowered to improve their own health and that of their communities.
None of these advances will be easy or happen in isolation — and no intervention is without risk. Patient’s rights, safety, and confidentiality must be ensured from the get-go. In contrast to the pace of change in Silicon Valley, the digital “revolution” in tuberculosis will be incremental and follow different paths in different settings. And like prior technology-driven revolutions, its impact is likely to be oversold in the short term and underappreciated in the long term.
At this week’s tuberculosis meeting, participants will be able to see or hear approximately 1,000 scientific presentations. Sadly, only nine of them are focused on using mobile phones to improve tuberculosis care. It is past time for TB researchers and care providers to work with tech innovators, business entrepreneurs, digital companies, and mobile phone operators to adapt the smartphone technology to improve care.
At next year’s meeting, I hope to hear presentations describing tuberculosis experts partnering with WhatsApp to raise awareness, with Vodafone to disseminate apps that help patients diagnose themselves, with Yelp to share the quality of their experiences with specific clinics, with Uber to transport clinical samples, and with Amazon to deliver medications directly to patient’s homes.
Mobile technology is poised to transform tuberculosis care in the hardest hit countries. Let’s not miss this opportunity.
Peter M. Small, M.D., is a Rockefeller Foundation Fellow and visiting scholar at Stony Brook University. He previously established and directed the tuberculosis program for the Bill and Melinda Gates Foundation. The views expressed here are the author’s alone.