Antimicrobial resistance (AMR) is a global challenge, but access to the diagnostics needed to detect resistant infections remains uneven. In many low-resource settings, limited infrastructure and high costs continue to restrict the use of advanced diagnostic technologies.
In response, David Roach, Instructor of Medicine at Harvard Medical School and Infectious Disease Physician at MassGen Brigham, and his team are developing a low-cost, portable diagnostic platform designed specifically for these environments. Here, he discusses the importance of designing diagnostics around local needs and why expanding access to affordable testing should be a global health priority.
Your BADLOCK platform focuses on rapid, portable detection of pathogens and resistance. How does this approach differ from existing point-of-care or molecular tools?
The major advantages of the platform are its ease of use, low infrastructure requirements, and affordability. From the outset, our goal was to develop a system that could be used in low-resource settings, where access to advanced diagnostic technologies is often limited, but the need is greatest.
Although the platform is still in the prototype stage, its cost is substantially lower than that of existing systems used for species identification and AMR gene detection from positive blood cultures. We are also designing the platform to operate with minimal laboratory infrastructure, which could support broader adoption across a wider range of healthcare settings.
What are the key considerations when designing diagnostics specifically for low-resource environments – both technically and operationally?
Key considerations include keeping per-test costs low and minimizing infrastructure requirements. Beyond these practical factors, it is important to consider the specific clinical use cases a diagnostic is intended to address and the healthcare settings in which it will be deployed.
There is no one-size-fits-all diagnostic solution. Successful implementation depends on aligning the capabilities of a test with local healthcare needs, available resources, and the clinical questions it is designed to answer. Careful consideration of these factors is essential to ensure that a diagnostic delivers meaningful value in the settings where it is most needed.
How do cost, infrastructure, and workforce constraints shape the choice and implementation of diagnostic tools?
In my view, these considerations need to be built into the design process from the outset. Diagnostic technologies should be developed with a clear understanding of the resources available and the healthcare needs of the settings in which they will be used.
A highly sophisticated test may perform well technically, but its impact will be limited if it is too costly, complex, or impractical for healthcare workers to adopt. Ultimately, successful diagnostics are those that balance innovation with usability, ensuring they can be implemented effectively and deliver real benefits to patient care.
How can collaborations – whether local, regional, or international – help bridge diagnostic gaps in low-resource settings?
Some practical steps include building partnerships with emerging diagnostic technology developers to support implementation in regions where these tools are most needed. These efforts should be coupled with strong local research infrastructure to ensure that feasibility and implementation studies can be conducted effectively and generate meaningful evidence.
Advocacy is equally important. Continued engagement with funders – including non-governmental organizations, philanthropic organizations, and national funding agencies – is essential to highlight the ongoing need for diagnostics that address unmet healthcare challenges in low-resource settings. Sustained investment will be critical to developing, evaluating, and scaling technologies that can improve access to timely and accurate diagnosis worldwide.
What’s your key message to pathologists and laboratory professionals regarding diagnostics in low resource settings?
Developing novel, low-cost diagnostics for AMR that are specifically designed for use in low- and middle-income countries should be a global health priority. To achieve meaningful impact, funding efforts need to focus not only on technological innovation but also on accessibility and scalability.
The AMR diagnostics field does not necessarily need more high-cost instruments designed for narrow use cases in well-resourced healthcare systems. Instead, there is a need for affordable, widely deployable platforms that can be implemented across diverse healthcare settings and reach the populations most affected by AMR.
The global health community should also explore procurement models similar to the Gavi pooled procurement model's approach to vaccines, using pooled purchasing mechanisms to improve access to essential diagnostics. Such strategies could help reduce costs, accelerate adoption, and promote more equitable access worldwide.
Improving diagnostic capacity is a critical component of the response to rising antimicrobial resistance. Because AMR is a global challenge, investments in diagnostics benefit all countries and are likely to have the greatest impact when pursued through coordinated international efforts.
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