To find out, Innosight hosted an Innovation Summit aimed at overcoming barriers to eradicating super strains of tuberculosis, the world’s second leading infectious disease killer, after HIV/AIDS. Held in conjunction with the Eli Lilly Foundation and the Stop TB Partnership, the two-day event attracted a wide range of invited leaders—from places as diverse as the World Health Organization (WHO), MIT, Partners in Health, and Wal-Mart.
“A lot of people in the room didn’t know about TB and didn’t think about TB,” said Dr. Lee Reichman, author of Time Bomb, a seminal book about the MDR-TB crisis. “All of a sudden they say: ‘this is a monumental problem, maybe we could solve it this way or that way.’ We need more thinking like this by people of diverse backgrounds.”
Preventing an epidemic
As the first major event held in Innosight’s newly opened Business Design Lab, the summit began by laying out the severity of the problem for those who held no expertise in global health. Since tuberculosis has been around for thousands of years and because vaccines are fairly cheap, there’s a perception in the developed world that the problem is well under control. But that’s not the case for “multi-drug resistant,” or MDR-TB, which arises when treatments are improperly applied.
There are an estimated 500,000 new cases of MDR-TB annually, leading to more than 150,000 deaths. The highest concentrations of the disease occur in India, China, Russia, and South Africa. “Due to incorrect treatment, MDR-TB is a man-made disease, said Lucica Ditiu, executive secretary of the WHO’s Stop TB Partnership. “That is unacceptable.”
Drug resistance forces public health officials to turn to second-line drugs (SLD). Because of a range of barriers, however, fewer than 20,000 patients (just 5%) are treated each year with quality-assured SLD drugs, which leads to further proliferation of the disease.
These super strains threaten to become an epidemic unless distribution, treatment and awareness problems are solved. That’s because all TB is caused by bacteria transmitted through the air—through coughing or even just by sharing a confined space. TB ravages the body, causing severe pain, night-sweats, fatigue, and coughing of blood. If the immune system is weakened through malnutrition or other disease, which is often the case; the disease burden is higher and survival rates are lower.
Deploying systems thinking
Overcoming such a complex cluster of problems requires “systems thinking,” said Innosight senior partner Joe Sinfield. He outlined a solutions discovery process inspired in part by how Thomas Edison invented not just a light bulb but an entire city-wide system for power generation. Systems thinking is multi-step process for “diverging, “ or breaking down a giant problem into more solvable components, and then “converging,” or putting those components back together into a holistic system.
To this end, Innosight identified a set of 14 barriers—such as lack of MDR-TB detection methods, lack of drug distribution, lack of laboratory capacity, lack of awareness, lack of financing—that stand in the way of solving the larger problem. The group of 40 attendees then broke down into seven groups, with each group tackling one barrier per day. Each group was given background information as well as brainstorming resources, such as “placemakers,” or movable white board walls, that facilitated the two days of collaborative brainstorming.
“I had to start at ground zero and figure this out and identify who were the key stakeholders,” said Rob Kusiciel, Wal-Mart’s vice president of inbound transportation. “It’s a very rapid process, and you have to bring a lot of focus and energy to it.” By the end, Kusiciel was convinced that new supply-chain solutions could lower costs and lead to breakthroughs that get the right drugs to patients in the far-flung places.
For those who had deep experience fighting TB, one of the biggest issues was overcoming long-standing grudges and conflicts. “We got people together who didn’t agree,” said Fernande Raine, a manager at Innosight who organized the summit. “We said: ‘Let’s put your politics aside, let’s put history aside, and let’s look at the barriers and generate new solutions to this specific problem.’”
By the end of the summit, the participants generated more than 90 specific MDR-TB solutions. Those raw ideas were consolidated down into a set of 14 “solutions platforms” that address the key barriers. Out of those, the team outlined a targeted selection of five key but realistic projects. Innosight and the Lily Foundation are currently exploring ways to bring those solutions to market.
Evan I. Schwartz is the Director of Storytelling at Innosight