Biomedical optics: illuminating paths to enhance health equity in the Philippines

Advancements in biomedical optics have significant potential to improve healthcare in low-to-middle-income countries, where preventable and treatable diseases remain prevalent. However, limited integration of relevant sciences hinders the development and application of optical techniques to medical research. Improving the biomedical optics research landscape requires comprehensive curriculum reforms, professional development initiatives, and the establishment of appropriate research infrastructure. Additionally, effective strategies for translating research into practical healthcare solutions include securing targeted funding grants, promoting interdisciplinary collaborations, and fostering international partnerships. These efforts can bridge the gap between advanced optics research and its real-world application, enhancing healthcare outcomes in resource-constrained settings.

In low-to-middle-income countries (LMICs) such as the Philippines, the burden of preventable and treatable diseases persists despite global advances in healthcare.The World Health Statistics 2023 highlights ongoing challenges such as maternal and child mortality, non-communicable diseases, and infectious diseases [1].These health burdens are compounded by limited healthcare resources, the geographic isolation of many communities, and socio-economic barriers that make access to care difficult.The COVID-19 pandemic has exacerbated these challenges, leading to an increase in diseases such as HPV, malaria, tuberculosis, and neglected tropical diseases (NTDs) [1].
In an archipelagic country like the Philippines, access to healthcare becomes a challenge as patients from geographically isolated and disadvantaged areas (GIDAs) are burdened with travel and other costs just to seek treatment.Moreover, socio-economic factors such as high poverty incidence, the presence of vulnerable populations, and communities entangled in crisis or armed conflict add another layer of difficulty in deploying advanced technologies for health in GIDAs.The use of these technologies may help augment healthcare delivery, emphasizing the need to go beyond merely treating all patients the same [2].Thus, the need for innovative healthcare solutions is more pressing than ever.
Biomedical optics offers a promising path forward by enabling decentralized diagnostics and therapeutic solutions to transform healthcare delivery in remote and underserved regions.The development of lasers and spectroscopy-based techniques, such as Raman and Infrared spectroscopy, has opened new frontiers in early disease detection, monitoring, and diagnosis of various medical conditions [3].In the Philippines, current methods for diagnosing Dengue Fever-relying on symptom manifestation, seromarkers (NS1), and immunoglobulin assays (IgG/IgM)-lack the ability to determine virus serotypes, which hampers patient management and increases the strain on healthcare facilities.Our ongoing research aims to pioneer a diagnostic approach using vibrational spectroscopy to characterize virus serotypes, potentially extending this method to other neglected tropical diseases.Additionally, ATR-FTIR has also shown promise in discriminating malignant from benign lung tissues which shows its potential as an alternative diagnostic tool for lung cancer [4].Optical imaging is not new to low-resource settings and is already being utilized in various applications, such as early cancer screening [6].Furthermore, the development of low-cost systems, such as a smartphone-based hyperspectral imaging system for skin analysis and monitoring, expands options for remote areas where traditional imaging modalities are scarce [5].Meanwhile, the application of AI in the analysis of brain scans to detect the penumbra among neurovascular or stroke patients has been advantageous in the management of stroke.By leveraging these optical technologies, LMICs like the Philippines could further improve healthcare outcomes and reduce mortality rates, and even lessen equity gaps in the global health setting [6].
In this editorial, the authors shed light on the nexus of health equity and leveraging health technologies in augmenting the health system in the context of an LMIC with the Philippines as an illustrative example.In the subsequent section, we discuss how targeted interventions and innovations can strengthen health systems and address disparities, advocating for increased attention and investment in this field.

Strengthening the biomedical optics research system
A thriving biomedical optics research system should enable the discovery of optical biomarkers, modification of optical techniques, expansion of clinical applications, and development of new medical devices.By advancing our understanding of the interaction between light and anatomical systems, we are enhancing our capability to integrate the applications of biomedical optics in the treatment and management of a myriad of medical conditions.To realize this in the Philippines and in other LMICs with similar challenges, the following key factors in fostering a strong research environment should be considered.

Educational reforms and curriculum development
As early as 1995, it has been observed that a significant barrier to successful collaboration between optical scientists and clinicians has been the disconnect in their educational backgrounds which can be partly traced to the educational structures [7].Currently, there are no dedicated Biomedical Optics and Photonics course available in the Philippines.Existing physics-based programs lack integration with biology and medical subjects, which are crucial for applying optical techniques to medical research.Conversely, medical schools typically exclude Physics from their curriculum, assuming that students have mastered these concepts in their undergraduate studies.A more extensive discussion is invested on Optics principles in training programs for specialists in Surgery, Ophthalmology, Radiology, and Dermatology but are geared towards its application rather than understanding the actual principle.Given that diagnostic techniques and treatments rely on physics principles, this gap limits the understanding and application of these technologies.
Thus, there is a need to revise the current curricula of both fields.This might entail the addition of specialized courses or restructuring of existing curricula to include interdisciplinary subjects.At the undergraduate level, integrating biology with physics for physics students and vice versa for medical students could harmonize these fields.An alternative short-term solution is to establish an interdisciplinary course that combines physics, optics, and biomedical sciences.Some countries have already demonstrated success in integrating biomedical optics into their education and research systems.Thailand was able to do it through the support of the National Science and Technology Development Agency through the Photonics Technology Laboratory of the National Electronics and Computer Technology Center [8].India and South Africa have also integrated biomedical optics through strong academic institutions and targeted government funding to address their healthcare needs [9][10][11].

Capacity-building of biomedical optics experts
A healthy number of biomedical optics experts can drive the innovation and adaptation of existing technologies to suit local needs.Through the development of local industries and research capabilities, we also enhance our medical supply chain thereby decreasing reliance on global supply which is affected by various geopolitical factors.This approach not only enhances self-sufficiency but also promotes economic growth and may serve as a strategy for preparedness in times of disaster and future pandemics such as COVID-19.
Presently, the Philippines faces a shortage of experts in this field, with only about 15% of the doctorate holders in Physics involved in biomedical optics [12,13].The majority of researchers come from the fields of Physics, Engineering, Health, Biology, and Chemistry (Fig. 1).Furthermore, since 2001, there have been just 37 publications in biomedical optics focusing on disease detection and monitoring (Fig. 1).These statistics indicate a need for more local learning platforms and funding support.To address this, initiatives such as the Department of Science and Technology's Balik Scientist and S&T Fellows programs are essential for accelerating research and development.Expanding advanced training programs and certifications in biomedical science, including specialized short courses and workshops on the biomedical applications of laser technology such as imaging, diagnostics, and therapy can further develop local expertise.Provision of fellowship opportunities at international institutions would also allow Filipino experts to gain exposure to advanced research and training.Additionally, regular participation in conferences serves as a valuable platform for expanding professional networks.Hosting international experts and visiting professors to conduct workshops, seminars, and collaborative research projects can also help build local expertise and foster global connections.

Investment in research infrastructure
The establishment of research centers that would provide the necessary facilities and equipment for conducting cutting-edge biomedical optics research is crucial in advancing this interdisciplinary field.Since these experiments would involve cells, tissue, blood, and other biological organisms, an integral component of these research centers is the inclusion of biosafety laboratories (BSLs).BSLs are essential for adhering to stringent safety protocols, including controlled access, specialized ventilation, and personal protective equipment, to protect researchers and the community from biohazards.For a biomedical optics research center that may possibly handle biological samples, a core containment laboratory would often be sufficient, however, this is dependent on the types of pathogens being handled.Presently, there are limited, if not none, core containment laboratory facilities with optical set-ups in the Philippines.Thus, for an ongoing optical research on vector-borne viruses, our team is co-designing a research laboratory fit for optical experiments.
Other fundamental aspects of these research centers include advanced imaging systems, spectroscopy instruments, laser systems, sample preparation and handling equipment, analytical and data processing tools, supporting infrastructure, and training and safety equipment.The WHO Laboratory Biosafety Manual discusses more details on the specifics of laboratories working on biological agents [14].Although there are numerous publications on the characterization of biological samples using techniques like Scanning Electron Microscopy and Confocal Microscopy, advanced optical setups such as Fourier Transform Infrared Spectroscopy, Raman Spectroscopy, Photoluminescence Spectroscopy, and Terahertz Spectroscopy are underutilized in the Philippines.Despite the presence of these advanced systems, only 6.2% are used for biomedical applications.The absence of suitable research environments not only hampers progress but also contributes to brain drain, undermining the potential benefits of local expertise.

Funding grants
The provision of research funding contributes to the smooth integration of biomedical optics research into the healthcare system.Targeted funding ensures that proposed technologies and solutions are tailored to the specific health challenges and contexts of these regions.Government grants, private sector partnerships, and international funding play pivotal roles in supporting these initiatives.
In the Philippines, government research funding agencies are instrumental from the conceptualization to the translation of biomedical optics research and development and in fostering a good research environment between diverse experts.The Philippine Council for Health Research and Development (PCHRD), a sectoral council of the Department of Science and Technology, primarily funds health research in the country.DOST-PCHRD aligns its funding with the nation's five-year health research agenda, ensuring that priority areas receive the necessary support [15].The inclusion of Medical Biophotonics in the 2023 Call for Proposals has significantly impacted the field.This new focus has enabled Filipino laser experts to leverage their expertise for health applications, specifically in medical diagnostics and therapeutics.Although this priority topic was only recently included, the number of proposals submitted reflects a growing interest and demand from local researchers.The scope of these currently funded projects includes applications in chronic disease and critical care management, and cancer imaging.Establishing funding support like this also contributes to the retention of local experts.This demonstrates a recognition of the potential benefits that biomedical optics can bring to the healthcare sector, particularly in improving disease detection and management.
Neighboring Southeast Asian countries with similar disease demographics could adopt this approach to enhance their healthcare capabilities.Collaborative research grants with international partners can further bolster these efforts by bringing together a diverse pool of experts to work on biomedical optics research that addresses relevant health concerns for both countries.Such collaborations can lead to the development of region-specific solutions and promote seamless knowledge exchange.

Multidisciplinary collaboration and partnerships: optical and clinical, local and international
Since most of the laser experts originated from the foundational sciences such as physics and engineering, they often lack the necessary background in medical science.Likewise, health experts typically do not possess the specialized skill set needed to develop advanced photonic technologies.Therefore, collaboration between these two groups is essential to complement each other's expertise.Recognizing this need, the Biomedical Engineering for Health program of DOST-PCHRD is actively facilitating avenues for laser experts and medical professionals to collaborate, thereby addressing gaps in current clinical practice and translating research findings into improved health services.
Developing Southeast Asian countries stand to benefit greatly from partnerships within the international community.These collaborations allow for the adoption of proven technologies and practices from other nations.One of the priority areas of PCHRD is working towards combating antimicrobial resistance (AMR) and as this poses a global public health threat, many partnerships were forged to fuel research and innovation in this field.As an example of potential partnerships, a team of researchers from the Department of Physics at the University of Oxford developed a combination of fluorescence microscopy and artificial intelligence to detect AMR, which could be beneficial in our local context [16].Another priority area where optics could be of value is in tackling re-emerging and emerging diseases.In the case of dengue diagnosis, the emerging market has technologies that use electrochemical impedance spectroscopy (EIS)-based sensing and/or surface plasmon resonance (SPR).These have a potential to be used in being developed as point of care (POC) diagnosis platforms, which are suitable in resource-limited settings like the Philippines [17].Additionally, since certain diseases are endemic to Southeast Asian countries, collaborative efforts with developed nations can provide unique opportunities for research on these diseases, especially now that some of these endemic diseases are now becoming present in other regions due to climate change.This mutual benefit can lead to the development of targeted solutions that are more effective for the target population.Access to diverse biological samples from these regions can also offer developed countries new insights and avenues for research.

Conclusion
The biomedical optics research landscape could still be further developed and augment the health system to achieve equity.Despite the challenges posed by limited resources and the complexities of implementing advanced technologies, realizing the potential of application and use of biomedical optics in the Philippines requires a strategic short-term and long-term actions at individual, institutional, and national levels.The local biomedical optics research could be substantiated through comprehensive educational reforms, professional development, continued funding and investment in research and fostering multidisciplinary collaborations and partnerships.These combined efforts can bridge the gap between lab research and clinical application, significantly advancing health equity and achieving universal healthcare for all.The advancements in biomedical optics can be pivotal in enhancing healthcare systems in low-to-middle-income countries, where preventable and treatable diseases remain prevalent.

Fig. 1 .
Fig. 1.Trend of biomedical optics publications from the Philippines by year (left) and by fields of expertise (right).