Ending Childhood Lead Poisoning Through Better Testing: A Q&A with Dr. Robbie Barbero
One-third of the world’s children have lead poisoning. A low-cost test could change that.
Lead exposure affects one-third of children (800 million) worldwide, costing the global economy up to $3.4 trillion annually and causing 765 million IQ points lost in children under age five annually. Yet, most children are never tested because current methods are too expensive and inconvenient.
In this conversation, Kumar Garg sits down with Dr. Robbie Barbero who is building a thesis-driven, philanthropic fund to catalyze development of an affordable, point-of-care blood lead test that could transform how we protect children from this silent threat.
Kumar Garg: Why does lead testing matter today?
Robbie Barbero: Lead poisoning is devastating, preventable, and often goes undetected. Childhood lead exposure impacts cognitive development and performance in school, resulting in loss of future earning potential and increased risk of arrest for offenses involving violence in adulthood. At the population level, reductions in lead exposure have been found to be responsible for significant declines in violent crime in America in the 1990s.
But here's what makes testing so critical: you can't eliminate what you can't detect. Lead sources can enter a child’s life through a variety of sources, such as paint, water, spices, baby food, applesauce, cosmetics, e-cigarettes, and even cookware. These sources vary by location and change over time. Without routine blood lead testing, we're flying blind.
KG: Can you give an example of how testing might reveal an unexpected lead source?
RB: In the 2010s, New York City's Department of Health and Mental Hygiene noticed something unusual in their routine blood lead testing data: children of Georgian ancestry had significantly higher blood lead levels than other demographic groups.
That discovery triggered a targeted investigation. Health officials worked with families, tested products in homes, and ultimately identified imported spices from Georgia as the source. These weren't obviously contaminated products. They were traditional spices that families had brought from their home country or purchased from specialty importers.
A multi-agency effort launched to prevent further imports of contaminated spices and educate the Georgian community about the risks. The results were dramatic: from 2017 to 2022, the rate of children with blood lead levels at or above 5 μg/dL declined by 96% among New York City children with Georgian ancestry. But the benefits didn’t stop there. The NYC Health Department reached out to authorities in the Republic of Georgia and shared their findings. A survey of children’s blood lead levels in Georgia showed that more than 40% of children ages two-seven had elevated blood lead levels. The government traced the source to a few major spice suppliers and quickly put a stop to their operations.
Think about what would have happened without that testing infrastructure in New York City. Children would have continued being exposed. The contaminated products would have kept circulating. It was only because New York City had comprehensive, routine testing — and someone was actually looking at the data — that this exposure was caught and eliminated.
KG: So if testing is so important, why don't we test more children?
RB: The vast majority of the 800 million kids with lead poisoning live in low-resource environments, and there are a multitude of reasons that it is hard to test them.
One of the reasons that is within our power to solve is the lack of low-cost and easy-to-use tests for lead poisoning. There is only one FDA-authorized point-of-care test (a test that can be run in a health clinic or in a doctor’s office) on the market. This test has been key to the United States’ multi-decade effort to reduce childhood lead poisoning because it can deliver a result within minutes from a drop of blood from a child’s finger. Unfortunately, it requires the healthcare provider to spend several thousand dollars on a laptop-sized instrument, plus another $10 per individual test kit. When you consider that the vast majority of the 800 million kids who are experiencing lead exposure are living in lower and middle income countries, you can understand why I say that it’s too expensive and out of reach for those kids.
Even in the United States, where federal law states that every Medicaid-supported child must be tested for lead poisoning before turning age five, at least one-third of those kids never receive their required tests. Through my conversations with pediatricians and public health experts who study this issue, I have learned that one of the main reasons is that the testing instrumentation and test kits are just too expensive for the medical professionals who are serving those children.
KG: If there is such a big need for a lower-cost, easier-to-use test, why hasn’t someone developed it already?
RB: The economics are brutal. Developing a new diagnostic test costs anywhere from $10 million to upwards of $40 million, and takes several years. And these numbers are true regardless of what kind of test you’re developing. If you’re going to commit to investing these resources in a new diagnostic development project, you’re going to want to pick a market that is huge, in order to maximize your return on investment. Unfortunately, the global blood lead testing market is only about $40 million to $50 million (though we do expect that to grow in the coming decade, as more countries adopt regular blood lead level testing for children). Compare that to the cancer diagnostics market, which is more than $170 billion. When the development costs are roughly the same but the market opportunity is three thousand times smaller, companies have no incentive to innovate.
This is a classic case where philanthropy can play a critical role and needs to step in – the social return on investment is enormous, but the market won't naturally produce the innovation we need. This is why Renaissance Philanthropy partnered with Clinton Health Access Initiative (CHAI) to accelerate the development of next-generation blood lead diagnostics. CHAI is a pioneer in market shaping, so working together was a no-brainer.
KG: How does your work address this market challenge?
RB: Element 82 is a thesis-driven, philanthropic fund that uses milestone-based incentives — essentially a prize competition — to catalyze development of an affordable point-of-care blood lead test in the next five years.
We started scoping this fund by creating a draft Target Product Profile for a low-cost, easy-to-use blood lead level test in November 2024. Right now, I’m working with CHAI to finalize the Target Product Profile with a broader team after consulting with a comprehensive set of experts, including many partners in UNICEF’s Partnership for a Lead Free Future. When we release the final version this summer, we will have a blueprint of the key product characteristics for the blood lead level test that the Element 82 fund will catalyze.
This work is structured around multiple phases with increasing awards: going from a working prototype, through manufacturing scale-up, and authorization from the appropriate regulatory authorities in places like the United States, India, and elsewhere. Alongside the milestone payments program, we will also launch and grow a community of practice to attract top scientists and technologists to work on advancing lead detection.
The kind of approach is inclusive, flexible, and it works: it attracts diverse innovators by defining the problem, not the solution. For example, in the 1990s, the CDC used a similar milestone-based program to catalyze the development of the first FDA-authorized point-of-care test. That was 30 years ago. Element 82 will drive the next generation of innovation we desperately need.
KG: Is it technologically feasible to get the kind of test you are describing, or is this wishful thinking?
RB: This is absolutely technically feasible. In fact, we have good reason to believe the technology is ready, but just needs the right incentives to bring it to market.
First, consider the timing. The current gold standard blood lead level tests were developed in the 20th century. Since then, we've seen revolutionary advances in diagnostics, materials science, and miniaturization. You can now buy a glucose meter that fits in your palm at your local pharmacy for $20 to $30, or a home COVID antigen test that gives you a result in 15 minutes for under $6. The underlying technologies that could enable better lead testing, have matured significantly.
Second, I’ve been working with a team of global diagnostics experts at CHAI on a technology landscape analysis that has identified multiple proof-of-concept technologies and prototype-stage innovations, from researchers all around the world, that demonstrate different approaches to lead detection and measurement. But you don’t have to take my word for it. Two years ago, the CDC ran a $1 million ideation challenge calling for concepts that could lead to advanced blood lead level diagnostics, and received some very innovative proposals.
Third, the specifications in our Target Product Profile are ambitious but grounded in what experts told us is achievable. We are deliberately setting targets that would represent meaningful improvement, while staying within the realm of technical possibility.
KG: What is the counterfactual? What would happen if Element 82 didn’t exist?
RB: We would march forward without any new blood lead testing capabilities. The global effort to eliminate lead poisoning would stall without tests that are available for the hundreds of millions of kids who live in low resource environments.
On the other hand, if we are successful, we estimate huge benefits through increased lifetime earnings and improved economic mobility in lower and middle income countries. And that doesn’t even take into account the impacts on cardiovascular health (one study estimated 5.5 million adults die annually from cardiovascular disease due to lead exposure), on improved cognitive and learning outcomes for kids, and on reduced future interactions with the criminal justice system for lead exposed kids.
But let's be clear about who benefits most: the children who face the greatest systemic barriers. Lead exposure creates what researchers call "toxic inequality," which is environmental harm that compounds across generations, affecting which children succeed in school, which communities build wealth, which families break cycles of disadvantage. By enabling earlier and wider detection, improved blood lead testing benefits precisely these populations.
KG: What do you need to make this happen?
RB: This work complements existing efforts focused on environmental lead detection and remediation by addressing the critical gap in testing — the early warning system that tells us when and where children are actually being harmed. Our partners in UNICEF’s Partnership for a Lead Free Future are active in other areas of lead exposure management in many countries around the world, which helps us take a holistic approach to our work.
Philanthropic capital de-risks the diagnostic development process, making it attractive for commercial investment. Once we demonstrate proof-of-concept (i.e. a working prototype that meets the target product profile), manufacturers can see a path to profitability for manufacturing scale-up, distribution network development, and market expansion. Once we achieve regulatory authorization, governments around the world will start to realize that a low-cost, reliable blood lead level test is on the horizon and will start planning budgets around utilization.
We already have a $3 million commitment from a philanthropist to anchor Element 82 and we're actively seeking additional anchor funding to launch, including with partners who focus on criminal justice, environmental health, child and maternal health, and economic mobility.
There are multiple ways to get involved. We’d love to hear from you:
If you’re an innovator or scientist and think you have a great approach to building a low-cost, easy-to-use blood lead level test
If you’re actively working on lead poisoning prevention efforts and want to learn how to partner with the Element 82 Fund
If you are interested in becoming an anchor donor for the Element 82 Fund
To learn more about Element 82’s work or to support this work, contact Robbie Barbero at robbie@renphil.org.
About Robbie Barbero
Dr. Robbie Barbero is an MIT-trained biological engineer, with experience working in the White House and multiple biotechnology companies. Most recently, he was the Chief Business Officer of a venture-backed biotechnology company that operated a business in the diagnostics and environmental lab testing industry.
