While there has been much publicised about the inequities in access to COVID-19 vaccines, dubbed in some outlets as ‘vaccine apartheid’ due to the overwhelming disparity in access between HICs and LMICs, relatively little has been written about diagnostics apartheid and the massive gaps in access faced by people living in and from LMICs. At time of writing, rapid self-tests are not available in most LMICs, while throughout the pandemic, rapid self-tests have been available for free or at highly subsidised rates in HICs, including the United Kingdom, Canada, the United States, Switzerland, and Germany.
Several countries have faced MPOX outbreaks for decades such as DRC, Central African Republic, and Nigeria, but continue to have less testing than HICs that only recently have had outbreaks.
Drawing upon the expertise of key actors in the diagnostics space, including the WHO, FIND, Global Access Diagnostics, Nigeria CDC, and Africa CDC, we unpacked what barriers to affordability and accessibility existed through both pandemics, and what needs to be done to ensure equity in diagnostics in future pandemics.
Key recommendations include:
- To establish robust multiyear integrated diagnostics country strategies in view of the upcoming 2023 WHO diagnostics resolution. These should include, inter alia, planning for income protection for those in the informal sector for future pandemics, local production, regional collaboration on regulatory processes, and community-led advocacy, demand creation, expertise on quantification and forecasting, and testing literacy.
- To establish/strengthen regional regulatory processes to ensure rapid, optimal, and equitable access to diagnostics in communities.
- To emphasise technology transfer as an essential component of pandemic aid, including through investments on local production of pandemic tools in The World Bank Pandemic Fund and other related aid.
- To build income protection funds as a crucial measure in diagnostics uptake strategies and in pandemic planning strategies, and to prioritise those in the informal sector.
- To invest in and place priority on advocacy and community-led demand creation in LMICs earlier in pandemics, to ensure equitable uptake, affordability, and rights-based approaches in access to pandemic tools.
- Rights-based testing approaches. This may require a shift in philosophies from prioritising PCR at all costs (which may restrict availability only to those close to laboratories and health facilities) to a pragmatic balance between PCR access and rapid antigen tests to ensure widespread access and self-empowerment in communities about their own healthcare – or investments in new handheld/point-of-care PCR platforms.