Johannesburg – Health experts are warning of a “diagnostics apartheid” in the global distribution of tests for Covid-19 and Mpox (previously known as monkeypox), with access for developing countries impeded by high prices, an over-reliance on slower PCR tests, and burdensome intellectual property rules on test components.
According to the People’s Vaccine Alliance and Matahari Global Solutions, a report commissioned by them and written by health experts from Matahari Global Solutions focuses on Mpox and Covid-19 as examples of the inequality in access to tests in developing countries.
“It comes as the World Health Organization (WHO) considers a resolution proposing a range of measures to improve access to diagnostic tests for all diseases,” read a People’s Vaccine Alliance statement.
The People's Vaccine Alliance said the authors called for governments and international institutions to urgently invest in local production of diagnostic tests to ensure developing countries were not reliant on producers from rich countries that dominated the global market.
They called for action to support the production of generic tests, including sharing technology, know-how, and intellectual property rights with producers in low- and middle-income countries. This included bringing Covid-19 tests into a deal reached at the World Trade Organization in June that eased some patent protections for vaccines.
“The report warns that poor access to rapid testing threatens the right to health, recommending that governments balance requirements to monitor diseases using tools like PCR tests with ensuring ease of access to rapid antigen tests, particularly in rural areas,” said the People’s Vaccine Alliance.
Mohga Kamal-Yanni, a policy head at the People’s Vaccine Alliance, said that while people in rich countries were able to get rapid antigen tests for Covid-19, others across the world were denied access.
“This research clearly lays out the system of diagnostic apartheid that emerged, where people in developing countries could not afford the price of tests when symptomatic – and testing of contacts to monitor disease spread was out of the question. Unless world leaders act today, the same inequality will be repeated in the next health crisis, with disastrous impacts,” said Kamal-Yanni.
Matahari Global Solutions’ principal consultant, Dr Fifa Rahman, said access to diagnostic testing was an essential part of the right to health that had been denied to many in low- and middle-income countries, with profound consequences.
“We know that many cases in Africa went undetected, simply because people in many countries haven’t had the opportunity to test. In the next pandemic – and in the remainder of this one – testing needs to be made available as a matter of human rights. Removing barriers to accessing diagnostics is essential to save lives – and to understand just how widespread a disease is,” said Rahman.
Some of the findings in the report include:
Rich country hoarding:
The director-general of Nigeria’s Centre for Disease Control (CDC), Dr Ifedayo Adetifa, warned of global shortages impeding access to tests at the beginning of the pandemic, with “richer countries buying up everything in far excess of what they required at any time, which then meant that even others who had their own funds could not procure in a timely manner”.
Covid-19 tests cost five days’ income:
In Kenya, where more than a third of the population lives on less than $1.90 (about R30) a day, PCR Covid-19 tests cost $11 in 2021, more than five times their daily income. In the Philippines, tests were priced at an average of $55, more than twice the average daily wage.
Poor access to MPOX tests:
MPOX tests can cost anywhere from $5 to $40, making them unaffordable for many low- and middle-income countries. Testing is relatively centralised, warned Dan Bausch, director of Emerging Threats and Global Health Security at FIND, meaning that “if you’re in New York or London, that would be a different scenario compared to if you are in Bangui (the Central African Republic), or even worse, 100km outside Bangui”.
Patent monopolies:
While the original PCR patent expired in 2007, most African countries heavily depend on GenXpert machines produced by Cepheid, a US company, to run automated PCR tests and return results quickly. Components of automated PCR machines are patented until the end of 2037 and therefore cannot be replicated. Lower-income countries cannot produce these for themselves as there has been no transfer of technology or sharing of know-how.
Over-reliance on PCR:
The WHO and many governments have prioritised PCR tests over rapid antigen tests as they are more accurate and help in monitoring the virus and its variants. However, as Brook Baker, a senior policy analyst at Health Gap who was instrumental in advancing Covid-19 test-and-treat discussions in the WHO’s Access to Covid-19 Tools (ACT) Accelerator, warned, “PCR tests are significantly more expensive; depend on expensive laboratory equipment, a highly trained workforce, and specimen collection and transportation to central facilities; and often result in serious delays in reporting results to patients and clinicians.”
The Star