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Global inequity of COVID-19 diagnostics: challenges and opportunities
  1. Shanti Narayanasamy1,2,
  2. Brenda Okware3,
  3. Winters Muttamba4,5,
  4. Kirtika Patel6,
  5. Kwabena Obeng Duedu7,
  6. Nirmal Ravi8,
  7. Nathan Ellermeier9,
  8. Muki Shey10,11,
  9. Christopher W Woods1,2,
  10. Wilber Sabiiti4
  11. On behalf of the COVID-19 Clinical Research Coalition, Virology, Immunology, and Diagnostics Working Group
    1. 1 Division of of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
    2. 2 Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
    3. 3 COVID-19 Clinical Research Coalition, Drugs for Neglected Diseases initiative, Geneva, Switzerland
    4. 4 Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK
    5. 5 Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
    6. 6 Department of Pathology, Moi University, Eldoret, Kenya
    7. 7 Department of Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
    8. 8 EHA Clinics, Kano, Nigeria
    9. 9 Duke Global Health Institute, Durham, North Carolina, USA
    10. 10 Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
    11. 11 Department of Medicine, University of Cape Town, Rondebosch, South Africa
    1. Correspondence to Dr Shanti Narayanasamy, Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC 27708, USA; shanti.narayanasamy{at}

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    Diagnostics for COVID-19 have advanced at an unprecedented pace over the last 2 years. Testing is a critical pillar of pandemic control and is required for epidemiological tracking, treatment and surveillance. Despite high-quality SARS-CoV-2 viral diagnostic capability, there are vast global inequities in access. The Virology, Immunology, and Diagnostics Working Group (WG) of the COVID-19 Clinical Research Coalition (CRC) brings together experts in immunology, infectious diseases and microbiology to advocate for equity-based COVID-19 research, prioritising solutions driven by communities in low-income and lower middle-income countries (LMICs).1 This commentary reflects the unique perspective of the WG on the asymmetry in COVID-19 diagnostic access between low-income and high-income settings, the barriers to these disparities and highlights opportunities to remedy these inequities.

    Two COVID-19 pandemics

    Two parallel COVID-19 pandemics are occurring. High and upper-middle income countries have widespread and affordable access to testing and high vaccination rates. In contrast, LMICs have minimal access to affordable testing and generally lower vaccination rates. The disparities are stark. In most high-income countries (HICs), SARS-CoV-2 testing is widely available, free or affordable. For these countries, diagnostics have been a conduit to the rapid return of prepandemic life, enabling leisure and social activities, reopening businesses and schools and allowing the resumption of mass gatherings. In most LMICs, however, the return to prepandemic life has been slow. Testing remains expensive and restricted to where it is deemed essential, such as for symptomatic individuals, healthcare workers, cross-border essential workers and international travellers. Outside of these indications, if molecular testing is available, it is often prohibitively expensive. The WHO regional office for Africa estimates that 85% of COVID-19 cases remain undetected across the continent.2

    SARS-CoV-2 testing metrics illustrate testing disparities between high-income and low-income countries. The Access to COVID-19 Tools Accelerator (ACT-A), established in April 2020 by the WHO, has set a benchmark …

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    • Collaborators The members of the COVID-19 Clinical Research Coalition Virology, Immunology, and Diagnostics Working Group are: Ayouba Ahidjo, IRD and University of Montpellier, France; Derseree Archary, Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa; Dharshan de Silva, Kotelawala Defence University, Sri Lanka; Améyo Dorkenoo, University of Lomé, Togo; Shymaa Enany, Suez Canal University, Egypt; Sophia Kitui, CDT Africa, Kenya; Blandina Mmbaga, Kilimanjaro Clinical Research Institute, Tanzania; Wolfgang Preiser, Stellenbosch University / NHLS Tygerberg, South Africa; Paramdeep Singh, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, India; Aida Sivro; Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa; and Misaki Wayengera, Makere University, Uganda.

    • Contributors SN and BO contributed equally to this paper. SN, BO, WM, WS and CWW conceptualised the piece, and SN, BO and WM prepared the initial draft. NE created the figure. All authors critically reviewed and edited the manuscript, and approved the final version for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.