TY - JOUR T1 - Global inequity of COVID-19 diagnostics: challenges and opportunities JF - Journal of Epidemiology and Community Health JO - J Epidemiol Community Health SP - 972 LP - 975 DO - 10.1136/jech-2022-219333 VL - 76 IS - 12 AU - Shanti Narayanasamy AU - Brenda Okware AU - Winters Muttamba AU - Kirtika Patel AU - Kwabena Obeng Duedu AU - Nirmal Ravi AU - Nathan Ellermeier AU - Muki Shey AU - Christopher W Woods AU - Wilber Sabiiti A2 - , Y1 - 2022/12/01 UR - http://jech.bmj.com/content/76/12/972.abstract N2 - 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 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 … ER -