Multi-pathogen testing is the future of diagnostics

As we rebuild and strengthen health systems ravaged by the pandemic, let’s change the question from ‘is it Covid?’ to ‘what is this?’

Over the past two years, the world has become obsessed with Covid-19 tests – and rightly so. These diagnostics, whether a PCR or lateral flow, have had a critical role in both curbing the spread of the virus, and getting treatment to those affected.

But as we exit the acute phase of the pandemic, the systems we use to control Covid-19 must be expanded to transform the management of other deadly health threats facing the planet – from major killers like tuberculosis, to localised pathogens such as Lassa fever.

That’s where multi-pathogen diagnostics come in. A patient doesn’t show up at their local clinic asking to be tested for Lassa fever – they show up because they are not feeling well, have a fever and a bad headache, and want to know what’s wrong. Imagine if a single test could be used to diagnose not just Covid-19, but many other epidemic-prone diseases, from one sample, in a primary care facility. Imagine if our health systems were structured around patients, not diseases.

It sounds futuristic, but this is an achievable vision in the next few years. Currently, complex testing systems that can identify multiple diseases rely on specialist, well-resourced laboratories. But a pipeline of multi-pathogen molecular tests that could are simple enough to be used in primary care clinics has been kickstarted by the pandemic.

As part of our work with the Access to Covid-19 Tools (ACT) Accelerator, FIND, the global alliance for diagnostics, has been proactively seeking those with the greatest potential for use in primary care clinics in low- and middle-income countries.

At the end of last year we announced a raft of initial investments, with the expectation that these tools will lead to increased access to essential molecular tests for many pathogens. The aim is to have one diagnostic platform that can identify Covid-19 plus diseases like HIV, tuberculosis, dengue, Ebola, Lassa fever, and others. This will be critical for both patient care and strengthened disease surveillance systems in the post-pandemic era.

To realise this potential, diagnostics have to remain high on the agenda – and there are worrying signs that their importance is being sidelined. Today, we are seeing Covid-19 testing rates plummet – decreasing globally by more than 50 per cent since December 2021 – as mandates are lifted, and tests cease to be subsidised. And still, access in lower income countries is patchy at best.

This might be our last opportunity

It’s true that testing does not need to match the rate we saw at the height of the pandemic. But we must continue to prioritise the most vulnerable, increase access and keep tabs on how the virus is evolving – and use the infrastructure to identify diseases beyond Covid-19.

So we must maintain the efforts we have made to build testing infrastructure, support local test manufacturing, and expand genomic sequencing capacities. Now is not the time to take our eye off the ball.

In the longer term, maintaining and further strengthening these programmes will also allow us to quickly ramp up capacity when and where needed – not only for Covid-19, but for many known threats, and the new technologies that will allow us to detect them.

We also need to rethink some of our regulatory systems and structures, so that they are nimble and flexible enough to support new innovations including multi-pathogen tests, to make diagnostics more affordable and supply more sustainable.

Most rapid tests for Covid-19 are still manufactured in a small number of countries, primarily South Korea and China. Development and implementation of locally manufactured diagnostics, including self-tests, must be enabled and prioritised, and developers incentivized by stable policies that assure them of predictable markets.

Today, the United States, Belize, Germany, Indonesia, and Senegal are co-hosting a second Global Covid-19 Summit, calling on governments, NGOs, and companies “to make new commitments and bring solutions to vaccinate the world, save lives now, and build better health security.”

As the attention of high-income countries wanes in the face of competing priorities – not least the devastating war in Ukraine – this might be our last opportunity to leverage Covid-19 to level up our health systems.

The first multi-pathogen tests could be available in primary care clinics in low- and middle-income countries as early as next year – a demonstration of the potential that can be achieved by maintaining, repurposing, and expanding the diagnostic test capacity that has been built for the Covid-19 pandemic.

Bill Rodriguez is CEO of FIND, the global alliance for diagnostics

Published in the The Telegraph, 12.05.2022