Call to G20 leaders to uphold diagnostics and equitable access to testing

A CALL TO ACTION ahead of the upcoming G20 health meetings, for world leaders to uphold diagnostics and equitable access to testing within their commitments to support sustainable recovery from COVID-19.

Testing is irrefutably a mainstay of the efforts to contain the humanitarian and economic fallout of the COVID-19 pandemic, saving lives and livelihoods, and enabling societies and economies to start to reopen safely. Monitoring the emergence and spread of variants, as well as the real-world efficacy of vaccination campaigns, relies on effective disease surveillance efforts. Ensuring people can receive the treatment they need requires integrated test-and-treat approaches. With no one safe until we are all safe, testing should be the cornerstone of health systems all over the world. Yet a year after this coronavirus first emerged, testing rates in low- and middle-income countries (LMICs) were 10 times lower than in high-income countries.

In 2020, fewer than 1 in 5 health facilities across Africa had access to COVID-19 tests. We need further innovation and technology transfers to ensure appropriate, high-quality (rapid) tests to be affordable and available everywhere. Politicians, Heads of State and Governments must understand this reality so that an adequate pandemic preparedness and response agenda can be put in place, addressing the urgent need to scale up testing capacity in LMICs to ensure equitable access to diagnostic testing tools and comprehensive disease surveillance.

Although Heads of State and Government have helped to roll out equitable access to diagnostic testing through the Access to COVID-19 Tools (ACT)-Accelerator Diagnostics Pillar, there is still a funding gap of nearly US$6 billion that must be mobilized in 2021 to deliver on its promise.

Beyond the pandemic itself, COVID-19 has also exposed the impact of years of sustained neglect in testing for all diseases. Diagnostics has been shown to be the weakest link in the care cascade for tuberculosis, neglected tropical diseases, diabetes, and hypertension, to name a few. Testing capacity is available in just 1% of primary care clinics in LMICs. For 50% of the top 20 diseases worldwide, there is still no appropriate test available that could reduce mortality rates significantly. Progress towards the UN Sustainable Development Goals is receding in the face of the pandemic, global health security remains a major risk, and the achievement of universal health coverage (UHC) by 2030 is in jeopardy.

Ahead of the Global Health Summit on 21 May 2021 and the 74th World Health Assembly, the global health and development community, following the FIND high-level forum, Testing is the first line of defence against COVID-19 and the foundation for preparedness to prevent future pandemics, call upon the World Health Organization, the European Union, the African Union, and the Heads of State from the G20 and G7 Presidencies to:

  1. Acknowledge that pandemic preparedness and response, as well as the attainment of UHC, requires a comprehensive, fully funded strategy for diagnostic testing;
  2. Support that this strategy requires global collaboration to spur innovation and a coordinated agenda integrated with vaccination and treatment approaches, that inspires multisectoral and national action. We must build on the successful efforts from the ACT-Accelerator Diagnostics Pillar, co-led by FIND and the Global Fund, and create a permanent diagnostics alliance. Aligning with the recommendations from the Independent Panel for Pandemic Preparedness and Response’s 2021 report, G7 countries must urgently commit to fully funding the ACT-Accelerator, while ensuring a coherent, strategic, inclusive and fully funded framework. This will enable research institutes, diagnostic developers and manufacturers, healthcare providers and, most importantly their employees, to create roadmaps for building safe, effective, affordable and thus sustainable diagnostic systems;
  3. Leverage global innovation using production capacity in LMICs to diversify manufacturing and supply of diagnostic tools. Currently the world is highly dependent on a small number of countries that manufacture diagnostic tests. Testing nationalism and broken supply chains demonstrate the need for change in manufacturing towards a more focused, resilient, and effective approach;
  4. Support the development of national Essential Diagnostics Lists (EDLs), based on the global WHO EDL, and integrate testing into fully funded national health action plans to protect against the global health emergencies of today and tomorrow. This includes prioritizing capacity building for diagnostic testing in LMICs, as well as building capacity to conduct in-country research, adapted to national contexts and priorities, as key to strong, sustainable and resilient health systems that can curb future health emergencies;
  5. Recognize the value of diagnostic testing beyond the health system, integrating it within areas of society such as schools and workplaces, border crossings, and large-scale social events and mandate WHO to urgently develop guidelines for diagnostic use and self-testing beyond healthcare settings;
  6. Support and fund existing and innovative digital health solutions to facilitate diagnosis via the ethical use of artificial intelligence, mobile monitoring devices, use of genomics, and self-testing tools – building on the significant advances made through investments for COVID-19;
  7. Build diagnostics literacy among policymakers, health workers, communities, and the media, especially in LMICs, to enhance confidence and understanding of the value of using diagnostic tests as a first line of defence to manage population health. We know public confidence – or rather lack of confidence – in all aspects of tackling a pandemic can impact take-up of all medical commodities, from testing kits to vaccines.


This call to action is endorsed by:


Access to medicine
dxd hub
The END Fund
G20 health and development partnership
The Global Fund
The Hepatitis Fund
Pandemic action network
Swiss Malaria Group
Treatment Action Group
TB Alliance
Uniting to combat NTD
UN Foundation


Dr Aminata Touré, former Prime Minister of Senegal and FIND Goodwill AmbassadorAkua Sena Dansua, former Ambassador of Ghana to GermanyDr Patty J. García, Professor, School of Public Health, Cayetano Heredia University
Carol Kachenga, Public Health AdvocatePeter Ngo’la Owiti, Communities Representative on the ACT-Accelerator Facilitation CouncilProf Madhukar Pai, Canada Research Chair in Epidemiology & Global Health, Associate Director, McGill International TB Centre
Dr Fifa Rahman, Civil Society Representative on the Diagnostics Pillar and Facilitation Council, ACT-AcceleratorSaurabh Rane, Survivors Against TB & TB AdvocateDr Cesar Ugarte-Gil, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia
Dr Vinod Joshi, Sharda University, India, former Indian Council of Medical Research as Scientist-G & Head, Department of Virology & Molecular Biology, Desert Medicine Research Centre, India

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