Given the time it will take to develop and scale new therapeutics and vaccines, mass testing provides a solution for governments wanting to help societies adjust to living with the virus today, while also saving lives and livelihoods.
Across Africa the level of testing has not yet been scaled to reflect the size of the outbreak, meaning that while testing may be being used to identify cases of Covid-19, its expansion is not keeping pace with transmission. This constrains efforts to fight the virus and impedes countries' efforts to reopen economies safely.
Until now many countries have faced poor availability of testing equipment and constrained laboratory capacity, exacerbated by a reliance on PCR swab tests, which has hampered efforts to deliver testing strategies at scale. However, there is a range of new innovations on the market that diversify testing technologies and create greater choice, while bringing down costs and easing supply constraints without compromising accuracy. These technologies are already being embraced by the private sector to allow operations to continue, safely.
With an estimated 500 million Covid-19 diagnostic tests required in developing countries over the next 12 months, 75% of which will be needed in decentralised settings (eg, primary health care, community-level care or hospital triage), the only way to test at scale is via a mixed testing strategy, using a range of tests matched to the context in which they will be used.
Governments should develop a testing strategy that will enable them to reopen economies safely, stay globally connected and provide a viable bridge to the moment a vaccine is available. Our new paper, included here as a downloadable PDF, sets out options to ramp up testing in Africa using a combination of approaches optimised for different uses.
In the absence of a vaccine, it is the scaling up of testing that will keep communities safe, allow key sectors to operate productively and keep African economies open and connected.
A proactive testing strategy will ensure proper identification of cases and help to actively manage transmission and risk. Scaling testing means moving away from one-off tests to testing regularly and in the right settings.
Scaling to a proactive testing strategy calls for a rethinking and reshuffling of resources, including the use of rapid antigen testing to confirm infection, where a positive result is likely, with PCRs used to confirm negative results.
PCR and antigen tests used in combination are particularly powerful. While scaling a testing strategy, strongly suspected cases (people who have sustained close contact with a confirmed case or who have strong symptoms) who test negative may also be given a PCR test as a follow-up.
Various antibody testing technologies can be used in combination. Rapid tests may be used in the first instance but a follow-up, lab-analysed test could be used for vulnerable people who need to know the number and quality of their antibodies.
A range of innovations in sample collection and analysis are emerging with the potential to significantly increase testing capacity and reduce costs.
There is now a wide range of tests already on the market, with promising new innovations to follow, including some that will be manufactured within Africa, eg, by Mologic in the UK and Senegal, available at cost in low-income countries.