Inequity in COVID testing: In Africa, at-home tests are uncommon and expensive.

Thembi Ndlovu went to a health center in Zimbabwe's capital in quest of a free coronavirus test after discovering that a friend had tested positive for COVID-19.

Thembi Ndlovu went to a health center in Zimbabwe’s capital in quest of a free coronavirus test after discovering that a friend had tested positive for COVID-19. However, none were left that day, leaving the 34-year-old hairdresser unclear if she needed to take extra care to protect her clients.

“I wish we could just go to a pharmacy and buy an inexpensive self-testing kit like we do for pregnancy or HIV,” she said as she walked out of the clinic in a Harare working-class suburb. “It would be a lot simpler.”

COVID-19 self-tests have been plentiful and free for millions of people in wealthy countries, including the United Kingdom, Canada, France, and Germany. However, the majority of Africans have

In November 2020, Zimbabwe opened free walk-in testing sites, although supplies are limited, and the country still lacks a comprehensive program to deliver at-home tests.

Self-tests are available in some pharmacies in Zimbabwe, but they can cost up to $15 apiece, which is a fortune in a country where more than 70% of the population lives in extreme poverty, which has been exacerbated by the pandemic. There are few, if any, possibilities for people to easily test themselves elsewhere on the continent, as well as in portions of Asia and Latin America.

The World Health Organization has yet to publish advice on the use of inexpensive self-tests, which is perhaps the biggest impediment to making them broadly available in underdeveloped countries.

Poor countries must wait for WHO permission before humanitarian groups and international agencies will donate huge numbers of tests because they lack the means of wealthier countries to buy them or evaluate their safety.

“Donors can’t use the tests until WHO says it’s OK, and countries don’t want to utilize the testing until they get that direction,” said Brook Baker, a Northeastern University professor who advises the WHO and others on fair access to COVID-19 drugs and tests.

According to some health professionals, the disparity between rich and poor countries is unfair, denying impoverished countries the opportunity to stop the spread of the coronavirus in the absence of immunizations. And, unlike the vast international effort to exchange vaccines, little progress has been made.

In Africa, as in other regions of the world, the omicron surge appears to have peaked. According to the WHO, Africa has seen at least 125,000 COVID cases and 1,600 fatalities in the last week, though this number is likely underestimated due to a lack of testing.

According to Baker and other experts, self-testing kits will not be widely available in the developing countries until next year.

WHO said in a statement that developing guidelines is a “rigorous process that takes time,” and that it intends to finalize COVID-19 self-testing advise in March. More than 31 million quick tests have been distributed to health workers in underdeveloped nations, according to the agency.

More than 100 groups signed an open letter to WHO Director-General Tedros Adhanom Ghebreyesus last week, urging the UN agency to provide the self-testing instructions as soon as possible, claiming that 85 percent of illnesses in Africa go unreported.

“We cannot tolerate a situation in which widespread testing, as well as linkage to care and treatment, becomes the norm in the populations of wealthier countries while diagnostic access… is missing in the populations of (poor) countries,” wrote the authors, who included Amnesty International and Oxfam as signatories. “Part of the same’medical apartheid’ that has marred the deployment of COVID-19 vaccinations,” they said.

Based on the experience of rich nations and groups that work closely with WHO, there is enough evidence that self-tests help decrease transmission.

“There’s no reason to believe that people in the United Kingdom will swab their noses any differently than those in Malawi,” said Bill Rodriguez, CEO of FIND, a Geneva-based global diagnostics alliance.

Rodriguez and others warn that with the extra-contagious omicron type driving worldwide transmission, timely self-tests are critical everywhere.

“We need to provide individuals every option available to lower their risk in impoverished nations where immunization rates are low,” Rodriguez added.

People would be more emboldened to take action if at-home testing were available, according to John Nkengasong, head of the Africa Centres for Disease Control and Prevention.

“We’ve learned from HIV that self-testing is crucial because individuals do the right thing when they know their status,” he says.

Others pointed out that, with generic copies of Merck and Pfizer’s COVID-19 pills on the way — following the companies’ agreement to allow dozens of manufacturers to develop versions for poor countries — the tests will become even more important in the coming months.

“It seems a little strange that we may have treatments before we have the testing that informs us who should have the treatments,” Baker of Northeastern University said.

A pilot study in Somalia indicated that health professionals employing the tests resulted in a 40 percent increase in cases being recognized, according to Dr. Mamunur Rahman Malik, WHO’s representative in Somalia.

“We don’t have a whole picture of how the disease is progressing without these tests,” Malik said, adding that the experiment demonstrated that the tests can be used in tough, conflict-ridden countries like Somalia.

Rodriguez added that WHO self-testing recommendations are also required so that authorities may address other challenges, such as increasing the supply of low-cost testing kits.

Some of the same issues that hampered the creation of the COVID-19 vaccine apply to test manufacturing, such as a scarcity of raw materials and qualified producers, but they aren’t as severe, he added.

He claimed that countries such as Brazil, India, Morocco, Senegal, and South Africa were producing low-cost self-tests.

Even rich countries have battled to keep appropriate supplies of at-home tests on hand, with demand greatly outstripping supply in the United States, Canada, and others at times.

Dr. Johannes Marisa, a public health specialist in Harare, lamented that people were only willing to get tested if they were unwell or needed a negative result for employment, jeopardizing efforts to halt the pandemic.

“It becomes dangerous because many people only seek medical help when they are really ill, and it is sometimes too late to save them,” he explained. Marisa believes that more education is needed to get individuals to be tested sooner.

The hairdresser, Ndlovu, was advised to come back to the clinic in two days to be tested. She had several clients who wanted their hair braided and she didn’t want to put them in danger, but she couldn’t afford the private tests that may cost up to $60 elsewhere.


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