COVID inequality: In Africa, home tests are sparse, expensive

“I wish we could just go into a pharmacy and buy a cheap self-test kit, as we do with pregnancy or HIV,” she said as she left the clinic in a working-class town in Harare. “It would be a lot easier.”

For millions of people in rich countries, COVID-19 self-tests are plentiful and free, including in the UK, Canada, France and Germany. But most people across Africa have limited access to them.

Zimbabwe introduced free walk-in test centers in November 2020, but supplies are tight and the country still has no national program to distribute home tests.

Although self-tests are available in some Zimbabwean pharmacies, they cost up to $ 15 each, a fortune in a country where more than 70% of the population lives in extreme poverty, exacerbated by the pandemic. The situation is the same elsewhere across the continent – and in parts of Asia and Latin America – with few, if any, opportunities to easily test themselves.

Perhaps the biggest obstacle to making cheap self-tests widely available in developing countries is that the World Health Organization has not yet issued guidance on their use. Without the resources of rich countries to buy tests or assess their security, poor countries will have to wait for WHO approval before aid groups and international agencies are willing to donate them in large numbers.

“Donors can not implement the tests until the WHO says it’s OK to implement, and the countries themselves do not want to use the tests until they receive that guidance,” said Brook Baker, a professor at Northeastern University who advises WHO and others on equal access. for COVID-19 medications and tests.

The Omicron rise appears to have peaked across Africa, as it has done in other parts of the world. Last week, the WHO said Africa recorded at least 125,000 COVID cases and 1,600 deaths, though that is likely to be a minority due to the lack of testing.

Baker and other experts have estimated that the self-test kits may not be widely available in developing countries until sometime next year.

In an open letter to WHO chief Tedros Adhanom Ghebreyesus, more than 100 organizations last week called on the UN agency to speed up its publication of self-testing guidelines, saying 85% of infections are likely to go unnoticed in Africa.

“We can not tolerate a situation where access to widespread testing, coupled with coupling to care and treatment, becomes the norm in the populations of richer countries, while diagnostic access … is lacking in (poor) countries,” the authors wrote, if the Signatories included Amnesty International and Oxfam. They called it “part of the same ‘medical apartheid’ that has plagued the spread of COVID-19 vaccines.”

Groups working closely with the WHO say there is ample evidence that self-tests help slow transmission based on the experience of rich countries and that the guidelines should have been issued a long time ago.

“There is no reason to believe that people who stroke their noses in the UK will do it differently than people in Malawi,” said Bill Rodriguez, CEO of FIND, a Geneva-based global alliance of diagnostics.

With the extra contagious omicron variant that drives global transmission, Rodriguez and others say the fast self-tests are badly needed everywhere.

“Without high levels of vaccination in developing countries, we need to provide people with all possible tools to reduce their risk,” Rodriguez said.

John Nkengasong, director of the Africa Centers for Disease Control and Prevention, said people would be more empowered to act if home tests were available.

“We have learned from HIV that self-testing is so critical because when people know their status, they are doing the right thing,” he said.

Others pointed out that with generic versions of COVID-19 pills made by Merck and Pfizer on the way – after companies agreed to let dozens of manufacturers make versions for poor countries – the tests will be even more crucial in the coming months.

“It seems a little confusing that we were able to get the treatments before we tested, which tells us which people should get the treatments,” Northeastern’s Baker said.

Dr. Mamunur Rahman Malik, WHO representative in Somalia, said a pilot study in that country showed that health workers using the tests led to a 40% increase in cases being detected.

“Without these tests, we do not have a complete picture of how the epidemic develops,” Malik said, adding that the project showed that the use of the test is also possible in difficult, conflict-ridden environments such as Somalia.

Rodriguez said the WHO’s self-testing guidelines are also needed so authorities can address other potential issues, including increasing the production of low-cost test kits. Some of the same problems that complicated the production of COVID-19 vaccines exist for test production, namely lack of raw materials and competent manufacturers, but they are not so acute, he said.

He said cheap self-tests were done in countries like Brazil, India, Morocco, Senegal and South Africa.

Yet even wealthy countries have struggled to maintain adequate supplies of home tests, with demand far exceeding supply at times in the United States, Canada and elsewhere.

Back in Harare, public health specialist Dr. Johannes Marisa over that people were not eager to be tested unless they were sick or needed a negative result to work, which compromised efforts to stop the pandemic.

“It becomes deadly because many people only present themselves at health facilities when they become seriously ill, and sometimes it’s too late to save them,” he said. Marisa said more training was needed to convince people to be tested earlier.

Ndlovu, the hairdresser, was told to return to the clinic in two days to be tested. She had several clients who wanted to have their hair braided and wanted to avoid putting them at risk, but she could not afford the private tests elsewhere that could cost up to $ 60.

“Monday is far away,” she said. “I’m too nervous.”


Cheng reported from Toronto. Mogomotsi Magome in Johannesburg contributed to this report.


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