The Covid-19 pandemic has highlighted the importance of diagnostics.
We still remember the world scarcity of rapid tests to detect infection during the first wave and the appearance of inaccurate (even false) tests, with which this involved in the control of the first outbreaks;
As we have verified, the ability to perform a reliable and quality test of SARS-COV-2 is key in the response to the pandemic.
But the difficulties in accessing diagnostic tests go beyond the Covid pandemic.
According to data that has just been known, in an investigation in The Lancet, almost half (47%) of the world population hardly has evidence and essential services to diagnose so common diseases such as diabetes, hypertension, HIV and tuberculosis
.
There is even no access to basic tests for pregnant women as the detection of hepatitis B and syphilis.
Without precise and affordable diagnoses, many people are treated blindly, with unnecessary, inappropriate or none therapies, putting at risk for poor quality medical care.
It also supposes a great gap to reach the world priorities of universal health coverage, mitigation of resistance to antimicrobials and preparation for an eventual pandemic.
These conclusions start from the analysis of the Diagnostics Commission of The Lancet, a committee of 25 experts from 16 countries who have studied global access to diagnoses.
The Committee calls on policy makers to save that gap in diagnosis, improve access and expand the development of medical tests beyond high-income countries.
“In large part in the world, patients are treated by diseases without access to key diagnosis services and tests. This is the equivalent of practicing medicine blindly. Not only is it potentially harmful to patients, but it is also a significant waste
Of the scarce medical resources. […] The Covid-19 pandemic has placed the tests at the top of the political agenda and global health, and must be a point of inflection to ensure that we prioritize the diagnosis of all
Diseases, “says Kenneth Fleming, president of the Commission and professor at the University of Oxford (United Kingdom).
The scarce tests include both the analysis of blood, tissue or urine samples, such as the image (radiographs, ultrasound, magnetic resonance, computed tomography, nuclear medicine tests).
In primary care only 19% of the population of low-income and media countries have access to simpler diagnostic tests (other than HIV or malaria detection).
The authors also reviewed data on access to tests recommended by the World Health Organization (WHO) in prenatal care.
These tests, among which are the detection of syphilis, reactive urine strips, hemoglobin tests, blood glucose and ultrasound, are considered essential and must be available within a two-hour patient travel time.
The report calculates that worldwide reduce the diagnostic gap for only six conditions (diabetes, hypertension, HIV and tuberculosis, in addition to hepatitis B and syphilis for pregnant women) of 35-62% to 10% would be a decrease of 1.1
Millions on the annual number of premature deaths in low-income countries.
The key to improving diagnoses is the availability of trained personnel: the Commission estimates a global deficit of up to 1 million diagnostic personnel, which must be addressed through training and education.
The Commission further recommends that countries urgently develop national diagnostic strategies: “Expanding diagnostic production through the location of more research, development and production in low-income and media countries is a key priority,” says Susan Horton, Assistant Co-president of
The Commission, and professor at the University of Waterloo (Canada).
Other recommendations include improving affordability, regulatory frameworks to monitor the quality and safety of tests and democratize diagnostics (increasing availability in the place of attention, as well as self-tests). “There are three things that are essential for the security of
The health: the safety of the diagnostics, the safety of vaccines and therapeutic security. […] Equity begins with the regionalization of the production of basic healthcare services as much as possible, and this includes the diagnosis ”
Exhibits John Nkengasong, director of African centers for the control and prevention of disease and co-author of the Commission.
