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New analysis from The Lancet has found that half of the global population lack access to basic diagnostics for many common diseases leaving patients worldwide at risk of poor-quality health care.
These key tests and services are essential for diagnosing common diseases, such as diabetes, hypertension, HIV, and tuberculosis, or basic tests for pregnant women such as hepatitis B and syphilis, according to new analysis. Without access to accurate, high-quality, and affordable diagnostics, many people will be overtreated, undertreated or not treated at all, or exposed to unnecessary and potentially harmful treatment.
The analysis was led by The Lancet Commission on Diagnostics, an in-depth report bringing together 25 experts from 16 countries to transform global access to diagnostics. The Commission highlights the centrality of diagnostics for any functioning health care system and calls on policy makers to close the diagnostic gap, improve access, and expand the development of diagnostics beyond high income countries.
It highlighted that a lesson from the Covid-19 pandemic was the crucial importance of timely, accurate diagnosis. Early issues developing tests hampered the understanding of, and response to the outbreak, resulting in the rapid emergence of unreliable, inaccurate (even false) tests. In high income countries, the ability to use existing public health laboratories, in addition to the private sector, was critical in ramping up testing capacity, but many low and middle income countries without access to this infrastructure were disadvantaged and left unable to reach full testing capacity.
Lack of diagnostic testing is equivalent of practicing medicine blind
Dr Kenneth Fleming, Commission Chair, University of Oxford, said: “In much of the world, patients are treated for diseases in the absence of access to key diagnostic tests and services. This is the equivalent of practicing medicine blind. Not only is this potentially harmful to patients, but it is also a significant waste of scarce medical resources.
“For the first time, our analysis shows the shocking scale of the challenges we are facing, and our report offers recommendations on how we close the gap. The Covid-19 pandemic has put testing at the top of the political and global health agenda, and it must be a turning point in ensuring we prioritise diagnostics for all diseases.”
Diagnostics include a collection of key tests and services that are essential to understand a patient’s health. These might include blood, tissue, or urine samples collected and analysed at the bedside or in a laboratory, or diagnostic imaging such as x-rays, ultrasound, MRI, CT, or nuclear medicine.
The report said that the availability of trained staff was key to closing the diagnostic gap. There is a global shortfall of up to one million diagnostics staff, which must be addressed through training and education.
Other recommendations from the Commission include improving affordability, enhancing regulatory frameworks to oversee quality and safety of diagnostics, and democratizing diagnostics (increasing availability of point-of-care tests, self-sampling and self-testing).
Writing in a linked Comment, Dr Sabine Kleinert, Senior Executive Editor and Dr Richard Horton, Editor-in-Chief of The Lancet add: “More attention to diagnostics as a fundamental element of health systems will not only help end the Covid-19 pandemic and strengthen preparedness to combat future pandemics, but will also be crucially important for general disease prevention, high-quality health care, and improved health outcomes globally.”