Harare, Feb 4 (UNA): After learning that a friend had tested positive for COVID-19, Thembi Ndlovu went to a health clinic in the Zimbabwean capital in search of a free coronavirus test. There was nothing left for that day, the Associated Press (AP) reported, leaving the 34-year-old hairstylist unsure if she needed to take precautions to protect clients.
“I wish we could go to a pharmacy and buy a cheap self-test kit like we do with pregnancy or HIV,” she said as she left the clinic in the town of Harare. “It would be easier.”
For millions of people in rich countries, COVID-19 self-tests have been plentiful and sometimes free, including in Britain, Canada, France and Germany. But most people across Africa have limited access to it.
Zimbabwe introduced free testing centers in November 2020, but supplies are scarce and the country still does not have a national program to distribute tests at home.
Although self-tests are available in some pharmacies in Zimbabwe, they cost up to $15 each, a fortune in a country where more than 70% of the population lives in extreme poverty made worse by the pandemic. The situation is similar elsewhere across the continent – and in parts of Asia and Latin America – with few, if any, opportunities for people to test themselves easily.
Perhaps the biggest obstacle to making cheap self-tests widely available in the developing world is that the World Health Organization has not yet issued guidance on their use. Without the resources of rich countries to purchase the tests or assess their safety, poor countries must wait for WHO approval before aid groups and international agencies are willing to donate them in large numbers.
said Brock Becker, a professor at Northeastern University who advises the World Health Organization and others on equitable access to COVID-19 drugs and tests.
Some health officials say the contrast between rich and poor countries is discriminatory and has denied poor countries an opportunity to stop the spread of the coronavirus in the absence of vaccines. And unlike the massive global effort to share vaccines, little has been done to launch more tests of any kind in much of Africa.
The Omicron eruption appears to have peaked across Africa, as it has in other parts of the world. Last week, the World Health Organization said Africa had recorded at least 125,000 cases of coronavirus and 1,600 deaths, although this is likely an underestimate due to a lack of testing.
Becker and other experts estimated that self-testing tools may not be widely available in the developing world until sometime next year.
In a statement, the WHO said developing the guidelines is a “rigorous process that takes time” and expects to finalize advice on the use of COVID-19 self-tests in March. The agency said it has provided more than 31 million rapid tests to health professionals in developing countries.
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 issuance of self-testing guidelines, saying that 85% of infections likely go unnoticed in Africa.
“We cannot tolerate a situation in which widespread access to testing, along with association with care and treatment, becomes the norm in populations of richer countries while access to diagnosis … is lacking in (poor) countries,” the authors wrote. Among the signatories are 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 World Health Organization say there is enough evidence that self-tests help slow transmission, based on the experience of rich countries, and that the guidelines should have been issued long ago.
“There is no reason to believe that people who wipe their noses in the UK will do it differently than people in Malawi,” said Bill Rodriguez, chief executive of FIND, a Geneva-based global diagnostic alliance.
With the highly contagious omicron variant driving the global transmission, Rodriguez and others say rapid self-tests are in great demand everywhere.
“Without high levels of vaccination in developing countries, we need to provide every possible means for people to reduce their risk,” Rodriguez said.
John Nkengasong, director of the Africa Centers for Disease Control and Prevention, said people would be better able to take action if at-home tests were available.
“We’ve learned from HIV that self-testing is critical because when people know their condition, they’re doing the right thing,” he said.
Others noted that with generic versions of the COVID-19 pills made by Merck and Pfizer on the way — after the two companies agreed to allow dozens of manufacturers to make versions for poor countries — tests will be even more important in the coming months.
“It seems confusing that we get the treatments before we do the testing that tells us which people should get the treatments,” said Baker of Northeastern University.
Dr Mamunur Rahman Malik, WHO representative in Somalia, said a pilot study in that country found that health workers using the tests increased cases by 40%.
“Without these tests, we don’t have a complete picture of how the pandemic is evolving,” Malik said, adding that the project showed that using the tests is also possible in difficult conflict-ridden environments such as Somalia.
Rodriguez said WHO guidelines for self-testing are also needed so authorities can address other potential problems, including ramping up production of inexpensive test kits. He said that some of the same problems that have complicated COVID-19 vaccine production exist for experimental manufacturing, namely the shortage of raw materials and efficient producers, but they are not that severe.
He said inexpensive self-tests are being conducted in countries such as Brazil, India, Morocco, Senegal and South Africa.
Yet even wealthy nations have struggled to maintain an adequate supply of tests at home, with demand far outstripping supply at times in the United States, Canada and elsewhere.
Back in Harare, public health specialist Dr Johan Marissa despaired that people were not eager to get tested unless they were sick or needed a negative result to work, to the detriment of efforts to stop the pandemic.
“It becomes deadly because a lot of people don’t present themselves in health facilities until they are seriously ill and sometimes it’s too late to save them,” he said. Marisa said more education is needed to convince people to get tested early.
Ndlovu’s hairdresser was asked to return to the clinic within two days for an examination. She had many clients wanting to braid their hair and wanted to avoid putting them at risk, but she couldn’t afford the special tests elsewhere that could cost up to $60.
She said, “Monday is far (far)”. “I am very worried.”
AOQ