Moving the dial on diagnostics
“Given that the key barrier to improving the global access to diagnostics is the inadequate resourcing of diagnostics due to low prioritisation, the over-riding aim must be to reverse this.”
In October 2021, the Lancet Commission on diagnostics revealed a staggering reality—47% of the world’s population has little to no access to even the most basic diagnostics. In low-income and lower middle-income countries, the figure soars to 81%.
This gap in access—most severe at the level of primary health care—was underscored by the COVID-19 pandemic, which highlighted the critical role of timely and accurate diagnostics in managing both communicable and non-communicable diseases.
But what progress has been made since the Commission was published? Have any of the proposed solutions been implemented? And are there new developments in technology or policy that could bridge the diagnostic divide?
What are diagnostics, and why do they matter?
Diagnostics are tools and tests used by healthcare professionals to identify diseases and health conditions in patients. They help determine what’s wrong, guide treatment decisions, and monitor how well treatments are working. Examples include blood tests, X-rays, and scans.
“[W]ithout accurate diagnosis, treatment might very well be wasted by treating the wrong disease or condition, or by delaying or not giving appropriate treatment. Diagnosis and treatment are interdependent and equally necessary”, wrote Commissioners in the 2021 Lancet report.
Diagnostics are crucial to a well-functioning, high-quality health system and provide excellent value for money (below). Enhancing access is important for advancing health equity, ensuring that all populations—regardless of socioeconomic status or geographic location—receive the necessary care.
The Lancet Commission on diagnostics: assessing progress on recommendations
“The over-riding reason for the poor global access to diagnostics has been the relatively low attention and priority given to diagnostics by policy makers and funders…”
The 2021 Lancet Commission explored the status of diagnostics globally and produced ten overarching recommendations. In the three-and-a-half years since publication, progress in access to diagnostics has been slow but promising—particularly in South and Southeast Asia and Africa.
Find the full recommendations on pages 44 and 45 in the Commission report.
The COVID-19 pandemic and a World Health Assembly Resolution on diagnostics have heightened awareness and political prioritisation of diagnostics.
Africa and South Asia, regions with significant diagnostics gaps, have seen strategic initiatives like the African Collaborative Initiative to Advance Diagnostics and India's Free Diagnostics Service Initiative. These efforts align with broader health and industrial goals, enhancing diagnostics capacity.
However, progress varies across regions, with high-income countries facing issues of affordability and access for marginalised groups.
Progress has been slower on recommendations with substantial resource implications (labour force, diagnostics for conflict situations).
But the emergence of a potential Global Diagnostics Coalition, a WHO-managed network, could play a crucial role in consolidating progress and coordinating global efforts to strengthen diagnostics capacity.
“Given the scale of the challenges, incremental increases in the current approaches to providing access to diagnostics are unlikely to work. Strengthening diagnostics capacity requires collaboration among many groups, as well as advocacy at all levels. When writing the Lancet Commission report, we were frequently told that, unlike pharmaceuticals, there was no global forum where diagnostic stakeholders got together. The Global Diagnostics Coalition will be vital for driving meaningful progress. We hope that the findings in our Review can inform the new Coalition”, says Prof Susan Horton, Commission lead.
The Global Diagnostics Coalition is launching at this year’s World Health Assembly.
Learn more about the Lancet Commission on diagnostics and progress to date ⤵️
🏷️ Kenneth Anthony Fleming, Susan Horton