In the medical field, vaccines and drugs receive a huge amount of attention while diagnostics hide in the shadows. This is unfair to say the least, since diagnostics are at the basis of medicine. Without diagnostics, doctors would not know how to treat people. In a number of low-income areas throughout the world, serious health issues go undiagnosed. Even when diagnostic testing is done in these areas, it is not always of good quality. But what are we to do about the extremely high number of people suffering and dying due to lack of a diagnosis?
A recent article in NEJM suggests that to improve access to critical diagnostics, we should make a list. The World Health Organization started a Model List of Essential Medicines (EML) in 1977, and the list has since improved access to medicines. So why don’t we do the same with diagnostics? We could create a Model List of Essential Diagnostics, or an EDL. Here are a few ways that such a list would make an impact:
1) More affordable diagnostics
When it comes to vaccines and drugs, volume discounts, bulk and advanced purchasing, and pooling mechanisms are widely used. While TB can be detected using the Xpert MTB/RIF test, affordability is limited. A list of essential diagnostics could encourage group purchasing by international organizations. With larger and more predictable volumes, manufacturers would be able to lower the costs of diagnostics tests. Countries can use the list to waive import duties and impose price controls in order to ensure affordability.
2) Better detection of emerging infectious threats
The epidemics of both Ebola and Zika have emphasized the need for surveillance. While there are a number of countries with reference laboratories, laboratory capacity at lower health system tiers tends to be weak. An EDL could increase laboratory capacity at every tier, thus helping countries to prepare for epidemics and implement international health regulations.
3) Better patient care and clinical outcomes
Patients will consistently receive access to quality essential diagnostics that will be always available as well as affordable. Governments, funders and manufacturers can make sure that a diagnostic is available and accessible once it is added to an EDL.
4) Better quality and regulation of diagnostics
While developed countries have regulatory agencies that determine the accuracy of diagnostic devices, resource-poor settings either do not have these agencies, or they are weak. An EDL could allow these agencies to focus on priority tests. It could also help to identify sub-standard diagnostics, as is already being done for malaria rapid tests.
5) Improved laboratory infrastructure and supply chain
In many low income settings, laboratory devices are unusable due to poor infrastructure and inconsistent supply chains. With an EDL in place, ministries of health could strengthen key infrastructures and create targeted supply chains for the important tests.
Our world does not have an equal distribution of healthcare. While we often focus on giving struggling people access to vaccines and drugs, there is not enough focus on diagnostics. Without diagnostics, we cannot know which drugs and treatments to give patients. We need to start treating diagnostics with the same importance at vaccines and drugs, and the first step to achieving this globally could be to create a Model List of Essential Diagnostics.