The Lancet Commission on diagnostics: transforming access to diagnostics

21 October, 2021

Citation, key messages and a comment from me below.

CITATION: The Lancet Commission on diagnostics: transforming access to diagnostics

Kenneth A Fleming et al.

The Lancet 2021. Published Online October 6, 2021

https://doi.org/10.1016/S0140-6736(21)00673-5

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00673-5/fulltext

KEY MESSAGES

1. 47% of the global population has little to no access to diagnostics.

2. Diagnostics are central and fundamental to quality health care. This notion is under-recognised, leading to underfunding and inadequate resources at all levels.

3. The level of primary health care is the diagnostic so-called last mile and particularly affects poor, rural, and marginalised communities globally; appropriate access is essential for equity and social justice.

4. The COVID-19 pandemic has emphasised the crucial role of diagnostics in health care and that without access to diagnostics, delivery of universal health coverage, antimicrobial resistance mitigation, and pandemic preparedness cannot be achieved.

5. Innovations within the past 15 years in many areas (eg, in financing, technology, and workforce) can reduce the diagnostic gap, improve access, and democratise diagnostics to empower patients.

6. As an example of the potential impact, 1·1 million premature deaths in low-income and middle-income countries could be avoided annually by reducing the diagnostic gap for six priority conditions: diabetes, hypertension, HIV, and tuberculosis in the overall population, and hepatitis B virus infection and syphilis for pregnant women.

7. The economic case for such investment is strong. The median benefit–cost exceeds one for five of the six priority conditions in middle-income countries, and exceeds one for four of the six priority conditions in low-income countries, with a range of 1·4:1 to 24:1.

Given the depth and breadth of the problems, sustained access to quality, affordable diagnostics will require multi-decade prioritisation, commitment, and investment. Incorporating diagnostics into universal health coverage packages will begin this process..

Our conclusion is that there is a strong case for investment to improve access to diagnostics...

COMMENT (NPW): The finding that '47% of the global population has little to no access to diagnostics' is a stark example of inequity. I have not had a chance to read this paper in full, but I would like to suggest there is not only a problem of lack of access to diagnostics, but also inappropriate use of existing diagnostics. Previous studies have revealed huge waste of resources from overuse of diagnostics, and this is a problem that is not limited to high-income countries but occurs also in low-income countries. I would like to suggest that meeting the information needs of health workers and the public with regards to the use of diagnostics is quite fundamental here. (Yes, access to information may not change behaviou, but it is a prerequisite.)

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org