COVID-19 vaccine distribution is increasing across the globe, but some of the most vulnerable communities still lack access to testing sites through their local health departments. 

While COVID-19 vaccines are an essential tool in ending the pandemic, testing remains crucial and is one of the most effective methods to trace COVID-19, stopping it from spreading and saving lives. 

Fighting COVID-19 will require a holistic approach that includes scaling up testing, according to Charlotte Diez-Bento, who works in the external relations and communications division at the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The Global Fund is helping countries mitigate the impact of COVID-19 on programs to fight other infectious diseases such as HIV/AIDS, TB, and malaria and support efforts to improve health care systems. A founding partner of the Access to COVID-19 Tools Accelerator (ACT-A), the organization is working to develop access to the tools necessary to end the pandemic. One of the ACT-Accelerator’s targets is providing 500 million COVID-19 diagnostic tests to low- and middle-income countries in 2021 and it has already procured 40 million tests. 

Global Citizen spoke with Diez-Bento about the need to continue using antigen tests and viral tests, what we can still learn from COVID-19 test results, what tactics will be required to end the pandemic and more.  

Global Citizen: Why does COVID-19 testing still matter even as vaccines roll out in countries around the world?

Diez-Bento: We need diagnostics to monitor where and how quickly the virus is spreading and where there [are] not enough vaccines. Access to vaccines [in] low- and middle-income countries is taking a lot of time and [will] probably reach these countries toward the end of this year at best. In the meantime, we need to reduce transmission with effective containment strategies based on testing, tracing, and isolation. These are the tools that we have at hand. We know it works. 

We need to ramp up diagnostic testing in India and middle-income countries because they are testing at a fraction of what the high-income countries are doing. We need to reduce the infection rates everywhere as quickly as possible to limit the emergence of new variants. The more cases we have worldwide, the more viral mutations we will have. 

We also need testing to accelerate the detection of these new variants, especially the variants of concern. If we want to ramp up genomic sequencing, we need to ramp up testing as well — it goes together. Testing is definitely critical for surveillance in general and to have real time knowledge on the epidemic, across regions.

This thing will not disappear with vaccination. When you look at where vaccines are being rolled out in high-income countries, you can see that the testing rates are actually increasing because we need to identify clusters quickly that might indicate any resistance or presence of variants that are bypassing some of the vaccines that are already available.

The situation is improving. We need testing to monitor clinical care. We need to diagnose patients to eliminate causes and then provide the appropriate treatment for COVID-19. 

In regions where they do have vaccines, but the vaccines are in short supply, why is testing even more crucial? 

Countries need to know what's happening in their country — how much the virus is spreading, where exactly, where are the clusters, and to apply the containment strategies that they have at hand, which is really testing, tracing contacts, and isolating the infected. That's really the proven method that is available [and] to do that you need to test. 

What barriers are there still to ensuring that people everywhere can access tests?

The ACT-Accelerator set as an objective for this year to provide at least 900 million tests to low- and middle-income countries. This is only to bring the testing rate in low- and middle-income countries at 50% of what it is in high-income countries [which would require $8 billion in funding to achieve in 2021]. It's not such a huge ask. It's actually the bare minimum that has to be done. 

The main barrier here is really funding to buy and deliver the tests to countries whether they are the PCR test or the rapid test. We actually have data on that. We had a survey in about 500 health facilities in Africa and Asia last year, and we found that in only 11% of the facilities in Africa, you could access antigen rapid diagnostic tests. [And only 8% of the facilities could conduct PCR tests.]

There is a need to work together with countries to prepare [for] uptick of these new testing strategies and these new tests. For example, [for] the rapid test, for countries to include that in their national testing strategies and make sure that they train people and ensure that [is] included in the overall strategy, not only at the central laboratories, but also decentralizing the testing to more remote areas or to decentralized local health facilities. 

One of the main barriers, which is access to these rapid tests, needs to be overcome so we can move to what we call community testing. Community testing [is] testing done in the communities, with the rapid test and then hopefully down the line, we have also home tests that are pretty reliable and affordable for these countries to achieve more coverage. 

If we have funding, we're able to increase volumes and then decrease the pricing of this test. But also make sure that we have enough research and development investments to get easy-to-use, low-cost [tests] to enable the return to normality and to be using these tests even in different settings for people to get back to work and to get back to their social activity. That's really about investing in innovation to reduce the price. These new testing tools can be available at low cost for low- and middle-income countries. 

With the vaccines, there's been a lot of talk about how not every country is able to manufacture them and that's been an issue. Is there a similar phenomenon with testing? Do low-and middle-income countries also have the resources and opportunities to make their own tests, or are they relying on either donations or buying from other countries? 

There are a number of initiatives at this moment in terms of the decentralization of manufacturing of diagnostic tests. You may have heard about what Senegal is doing, on low- cost diagnostic tests. There is a lot of technology transfer happening to grow that local production over time. There are a number of initiatives in other places. 

I would say it is less problematic as it is for vaccines. The ACT-Accelerator has really embedded the decentralization of manufacturing and technology transfer into their key objectives. It just takes time. It's a medium-term objective because it requires some investment over time to develop manufacturing. The baseline is [that] the situation is already pretty good compared to vaccines. There are many opportunities there. 

Testing has been around since the early days of the pandemic, but have there been any innovations or improvements since testing first rolled out?

When the pandemic started, we had access mostly to PCR tests that were available only out of central labs. Even in high-income countries, we started having access to new rapid tests from after the summer last year and rapid tests have now been rolled out across the world. 

There are lots of investments in innovation in making these tests easier to use, more sensitive, more reliable in terms of results. Instead of at the beginning of the pandemic, having to wait for a few hours to get the results of your PCR test, from September, October or since last summer, you could have the results in 15 minutes to 30 minutes. That's really an improvement. 

Now we can see that the first generation of this rapid test, which has arrived in high income countries, has not yet [arrived] to low- and middle-income countries. What we're seeing is that there needs to be more funding and more volume to drive innovation and drive the prices down so this test can be affordable and it can be rolled out in low- and middle-income countries complementing, of course, the PCR testing.

All of these different diagnostic tests need to be used in combination with each other, because obviously, if you want to track the variants, you need to have samples from PCR testing. You don't have a sample from a rapid test so you cannot do the genomic sequencing. They need to get the right mix of tests in each country to be able to really deploy the full testing strategy and to cover all the needs that we have. 

The @ACTAccelerator’s diagnostics pillar has procured over 65 million #COVID19 tests for lower income countries, and aims at procuring 900 million tests by the end of the year. Read more about the progress so far & future aims to #ACTogether: https://t.co/ig7oUyXRDN@GlobalFundpic.twitter.com/Y1FO9Nf9er

— FIND (Foundation for Innovative New Diagnostics) (@FINDdx) May 2, 2021

Why do you think testing remains the most underrated tool to help combat COVID-19 with so much attention being put on vaccines right now?

There is so much focus on vaccines because politicians have been willing to present the vaccines as the silver bullet, and they're not. If you look at experience in managing other pandemics, we know perfectly that we need the full arsenal of tools. You need to diagnose people. You need to treat those who are sick. And you need to have a vaccine in place to make sure you sustainably reduce your transmission and possibly at some point eliminate this pandemic. 

The focus on vaccines was maybe more palatable and easier. At a political level we know that that's a crucial part of the solution. But until we get the full vaccine coverage, it might be a long year, long two years, or long three years maybe, depending on a number of variants that we hit. Basically, what do you do during this time? You are in a tunnel and you don't know how dark and how deep this tunnel is going to be [or where] the light at the end of the tunnel [is]. 

The vaccine is great, but you still need to test people. You still need to cure and to treat and have oxygen to try to save lives and to have drugs that work to save lives and identify transmission and the epidemiological trends in each country. It's all connected and goes together. 

We need to say that easy-to-use and low-cost tests would get us to normalcy — not only vaccines, but the daily or weekly testing. It would probably be part of our life. It might be a little bit less glamorous for politicians, but that's definitely part of the solution. That will go hand in hand with good vaccines for sure. 

This interview has been edited for clarity and length.