Developing countries faced “apartheid” distribution of COVID-19 and Mpox tests, report finds

Developing countries faced “apartheid” distribution of COVID-19 and Mpox tests, report finds

Release date: 1 February 2023

Health experts have warned of a “diagnostics apartheid” in the global distribution of tests for COVID-19 and Mpox (previously known as Monkeypox), with access for developing countries impeded by high prices, an over-reliance on slower PCR tests, and burdensome intellectual property rules on test components.

The report, commissioned by the People’s Vaccine Alliance and authored by health experts from Matahari Global Solutions, focuses on Mpox and COVID-19 as examples of the inequality in access to tests in developing countries. It comes as the World Health Organization (WHO) considers a resolution proposing a range of measures to improve access to diagnostic tests for all diseases.

The authors call for governments and international institutions to urgently invest in local production of diagnostic tests, to ensure developing countries are not reliant on producers from rich countries who dominate the global market.

They call for action to support the production of generic tests, including sharing technology, know-how, and intellectual property rights with producers in low and middle-income countries. This includes bringing COVID-19 tests into a deal reached at the World Trade Organization in June that eased some patent protections for vaccines.

The report warns that poor access to rapid testing threatens their right to health, recommending that governments balance requirements to monitor diseases using tools like PCR tests with ensuring ease of access to rapid antigen tests, particularly in rural areas.

The report’s shocking findings include:

  • Rich country hoarding: The Director General of Nigeria’s Centre for Disease Control (CDC) warned of “global shortages” impeding access to tests at the beginning of the pandemic, with “richer countries buying up everything in far excess of what they required at any time, which then meant that even others who had their own funds could not procure in a timely manner.”
  • COVID-19 tests cost five days’ income: In Kenya, where more than a third of the population lives on less than $1.90 a day, PCR COVID-19 tests cost $11 in 2021, more than five times their daily income. In the Philippines, prices averaged $55, more than twice the average daily wage.
  • Poor access to Mpox tests: Mpox tests can cost anywhere from $5 to $40, unaffordable for many low and middle-income countries. Testing is “relatively centralized”, warns Dan Bausch, Director of Emerging Threats and Global Health Security at FIND, meaning “if you’re in New York or London – that would be a different scenario compared to if you are in Bangui (Central African Republic), or even worse, 100 kilometres outside Bangui.”
  • Patent monopolies: While the original PCR patent expired in 2007, most African countries heavily depend on GenXpert machines produced by Cepheid – a US company – to run automated PCR tests and return results quickly. Components of automated PCR machines are patented until the end of 2037 and therefore cannot be replicated. Lower-income countries cannot produce these for themselves as there has been no transfer of technology or sharing of know-how.
  • Over-reliance on PCR: The WHO and many governments prioritised PCR tests over rapid antigen tests, as they are more accurate and help in monitoring the virus and its variants. However, as Brook K Baker, a Senior Policy Analyst at Health Gap who was instrumental in advancing COVID-19 test-and-treat discussions in the WHO’s ACT-Accelerator, warned, “PCR tests are significantly more expensive; depend on expensive laboratory equipment, a highly trained workforce, and specimen collection and transportation to central facilities; and often result in serious delays in reporting results to patients and clinicians.”

Mohga Kamal-Yanni, Policy Co-Lead for the People’s Vaccine Alliance, said:

“While people in rich countries were able to get rapid antigen tests for COVID-19, our families and friends across the world were denied access. This research clearly lays out the system of diagnostics apartheid that emerged, where people in developing countries could not afford the price of tests when symptomatic – and testing of contacts to monitor disease spread was out of the question. Unless world leaders act today, the same inequality will be repeated in the next health crisis, with disastrous impacts.”

Dr Fifa A Rahman, Principal Consultant, Matahari Global Solutions, said:

“Access to diagnostic testing is an essential part of the right to health that has been denied to many in low and middle-income countries, with profound consequences. We know that many cases in Africa went undetected, simply because people in many countries haven’t had the opportunity to test. In the next pandemic – and in the remainder of this one – testing needs to be made available as a matter of human rights. Removing barriers to accessing diagnostics is essential to save lives – and to understand just how widespread a disease is.”

In his opening remarks at the WHO Executive Board meeting this week, Director-General Dr Tedros Adhanom Ghebreyesus underlined the underreporting of COVID-19 cases, saying “In the past eight weeks, more than 170,000 people have lost their lives to COVID-19. And that’s just the reported deaths; we know the actual number is much higher.”


Notes for editors

Spokespeople from the People’s Vaccine Alliance and Matahari Global Solutions are available for interview.

The full report is available here:

The WHO Executive Board is expected to discuss a resolution on diagnostics this week, proposed by Eswatini, under the agenda item on universal health coverage:

In October 2020, South Africa and India proposed a waiver of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for medical technologies relevant to COVID-19, including vaccines, tests, and treatments. The waiver was supported by more than 100 low- and middle-income countries but was blocked by a small number of rich countries including the EU, UK, and Switzerland.

After 18 months, the WTO finally decided in June 2022 to streamline existing rights to use compulsory licenses to produce generic COVID-19 vaccines for domestic use and for export without the patent holder’s permission. The June decision required member states to reach a decision on tests and treatments by December 2022. At the last moment, WTO member states postponed the deadline, after a request for delay from the United States.

Media contact

Joe Karp-Sawey, Senior Media Advisor, People’s Vaccine Alliance

[email protected]