Rapid diagnostic testing and portable technologies

Rapid diagnostic testing for Malaria, HIV, Tuberculosis (TB), and COVID-19 have been a success story in Africa [8]. Rapid point of care and self-administered testing kits for HIV which can deliver a result within minutes have reduced costs in testing and improved linkage to HIV care [9, 10]. Similarly for TB, the widespread implementation of rapid molecular testing which is recommended by the World Health Organization, has led to reduced delays in diagnosis and treatment initiation [11]. There is an opportunity to build on these achievements to develop rapid diagnostic tests for other pathogens with pandemic and outbreak potential–indeed, to support COVID-19 diagnostic testing, countries employed existing HIV and TB molecular testing platforms. Just as they were repurposed to respond to the COVID-19 pandemic, these platforms can be adapted proactively for future disease outbreaks by using multiplex approaches capable of diagnosing multiple pathogens. In addition, portable technologies e.g., suitcase lab [12] and MinION (Oxford Nanopore), that have been successfully implemented for diagnosing and sequencing SARS-CoV-2 can be used for other emerging pathogens [13]. Combining these new portable technologies with modular biocontainment facilities makes on-site diagnosis feasible, even in remote locations where outbreaks may occur.

An approach that focuses investment towards expanding rapid testing and molecular diagnostic tools is important for improving scalability and response times in resource constrained settings compared to centralized physical laboratory structures which are more expensive to build and maintain. The more traditional laboratory model can be reserved for referral laboratory tasks such as confirming diagnoses in the context of new outbreak with more effort being committed to decentralizing laboratory capacity. This will enable the rapid deployment of diagnostic teams when an outbreak is suspected, leading to faster containment and response times.

While most African countries have acquired these portable technologies and are ready to deploy in case of an outbreak [12] a potential limiting factor is the reliance on suppliers outside Africa for reagents and consumables. Having manufacturers in Africa capable of producing these diagnostic tools will boost the scalability and utilization of these technologies. Collaborative partnerships between African research institutions, universities, governments, biotechnology companies, and international organizations can facilitate R&D, technology transfer, and capacity building for local production of diagnostic tools. For example, the Pasteur institute in Senegal recently launched Diatropix a non-profit initiative in collaboration with industrial partners to develop rapid diagnostic tests which can be produced locally in Africa [14]. Encouraging more of such initiatives will provide access to expertise locally, draw more funding, and regulatory support and promote regional knowledge sharing and innovation. All of these factors are key to wean over-reliance on foreign support from outside Africa.

National and regional laboratory networks

Creating national laboratory networks which communicate with regional hubs of excellence across Africa will enhance the continent’s laboratory capacity by consolidating resources and facilitating knowledge exchange, and collaboration [15, 16] (Fig 1B). For instance, a national laboratory in a given country could either conduct wet lab genomic sequencing and share its data with a regional bioinformatics hub for analysis or refer positive samples for genomic sequencing and analysis [17]. At the peak of the COVID-19 pandemic, countries referred COVID-19 positive samples to reference sequencing laboratories in Senegal, Nigeria and South Africa for sequence identification [18]. The surveillance of other diseases like measles, yellow fever and polio employ similar sample referral networks [19]. Establishing a bioinformatics hub in Africa will need more investment in infrastructure including high-speed internet, reliable electricity supply, and adequate computing resources. This needs to happen alongside developing and strengthening mechanisms for secure data sharing. Another benefit of regional hubs is having a pool of trained biomedical engineers who can service instruments from different manufacturers, reducing reliance on imported expertise from outside the continent. By ensuring prompt equipment maintenance and reducing downtimes, these hubs can enhance efficiency and minimize delays in diagnosis. Funding to establish and sustain these regional hubs could be provided directly by African governments themselves or indirectly through the regional economic commissions or through the African Union. Additional support could also be provided by developmental agencies and organizations including The Global Fund, The World Bank, and other philanthropic foundations.

Strengthening infrastructure and regional laboratory supply chains

Relying on local government funding or international partners to build and maintain laboratory infrastructure is not enough. Innovative financing mechanisms through public-private partnerships should be encouraged and incentivized to secure additional funding for laboratory capacity building. This sector has tremendous growth potential and opportunities for manufacturing, training, and job creation. Additionally, improving the supply chain and logistics to ensure that reagents and consumables can be delivered promptly or even manufactured locally is crucial. Establishing efficient workflows with airlines and shipping companies and implementing local regulations that facilitate the shipment of reagents, consumables, equipment, and biological resources and samples will greatly relieve existing logistical barriers [20].

Training of personnel and skills maintenance

In Africa, it is crucial to prioritize training skills in bioinformatics, data analysis and interpretation, and laboratory techniques. The short-term strategy should focus on hands-on training for laboratory scientists in advanced techniques such as Next Generation Sequencing library preparation, genomic data quality control analysis, specific bioinformatics pipelines, and utilization of open platforms like GISAID, Nextstrain, and Pangolin. Instead of hosting training workshops in western countries, laboratory infrastructure in Africa should be utilized for these. The African CDC’s Pathogen Genomics and Bioinformatics Fellowship Program is an excellent example of a short-term training program, with two tracks covering the wet lab and dry lab techniques. Long-term training programs should be tailored to more advanced skills such as script writing, sequencing data curation, phylogeny tree analysis, primer design, test development, and field service engineer training, all aimed at enhancing the continent’s diagnostic capacity. African governments, in collaboration with international partners, can establish contextually tailored training facilities and programs that meet regional needs instead of relying on external funders to set the agenda for training. Additionally, establishing robust regulatory frameworks at national and regional levels is crucial to ensure high-quality laboratory services. This means developing and implementing national policies and guidelines for laboratory quality assurance, as well as establishing accreditation systems that ensure laboratories and personnel meet pre-established standards.