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Our fight against COVID-19 is far from over

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Dr Sanjay Sarin, Head, FIND in India and Vice President, Access at FIND cautions Viveka Roychowdhury that we need to intensify efforts to realise mass testing for test-trace-isolate implementation and sequencing-based surveillance – so that viral evolution does not jeopardise progress. As FIND is co-leading the Diagnostics Pillar of the Access to COVID-19 Tools (ACT) Accelerator, he outlines FIND India’s work to ensure equitable access to reliable diagnosis, strengthen India’s COVID-19 diagnostic capacity as well expand primary care testing in support of universal health coverage to combat diseases like TB, that disproportionately affect vulnerable populations in the country

Diagnostics is the first step in the treatment journey not just during a pandemic but also for NCDs, and infectious diseases like malaria, dengue etc. But resource scare countries like India do not have the funding to process affordable access to quality diagnostics testing equipment. How does FIND play a role in bridging this gap?

Indeed, testing is the first and best line of defence against any infectious disease including COVID-19. Yet, about 50 per cent of the world’s population does not have access to safe and quality diagnostics as per the recently launched The Lancet Commission on diagnostics. Low- and middle-income countries like India have limited resources to rapidly scale up and implement testing. And this is where FIND, the global alliance for diagnostics, comes into the picture. We ensure equitable access to reliable diagnosis by connecting communities, funders, decision makers, healthcare providers and developers to spur innovation and make testing an integral part of sustainable, resilient health systems.

We are working to save 1 million lives and save $1 billion in healthcare costs to patients and health systems. How are we doing that? As co-convenors of the Access to COVID-19 Tools (ACT) Accelerator diagnostics pillar, and a World Health Organisation (WHO) Collaborating Centre for Laboratory Strengthening and Diagnostic Technology Evaluation.

In the last one year, FIND has strengthened India’s COVID-19 diagnostic capacity by provisioning high-throughput COVID-19 testing machines, automated nucleic acid extractors and ancillary equipment for public sector laboratories across the country. These items have helped in improving testing throughput and reducing turnaround times. This coupled with independent evaluations of COVID-19 tests; and training India’s public sector laboratory network has enabled FIND to continue bridging the gap between implementers, funders and communities, thereby maximising impact – from innovation to implementation.

As infectious diseases agents mutate, diagnostic test kits need to evolve as well. What is FIND’s research on this front as far as COVID-19 goes?

The tests evaluated by FIND for COVID-19 are relatively broad, the efficacy of which is not being impacted by the mutants/variants of concern. But we continue to monitor the situation closely, as new variants emerge. In fact, this is one of the reasons why FIND has been advocating and supporting capacity building for sequencing – so that we can track the evolution of the virus and accordingly modify the testing strategies to mitigate their impact.

Diagnostic test kits are evolving beyond invasive, lab-based test kits to point of care (POC) kits. What kind of R&D is FIND funding in COVID and beyond?

There is a critical need to decentralise testing, especially in countries with a large population like India. The development of rapid, POC molecular diagnostic tests that have sensitivity and specificity comparable to the current gold standard techniques can significantly aid testing expansion. Such POC devices can generate information on both – viral presence and host response (e.g., antibodies), especially in non-laboratory settings with rapid turnaround times. The deployment of testing solutions out of centralised laboratories, for instance, at the primary care level, could be a key step for the rapid detection and identification of COVID-19 and prevention of transmission to the community.

FIND has been conducting independent evaluations of molecular tests and immunoassays, in collaboration with WHO and multiple partners, to assist in-country decision making. FIND is also supporting both research and development as well as local manufacturing efforts for point of care molecular and rapid tests, in multiple countries.

Where does FIND get its funding? And how does it decide which projects it will fund? What are the funding methodologies?

FIND is funded by multiple donors across the globe through multilateral mechanisms, country governments as well as private foundations and corporate partners. FIND has a Scientific Advisory Committee consisting of global experts on infectious diseases which guides the selection of projects supported and implemented by FIND. FIND also identifies projects in consultation with in-country and other global stakeholders to ensure that the funds are deployed towards supporting the top priorities and in-country challenges.

Crystal ball gazing into 2022, what are the predictions for the COVID-19 scenario and therefore what are the focus areas for FIND?

Our fight against COVID-19 is far from over and requires intensified efforts to realise mass testing for test-trace-isolate implementation and sequencing-based surveillance – so that viral evolution does not jeopardise progress. In 2022 and beyond, the pandemic is likely to evolve as there are significant swathes of unvaccinated population across the world, thereby allowing the virus an opportunity to evolve and potentially continue to infect.

Going forward, we seek to harness the momentum around testing for COVID-19, leveraging emerging digital innovations, and building on our organisational experience to continue supporting development and evaluation of new tests as well as working with countries on strengthening their response to outbreaks and pandemics.

In support of universal health coverage (UHC), our goal is to expand primary care testing to combat diseases that disproportionately affect vulnerable populations. Reducing the diagnostic gaps in TB, hepatitis, antenatal screening for both infectious and non-communicable diseases (NCDs), fever, pneumonia and neglected tropical diseases (NTDs) will save lives and livelihoods, save health systems money, and contribute to global and national disease elimination targets.

Alongside our efforts to serve diseases and populations, we are working to strengthen the diagnostic ecosystem. This includes advancing sequencing efforts to improve surveillance and diagnosis, fostering an integrated biobank network to facilitate diagnostic development and implementation across diseases, and diagnostic network design to optimise national lab networks’ testing capacities. To enable accountability from all parties, we aim to cement the essential place of diagnostic testing within health systems through political commitments at the highest levels.

COVID-19 has distracted public health officials and diverted resources from other diseases like TB, malaria, polio, leprosy etc besides NCDs etc. In which areas do you see us playing catch up in 2022 and beyond? Any priority areas you can flag off?

The unprecedented COVID-19 pandemic has severely impacted health services for several other infectious diseases including TB. Recent data from nine high burden TB countries (representing 60 per cent of the global TB burden) shows a decline in TB detection ranging from 16-41 per cent. This drop has brought the overall number of people diagnosed and treated for TB in these countries to 2008 levels, a setback of 12 years. It is estimated that India witnessed ~ 60 per cent decline in TB notifications, during the lockdown period in 2020 as per the data available on government’s Nikshay platform. Such a scenario may have led to significant morbidity and mortality as well as increase in the risk of TB transmission, within affected households.

The pandemic has demonstrated the need to strengthen our existing health system, one that allows us to break disease silos and administer patient-centred care. It is critical to invest in building resilient health systems, develop patient centric strategies to mitigate the impact of COVID-19 on disease like TB, HIV and malaria including leveraging the significant investments in diagnostics and care infrastructure as part of response to COVID- 19 for the overall well-being of the population and protection from future pandemics.

What kind of partnerships does FIND look for with public health agencies and other organisations for COVID-19?

Partnerships are the core of our operating model. Our unique position, bridging the public and private sectors, allows us to bring a diverse set of stakeholders together to resolve technical, financial, and logistical barriers to diagnostic innovation in low-resource settings.

Our many partners include public, government donors, philanthropic organisations, industry, academic and research institutions, international public health organisations (including non-governmental organisations and foundations), health ministries and disease control programmes.

All our activities are based on scientifically validated or independently reviewed data and objective standards. Our work with private sector partners (including all entities that are privately owned or are developing or commercialising products or services for commercial purposes) is guided by our Private Sector Partners Policy, in compliance with our Code of Conduct and Statement of Recognition of Independence for private sector partners. These documents describe the principles to which our organisation always adheres to, in terms of governance, workforce environment, collaborations, research, and financial stewardship.

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