This blog post was written by Dr Janet Perkins, DiaDev Project,University of Edinburgh

Access to diagnostics, an essential component of robust health systems, remains vastly inequitable from a global perspective, with these medical resources all-too-often concentrated in the Global North, and scarce in the Global South, despite the latter having larger populations and higher disease burdens. While calls to address this inequity are common, they do not always pay sufficient attention to the role played by the development and manufacturing of diagnostics, which are also concentrated  in high-income settings, in generating those inequities. Investing in diagnostic research and development at the point of use offers a promising, yet under-pursued, pathway for designing diagnostics attuned to local contexts and needs and bringing production close to end users. The Global Frugal Diagnostic Network is building a community of policymakers, researchers and practitioners passionate about re-imagining and re-creating diagnostic ecosystems to make this vision a reality.

The Network’s first Meet and Greet, held virtually on 24 May, 2023, brought together over 50 researchers, developers and manufacturers, regulators and representatives of non-governmental organizations (NGOs) engaged in diagnostics from across Africa, Asia, Europe and North America—a truly global event. The Meet and Greet provided a platform for participants to become acquainted with one another and share future aspirations for the Network.

Founding members, Harry Akligoh, based in Ghana and Professor Maiwenn Kersaudy-Kerhoas from Heriot-Watt University in Edinburgh, Scotland, kicked off the event by welcoming participants and emphasising the importance of creating such a network. Mr. Akligoh highlighted the lacuna between health needs and capacities to develop solutions to address these needs in the Global South. Africa and Asia experience high burdens of infectious diseases for which diagnostics are critical to clinical management, control and elimination; however, the workforce with the capacity to lead the development of diagnostics for these diseases tend to migrate from these settings to the Global North to participate in research and development, carrying global health knowledge and education with them.

Mr. Akligoh highlighted the COVID-19 pandemic as a critical moment during which the current structures of diagnostic development and deployment were revealed as deeply inequitable. “We have seen most abysmally how supply chains were disrupted, and the manufacturing of diagnostics happening far from where they were most needed. This brought into question the inequalities in the distribution of diagnostics.” Hence the importance of communities, such as the Network, that seek to challenge and change these existing structures. Mr. Akligoh highlighted promising changes we are already seeing: the manufacturing of Diatropix lateral flow assay in Senegal, initiatives to promote independent reagent production, and teaching programmes to deliver digital diagnostic solutions. “This is just the beginning,” he said, and the Global Frugal Diagnostic Network will work to build on these advances.

Frugal diagnostics are about the “development of simple diagnostics by the people who need them,” as Professor Kersaudy-Kerhoas elaborated in her presentation. Developing frugal diagnostics involves using the resources immediately available in under-resourced settings, designing and manufacturing diagnostics that require minimal investment and infrastructure. “[Frugal diagnostics] recognises decentralised systems of diagnostic development and manufacturing as essential to the creation of sustainable and equitable health systems,” she summarised.

Following this warm welcome, Dr. Collins Otieno Odhiambo of the African Society for Laboratory Medicine and Zibusiso Ndlovu from Medicins Sans Frontières (MSF) South Africa honoured participants with flash talks to set the scene. Dr. Otieno Odhiambo described transformations we have seen across Africa in strengthened laboratory systems, largely due to funding streams for AIDS, malaria and tuberculosis. However, the continent faces numerous threats of disease outbreaks and remains overwhelmingly reliant on countries outside the continent for medical supplies, he explained. Thus, the local context is rarely taken into account when designing and manufacturing diagnostics. As a result, Africa often ends up last in line for medical supplies, endemic diseases are marginalised, and infrastructure and waste management considerations are neglected. However, there are reasons to be optimistic. The landscape of medical manufacturing is growing throughout Africa, Dr. Otieno Odhiambo argued, and, most promisingly, several diagnostic companies now have their headquarters based in the continent. 

Based on his experiences, involving end-users in the development of diagnostics with MSF, Zibusiso Ndlovu emphasised the importance of the value chain in the diagnostic development-to-adoption continuum, which tends to be fragmented. Because of the inadequate attention to this value chain, he explained, “In many instances we see that devices can meet the clinical requirements, but they can still fail to be adopted successfully in different regions.” Involving end-users is an essential component of understanding the value chain and moving understanding beyond clinical aspects to encompass the entire diagnostic life cycle, including waste management, which remains underrepresented in test development. “This is where we are hoping this network can also help to shed light and provide some mentoring on how to improve and bring the development of these tests closer to where patients with diseases are,” he said.

Inspired by these provocative flash talks, participants split into breakout rooms for personal introductions and to share what had brought them to the Network. The groups discussed ideas for the mission of the network, potential activities and next steps for building a vibrant community that can foster international perspectives to generate locally-relevant solutions, leverage synergies, and connect people across various horizons for fruitful collaborations towards more equitable diagnostic development.

We look forward to welcoming familiar and new faces to the 2^nd Meet and Greet of the Global Frugal Diagnostic Network scheduled on 30th August 2023, 4-5 pm GMT!

The Global Frugal Diagnostic Network is supported by:

Heriot-Watt University, Royal Academy of Engineering (Frontiers Champion Award), University of Edinburgh,  European Research Council (grant number 715450), and the Kühne Foundation.

Founding members include:

Maïwenn Kersaudy-Kerhoas, Heriot-Watt University, UK

Harry Akligoh, Yemaachi Biotech, Ghana

Zibusiso Ndlovu, MSF, South Africa

Alice Street, University of Edinburgh, UK

Ayokunle Olanrewaju, University of Washington, US

Elena Rosca, Ashesi University, Ghana