Investing in medical laboratory networks: Will COVID-19 (coronavirus) be a wake-up call?

With every disease outbreak we count the cases and fatalities, quantify the staggering socioeconomic and health costs, and remind ourselves of the importance of investing in health systems early before costs spiral out of control, the elusive “wake-up call.”

The 2003 SARS outbreak sapped the world’s economy by $40 billion. The economic toll of the 2014-2015 West Africa Ebola outbreak was nearly $53 billion. The ongoing COVID-19 pandemic has plunged countries into the single largest public health and economic crisis of our lifetime.  Countries in Africa are likely to see decades of progress dissipate, with projected losses of output between $37 and $79 billion in 2020. While the estimated annual cost ($2-3.5 billion) of epidemic preparedness in Africa is steep, it is lower than the cost of inaction. 

The importance of strong health systems

It is well recognized by global health experts that:

1. Investments in laboratories and disease surveillance networks are essential elements of national public health responses to outbreaks
2. A One Health approach — a collaborative, multisectoral, and transdisciplinary approach working at the local, regional, national, and global levels —is critical given the pervasive risk of transmission from animals to humans
3. Collective action can enhance the impact of national investments, as diseases know no borders and can wreak havoc in this increasingly interconnected world

Despite the merits of investing in robust health systems and the staggering cost of inaction, progress has been inadequate.  International preparedness for epidemics and pandemics remains weak, reflecting years of neglect and underfunding. Countries’ average score on the Global Health Security Index is about 40 out of 100, with much lower scores in developing countries. Within this generally bleak picture, some countries have made progress, and it is important we learn from them.

East Africa Public Health Laboratory Networking Project

In the late 2000s a group of leading public health officials from East Africa came together in Nairobi to brainstorm a regional approach to communicable disease control. The collective wisdom that emerged was that a regional network could facilitate innovations in service delivery and serve as a platform for cross-country collaboration.

Thus, the East Africa Public Health Laboratory Networking Project was born, the first regional health project at the World Bank.  Nearly a decade later, we are beginning to see the fruits of this cross-country network, which is now being leveraged for the COVID-19 response. 

The five participating countries (Burundi, Kenya, Rwanda, Tanzania, and Uganda) have benefited from the development of a network of 40 well-equipped public health laboratories with trained personnel and enhanced diagnostic and surveillance capacity. With the majority of hospital laboratories located in cross-border areas, access to services has improved for vulnerable groups, while cross-border disease outbreak preparedness has been boosted. 

The laboratories have benefited from the latest molecular technologies that ensure rapid turnaround and greater accuracy and can now be leveraged for COVID-19 testing. They have all made progress on the Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA), with 94% attaining at least three out of five stars, in contrast to 9% at project inception.  Nearly 40% have reached the gold standard international accreditation. This augurs well for quality-assured diagnostic testing.

Investments in strong national systems

A good example of a successful investment is the Wajir Referral Hospital laboratory, recently in the national spotlight in Kenya, as it was officially designated a COVID-19 testing site. The laboratory went from a modest one-room hospital with limited testing capacity to a state-of-the art facility that has reached international accreditation and has capacity to test a wide range of diseases of public health importance.

The Wajir laboratory played a critical role in numerous disease outbreak investigations, including measles (2013), cholera (2015, 2019), Dengue fever (2017), and Kala-azar and Rift Valley Fever (2018). It serves as a center of excellence, conducting COVID-19 testing for neighboring Mandera, Garissa, and Marsabit counties.

The governor of Wajir, Mohamed Abdi Mohamud, captured the sense of achievement and pride well:

“The referral laboratory, with skilled and dedicated staff, has been a great asset to the community and the entire region as a reference laboratory in clinical diagnosis, disease surveillance and outbreak investigations.”

The facility has been equipped with appropriate biosecurity measures to ensure the safety of health care workers.  It has capacity to test 60 to 100 COVID-19 samples in 24 hours, reducing the need to ship specimens to Nairobi. The governor also reiterated the importance of adequate financing to sustain gains in outbreak preparedness capacity and to support clinical care.

Cross-country collaboration

The network has proved its value, with each country leading a community of practice on laboratory networking and accreditation, disease surveillance, training and capacity building, and performance-based financing with strong country ownership. 

The East, Central and Southern Africa Health Community (ECSA-HC) has supported benchmarking of country performance using a unique peer review mechanism. Each year, countries assess each other’s performance against the SLIPTA checklist.

The regional intergovernmental organization has also led critical work on antimicrobial drug resistance surveillance, cross-border disease outbreak investigations, and tabletop simulations using a One Health approach. It has also organized regional training and brokered numerous partnerships, including with the African Society for Laboratory Medicine (ASLM), the WHO, and most recently with the Africa Centres for Disease Control and Prevention.  ECSA-HC’s in-depth knowledge of country contexts has enabled it to provide just-in-time support and to establish platforms for learning that are now being leveraged for COVID-19 training.

Lessons for the COVID-19 response

The COVID-19 pandemic should serve as the ultimate wake-up call for the importance of investing in resilient health systems  with strong surveillance, detection, and clinical capacity to rapidly identify, treat, and halt transmission. 

The evidence is clear: investing in health early saves lives and helps protect livelihoods.