Physicians 'practicing medicine blind' in areas without adequate access to diagnostics
Nearly half of the world’s population, primarily in low- and middle-income countries, has little to no access to essential diagnostic tools for common diseases, according to findings published by The Lancet Commission on Diagnostics.
The findings illustrate how the COVID-19 pandemic has “exposed the centrality of access to diagnostics as a key component of detecting and controlling emerging infectious diseases,” according to a press release.
“There are three things that are essential for health security: diagnostics security, vaccine security and therapeutic security,” John Nkengasong, MSc, PhD, director of the Africa CDC, said in the release. “Strong health systems, and strong public health systems, require all three. Equity starts with regionalizing production of health security commodities as much as possible — and this includes diagnostics.”
Gaps in diagnostics and treatment
Nkengasong and colleagues investigated the current status of diagnostics using the six WHO building blocks of health systems: health service delivery, health workforce, health information systems, access to diagnostics, financing and leadership and governance.
The researchers found a diagnostic gap of 35% to 62% for six common diseases — diabetes, hypertension, HIV and tuberculosis in the overall population as well as hepatitis B virus infection and syphilis in pregnant women. Specifically, they reported finding a diagnostic gap of 56% for diabetes, 62% for congenital hepatitis B, 46% for HIV, 61% for hypertension, 62% for congenital syphilis and 35% for tuberculosis. For tuberculosis alone, Nkengasong and colleagues estimated that about 30% of patients are not diagnosed or reported, contributing to 1.5 million annual deaths worldwide. Also, the researchers found a treatment gap of 13% for diabetes, 26% for congenital hepatitis B, 24% for HIV, 23% for hypertension, 26% for congenital syphilis and 26% for tuberculosis.
The most severe diagnostic gap was observed in primary care settings, where 81% of people in low-income and lower-middle-income countries did not have access to simple diagnostic tests besides those for HIV and malaria, according to the researchers. In hospitals, 30% to 40% of people lacked diagnostic tests. Individuals who were poor, marginalized, young or less educated had the least access to diagnostic tests, Nkengasong and colleagues wrote. Overall, they concluded that 47% of the global population currently has little to no access to diagnostics. They also estimated a global shortage of as many as 1 million diagnostic staff members.
Improving global disparities
Reducing the diagnostic gap for the six common diseases to 10% would lower annual premature deaths in low- and middle-income countries by 1.1 million and annual disability-adjusted life-year losses by 38.5 million, the researchers estimated.
To improve access to diagnostics, Nkengasong and colleagues recommended increasing financing, applying recent innovations in technology and expanding production of diagnostics in lower-income countries instead of concentrating it in high-income countries. Also, they advised improving affordability and democratizing diagnostics to reduce the gap.
“In much of the world, patients are treated for diseases in the absence of access to key diagnostic tests and services. This is the equivalent of practicing medicine blind,” Kenneth A. Fleming, MB ChB, DPhil, commission chair and emeritus fellow at the University of Oxford, said in the release. “Not only is this potentially harmful to patients, but it is also a significant waste of scarce medical resources. For the first time, our analysis shows the shocking scale of the challenges we are facing, and our report offers recommendations on how we close the gap.”
References:
Fleming KA, et al. Lancet. 2021;doi:10.1016/S0140-6736(21)00673-5.
The Lancet: Half of the global population lack access to basic diagnostics for many common diseases, new estimates suggest. https://www.eurekalert.org/news-releases/930549. Published Oct. 6, 2021. Accessed Oct. 12, 2021.
Perspective
Back to Top
In a recent study published in The Lancet, the Commission on Diagnostics found that the COVID-19 pandemic has produced deep, global reverberations that extend far beyond the enormous human toll of the SARS-CoV-2 virus itself. The authors found that pandemic-related disruptions to global supply chains and the disruption of local care services may have contributed to a loss of or limitation in access to fundamental diagnostic testing and/or care services to 47% of the world’s population. This has resulted in disruptions to care of patients affected by hypertension, diabetes, tuberculosis, pregnancy and HIV infection.
The resulting human toll of these reductions in access to care will take years to fully assess. The impact of these care disruptions fell mostly upon individuals in low- and middle-income countries. These data should provoke concern in policymakers and renew our sense of humility in how we should act upon these findings.
Over the past three decades, we have seen enormous progress in patient survival and outcomes for devastating, potentially life-ending diagnoses like HIV infection. Yet the systems that we have built to achieve these outcomes are vulnerable to both foreseeable and unforeseeable events. This should remind us that we cannot technologize ourselves out from the impact of conditions like HIV infection. This should reinforce the importance of prevention in averting the need for downstream care services and reemphasize the importance of building more local resources, infrastructure and clinical delivery leaders who can ensure that the impact of global events or supply chain disruptions are minimized.
Technology will not save us, but better local resource and more effective design of robust systems that are sustainable in resource-limited settings should frame our evolving response to this devastating global pandemic.
Collapse
Read more about