• Mary-Edens McAbee

The Global Difference: What Coronavirus Testing Accessibility Tells Us

Current coverage of the COVID-19 pandemic predominantly focuses on confirmed cases and deaths. However, those front-page headlines look very different on kitchen tables across the world. This is largely due to differences in international responses as each country faces this challenge with their own legal protocols and public health strategies. COVID-19 testing practices are at the center of these responses, and their accessibility embodies these differences.

Coronavirus testing is the key to relieving the global effects of the pandemic. Testing provides statistical evidence on the rate of spread through confirmed case numbers, which ultimately aids government leaders and researchers' understanding of the virus’ full impact in individual countries. Once the effects of the virus are better understood, legal protocol for handling the next phases can be more informed and responsive.

Testing procedures for COVID-19 have changed in accordance with the novelties the virus itself has presented. The speed with which cases began to rise across the world was paralleled by the rapid production of an accurate test in a matter of days. This speed was unimaginable during historical pandemics, and was due to the collaboration between the World Health Organisation (WHO) and international researchers. However, countries’ independent responses were staggered, and some chose to develop their own testing practices. A look at the various legal protocols allows for a broad comparison of strategies and their results.

Individual response strategies have the ability to shape the effect of COVID-19, and the numbers broken down by country magnify the effects of delayed testing. For example, while legal protocol regarding disease control in the United States is particularly rigid, the Food and Drug Administration (FDA) gave the Centre for Disease Control and Prevention (CDC) permission to employ Emergency Use Authorisation regarding COVID-19 products. Still, during the pivotal response weeks in late February, the US had only reported approximately 800 tests. In fact, the first diagnostic test had proven faulty and stunted testing capabilities as the country sought a more accurate procedure. However, by early March, new testing practices were already in place due to the responsiveness of the FDA made possible by EUA.

On the other hand, South Korea was the first country to offer public testing to the entire population in early February and, consequently, saw a muted peak number of cases and deaths compared to countries that limited initial testing. The Ministry of Food and Drug Safety worked alongside South Korea’s CDC to ensure swift approval for diagnostic testing, resulting in a multitude of approved tests before the end of February. South Korea, which was duly prepared with contact tracing and testing initiatives due to their history of Middle East Respiratory Syndrome (MERS), reported nearly 8,000 tests in February, compared to the US’ 800.

The effects of varied access to initial testing have become clear in recent months. Testing in the United States was delayed for weeks due to its overall response to the virus, while South Korea immediately initiated a country-wide response for testing and prevention. These two countries, respectively, are reporting current confirmed cases at nine percent and one percent of total tests. There are many variables to consider when comparing those two numbers; however, the difference in initial response as shown through testing statistics is most prominent.

Across the European Union, a number of tests were formulated throughout late February to early March and were still being modified in June to ensure the best results. Italy was plagued by political conflict when first addressing testing procedures and endured one of the worst outbreaks in the beginning stages of the spread. Even with a national declaration of a state of emergency, the Italian Ministry of Health struggled to contain the impending exponential crisis and no official expediting legislation was passed. Many other countries, such as the United Kingdom, had similarly delayed responses due to uncertainty, and faced similar, if not more severe, consequences of restricted accessibility to COVID-19 testing. While the UK’s Medicines and Healthcare Products Regulatory Agency announced flexibilities in their review and approval processes, these have not been made public.

China, the epicenter of the virus, had initial difficulties with testing accessibility due to the speed of the spread; however, it is now widely available to its citizens. In Wuhan, an initiative to test all residents has been proposed, demonstrating the country’s dedication to testing accessibility. The National Medical Products Administration has expedited review and approval processes required for all COVID-19-related products. New drug applications are now reviewed and processed in a matter of two days as opposed to the usual 60. This Special Review and Approval Procedure has set an example for the rest of the world in its recognition of the severity of COVID-19.

Unfortunately, there are still many areas where testing is not reportedly accessible to the wider public. A startling majority of Central African and South American countries are not actively reporting case numbers or testing policies. This ultimately leads to less accurate case reporting and a gap in understanding the scope of the pandemic.

While testing procedures are most relevant at the moment, creating a vaccine for the virus is the next step that researchers around the world are working toward every day. However, a vaccine will ultimately face the same international accessibility differences shown by testing procedures.

From a legal stance, there are many hurdles for a proposed vaccination to jump before being approved all of which vary internationally. The FDA in the United States requires a number of inspections throughout the preliminary laboratory stages before a possible vaccine is approved for clinical trials. Once approved, a series of trials must be proven successful for the vaccine to be officially announced. This includes the first sets of trials on human participants. In China, the National Medical Products Administration has continued its emergency fast-track measures to expand to vaccine discovery and has experienced laudatory progress in the past months.

Overall, the timeline for a vaccine from discovery in a lab to public access is lengthy no matter the legal process of its origin. Time will tell how each country handles this challenge, but the response to COVID-19 testing serves as a predictor for the next phase in the global fight to quell this pandemic.