Since May 2020 the Platform for ACT-A Civil Society & Community Representatives (the Platform) has been supporting community and civil society representatives in ACT-A and advocating for and ensuring that every aspect of the ACT-A has reserved space for communities and civil society to bring their expertise, experience and voices to the table.
The Platform is co-led by WACI Health, Global Fund Advocates Network (GFAN) and STOPAIDS.
Timely and accurate diagnostic testing for SARS-CoV-2 is an essential part of a comprehensive COVID-19 response strategy. Ag-RDTs can be performed by individuals in which they collect their own specimen, perform a simple rapid test and interpret their test result themselves at a time and place of their choosing, termed COVID-19 self-testing. This interim guidance provides a new recommendation that COVID-19 self-testing, using SARS-CoV-2 Ag-RDTs, should be offered as part of SARS-CoV-2 testing services. It also includes implementation considerations that can guide decisions on whether, and how, to adopt self-testing in different contexts, including the populations being prioritized; the disease prevalence in that population; and the impact on accessibility of testing, health care services and result reporting.
FIND, alongside the Global Fund, was named co-convener of the diagnostics pillar of the Access to COVID-19 Tools Accelerator (ACT-Accelerator) in 2020.
Traditional models of diagnostic testing are often characterized by a centralized approach, particularly true in low- and middle-income countries (LMICs). However, there are several common barriers to centralized testing.
FIND is part of the process to remedy this, and this includes how the ACT-Accelerator has, since inception, worked to transform access to decentralized testing.
This FIND case study explores the process and partnerships that have driven progress across four stages:
The study also highlights learning, impact and recommendations from a decentralized approach in response to the COVID-19 pandemic.
Bangladeshi scientists participate in next generation genome sequencing of SARS-CoV-2 genome
In November 2022, The Child Health Research Foundation (CHRF) of Bangladesh announced that, for the first time, the SARS-CoV-2 genome was sequenced at the Next generation sequencing Research and Innovation Lab, Chittagong (NRICh). CHRF stated, “With support from our friends at FIND, CHRF helped set up the lab and provided training for its members. We will continue decentralising genomics and building scientists for Bangladesh.”
What is the ACT Accelerator?
The Access to COVID-19 Tools (ACT) Accelerator was created after the outbreak of the SARS-COV-2 pandemic in 2020.
It is a global collaboration that uses existing public health infrastructure and expertise to accelerate the development and production of Covid-19 tests, treatments, and vaccines. It also focuses on providing equitable access to diagnostics and treatment.
The ACT Accelerator was launched in April 2020.
It has played a significant role in supporting the fasted and best coordinated global effort in history to fight a disease.
Its current focus is on scaling up access to Covid-19 tools worldwide.
Who are the convenors?
The ACT-Accelerator is co-convened by leading global health organizations.
It consists of three pillars and two or three partner agencies managing these.
What are the three pillars?
The three pillars of the ACT-Accelerator are the vaccines pillar, the diagnostics pillar, and the therapeutics pillar.
What does each pillar do?
The Vaccines Pillar has set a goal to rapidly rollout at least 2 billion vaccine doses in 2021 to high risk groups. It also has a goal to expand research and development.
Its third task is to identify new and emerging risks from variants of the SARS-COV2 virus.
The Diagnostics Pillar aims to identify new diagnostics and devliver 900 million high-quality tests by the end of 2021 to low- and low-middle income countries.
The Therapeutics Pillar promote research for effective treatments and ensure that countries optimize clinical care including the use of corticosteroids and medical oxygen for severe and critical patients. It also seeks to introduce new therapies and distribute up to 100 million treatment courses for populations in low and middle-income countries.
What does the Health Systems Connector do?
The Health Systems Connector (HSC) works across the three product pillars to identify and address bottlenecks in health systems worldwide and to enable the rollout of Covid-19 tools. The HSC also focuses on the rollout of personal protective equipment to health workers.
What is the role of the Access & Allocation workstream?
This workstream focuses on ensuring global equity and the allocation of Covid-19 resources. It also ensures that civil society and community engagement are integrated across all the pillars.
The ACT-Accelerator has supported the most rapid and coordinated effort in world history to develop tools to fight disease.
How the the ACT-Accelerator works
The Access to COVID-19 Tools (ACT) Accelerator is a time-limited global collaboration designed to rapidly use existing global public health infrastructure and expertise to accelerate the rollout of COVID-19 diagnostic tests, treatments and vaccines globally and overcome inequities in low- and middle-income countries.
What does the ACT-Accelerator do?
The ACT-Accelerator focuses on development, production and equitable access to COVID-19 tests, treatments and vaccines.
Launched in April 2020, it has supported the most rapid and coordinated effort in world history to develop tools to fight disease.
Now, ACT-Accelerator is expanding to provide access to COVID-19 tools globally.
Who is involved?
The ACT-Accelerator brings together expertise from several global health institutions, academic researchers, policymakers, regulators, the private sector, including research and development, the manufacturing industry, and those working on market shaping, procurement and delivery.
How does it work?
The ACT-Accelerator focuses on vaccination, diagnostics and treatment.
The Diagnostics Pillar is co-convened by the FIND, the global alliance for diagnostics (FIND) and the Global Fund, focusing on the needs of low- and middle-income countries in their fight against COVID-19.
World partners
WHO leads programmes on regulatory policy, product procurement, allocation, and country access and support. The organization also supports research and development.
The Health Systems Connector (HSC) works across the three product pillars. It is co-convened by the Global Fund, the World Bank, and WHO, with support from The Global Financing Facility for Women, Children, and Adolescents (GFF).
What are the ACT-Accelerator’s goals?
To identify and address country-specific issues that delay the rollout of tests, vaccines or treatments and ensure that there is sufficient personal protective equipment (PPE) available to health workers.
New partnership to prepare for rapid antigen testing in Africa
On September 11, 2022 the Foundation for Innovative New Diagnostics (FIND) and the Africa Centres for Disease Control and Prevention (Africa CDC) announced a new partnership to prepare for the introduction of new high quality antigen rapid diagnostic tests for Covid-19 over the next three years.
Fast and reliable testing has emerged as a cornerstone of the global response to the COVID-19 pandemic but has only sometimes been available to African countries during the pandemic.
Access to diagnostics also presents a significant hurdle in the fight against Covid-19 and other diseases, including TB and malaria.
Regulatory interventions have smoothed out the supply of accurate and fast antigen tests, but it has now become necessary to build capacity to ensure a speedy rollout.
While there have always been global inequities in accessing diagnostics, these became clearer and worse during the Covid-19 pandemic, with supply chain wars and quality issues impacting heavily on the situation.
In response to the announcement Dr. John Nkengasong, Director of Africa CDC, stressed the importance of fast and accurate results so that patients can be isolated and health workers can trace close contacts, especially in low- and middle-income countries (LMICs).
Rapid tests are a fast and accurate way to diagnose patients in a primary healthcare setting
Global partnership feeds healthy supply of rapid COVID-19 tests to low- and middle-income countries
A set of global agreements reached in September 2020 paved the way for 120 million rapid COVID-19 tests to be distributed to low and middle-income countries.
The Access to COVID-19 Tools (ACT) Accelerator, working with other organizations, concluded these agreements to enable the manufacture, distribution and rollout of these vital diagnostic tools.
At the time, there was a huge unmet need for fast diagnostic testing globally, especially in the low and middle-income bracket.
The Africa Centres for Disease Control and Prevention (Africa CDC), the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative (CHAI), the Foundation for Innovative New Diagnostics (FIND), the Global Fund, Unitaid, and World Health Organization (WHO) all worked on this project.
There was a particular focus on making tests available to countries without extensive laboratory facilities or trained health workers to implement molecular (polymerase chain reaction or PCR) tests.
Why is testing crucial in the fight against COVID-19?
Rapid tests are a fast and accurate way to diagnose patients in a primary healthcare setting, as this is where most people access services.
Rapid tests are also cheaper than laboratory tests. With a fast initial diagnosis, track and trace teams in more remote and rural areas can start work sooner without waiting for laboratory test results.
Quick results can prevent the virus from spreading in communities. Rural and remote healthcare settings especially need access to rapid testing, as accessing centralized laboratory services can take a long time.
Procurement
The Global Fund made $50-million available to purchase 10 million tests per country.
Distribution
FIND and WHO supported countries in distributing these tests.
Unitaid and the Africa CDC combined resources rollout tests to countries in Africa from October 2020.
The study was to evaluate how effective serological tests (antibody tests) are in detecting a durable immune response to SARS-COV-2.
Study to investigate efficacy of antibody testing in patients’ immune response to COVID-19
In October 2020, the Foundation for Innovative New Diagnostics (FIND) and French Microbiology Technology Research Institute, BIOASTER, announced a joint clinical study to investigate the efficacy of antibody testing for COVID-19.
The aim was to improve understanding of how the immune response in affected patients changed over time.
The study evaluated how effective serological tests (antibody tests) are in detecting a durable immune response to SARS-COV-2.
At the time, no vaccines were available, and information on naturally acquired immune responses in people infected with the virus was vital.
FIND co-convenes the Diagnostics Pillar of the Access to COVID-19 Tools (ACT) Accelerator, and this study was part of its work.
The study examined antibody responses of patients seeking care at the Hospices Civils de Lyon and Centre Hospitalier Annecy Genevois in France.
The plan was also to gather future antibody test data from low- and middle-income countries.
Dr. Catharina Boehme, CEO of FIND, said at the time that it was not clear how human immunity would change, as people got infected and recovered.
Project Stellar to help countries expand diagnostic testing for Covid-19
In Sub-Saharan Africa, COVID-19 testing rates are still low in most
Countries. One of the reasons for this is inadequate investment in laboratory capacity. There is a similar trend in testing rates for HIV, TB, and malaria.
In addition, despite the availability of rapid antigen tests, many countries have not effectively decentralized testing to a community level.
New investment
Since February 2022, C19RM 2021, the response arm of the Global Fund, has been investing US$800 million across 100 countries to procure COVID-19 diagnostics and commodities.
Project Stellar was created in February 2022 within the Global Fund to support countries in reaching Covid-19 testing goals and strengthen laboratory systems over the longer term.
Goals
It aims to offer assistance with planning, mobilizing resources, and creating a targeted advocacy program to encourage testing. Countries will also receive help in developing a diagnostics strategy and algorithm.
Other goals for the project that will run up to December 2023 are to scale up testing, including training and community outreach, and the management of data and surveillance systems.
The project will also aim to improve regulatory approvals of rapid antigen tests and coverage for COVID-19 testing.
Another goal is to advocate for wastewater-based surveillance and epidemiological monitoring at a country level. Wastewater surveillance often provides an early warning system of cases rising.
Project Stellar will also help countries to strengthen data management and surveillance systems.