Why we cannot overlook diagnostics in the pursuit of universal health care

Where you live should not determine if you live.

This principle took centre stage at last month's United Nations General Assembly's health hearings, as representatives discussed how best to accelerate action on the UN's 2030 agenda. Chief among these was the focus on universal health coverage and pandemic preparedness.

The shared learnings from COVID-19 have cemented the invaluable role decisive global action plays during international health emergencies and prompted countries to take immediate measures to strengthen health security. This is even more pressing in low- and middle-income countries (LMICs) that grapple with capacity and capability challenges, the absence of uniform regulatory mechanisms, as well as the added challenge of rapidly growing patient populations and a sharp rise in the number of elderly.

We can no longer sideline achieving sustainable development and global health security and must follow this world vision with urgent interventions. More importantly, we must acknowledge that no one can do this alone.

Collective action is needed to address critical areas and support the implementation of critical policy and guidelines in line with the World Health Assembly diagnostics resolution and the 2030 goals.

Collaboration among private and public stakeholders is essential.

Asia Pacific, home to 60% of the world’s population, has work to do when it comes to helping the world achieve universal healthcare. The South-East Asia region has the highest level of out-of-pocket spending as a share of current health expenditure among all WHO regions. In 2017, this translated to 117 million people facing poverty due to health spending.

With less than seven years until the 2030 deadline, achieving universal healthcare is an undeniably tall task. But it’s further complicated by the fact that 47% of the world doesn’t yet have access to even the most basic diagnostics.

Through necessity brought on by the pandemic, we saw a surge in diagnostics innovation, approval and distribution. Despite this, diagnostics make up just 2% of healthcare spending.

Life-changing innovation is only meaningful if it reaches those who need it. Diagnostics must play a more central role in national healthcare plans — for crisis preparedness and routine healthcare services. The Asia Pacific bears a substantial global burden of infectious diseases, and the prevalence of non-communicable diseases like cancer and cardiovascular diseases adds to health systems' growing challenges. This necessitates a more prominent role for diagnostics, not only as a means to facilitate treatment but as a gateway for early intervention — preventing disease from getting worse and detecting it before it even starts. This early intervention approach pays dividends in better patient health outcomes and long-term cost savings for healthcare systems.

A clear case for this is in breast and cervical cancer, where targeted and sustainable interventions by emerging economies in the Asia Pacific can help to accelerate their progress towards WHO targets for both diseases, as also highlighted by the Asia Pacific Women’s Cancer Coalition report.

The industry must cooperate to facilitate pathways to enable diagnostics access.

Roche Diagnostics is supporting hepatitis control and elimination programmes in Pakistan together with Aga Khan University Hospital and The Health Foundation, to the benefit of 36,000 patients over two years. This initiative is part of a wider Global Access Program, which supports low- and middle-income countries in strengthening their diagnostics infrastructure. Since its launch in 2014, the company has provided diagnostics solutions to 89 countries globally, covering a range of high-burden diseases such as Tuberculosis (TB), Hepatitis B and C (HBV and HCV), and Human Papillomavirus (HPV).

The industry must continue to innovate — exploring opportunities in digital health to bring diagnostics closer to patients, for example — and look for ways to partner with other organizations to boost Asia-Pacific’s diagnostics capacity.

The absence of a homogenous healthcare landscape in the Asia-Pacific demands localized diagnostic strategies. A one-size-fits-all solution to universal healthcare coverage is unsustainable. Still, while diagnostics strategies should be tailored to each country, there are areas of opportunity that apply across much of the region.

As The Lancet Commission on Diagnostics recommends, countries should formalize the role of diagnostics in every step of the healthcare journey. That means laying out national diagnostics strategies and introducing national essential diagnostics lists (EDL) to improve access.

Another way is by strengthening laboratories. Universal health coverage is not attainable without a network of laboratories and a skilled workforce to support patient diagnosis, early interventions and continued patient/disease monitoring. Laboratory systems are crucial to enabling the speed and accuracy of diagnostic test results, particularly in a public health crisis. Despite the critical role of laboratory results in supporting clinical decision-making, they account for only 5% of hospital costs.

To achieve the goal of early detection, continued investment by governments and private-sector organizations is necessary towards lab funding, workforce capacity and training.

The challenge of diagnostic availability and accessibility is another area where cross-sectoral collaboration can make a difference. Government spending on health in Asia Pacific is relatively low, representing just 35% of the region’s overall health expenditure. Increased funding for screening programmes can significantly reduce the burden on acute care facilities by facilitating prompt detection and treatment. The diagnostics industry can support this by providing technical assistance and expertise to health authorities as they establish their essential diagnostics lists and by innovating to produce diagnostics suited to low-resource settings.

Finally, the public and private sectors can fully embrace the potential of digital health solutions by creating a robust, trusted framework for diagnostic data collection. For example, Thailand's health system moved from paper-based to electronic health records. The national population registry serves as a delivery system. It sets the baseline list of beneficiaries for the universal healthcare scheme, allowing for rapid coverage and eliminating the need for a duplicative enrollment campaign.

Early diagnosis isn't a nice to have, it's a vital part of making universal healthcare possible. With seven years to go, we do not have much time left to provide diagnostic access to nearly half of the world's population and it can be a daunting task when working alone. The 78th UN General Assembly was an important step in putting forward action-oriented roadmaps — but significant work lies ahead.