Increasing Access to Diagnostics in Southeast Asia

The coronavirus disease (COVID-19) pandemic put these systems under considerable pressure. Testing, contact tracing, and isolation were primary tools used to control the disease, while early detection through diagnostic technologies such as polymerase chain reaction tests helped limit its spread.

The pandemic exposed weaknesses in the systems supporting diagnosis. Health authorities faced fragmented laboratory systems, bottlenecks in referral and specimen transport, personnel shortages, infrastructure gaps, slow generation of evidence for decision-making, and unclear governance arrangements^[1].

Some of the laboratory initiatives developed during the pandemic have been incorporated into longer-term strategic plans. These include expanding laboratory capacity, strengthening coordination mechanisms, and establishing regional training hubs. Thailand, for example, has been expanding laboratory capacity in every province. A key priority now is establishing nationwide public health laboratory networks backed by rapid and well-integrated referral systems. Such networks will also require sustained political and financial commitment to maintain them.

The Philippines offers an example of how the public and private sectors can collaborate to expand testing capacity. The private sector Task Force T3 (Test, Trace, Treat) was created to support the government's COVID-19 response. Testing capacity increased to 34,000 tests per day from 4,500 tests per day within a month, and eventually reached 100,000 tests per day, as testing laboratories were established across the country.

Testing was one of several areas in which public–private partnerships emerged during the pandemic across the region, alongside public health surveillance and vaccination.

The challenge is thus to strengthen the gains after the immediate crisis has passed.

Expanding laboratory capacity does not by itself close the diagnostic gap. Health worker shortages and logistics, infrastructure, and governance gaps can prevent countries from making full use of that capacity.

Building and sustaining the workforce for disease surveillance and control require workforce planning, training infrastructure, curricula, and opportunities for international training and exchange, including partnerships with academic institutions and volunteers.

Information systems are also important. Diagnostic results need to be shared to allow action from health authorities and providers. Modernizing information technology and integrating it with infectious disease reporting systems improves the reporting and use of diagnostic information. Artificial intelligence can be explored as a tool for surveillance.

Indonesia's One Data system, for example, brought together data collection, processing, analysis, and dissemination for COVID-19 surveillance. Its development highlighted the difficulty of integrating information across different levels of government and between public and private systems.

Governance is also important. Legal and regulatory frameworks can constrain or enable effective disease surveillance. Countries need clear arrangements for referral, coordination, and disease-control efforts. These in turn need to be supported by strategic and operational plans, testing protocols, and institutions responsible for national disease surveillance. These arrangements can also support action-oriented research and the establishment of national disease surveillance agencies.

Clear policy can also help create the conditions for public–private partnerships during health emergencies.

A laboratory, however, cannot function on its own. It needs an effective referral system to move specimens and results, trained personnel to operate it, and institutions with clear responsibilities.

Disease threats do not stop at national borders. Health, agriculture, and related sectors must work together to monitor zoonotic pathogens and investigate outbreaks affecting humans and animals. Environmental and climate-related considerations need to be incorporated into surveillance, given the increasing impact of climate-sensitive diseases such as dengue.

Regional cooperation also needs to extend across borders. Priorities include developing border governance protocols; strengthening infectious disease data sharing, epidemic control equipment, and cultural and linguistic competencies in border areas; and conducting regional drills so countries can coordinate responses more effectively.

Building these capabilities into routine health systems can help countries close diagnostic gaps not only during major outbreaks, but also in detecting and managing common diseases.

^[1] These issues were discussed by health officials, practitioners, and other stakeholders from Cambodia, the Lao People's Democratic Republic, the Philippines, Thailand, and Viet Nam at a regional meeting convened by the Asian Development Bank in Bangkok in August 2023. The discussions drew on pandemic experience to consider how countries could strengthen health security and prepare for future health challenges.