As part of WHO supported laboratory strengthening activities during the ongoing COVID-19 pandemic, a series of steps were taken to contribute to policy-making, improve diagnostic capacity and bio-risk management, provide guidance to Member Countries, undertake regional networking and deploy relevant human resources and laboratory supplies, where required.
Guidance and policy-making: A significant development during the pandemic relates to SEARO working closely with WHO HQ to develop the Global laboratory guidance for diagnostic testing. This came handy during the evolving phase of the pandemic with inputs from the region for reflection in the interim WHO guidance documents to address challenges. Prior to this, the SEARO team had provided a regionally developed information note, technical clarifications, and stepwise algorithms to address technical and supply related issues. The use of WHO’s COVID-19 Laboratory assessment tool was advocated at national and sub-national levels to assess capacities of existing laboratories which implemented or aims to implement SARS-CoV-2 testing.
Diagnostic capacity: As a starting step of response by WHO SEARO, three expert laboratories from WHO SEAR were identified as global reference laboratories in collaboration with WHO HQ to offer confirmatory testing for COVID-19. During the early stages of the pandemic when countries were still developing their diagnostic capacities, this measure helped them seek assistance for confirmatory testing for diagnosis and quality assurance, to refer specimens effectively and promptly. Support for such shipments was also offered from the WHO. Another task WHO SEARO facilitated through the reference laboratories was the technology transfer of COVID-19 testing to countries in need. Considering shipment delays and difficulties due to COVID-19 control measures, a regional stockpile was created for essential laboratory supplies and made available to countries on the need-basis for catering to acute shortages.
Periodic needs assessments, weekly calls with country offices and sharing of the latest knowledge, technical updates, and standard operating procedures (SoP) regional/country specific technical webinars and trainings were helpful in addressing critical gaps and needs. More than 16 technical webinars related to laboratory diagnostics were organized by SEARO in collaboration with WHO collaborating Centres (CCs), Global reference laboratories, WHO HQ and technical partners.
SAR-CoV-2 polymerase chain reaction-External Quality Assessment Programme (PCR-EQAP) for national and sub-national laboratories organized in collaboration with WHO HQ contributed significantly to assess the performance of laboratories testing for SARS-CoV-2 by PCR. More than 1800 laboratories from national and sub-national levels participated in the programme (more details at SEARO WSR 24)
Context specific laboratory testing strategy recommendations were provided on time-to-time basis depending on arising needs. This entailed utilization of testing methodologies such as point-of-care (PoC) diagnostic tests and rapid antigen tests to increase access to diagnostics at country level.
In the background of threats offered by the emergence of the new SARS-CoV-2 variants and the changing landscape of the pandemic due to them, a regional strategy was finalized for genomic sequencing strengthening for short-term and medium-term capacity building and sustaining genomic sequencing capacity in the region.
Bio-risk management: Laboratory biosafety and biosecurity was fundamental in protecting the laboratory workforce. The first series of webinars were held as early as January 2020 and then periodically, to brief and update countries on the biosafety considerations for implementing SARS-CoV-2 diagnostic testing (including rapid antigen diagnostics tests and PoC nucleic acid amplification tests). Followed by an e-learning module for COVID-19 testing, a training of biosafety and safe use of biosafety cabinets was offered in collaboration with Public Health England and WHO HQ.
Currently, a regional biosafety quick reference manual is being developed, emphasizing bio-risk assessment and mitigation strategies. It will be based on WHO’s laboratory biosafety manual 4th edition which was published in 2020. A regional training to implement the above will be launched once it will be finalized.
Regional networking: An informal regional laboratory network was established in 2019 for effective knowledge sharing related to high threat pathogens. The regional webinar platform of this informal network was quickly translated for COVID-19 to disseminate and share updated information. Experience sharing webinars from Thailand and India were some significant contributions from this regional platform. Collaborations with partner organizations such as UNICEF, the International Atomic Energy Agency (IAEA), Mahidol Oxford Research Institute etc., contributed to a regular sharing of information through regional webinars. Networking with WHO CCs, global reference laboratories and regionally identified centres of excellence played a vital role in establishing diagnostic facilities in several countries, enhancing genomic sequencing through referral testing, diagnostic capacity building including genomic sequencing and providing need-based technical assistance.
Deployments and human resource planning: SEARO facilitated the deployment of laboratory experts for countries in need through Global Outbreak Alert and Response Network (GOARN). In the intense phase of the transmission of the pandemic when countries were struggling for technical resources and expertise, expert deployments were made to Nepal and Cox’s Bazar, Bangladesh, amongst others. Remote support from experts was provided on need basis.
The diagnostic capacity for SARS-CoV-2 was rapidly scaled up among SEAR member countries. Efforts to address evolving diagnostic demands continued due to changing phases of the pandemic in the region. WHO SEARO advocated for importance of the collaborative and coordinated efforts through pragmatic approaches as key in sustaining and scaling up diagnostic capacity for SARS-CoV-2. It was contributing to the regional flagship of scaling up of capacities for emergency risk management too.
Based on lessons learned from the current pandemic response, efforts are now underway to leverage these capacities to prepare for response to other high threat pathogens with outbreak potential in future.