Test backlogs hit record levels in South Africa as global supplies are rationed

South Africa’s backlog of unprocessed tests has climbed as high as 100,000 this month, undermining its fight against the pandemic and exposing the fault lines in the global supply of crucial testing equipment.

South Africa, which has the largest number of COVID-19 cases in the African continent, is at the mercy of global suppliers who arbitrarily allocate their test kits to the world’s continents and then to specific countries, according to South African health officials.

The test-kit shortages are wreaking havoc across Africa, where many countries have conducted only a few thousand or a few hundred tests, far fewer than what they need to get their cases under control. The growing shortages in Africa could be a forewarning of worsening problems in the global supply as wealthier countries launch their own efforts to expand their testing programs.

South Africa’s backlog of tests is an example of how developing-world countries depend on a small coterie of global suppliers, since their testing devices are not interchangeable and must use the proprietary kits that each manufacturer sells.

“Regardless of what we order, we get what the supplier gives,” Kamy Chetty, chief executive officer of South Africa’s national health laboratory service, said at a briefing on Friday night.

The global manufacturers of two of the leading high-volume testing systems, GeneXpert and Roche Cobas, are providing only 20,000 test kits to South Africa a week, when the country has asked for 20,000 test kits a day, officials told the briefing.

Wealthy countries are muscling Africa out of the queue for supplies, African leaders say. “The collapse of global co-operation and a failure of international solidarity have shoved Africa out of the diagnostics market,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention, said in a recent commentary.

In an effort to ease the shortage, South Africa has given approval to 23 domestic suppliers of test kits, but they haven’t begun production yet.

New figures from South African health authorities show that the test backlog had reached 101,000 unprocessed tests by May 21. The number had declined slightly to 84,000 by Thursday.

“This challenge is caused by the limited availability of test kits globally,” Health Minister Zweli Mkhize said in a statement, citing an “inadequate supply” of extraction kits and high-volume PCR test kits.

On average, it is taking eight days for South Africa’s public laboratories to produce test results. With the backlog at its current level, thousands of people are unaware they are carrying the virus, simply because of the delays.

As of Friday, South Africa had 29,240 confirmed cases of the novel coronavirus, and the country had conducted more than 680,000 tests – the largest number of tests in Africa, but still only 1.2 per cent of its population.

The problem is worse in other African countries. Nigeria, with a population of about 200 million and one of the fastest-growing case loads in the continent, has conducted fewer than 60,000 tests so far. Mozambique has done only 10,000 tests, while South Sudan has done fewer than 3,400 tests.

Because of the lack of testing, it is difficult to know whether Africa’s relatively low number of COVID-19 cases is a result of effective strategies or simply a failure of detection.

Over all, only about 0.1 per cent of Africa’s population has been tested for the virus, compared with 2.3 per cent of the population in Organization for Economic Co-operation and Development (OECD) countries.

According to a report by the Tony Blair Institute for Global Change, the rate of testing in sub-Saharan Africa is less than 1,200 tests per million people. This compares with 42,000 tests per million in Canada and 62,000 tests per million in Italy.

“Several countries in West Africa have already recruited university students into diagnostics and still can’t move beyond 300 to 500 tests per day,” the report said this month.

To reach the same level of mass testing as Europe, for example, Africa would need to conduct 65 million more tests, the report said.

“Most governments [in Africa] are currently rationing their use of test kits,” Kate Dooley, the institute’s West Africa director, said. “Scaling up testing now is critical to COVID-19 containment efforts in Africa.”

Some African countries placed orders for test kits in March and were still waiting for their orders after six to eight weeks, she said.

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