Costs Of COVID-19 Tests Could Be Limiting Scale-Up in Europe; WHO Says ‘Herd Immunity’ Approach Lacks Evidence Base
Triage tent for COVID-19 cases in a hospital in Visby, Sweden

A leading medicines access group in Europe has issued a protest against the high price of COVID-19 tests in France, amidst rising concerns that the cost of the diagnostic test may also be limiting the number of people who are being tested in Europe – the new global epicenter of the COVID-19 pandemic.

In France, the test costs 135 Euros, although production costs amount to only about  €12 according to the Observatoire Médicaments Transparences, a French civil society watchdog, that published an open message on the issue Tuesday.

Meanwhile, in a press conference on the COVID-19 pandemic in Europe, convened by WHO’s European Regional Office, Dorit Nitzan, WHO/European Coordinator of Health Emergencies, told reporters Tuesday that the cost of the test depends on the country, but ranges from €30 to €60 . 

“Some countries have to be economical and efficient in using it,” said Nitzan. “It’s not cheap, but it’s more costly to be sick.”

In an interview with Health Policy Watch, Paline Londeix, founder of the French Observatory for Medicines Transparency, said that it was unclear why the price was so high since the 48 labs in France performing the COVID-19 test are all public, and the tests are being performed on “open platforms” using molecular (PCR) tools whose patents have expired and are thus in the public domain.

“These 48 labs are public labs, so it might be a price set artificially by the public sector,” she said, adding that the group was asking the Ministry of Health to comment in greater detail on the costs of the tests.

“WHO is working very hard to make sure that people are rapidly tested and informed. This is a key element of the public health response. We are working with member states in Europe to advise them,” said Richard Pebody, WHO Europe’s Head of Emergencies.

But as more countries see intensive community transmission of the virus and the number of cases mounts, “there can be challenges in terms of accessing enough tests to meet the local demand,” acknowledged Pebody. “That has happened in some countries in Europe.”

“Some countries have made decisions to focus testing for more severe cases,”  Pebody admitted.

Whether by necessity or design, even some of Europe’s most affluent countries, such as Switzerland, are currently limiting testing to people who are either seriously ill or symptomatic people and at high risk due to their age or pre-existing conditions.  That contrasts sharply with experiences in other nations, which have aggressively pursued testing measures. Examples include Italy and Israel in WHO’s European Region, as well as the Republic of Korea and Singapore in WHO’s Western Pacific Regional bloc.  

While testing needs to be part of an integrated approach, countries should accelerate their efforts as much as possible to test not only seriously ill and symptomatic cases, but their contacts, said Hans Kluge, WHO’s Regional Director for Europe at the briefing.

“When a country has capacity, we need to increase testing. We need to test contacts of probable and confirmed cases. In healthcare settings, there may be reason to prioritize, particularly in closed settings. Addressing coronavirus in prisons is important,” he said. 

“Herd Immunity” Measures Not Recommended by WHO 

In the press conference, WHO officials also said that deliberate strategies that permit the virus to sweep through the population so as to generate “herd immunity”, lack sufficient scientific evidence, and are not recommended by WHO at this point.   

Such an approach is being taken by the United Kingdom, followed by The Netherlands, whose prime minister Mark Rutte delivered an extraordinary televised address to warn Dutch citizens that the country was facing an unprecedented peacetime threat. But Netherlands will not follow France, Spain, Switzerland and Italy in nationwide lockdowns,Rutte was quoted as saying, noting that along with the United Kingom, the Dutch would attempt to build “herd immunity” among healthy parts of the population, to protect the older and more vulnerable. 

Dutch PM Mark Rutte addresses the nation for the first time during the COVID-19 pandemic.

WHO has recommended against use of the herd immunity approach, saying it is untested in the case of this novel coronavirus. The virus leaves about 20% ill enough to require hospitalization, and about one-half of those hospitalized need advanced respiratory or ICU care. It has a fatality rate of about 3.4%, on average, rising sharply to about 20% among people over the age of 80.  

“We do not have enough evidence about the “herd immunity” approach. It’s not the right time to recommend this,” said Nitzan, of the WHO European Regional Office, in the press briefing about the COVID-19 pandemic in Europe, which was broadcast live on the European Region’s Facebook page.

Said Kluge, WHO continues to recommend the same strategies to Europe “that we know works to turn the tide against the epidemic.”

Number 1, contain the outbreak, do aggressive case finding which means then diagnosing/testing, putting in quarantine….. Number 2 strengthening the capacity of the healthcare system for the influx of patients. Number 3 – the whole community mobilization with social distancing.”

European Case Load Approaching Cumulative Count Of China  

The total number of COVID-19 cases in Europe now stood at more than 66,000 active cases and 2,740 deaths, according to the two leading sources tracking data, including Johns Hopkins University and China’s Health Ministry.   That is in comparison to China which saw a cumulative total of 81,058 cases, but was reporting no new cases at all on Tuesday. 

Italy, the epicentre of the European outbreak, now has the most active cases in the world, with a cumulative total of 27980 confirmed infections and 2158 deaths, followed by Spain with 11309 cases and 509 deaths; France with 6664 cases and 148 deaths; and Germany with 8082 cases and only 20 deaths. Switzerland has reported 2650 cases and 19 deaths, according to the Swiss Federal Office of Public Health

The Netherlands, which has 1413 confirmed cases and 24 deaths, is pursuing a strategy of “herd immunity.” 

The UK, with 1960 cases and 56 deaths, is doing the same – although Prime Minister Boris Johnson took a stronger approach to the country’s response on Monday, saying “we need to go further, it looks like we are approaching the fast-growth part of the upward curve.” 

Active cases of COVID-19 around the world as of 5:13 PM CET 17 March, Numbers change rapidly.

 

Gauri Saxena and Svet Lustig contributed to this story

Image Credits: Wikimedia Commons: Visbystar, Twitter: @Mehreen, Johns Hopkins CSSE.