Table 2

Key challenges to diagnostic preparedness and potential solutions

Challenges	Proposed solutions
Research and development
Lack of diagnostics in a format adapted for field use	Develop comprehensive diagnostic platforms that can rapidly adopt new assays to build sustainable capacity at country level. Develop diagnostics with limited sample preparation and training needs.
Insufficient funding and lack of coordination between donors leading to duplication of effort	Establish coordinating body for diagnostics funding. Match small start-up companies/academia with larger diagnostics or vaccine/pharmaceutical manufacturers with greater capacity.
Poor commercial viability of diagnostics during non-outbreak periods	Provide market incentives for manufacturers and establish sustainable business models to offset losses during non-outbreak years. Provide funding for stockpiling of tests.
Limited access to samples leading to further delays in diagnostic development	Establish a specimen sample bank, open to both the diagnostics and vaccines industries, including storage locations and processes for access.
Limited collaboration between experts and laboratories with pathogen-specific expertise	Expand networks of expert personnel and laboratories to allow more rapid responses during outbreaks and maximise knowledge sharing. Partner diagnostics and vaccine developers to find novel diagnostic targets.
Delays in sharing of diagnostic data affecting response and containment times	Create connectivity solutions enabling real-time data reporting.
Logistical and healthcare system preparedness
Shortages of diagnostic materials and supply chain interruptions during outbreaks	Preselect suppliers to ensure appropriate capacity for outbreak situations. Establish manufacturing lines for diagnostic production during outbreaks.
Poor diagnostic and surveillance capacity at national level in many countries	Reinforce surveillance capacities through implementation of surveillance laboratory networks, adapted to specific country needs, or transformation of surveillance laboratories for routine testing. Educate healthcare workers on the importance of real-time reporting. Link diagnostics and vaccines in a common health programme. Adopt a ‘One Health’ surveillance approach that integrates human, animal and ecological health.