We need a moonshot for new diagnostics if we want effective pandemic control

The COVID-19 pandemic has highlighted how difficult it is to deploy the tools we have on hand to diagnose infectious disease.  Testing reagents have been in short supply and hospital labs have been backlogged. We are simply unable to keep up with the demand for testing for the SARS-CoV-2 virus, even with very modest targets. While our local hospital labs are heroically doing their best to maximize testing volumes, they are crippled by inadequate tools.   

The best tests available right now are slow and difficult to conduct.  Patients are swabbed to collect material from the respiratory system, the swabs are sent to a hospital lab, and tested using protocols that require highly specialized training, given the potential for false results.  This takes days and makes it difficult to use test results effectively. Nor are the current tools scalable enough to keep up with a pandemic. Testing is centralized in designated hospital labs and relies on a single technology, making the system highly vulnerable to bottlenecks and supply chain disruptions.    

No rationally designed disaster plan would rely so heavily on a single, suboptimal solution.  Even with the introduction of point-of-care tests, a needed capability that allows tests to be conducted outside of overburdened hospital labs, we will not have the capacity to routinely test in the manner required for effective control of the pandemic.  

So why don’t we have better technology that would enable rapid, on-the-spot testing?  Imagine if we had a device that could quickly test the saliva of a patient within minutes—and if we could all run our own tests from home just as we take a temperature reading. This would be transformative.  

The fact that we are struggling with diagnostic testing is not because we lack the ability to detect the virus with the required speed. The problem is related to a lack of attention to—and investment in—diagnostic technology development.

The fact that we are struggling with diagnostic testing is not because we lack the ability to detect the virus with the required speed. The problem is related to a lack of attention to—and investment in—diagnostic technology development. With a well-supported and diversified diagnostics sector, the global toolbox for pandemic response would have the resilience that is so desperately needed. But this is not the case today.

Most venture capital investors avoid diagnostic technology startups as the margins on these products are low, commercialization scale-up costs are high, and it is therefore difficult to get financial returns that investors expect. Our universities are very strong in the physical sciences and engineering disciplines that form the foundation of technology development. Canada has been home to many promising diagnostic startups—but these companies have had difficulty surviving. Commercialization has often been a dead end due to lack of capital.

It is time to solve this problem. We need a moonshot effort that will support the development and scale-up of the tools that will alleviate testing bottlenecks and reduce supply chain vulnerabilities.  It must be co-ordinated, strategically managed, and pursue multiple promising technologies. This moonshot will require funding to support both advanced diagnostics research in academia and the launch and growth of companies with promising diagnostic technologies.   

The COVID-19 pandemic is our focus today. But there are so many other critical problems that need new diagnostic solutions.

The COVID-19 pandemic is our focus today. But there are so many other critical problems that need new diagnostic solutions—the continued emergence of antimicrobial resistance has the potential to cause future crises of a similar scale. We need a short term and a long term plan ensuring that diagnostic platforms that can be applied to a myriad of public health threats are available within the Canadian health care system. 

We all know that life-sciences investment dollars in Canada are scarce, but the situation is particularly acute where seed funds are needed for early stage company creation and launch. In the U.S., the majority of seed funding for startups actually comes from the government.  The Small Business Innovation Research program gives out sizeable grants (worth more than US$1-million) that help new companies launch. Many academic researchers use this program to start companies based on research headed in a translational direction.We need similar programs as well as those that will support the scale-up and clinical deployment of new diagnostic tools. 

At the University of Toronto, our scientists, clinicians, and engineers are working hard to develop new diagnostic solutions for COVID-19.  With the launch of the University of Toronto COVID-19 Action Initiative, the accelerated development of several new technologies is being funded as we speak.

Many of the projects underway are solutions to current diagnostic testing bottlenecks that will make a significant impact on the current COVID-19 crisis and the inevitable future waves that will ensue.  But if we continue to neglect this area and do not invest at the level needed to get transformative tools to the patient, we will find ourselves in this same situation again.  We need a robust diagnostics strategy in Canada in the face of a pandemic like COVID-19. 

Written by: Shana Kelley & Keith Pardee
Publication: The Hill Times