Equivocal diagnostics: Making a 'good' point-of-care test for elimination in global health

Alice Street*, Emma Michelle Taylor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

What is a diagnostic test for? We might assume the answer to this question is straightforward. A good test would help identify what disease someone suffers from, assist health providers to determine the correct course of treatment and/or enable public health authorities to know and intervene in health at the level of the population. In this paper, we show that what a specific diagnostic test is for, the value it holds for different actors, and what makes it good, or not, is often far from settled. We tell the story of the development and design of a rapid antibody test for onchocerciasis, or river blindness, tracking multiple iterations of the device through three configurational moments in the framing of onchocerciasis disease and reshaping of the global health innovation ecosystem. Efforts to build that ecosystem for diagnostics are often premised on the notion that public health needs for diagnostics are pre-given and stable; the challenge being how to incentivise investment and find a customer base for diagnostics in under-resourced settings. By contrast, we show that for any disease, diagnostic needs are both multiple and constantly in flux, and are unlikely to be met by a single, stand-alone product. In the case of the onchocerciasis Ov-16 rapid test, we argue that the failure to recognise and address the multiplicity and instability of diagnostic needs in the innovation process resulted in the development of a rapid point of care test that might be manufactured, procured and used, but is unloved by public health experts and commercial manufacturers alike. The equivocal value of the onchocerciasis rapid test, we suggest, reveals the inadequacy of the current global health innovation ecosystem for developing diagnostic ‘goods’.
Original languageEnglish
Pages (from-to)1-23
JournalSocial Studies of Science
Early online date23 Apr 2024
Publication statusE-pub ahead of print - 23 Apr 2024

Keywords / Materials (for Non-textual outputs)

  • diagnostics
  • neglected tropical diseases
  • innovation
  • product development
  • global health


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