TESTING IS NOT ENOUGH!

ACTION AGAINST AIDS, GERMANY – OCTOBER 2020

IN FOCUSAligning public health activities with human rights and modernapproaches to health promotion

OutlookWhat measures can we take to overcome the coronacrisis, limit its consequences or use scarce resourcesefficiently? Every day we experience uncertainties andcontradictions on these questions among scientists,health experts, politicians and in society. We must allstrive for a broad consensus to overcome the globalCOVID-19 pandemic. With our publications IM FOKUSwe want to stimulate discussion and promote opinion-forming: We write based on our experience of HIVwork. We are not interested in COVID-19 to beequated with HIV, but to discuss which experiencesfrom HIV work could be helpful in dealing with COVID-19. We do not intend to replace scientific papers, norcan we present the current state of knowledgecomprehensively and conclusively.

What tests deliver and when they havea benefitTesting for SARS-CoV-2 infections is considered keyto controlling the Corona 19 pandemic. However,what initially appears to be a sensible measure, suchas testing of travellers returning home, not onlyencounters technical difficulties, but must beconstantly re-evaluated by weighing up conceivablebenefits and harms.

Testing is not a simple technical actGenerally speaking, a corona test is a methodicalprocedure with an instrument designed to confirm theassumption that the person tested meets thecharacteristic of being a "carrier of SARS-CoV-2". This

admittedly abstract description opens the view to anumber of crucial points that should be clarifiedbefore a test is performed: What are the implicationsof a test for the person tested? Who has access to atest and who does not? Who can agree to the testbeing carried out and under what conditions? What isthe importance of counselling, education, andinformation? Under what circumstances can tests bemade compulsory and by whom? How reliable aretests, i.e. what do they actually measure? Does thetest result allow a statement about infectivity and riskof transmission? What is the individual benefit of atest if there is no treatment or access to treatmentand what is the collective benefit? Can a benefit beinferred for treatment of an individual or for publichealth? Who evaluates a test result healthprofessionals, public authorities, service providers?Who derives which recommendations for action orregulations from it? The incomplete list of questions makes it clear thattesting is not a simple technical act, but a complexhealth policy measure with many consequences, theintention, effects and consequences of which must beevaluated. In the end, tested persons are assigned toa category such as healthy or infectious, withsometimes considerable consequences for theindividual.

COVID-19, HUMAN RIGHTS AND WHAT WE CAN LEARN FROM THE HIV WORK

Experiences from testing for HIVIn the area of HIV, we have learned that we mustovercome outdated strategies of disease control tobe successful. Coercive measures justified by testing

have serious disadvantages for tested persons andultimately damage the health protection of all.Jonathan Mann, the Director of the Global AIDSProgramme of the World Health Organisation (WHO),initiated the paradigm shift as early as the late1980s. He made social determinants and humanrights the cornerstones of public health. Theidentification of "cases" or the measures taken totrace infection chains can bring carriers of pathogensinto conflict with the law. Tested persons are hastilyand uncritically categorised into "groups" or"clusters". Every member of a group is generallyaccused of immoral or dangerous behaviour. Thegroup thus becomes a threat to public health.

We experience daily that exclusion caused bystereotypes and measures against supposedlyinfectious persons lead to the fact that they are nolonger reached by education, prevention and care. For"risk groups", blanket restrictions of liberty, isolationmeasures or quarantine obligations are imposed. Thedanger is that structural, social or political conditionsthat lead to an increased risk of infection are ignored.As a result, the problems of structures and conditionsthat cause illness remain unsolved. The involvementof affected individuals and groups and respect fortheir rights are key to the successful implementationof public health measures.

COVID-19 does not affect everyone in the same way.Some people have an increased risk of exposurecompared to the average population. Examples aremedical and nursing staff, people living together inclose quarters such as collective centres, prisons, oldpeople's homes, nursing homes or security guards orteachers, groups such as migrant workers, seasonal

IN FOCUS - TESTING IS NOT ENOUGH!

workers, asylum seekers, travellers (to risk areas) orsocially disadvantaged people in our society. Onlythrough their participation and respect for their self-determination can the greatest possible benefit for allbe achieved. The benefits must not only be seen ineconomic terms. Implemented measures must becontinuously reassessed. Criteria for success are theorientation towards science, human rights, participationand active involvement.

Considering the global perspectiveIn the face of the corona pandemic, we must not thinkonly locally and nationally. The corona crisis will only besolved globally.As far as testing is concerned, ouractions are already having a serious, thoroughlydetrimental impact on the ability of the internationalcommunity to cope with the COVID-19 pandemic on aglobal scale. By developing and using resources in thehealth sector, we have an influence on their globalavailability. At the moment we do not show enoughsolidarity to share our knowledge and technology lead.On some continents, such as Africa, or in somecountries, far too little testing has been done so far. Inaddition to providing technology, we should alsoparticipate in the development and adaptation oftesting strategies based on research. One benefit for uswould be to be better informed about the global

the measures are systematically reassessed andcontinuously adapted to new evidence, the policy-makers communicate the measuresinitiated in a scientifically substantiated andtransparent manner, in particular if restrictionsand limitations of liberty rights are derived fromthem,

We are committed to promoting public health byseeking to maximise the fullest possible benefits forall. This is achieved when actions are technicallyefficient or knowledge-based and when the needs andrequirements of those groups for whom it is mostdifficult to implement these actions are taken intoaccount. We consider it vital that

What remains to be done and should be respected

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all public health directives on testing and theassociated control measures are subject tosystematic democratic control,adequate and effective education and informedconsent are provided during testing,well-prepared and comprehensible information ismade available in all necessary languages andcommunicated through detailed advice,tested persons receive clear instructions for allconceivable test outcomes, such as positive,negative or undefined test results,it is made clear to tested persons, on the one hand,that diagnostic tests such as a PCR - examinationor antigen tests provide a snapshot of the situationand therefore compliance with the comprehensiveAnti-SARS-CoV-2 hygiene and behaviour rules -continue to be useful and important; on the otherhand it is conveyed, that SARS-CoV-2 antibodytests mainly have an epidemiological significance,tested persons with their consent are activelyinvolved in the identification and counselling ofcontact persons,tested persons are informed about the confi-dentiality of their data, as well as personal andlegal consequences that test results might entail,test strategies are reviewed for the impact theyhave on the exclusion of groups and individuals,which means, among other things, that a positivetest result opens up access to health services andcare for everyone, regardless of insurance status, the public health sector is provided with sufficienthuman and up-to-date technical resources toeffectively trace chains of contact,test measures related to an event, but then offeredwithout financial or administrative accessrestrictions and, as mentioned above, combinedwith information and advice, instead of conducting mass tests, specific groupswith increased risks, such as nursing and healthcare staff, teachers and educators, are given theopportunity to have regular tests, Germany shows global solidarity with regard toaccess to testing and the development ofmeaningful strategies.

What to avoidThe obligation of the governments to ensure publichealth and, for example, to protect vulnerable groupsor people with risk factors, must not lead to thesystematic undermining of human rights. Restrictionsmust always be limited in time and democraticallylegitimised. Good communication in times of crisis does notinclude the categorical regulation of measures.Experts, politicians and decision-makers acting in thisway encourage distrust and resistance. It is clear thatdecisions and orders have to be withdrawn again andagain due to new findings. In this sense, politicalcompetition that does not serve public health must beavoided. It damages trust in public action in the longterm.

In the so-called risk communication on COVID-19,official and academic communication and in themedia, language should be used with care. Access totesting must not be made more difficult by blamingand exclusion. Not only risk behaviour, but also thecontext and structural conditions that enabletransmission must be taken into account.

Even for experts, testing is a complicated subject. Inparticular, the evaluation of test statistics is oftenmisunderstood or given too little consideration.Reliable and generally understandable informationshould be published by independent certifiedinstitutes. All media bear a special responsibility toavoid misinformation.

IN FOCUS - TESTING IS NOT ENOUGH!

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Robert-Koch Institut; Hinweise zur Testung vonPatienten auf Infektion mit dem neuartigen SARS-CoV-2; https://kurzelinks.de/RKI-Corona-Teste-StrategieWDR - Quarks: Wie funktioniert ein Corona-Test:https://kurzelinks.de/WDR-QUARKS-Teste-FunktionMueller, C. Coronavirus: Wie Testen undKontaktverfolgung funktionieren.https://kurzelinks.de/Medium-Pueyo-Mueller-Testenhttps://bit.ly/3844Jvg

If you wish to know more

ImpressumPublisher: Aktionsbündnis gegen AIDS, DeutscheAidshilfe, Missionsärztliches Institut Würzburgv.i.S.d.P.: Klaus KochEditors: Michael Krone, Klemens Ochel, Sylvia Urban,Gerhard Schwarzkopf, Peter WiessnerLayout: Theresa KresseContact: Aktionsbündnis gegen AIDS, Rungestr. 19,10179 Berlin, Germany+49 30 536799842 info@aids-kampagne.deReprinting is only permitted by referencing the sourceYou can download this document viahttps://bit.ly/2HXXj1r

During a pandemic, it is not in the public healthinterest to create unnecessary financial barriers totesting. Uncertainty about funding and bureaucratichurdles reduce access and acceptance. Due to thepossibility of SARS-CoV-2 transmission in the phaseof infection before symptoms appear, the possibilityof free testing in this phase must be created, forexample, if contact with a sick person has beenreported.

IN FOCUS - TESTING IS NOT ENOUGH!