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Introduction
Laboratories are critical for supporting effective infectious disease surveillance and outbreak response, and lack of adequate laboratory capacity is a global challenge. As part of global health security initiatives, cooperative threat reduction efforts and international development programmes, sophisticated laboratories have been provided to mitigate biological threats and bolster a country’s capacity for detection, diagnosis and storage of high-consequence pathogens. Very often, these use the assumptions, standards and templates applied in high-income countries. However, it can be difficult or even impossible to sustain these facilities in low-resource environments. There can sometimes be limited local technical capacity and capability, which can result in a high reliance on imported expertise, skills, equipment and other resources. Sustainability can therefore be hard to achieve. In addition, when a funding partner withdraws, the laboratories can become disused, foundering without the trained personnel and financial resources to sustain them.
To help address this situation, a proposal gaining increasing support internationally is to adopt an approach based on a local risk assessment, whereby laboratories are appropriately and optimally tailored to the local risks and to the resources available, both in the short and longer term, without compromising biosafety and biosecurity.
A Chatham House workshop was convened in Abuja, Nigeria, in 2018 to explore what West African countries would find most appropriate in terms of building laboratory capacity, what the main challenges have been so far, and what needs to be done to improve the sustainability of laboratories in the region. It emerged that there was a need for a more structured conversation between the funding partner and recipient country early in the process – prior to embarking on the detailed planning phase for the establishment or repurposing of a laboratory. This should involve careful consideration and an assessment of existing and planned capacity, needs and contextual issues, together with proposals for how to address the issues revealed, so that any ensuing laboratory demonstrably supports the national strategy and therefore flourishes.
The purpose of this tool
This tool aims to provide a structure for such a conversation. Developed in close collaboration with international experts and West African stakeholders, it seeks to increase local ownership and help partners ensure they have given due attention to all the relevant aspects, including risks and benefits, that need to be considered at an early stage. It should provide clarity on what is needed and improve the sustainability of any laboratory project that might result from the discussions. The tool can be applied when a new laboratory is being considered, or when an existing laboratory is to be repurposed or strengthened. It is also appropriate for use with public health, veterinary and environmental laboratories. Although the tool was developed in the context of high-consequence pathogens in Africa, it is anticipated that it will find global application.
It should support recipient countries to take stock of their capacities and capabilities, identify gaps, conduct an analysis of their needs and to develop the business case that can assist in seeking the necessary political and financial support for the laboratory. Meanwhile, it should facilitate the process of due diligence for the funding partner and provide a better understanding of what the recipient country perspective and realities are, and what the scale and nature of any investment might be.