Calls are growing for the federal government to provide widespread access to free COVID-19 rapid antigen tests as Australia pivots away from expensive and time-consuming PCR testing.
Prime Minister Scott Morrison said he doesn’t want to “undercut” suppliers and Health Minister Greg Hunt argues free rapid antigen tests would cause demand to spiral out of control.
But many countries around the world have been offering the relatively simple at-home tests for free, or at a capped price, since early last year.
English public health physician and data scientist Professor Iain Buchan said limiting supply to those who could afford it was much less useful than “mass participation”.
“This is a public health emergency. It’s not a free market situation,” he said
Price gouging and widespread stock shortages have made it difficult for many Australians to buy RATs at a time when authorities are begging them to avoid long lines for PCR testing unless absolutely necessary.
Consumer watchdog the Australian Competition and Consumer Commission (ACCC) has received more than 100 complaints as test prices surge well beyond $30 in some places.
In many countries, free access to RATs is widespread — although many countries have experienced supply shortages in recent weeks — while some have implemented price limits to prevent price gouging.
United Kingdom
The UK offers free rapid tests through a wide array of methods and encourages people to register their results with the National Health System to help better track the spread of coronavirus.
Tests are available to pick up from pharmacies, community collection points such as libraries or mailed out to homes.
Schools also offer rapid tests and children aged 11 and over are encouraged to take one twice a week.
United States
US President Joe Biden said the federal government will buy half a billion rapid test kits and distribute them free of charge to people to use at home.
But the administration is still working on details for how the program will work, such as how many tests people will be able to get at once.
The first delivery is not expected until this month.
The government is planning a website for people to use to request tests once they’re more widely available.
RATs are currently available from pharmacies but just after Christmas NPR reported similar issues to what Australia has been experiencing with widespread shortages and tests costing US$7–US$15 ($9.70–$20.70) each.
Other reports have cited much higher prices.
New Zealand
New Zealand, where COVID-19 cases are back down in the double figures after a brief November spike, has a much more limited approach to RATs then Australia.
The government said self-tests will be available for purchase by the general public early this year but has limited supply to supervised testing for now due to accuracy concerns.
But Professor Buchan said the “marginal gain” in accuracy wasn’t worth the limits this approach placed on how many people could get tested.
“It’s counterproductive. Instructional videos on an app of how to self swab — I think there have been a few small scale trials of that and that really works,” he said.
“People are swabbing regularly, learning to do that and entering the results in via an app that guides them, that’s the way forward.”
There are dozens of testing centres spread across the island, some of which also offer PCR tests. The rapid tests cost $15 each at every centre.
Health and Beauty retailer Watsons said the average self-test kit cost about $6, Channel News Asia reported in December.
Germany’s approach to rapid testing is repeatedly hailed as one of the best in the world; in June the New York Times reported there were more than 15,000 pop-up rapid test centres across the country, including 1300 in Berlin alone.
Germans are eligible for one free rapid test a week, regardless of vaccination and recovery status, according to a November announcement by Health Minister Jens Spahn.
The program was first introduced in March of last year.
France scrapped free COVID-19 testing in October in a bid to encourage vaccination and cut public spending.
Tests are available at pharmacies and limited to €6 ($9.40) according to The Local, following earlier reports of prices between €22 and €44 ($34.30 and $68.60).
Supermarkets were allowed to start selling the tests in the lead up to New Year’s Eve.
In Portugal, everyone is eligible for four free RATs a month — more in the capital Lisbon — carried out by a professional in their local pharmacy.
Appointments quickly filled up in the days immediately before Christmas and New Year’s Eve, partially due to government rules temporarily demanding negative tests for entry into restaurants.
Self tests, which were also difficult to get hold of across the festive period, are available from supermarkets and pharmacies.
Profit margins have been capped at 15 per cent since April 2021, shortly after they arrived in the country and they usually retail for about €2.80–€5 ($4.40–$7.80).
PCR testing is free with a referral from the National Health Service phone line, which has been inundated in recent weeks.
Several free rapid testing posts were set up throughout major cities in recent months.
Why rapid testing over PCR?
Apart from skipping hours-long lines for PCR tests, experts say there are other major advantages to using rapid tests, despite their lower sensitivity.
The first of these is right there in the name. People can get a result within 10 to 30 minutes, rather than waiting anywhere from one to as long five days depending on how overwhelmed the Australian labs processing PCR samples are.
“There is a need to use testing, to pivot testing towards symptomatic testing because there are so many people affected by Omicron that we have to use scarce resources wisely,” Professor Buchan said.
“And a lateral flow test is 10 times cheaper than PCR and 10 times faster.”
The executive dean of the Institute of Population Health at the University of Liverpool said in some cases PCR testing could be less useful because by the time someone got their result back, they were probably no longer infectious.
“There are difficult choices that have to be made,” he said.
“But it’s very clear to me that open access PCR testing for anyone with a sniffle, or anyone that wants a PCR test is a waste of time and a waste of money.”
Professional Pharmacists Australia called for RATs to be free and available to all Australians.
“Most Australians find the cost of testing their family prohibitive – if they’re able to find testing kits at all,” president Geoff March said, in a statement.
“If Australians have to rely on the private sector to get Covid tests, they will be paying up to $20 each – that’s $100 for a family of five for just one test each time.”
How accurate are rapid tests?
Rapid tests are not as sensitive as PCR tests, as the PCR process can amplify even very small amounts of the coronavirus.
Experts are confident in the ability of RATs to detect the virus when carriers are a their most infectious, particularly when symptomatic but less confident about detecting asymptomatic cases.
A March 2021 Cochrane Library meta-analysis of 48 studies found an average of 72 per cent sensitivity for symptomatic patients and 58 per cent for those without symptoms.
Professor Cochrane said roughly eight out of 10 people who were likely infectious would be picked up with a rapid test, and that figure could likely be improved by using multiple tests.
He stressed the importance of authorities clearly communicating how to accurately use rapid tests and what they are for.
“It’s a public health test to detect people who are infectious. It’s not a clinical test to detect people who have been infected,” he said.
“And this is really important in Omicron because the disease is ending quicker.
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“So infectiousness is stopping sooner and the biggest risk is people being off work in critical services.”
Professor Cochrane and other researchers found rapid testing and communication reduced hospitalisation by about a third during a pilot study in Liverpool.
Source: 9News
