Global diagnostic systems must evolve to prevent future pandemics

The review also calls for embedding diagnostics within the One Health framework, which integrates human, animal, and environmental surveillance. Because most emerging infectious diseases are zoonotic in origin, early detection depends on shared monitoring systems that span veterinary and environmental data alongside human health metrics.

A new scientific review warns that global diagnostic systems remain vulnerable to the same failures that crippled responses to SARS, H1N1, Ebola, and COVID-19 pandemics. The study, published in the journal Pathogens, argues that only a multi-layered diagnostic network, combining molecular, antigen, serological, genomic, and point-of-care testing, can prevent history from repeating itself.

Titled “Advancing Laboratory Diagnostics for Future Pandemics: Challenges and Innovations,” the paper examines how past epidemics reshaped diagnostic science and what new technologies could safeguard global health systems. The authors conclude that innovation alone will not suffice without equitable access, integrated data systems, and political commitment to global cooperation.

Lessons from two decades of epidemic failures

Since the early 2000s, the world has endured a series of health emergencies that exposed the structural weaknesses of traditional diagnostic models. The authors trace these failures through four major outbreaks, SARS (2002–2003), H1N1pdm09 (2009–2010), Ebola (2014–2016), and COVID-19 (2019–2023), to show how delayed testing, unequal access, and fragile supply chains repeatedly hindered global response.

The 2003 SARS outbreak, which spread from China to nearly 30 countries, revealed the paralysis caused by incomplete laboratory infrastructure and slow data exchange. Early testing was hampered by low viral loads in samples and lack of standardized protocols, forcing clinicians to rely on patient travel histories and symptom patterns rather than confirmed diagnostics. The episode spurred unprecedented investment in molecular diagnostic capacity, particularly in Asia, and emphasized the value of real-time international cooperation.

When H1N1pdm09 struck six years later, it became the first global influenza pandemic of the century, and a critical stress test for surveillance systems. More than 214 countries and territories were affected, with the majority of deaths occurring among people under 65. The crisis led to a rapid global transition from basic antigen tests to nucleic acid amplification tests (NAATs), particularly reverse transcription polymerase chain reaction (RT-PCR), which became the new gold standard for influenza detection. Yet the same pandemic revealed that more than half of WHO member states had little to no seasonal influenza surveillance capacity at the time.

The Ebola epidemic of 2014–2016 in West Africa underscored another glaring gap: the absence of local diagnostic infrastructure. With most samples sent abroad, test results often took days or weeks to arrive, during which patients waited in crowded holding centers and transmission continued unchecked. The introduction of mobile laboratories and the use of GeneXpert platforms reduced turnaround times dramatically, from over two days to just a few hours, proving that decentralized diagnostics could save lives even in resource-limited environments.

Then came COVID-19. By 2023, the pandemic had claimed over seven million lives worldwide. For the first time, large-scale automated PCR systems, rapid antigen tests, and next-generation sequencing (NGS) platforms were deployed simultaneously. Yet these successes were overshadowed by systemic inequities. Wealthier nations monopolized test kits and reagents while low- and middle-income countries (LMICs) struggled with shortages, fragile logistics, and unstable energy supplies. The “just-in-time” global supply model collapsed under soaring demand. COVID-19, The authors write, demonstrated that no single technology, no matter how advanced, could stand alone in a crisis.

The collective lesson across all four pandemics is clear: centralized laboratories and isolated national efforts cannot sustain effective epidemic control. Future preparedness depends on building an interconnected global network that ensures speed, scale, and equity in testing.

How new diagnostic technologies are rewriting pandemic response

The study details an unprecedented technological leap in the past decade, led by advances in molecular diagnostics. While PCR remains the cornerstone of pathogen detection, new approaches such as loop-mediated isothermal amplification (LAMP), transcription-mediated amplification (TMA), recombinase polymerase amplification (RPA), and droplet digital PCR (ddPCR) are redefining how and where testing can occur.

LAMP operates at a constant temperature, eliminating the need for expensive thermal cyclers and allowing faster results even in remote settings. Its adaptability and affordability make it particularly valuable for community-level screening. TMA, by contrast, functions at a slightly lower temperature but with extreme sensitivity, making it suitable for large-scale automated platforms used in clinical laboratories. RPA’s flexibility is unmatched, it can operate at body temperature and deliver results within minutes, making it an ideal candidate for true point-of-care testing.

ddPCR represents a more refined leap forward. By partitioning samples into thousands of microdroplets, it quantifies viral RNA with exceptional precision, detecting even the smallest viral loads that elude conventional PCR. During the COVID-19 crisis, this technology proved vital in tracking persistent infections in immunocompromised patients. The authors also note the rise of multiplex PCR, which allows simultaneous detection of dozens of respiratory pathogens, from influenza and RSV to SARS-CoV-2, thus enhancing both efficiency and accuracy in clinical decisions.

Beyond molecular techniques, antigen testing continues to play a critical role in rapid mass screening. These assays, which detect viral surface proteins, have become indispensable in schools, workplaces, and airports. However, their sensitivity depends heavily on viral load. To counteract this, multi-target assays now detect both nucleocapsid and spike proteins to reduce false negatives, while smartphone-based readers use AI algorithms to standardize interpretation and eliminate human error.

Serological testing, though less useful for early diagnosis, remains essential for retrospective surveillance and immunity assessment. Modern multiplex assays can differentiate between infection- and vaccine-induced antibodies, enabling public health agencies to estimate population-level immunity. Combining biosensing with artificial intelligence has produced portable systems that can instantly categorize individuals as protected, unprotected, or infected, drastically improving post-outbreak monitoring.

Next-generation sequencing has transformed from a research tool into a public health necessity. The COVID-19 Genomics UK (COG-UK) Consortium demonstrated how real-time genomic surveillance could trace viral mutations such as Delta and Omicron, enabling governments to adapt containment strategies. The emergence of metagenomic NGS (mNGS) now allows for the detection of unknown pathogens directly from patient samples without prior knowledge of the organism, providing a critical first line of defense against “Disease X” scenarios.

Point-of-care testing (POCT) technologies have pushed diagnostics beyond the laboratory altogether. Portable molecular analyzers, smartphone-integrated test kits, and wearable biosensors have extended the reach of real-time health monitoring to homes and community clinics. These devices deliver results within minutes, operate without laboratory infrastructure, and can automatically upload data to cloud platforms for integration with national surveillance systems. The study highlights the WHO’s REASSURED criteria, emphasizing real-time connectivity, affordability, sensitivity, and deliverability, as the benchmark for future diagnostic development.

Perhaps the most groundbreaking innovation emerging from the paper is the introduction of microfluidic digital focus assays, which combine short-term cell culture with digital PCR to measure infectious virus load within hours. This method directly quantifies replication-competent virus rather than inactive fragments, bridging the gap between detection and infectivity, an area where conventional PCR has long fallen short.

Together, these advances suggest a future diagnostic ecosystem that is faster, smarter, and more decentralized. Artificial intelligence, automation, and big data analytics are expected to serve as the connective tissue linking each layer, from laboratory to field, creating a seamless diagnostic continuum.

Building the next global defense: Equity, integration, and one health

The authors argue that while technology has advanced, governance and equity remain the real barriers to progress. The COVID-19 crisis, they note, widened the diagnostic divide between high- and low-income regions, with most LMICs unable to sustain operations due to unstable energy infrastructure, costly reagents, and lack of technical expertise. True resilience, the authors contend, requires investment not only in devices but also in human capital, maintenance systems, and regional manufacturing capacity.

The study calls for an urgent shift from donor-driven aid to sustainable infrastructure building. This means developing local manufacturing for diagnostics, ensuring supply chain resilience, and establishing financing mechanisms that cover recurrent costs such as reagents, spare parts, and equipment servicing. The authors cite integrated diagnostic models emerging in Africa, such as “one-stop” multi-disease testing centers leveraging existing HIV or maternal health networks, as promising examples of efficiency in resource use. Similar efforts in Latin America are fostering regional cooperation through the Pan American Health Organization’s Innovation and Regional Production Platform.

Global coordination, the authors say, is vital to this transformation. The paper highlights the 2025 WHO Pandemic Agreement as a landmark commitment to equitable access to diagnostics, framed around a “whole-of-government, whole-of-society” approach. It complements the international “100 Days Mission,” which aims to make vaccines, treatments, and tests available within 100 days of detecting a new pathogen. Achieving this goal will require pre-positioning diagnostic tools and establishing clear regulatory standards for infectious virus quantification, areas that currently lack harmonized protocols.

The review also calls for embedding diagnostics within the One Health framework, which integrates human, animal, and environmental surveillance. Because most emerging infectious diseases are zoonotic in origin, early detection depends on shared monitoring systems that span veterinary and environmental data alongside human health metrics.

Finally, the authors stress the role of the laboratory medicine community in closing the global gap. They propose cross-border laboratory twinning programs, remote training platforms, and standardized quality assurance systems to strengthen local capacities. Digital technologies and AI-driven networks, they argue, should be used not just for data analysis but for equitable knowledge transfer.