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Fossil fuel burning was pumping CO 2 into the atmosphere extremely rapidly, he said, though it took time for the atmosphere and oceans to respond fully. He added that global temperature had already risen by 1C since the industrial revolution, when CO 2 levels were parts per million ppm. CO 2 was now at ppm and rising, suggesting the planet would be locked into rises of 3C-4C in the next few centuries. Ice melting, he said, took even longer and the huge sea level rises indicated by the Pliocene evidence would probably take a few millennia to come about.

In the Pliocene a variety of beech and possibly conifer trees grew at Oliver Bluffs, miles from the South Pole. The tree remains had been unearthed as fossils, along with cushion plants and mosses.

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They found fossil leaves of southern beech. I call them the last forests of Antarctica. They were growing at ppm CO 2 , so this may be where we are going back to, with ice sheets melting at times, which may allow plants to colonise again.

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The evidence showed summertime temperatures in the Pliocene were a tundra-like 5C near the Pole, compared with C to C today. The presence of plants showed the Antarctic ice cap was much smaller in the Pliocene and the sea level much higher. About m years ago an even more extreme climate occurred. For undisclosed reasons, the manufacturer of one requested that it be taken off the lists of approved diagnostics in May Diagnostics for sale Test name and provider.

Diagnostics are fundamental to containing outbreaks. Without such tests, it is impossible to trace whether people with the disease have infected others, whether the virus persists in survivors, or to investigate the cause of deaths. In our view, the various Ebola diagnostic approaches need to be evaluated and the best ones prioritized. Most importantly, developers must be incentivized to sustain their investment in diagnostics during and after epidemics, so that health workers are not scrambling to obtain tests when the next outbreak arrives. This permits medical products that the agency has not yet approved to be used in an emergency — to diagnose, treat or prevent serious diseases or conditions when there are no available alternatives see go.

The following month, the WHO instigated an Emergency Use Assessment and Listing procedure, to enable faster review of diagnostics in a public-health emergency see go. It also called on manufacturers to develop diagnostics that would be easy to use and give quick results at the sites where people were being tested, and in countries lacking health infrastructure and trained personnel. What they do need is a handful of reliable, easy-to-use PCR-based and rapid diagnostic tests that are consistently available.

Why are so few of the approved company-provided diagnostics in stock and on sale? Developing diagnostics for unpredictable infectious diseases such as Ebola is a high-risk strategy for manufacturers. Compared with the millions of tests consistently needed for diseases such as malaria and tuberculosis, relatively few are required for viral haemorrhagic fevers such as Ebola — even during outbreaks that typically affect hundreds or thousands of people.

This means that the costs of manufacturing a test, stockpiling the raw materials and final product, and addressing the logistical and distribution challenges to get it deployed on the ground, far exceed gains made from sales.


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Over the past 20 years, the company has developed and commercialized nearly 50 molecular diagnostic assays in response to emerging infectious diseases. Altona owes its success partly to its close ties with research centres such as the Bernhard Nocht Institute for Tropical Medicine in Hamburg. These relationships have enabled it to become highly specialized in the marketplace for tropical and emerging infectious diseases. And because Altona produces the main components of its diagnostic itself, it can ramp up production rapidly.

Despite this, getting the kit to health workers in the current Ebola outbreak and in other poor settings is problematic. It is encouraging that the company plans to incorporate several of its assays into a system that could be used in situ in field laboratories to identify multiple pathogens in parallel. As fears about Ebola waned at the end of the West Africa outbreak, so did public and private funds available to manufacturers.

Emergency medicine

Companies struggled to get enough samples to evaluate their tests even during the emergency 5. But with fewer people infected, it becomes even harder to evaluate tests in the field, and to obtain national and local permissions to share samples and transport clinical specimens. We think that two actions are urgently needed to improve the availability of diagnostics — both in the current DRC Ebola outbreak and in future crises.

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Evaluate and prioritize specific diagnostics. For Ebola, health workers need two or three PCR-based tests and two or three rapid diagnostic tests that can be used in tropical settings where resources are scarce. PCR-based tests tend to be more accurate, so are preferable if the necessary infrastructure and expertise are available.

Rapid diagnostic tests are simpler to conduct, and so easier to use in the field. Competition between multiple manufacturers can drive down prices, and having alternative options might provide a safeguard if there are problems with supply. To maximize the chances of health workers making a correct diagnosis in an epidemic, prioritized tests should include those that can simultaneously identify co-circulating pathogens that cause similar symptoms.

For Ebola, this might be other Ebola virus strains, such as the Sudan or Bundibugyo virus; the protozoan that causes malaria; or other haemorrhagic-fever viruses, such as Marburg and yellow fever. In selecting the most promising candidates, various factors will need to be considered besides reliability and ease of use in the field — such as whether the associated infrastructure already exists.

Although the machines are not always located in the right places to be useful in an Ebola outbreak, people are used to handling them.

Indeed, their widespread installation has already enabled the deployment of the Xpert Ebola assay in the two recent DRC outbreaks. Incentivize developers.

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Many more such programmes are needed — particularly ones that focus on disease outbreaks. Greater investment in surveillance could be another way to assure markets for developers and manufacturers. Establishing national and regional surveillance programmes for viral haemorrhagic fever, for example, throughout central and West Africa would require thousands of diagnostic tests. In Uganda, a national surveillance programme has confirmed 16 independent viral haemorrhagic-fever outbreaks since , reduced the time of response to outbreaks from 2—3 weeks to 1—3 days, and resulted in shorter and less severe outbreaks 7.

Much can also be learnt from the vaccine community. For example, a public-health organization and a government authority might commit to purchasing a vaccine before it has been licensed. This provides an important incentive for the vaccine industry, in which licensing remains the biggest bureaucratic barrier. The vaccine had not been approved by regulators at that stage. The same kinds of deal should be made for diagnostics. The deployment of diagnostics and surveillance programmes in LMICs requires sustained funding: from international organizations and funders, such as the United Nations and the Africa Centres for Disease Control and Prevention; the ministries of health of G20 countries; public—private partnerships; and the governments of the countries at risk.


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And, just as for vaccines, we think that some kind of global alliance is needed. But in our view, it lacks the financial support and heft to convene stakeholders from across the diagnostics field.

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It is also liaising with funders to help push promising vaccine candidates for LMICs into clinical trials. We urge CEPI to incorporate diagnostics into its programme. Together, these steps will help to ensure that investments made during one outbreak are not wasted. Such efforts must be sustained so that they can help people to tackle the next crisis.