After learning that a friend tested positive for COVID-19, Thembi Ndlovu went to a health clinic in Zimbabwe’s capital in search of a free coronavirus test. But there were none left that day, leaving the 34-year-old hairdresser unsure if she needed to take precautions to protect clients.

“I wish we could just walk into a pharmacy and buy a cheap self-testing kit like we do with pregnancy or HIV,” she said as she left the clinic in a working-class township of Harare. “It would be much easier.”

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For millions of people in rich countries, COVID-19 self-tests are abundant and free, including in Britain, Canada, France and Germany. But most people across Africa have limited access to them.

Zimbabwe introduced free walk-in testing centers in November 2020, but supplies are tight and the country still has no national program to distribute at-home tests.

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Although self-tests are available in some Zimbabwean pharmacies, they cost up to $15 each, a fortune in a country where more than 70% of the population lives in extreme poverty made worse by the pandemic. The situation is similar elsewhere across the continent — and in parts of Asia and Latin America — with few, if any, opportunities for people to easily test themselves.

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Perhaps the biggest obstacle to making inexpensive, self-tests widely available in the developing world is that the World Health Organization has yet to issue guidance on their use. Without the resources of wealthy countries to buy tests or evaluate their safety, poor countries must wait for WHO approval before aid groups and international agencies are willing to donate them in large numbers.

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“Donors cannot deploy the tests until WHO say it’s OK to deploy, and countries themselves don’t want to use the tests until they get that guidance,” said Brook Baker, a professor at Northeastern University who advises the WHO and others on equitable access to COVID-19 medicines and tests.

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Some health officials say the discrepancy between rich and poor countries is discriminatory and has denied poor countries a chance to stem the spread of the coronavirus in the absence of vaccines. And unlike the massive global effort to share vaccines, little has been done to roll out more tests of any kind across much of Africa.

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The omicron surge appears to have peaked across Africa, as it has in other parts of the world. In the last week, the WHO says Africa recorded at least 125,000 COVID cases and 1,600 deaths, although that is likely an undercount due to the lack of testing.