Cunning plan needed to use expiring RATs

Stockpiled tests should be freely distributed with a smart messaging campaign to ensure effective use.

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Stockpiled rapid antigen tests (RATs) held by state governments and nearing their expiry dates should be given away at pharmacies “and every street corner”, accompanied by a public health messaging campaign telling people exactly how and when to use them. 

The ABC reported this week that millions of RATs, purchased by the states, are languishing in warehouses, with many due to expire in the next three months. According to the report, 518 million tests were purchased in the past year. Queensland distributed only 35.4% of their tests, followed by the NT (43.2%), ACT (50%), Victoria (59.5%), WA (62.5%) and Tasmania (66.7%). NSW and South Australia did not report numbers. 

The question now is what to do with the stockpiled RATs. 

Professor Adrian Esterman, chair of biostatistics and epidemiology at the University of South Australia, was in no doubt. 

“I was asked a few days ago if we should be sending them overseas. My answer was, for heaven’s sake, we need them desperately at home,” Professor Esterman told TMR. 

“Our testing rates have plummeted – we should be getting them out at every pharmacy and even on street corners.” 

On Monday, the World Health Organization declared that the covid pandemic “continues to constitute a public health emergency of international concern” and confirmed recommendations including achieving 100% vaccination coverage, improved reporting and surveillance, and increased “uptake and long-term availability of medical countermeasures”. 

“All of those recommendations make perfect sense,” Professor Esterman said. “It’s just that the Australian government isn’t doing half of them.” 

But giving away the stockpiled RATs wasn’t enough, he said. 

“There’s no point giving them out unless people are aware of how to use them properly.  

“Messaging about every aspect of covid-19 has been abysmal – we tell people to wear a mask, but we don’t say when to wear them, what type to wear, and how to wear it – the same is true for messaging about RATs. 

“A single test is pretty useless unless you are chock-full of the virus. But if you do them serially – one then another 24 hours later and then a third another 24 hours later – they can be very accurate.” 

A spokesperson for NSW Health confirmed that 150 million RATs were purchased by the state between January and March 2022. 

“To date, no RATs purchased by the NSW government have reached their expiry date,” the spokesperson said. 

“NSW Health continues to actively explore opportunities to maximise product usage, and while no disposal has been required to date, disposal options will be considered for any surplus or expired stock. 

“A significant amount of inventory has been quarantined for future use, as the covid pandemic continues to impact the NSW community throughout 2023 and into 2024. 

“NSW continues to provide free access to RATs for priority populations. This includes distribution of RATs to vulnerable populations, through schools, health settings, non-government organisations, and Service NSW. 

“NSW Health works with stakeholders to ensure priority access to free RATs for groups in most need, including Aboriginal communities, the aged care and disability sectors, CALD communities, and rural and remote populations. If someone is a Commonwealth concession card holder or are immunocompromised, or if they are a carer of someone who is, they can also access free RATs from Service NSW.” 

A spokesperson for WA Health said: 

“The nation-leading WA Free RAT Program distributed more than 4.6 million free RATs from October to December 2022 alone. 

“Approximately 2.04 million RATs are due to expire in the first quarter of 2023, all of which are professional-use RATs. 

“There are around 40 million self-test RATs remaining, which continue to be distributed and available through schools, pop-ups, and offices of members of parliament across the state.” 

A Queensland Health spokesperson confirmed that 37.8 million RATs were purchased by the state at a cost of $260.7 million and that as at 16 January 2023, 24.4 million remained in warehouses and health distribution centres. 

“To date, a total of approximately 13.4 million individual RATs have been distributed to Queensland government agencies, with the majority being provided to hospital and health services, to support the covid-19 response. These RATs have been provided both to staff and members of the public (for example, at testing facilities and through the concession card scheme). 

“As at 31 December 2022, about 70,000 RATs held in distribution centres and warehouses have expired. A further 3.4 million RATs are due to expire in the three months from January to March 2023. None of the expired RATs have been disposed of yet. 

“Queensland Health is actively managing the expiry risk of RATs and is exploring several distribution strategies to minimise avoidable expiry and disposal risks. This includes donations of self-administered RATs to the not-for-profit and other non-government sector organisations. 

“Queensland Health is also exploring avenues with the Therapeutic Goods Administration regarding extending the shelf-life of RATs.” 

Associate Professor Paul Griffin, an infectious diseases physician affiliated with the University of Queensland, told TMR that the time had comes to “make people understand that the pandemic is not over”. 

“This is going to be with us for the long term and minimising transmission is important. 

“[These stockpiled RATs] should be used however we can before they expire, but it needs the right messaging so people understand the limitations. 

“The more testing the better.” 

Professor Bruce Thompson, Head of the Melbourne School of Sciences at the University of Melbourne, said RATs were still important given the waning uptake of vaccination. 

“We are two major variants down,” he said. “Delta – the variant these vaccines were designed for – is extinct. 

“We need to start testing much more frequently than we are, we need different, better messaging, and it would be stupid to throw the stockpiled RATs out. 

“We need better vaccines – no question – but we also need to test more.”