Dr Talkmore Maruta

ASLM

A suspected Ebola case doesn’t announce itself with fanfare. It arrives as a patient with a fever, a health worker’s uneasy instinct, and a specimen that needs to move — fast, safely, and to the right place — before anyone can say with certainty what they’re dealing with. In the Democratic Republic of Congo’s current outbreak, that chain of events has played out many times. And each time, it has depended on something largely invisible to the public: a laboratory system built, tested, and quietly strengthened over twenty years.

Months before this outbreak began, the African Society for Laboratory Medicine (ASLM) completed something like a stress test on paper — a multi-country assessment of laboratory systems across the continent, designed to answer a deceptively simple question: if an epidemic-prone disease emerged tomorrow, how ready would Africa actually be?

The answer, in hindsight, reads almost like a preview of what was to come. Across 26 countries assessed, every single one had a functioning surveillance system and core diagnostic testing capacity. Nearly nine in ten had dedicated laboratory coordination units. All had laboratory policies and regulatory frameworks on the books. Nearly 3,964 laboratories had been mapped across just fourteen of the countries studied, the majority sitting at the primary healthcare level — meaning diagnostic reach extends well past capital cities and reference hospitals.

None of this happened by accident. It is the residue of decades of investment aimed originally at other diseases entirely — HIV, tuberculosis, malaria — plus a more recent wave of pandemic-preparedness funding. Laboratory systems built to fight one set of diseases turned out to be exactly the scaffolding needed to respond to another.

When Ebola resurfaced, that scaffolding held. Suspected cases were confirmed rapidly. Surveillance systems flagged and reported them. Trained personnel — many of whom had been through exactly this kind of mobilization before, in earlier outbreaks or through routine disease programs — were activated rather than recruited from scratch.

But the same assessment that documented all of this progress also flagged something else, something less comfortable: capacity is not the same thing as capability. Having a laboratory is not the same as having a laboratory that can move a specimen across a fragmented referral network in an emergency. Having a surveillance system is not the same as having one that talks, in real time, to the laboratory information system next door. Having trained staff is not the same as having a surge plan for deploying them when caseloads spike overnight.

The current outbreak has tested exactly those seams — and largely confirmed where they still exist. Specimen referral, workforce surge capacity, digital interoperability between labs and surveillance platforms, and reliable domestic financing were all flagged as weak points before the outbreak began. They remain the areas where the response has had to improvise hardest, patching gaps in real time rather than executing a plan built for exactly this moment.

This is, in one sense, an unusually hopeful story: a continent that invested seriously in public health infrastructure, and is now watching that investment pay dividends in a live emergency. In another sense, it’s a warning delivered twice over — once on paper, and now in practice — that the next phase of that investment has to move beyond bricks, machines, and training certificates, toward the harder, less photogenic work of making all of it function as one system. Africa did not start this response from zero. But whether it starts the next one from further ahead, or from the same familiar gaps, depends on what happens with that lesson now.

Our Call to Action

To African Governments: Move beyond project-based investments towards sustainable national ownership of laboratory systems. Integrate laboratory services as core components of national health security strategies, establish predictable domestic financing, strengthen governance and ensure that laboratory networks remain operational between outbreaks — not only during emergencies.

To Development Partners and Financing Institutions: Continue investing in laboratory systems but increasingly prioritize programs that strengthen operational capability rather than infrastructure alone. Investments should support integrated laboratory networks, emergency logistics, digital interoperability, workforce resilience and sustainable institutional capacity that countries can maintain beyond individual donor-funded projects.

To National Public Health Institutes, Ministries of Health and Laboratory Leaders: Shift the focus from expanding individual laboratory capacities to optimizing the performance of the entire laboratory system. Strengthen specimen referral networks, improve interoperability between laboratory and surveillance systems, institutionalize emergency preparedness exercises and ensure that quality, biosafety and biosecurity are embedded throughout routine laboratory operations.

To Regional Institutions, Including Africa CDC and ASLM: Continue strengthening regional collaboration by promoting harmonized standards, workforce development, laboratory networking, quality improvement, biosafety and biosecurity, and coordinated emergency support. Regional mechanisms should increasingly facilitate the sharing of expertise, diagnostics, data and surge capacity so that no country responds to future outbreaks in isolation.

The DRC Ebola outbreak should be viewed as an opportunity to reflect on the maturity of Africa’s laboratory systems. It reinforces that sustained investments have established substantial laboratory capacity, while also emphasizing the need to ensure these capacities operate as integrated, resilient systems during emergencies. The next challenge — and opportunity — is to ensure that these investments consistently translate into operational capability that protects lives.

Ultimately, the measure of success will not be the number of laboratories constructed, professionals trained or diagnostic platforms installed. It will be the speed with which countries detect outbreaks, the effectiveness with which laboratory systems support coordinated response, and the resilience of these systems in safeguarding communities against future biological threats.

The next chapter of Africa’s laboratory systems must therefore be defined not by building more capacity, but by delivering capability that is integrated, sustainable and ready when it matters most. More information on ASLM response https://outbreak.aslm.org/