As Britain scraps free mass testing, Hong Kong will swab its entire population

At the start of the pandemic, the World Health Organization (WHO) had one very clear message for countries around the world: "Test, test, test."

Two years later, the advice remains the same, but not all governments are listening to it.

This week, Britain's Prime Minister Boris Johnson hailed England's new "living with Covid" strategy, dropping its remaining pandemic restrictions despite the reality that tens of thousands of people are still testing positive each day — including, on Sunday, Queen Elizabeth II.

The plans unveiled by Johnson, who says the next phase is all about "encouraging personal responsibility," include an end to England's free coronavirus testing scheme. At the program's peak, more than 2 million swabs per day were being carried out and logged in the United Kingdom — yielding arguably the most robust data set in the world.

The UK's move to axe free mass testing after March was met with backlash from public health experts, who fear it could have major consequences on global efforts to track Covid-19. The WHO's special envoy for Covid, David Nabarro, said on BBC radio over the weekend that he worried Britain's decision to drop all rules and adopt "a line that is against the public health consensus," could "create a bit of a domino effect around the world."

The dismantling of these surveillance systems would have a dire impact on our understanding of the virus as it continues to evolve and spread, WHO epidemiologist Maria Van Kerkhove said during an online question-and-answer session on Tuesday. Though global infections have fallen about 20% this week, compared to the previous week, she warned that the decline "may not be real" due to reduced testing. "We are very concerned about a reduction in testing around the world. We need to continue to test for SARS-CoV-2. We cannot abandon our testing practices," Van Kerkhove added.

Still, some countries and regions are hanging on to testing as a major strand of their pandemic strategy.

Hong Kong's chief executive, Carrie Lam, announced a massive mandatory testing drive Tuesday as the territory grapples with its worst coronavirus outbreak yet, spurred by Omicron. The entire population — nearly 7.5 million people — will undergo three rounds of compulsory Covid-19 testing in March, and testing capacity is expected to increase to 1 million a day or more, according to Lam. Hong Kong has largely stayed in lockstep with mainland China's "zero-Covid-19" policy, which has meant that as other countries like Britain have shifted their approach to treating the virus as endemic, the city has been stuck in a never-ending cycle of lockdowns to quell outbreaks.

The extremely transmissible Omicron variant put a massive strain on testing programs around the world earlier this year, making rapid tests even more scarce. As cases surged, vaccinated and boosted people trying to ensure they were not positive before contact with vulnerable individuals or attending gatherings found themselves scrambling to find available test kits.

The United States poured billions into scaling up test manufacturing capacity, but still failed to avert a shortfall amid the Omicron spike. In a briefing by the White House Covid-⁠19 response team last week, Dr. Tom Inglesby, senior adviser to the task force, said that the administration was seeking to address supply chain challenges and expand domestic testing capacity, to "be ready if we face a new variant or surge in the future." The US government said it has secured 1 billion tests, 200 million of which have already been shipped free of charge to Americans across the country.

"Testing will remain a critical part of our overall COVID response strategy. We're making investments now for whatever this virus brings in the time ahead," Inglesby said.