The END-VOC consortium will support the European and global response to the COVID-19 pandemic and Variants of Concern (VOC) through well characterised cohorts and linked with existing European and international initiatives. END-VOC consists of 19 partners in Europe (UK, Spain, Italy, Germany, Netherlands, Norway, Italy), South America (Brazil and Peru), Africa (Mozambique, South Africa, Nigeria and 13 ANTICOV African countries), Middle East (Palestine) and Asia (India, Pakistan, Philippines) with a focus on countries affected by VOCs and VOIs. We will elucidate the global circulation of the current and emerging SARS-CoV-2 VOCs and their characteristics, including transmissibility, pathogenicity and propensity to cause reinfection, to support best control strategies and the development of diagnostics; evaluate the impact of VOCs on the effectiveness of different vaccines and vaccination strategies; and assess the implications of VOCs on the choice of optimal treatment options. END-VOC will also investigate how VOCs alter long-term post-infection sequelae and where new VOCs emerge within hosts using our clinical cohorts. We will inform future preparedness and response working closely with international and national public health organisations and existing cohort consortia. Specific beyond state-of-the-art components of END-VOC include the use of novel phylogenetic prediction tools and mathematical modelling; generation of powerful cohorts through sentinel surveillance in low and middle income settings and cohorts of travellers to increase our global reach; use of novel predictive modelling of clinical outcomes by VOC and comorbidity/treatment and evaluation of differences in natural and vaccine immunity by VOC; antiviral screening models within cohorts and an artificial intelligence driven tool for the prediction of long COVID.

Many people living in resource-poor settings have never had access to the laboratory facilities or technical expertise that are needed to diagnose diseases. With the development and deployment of a new generation of affordable, easy-to-use, and portable diagnostic devices that are designed for places with no laboratory infrastructure, the global landscape of diagnosis is dramatically changing. Can portable diagnostic devices strengthen health systems in resource-poor settings? DiaDev is the first study to comprehensively address this question through comparison across multiple devices, sites of production, and contexts of use. Diagnostic technologies are often championed as universal solutions to health equity and access. This ethnographic study investigates the extent to which how diagnostic devices work and what they can achieve depends on the locally specific relationships through which they are designed and used. Five ethnographic case studies from the USA, India and Sierra Leone examine the partnerships between donors, governments, humanitarian organisations and users that characterise current models of technological innovation and implementation in global health, the processes by which diagnostic devices are integrated with health infrastructures in target settings, and the practices of knowledge production and use they entail. The ultimate aim is to generate new insight into (i) changing relationships of power between governments, donors, and business in global health, and (ii) the ways in which diagnostic devices are transforming health systems in resource-poor settings. It will produce a new context-specific and comparative framework for exploring the opportunities and challenges involved in the design and use of diagnostic devices. Through innovative collaborative methods it will also develop a set of ‘health system strengthening tools’ that will enable stakeholders to improve the design and use of these devices in dialogue with the project findings.