Dr. Niamh Power:

On scalability, all private providers of antigen and PCR testing for travel will need to be brought on board. Looking back at levels of travel from 2019, which would have been the last normal year, approximately 25 million passengers went through Dublin Airport alone. All hands on deck are needed for this.

I understand the idea of self-testing would of course make things much more scalable and convenient. As far as I am aware, however, the European Commission has stated self-testing will not be allowed for the EU digital green certificate. That needs to be worked on. From my own experience of self-testing, our company supervised a self-testing event of 300 airline pilots who are generally clever and well able to follow instructions. There are definitely some issues there with practice. In UK schools, for example, the kids self-test at school three times and then they are allowed to do so at home. There is definitely a learning curve regarding swabbing and the actual processing of the tests. While it is a learning curve, it can be overcome. The European Commission would have to get on board with that.

Regarding resistance to antigen testing, as a medical doctor and having been involved in providing antigen testing for travel, I do not understand why there is such resistance. I do not see any evidence for it. I would like to see the evidence if it exists. Several arguments have been made, one of which is antigen testing will encourage poor behaviour. In fact, the Covid-SMART project in Liverpool in the UK did not support that argument. It is back to the argument of seat belts and condoms that we have had, namely, applying a public health tool will not necessarily encourage poor behaviour.

From the aviation context, the poor behaviour argument is moot. We have very well controlled environment both at airports and in aircraft. Poor behaviour and non-compliance with regulations will not be tolerated. Those passengers will just not be carried. From the behavioural aspect, I do not think that is an issue for travel.

On the sensitivity argument and the public health risk, sensitivity can be improved by proper sampling techniques and use of the testing. For the moment, this will mean that it should be monitored testing as per the EU guidelines. There is a definite role for self-testing for screening purposes for schools, colleges, other forms of transport, workplaces, residential care homes etc. Thousands of leaving certificate students will start their exams today. Many of them will be told, unfortunately, that they cannot sit their exams because they have been designated a close contact. Had we been organised to facilitate those students, they could have taken a rapid antigen test just before going into the exam and then be able to do it. There are many opportunities that we have missed to roll out antigen testing for the good of society.

On sensitivity regarding travel, it has been shown in studies that an antigen test 24 hours before a flight is as good as a PCR test only two hours before. That is a very simple fix. One just requests an antigen test 24 hours before. Professor Mina will have more statistics on this. His studies will show that the real issue with sensitivity is the period of time before a person becomes positive on an antigen test when they are already positive on a PCR test. That is just an eight-hour to 24-hour window. Even a 48-hour antigen test would be as good as a 72-hour PCR test. These can all be overcome and should not be a reason why we should discount antigen testing for travel.