An overview of the future requirements for rapid COVID-19 diagnostic assays for antigen lateral flow devices.
The Department of Health and Social Care (DHSC) has concluded a review of the most likely future requirements and use cases for rapid diagnostic assays for specific SARS-CoV-2 antigens (lateral flow devices).
The review has enabled the development of selection criteria. The selection criteria will be applied to decide which lateral flow devices should proceed through the validation process. The selection criteria are split into primary criteria and secondary criteria. A lateral flow device must conform to all the primary criteria and at least one of the secondary criteria to be considered for validation.
The rationale for this approach is that DHSC will only seek to validate lateral flow devices that have predicted future use cases and that the resources available for validation will be best deployed to align with the national strategy for Test and Trace.
This page sets out the primary and secondary selection criteria for lateral flow devices. The validation will continue to follow the government protocol.
Primary selection criteria
DHSC will only validate lateral flow devices that conform to all the primary selection criteria. The primary selection criteria are as follows:
1. DHSC will not validate lateral flow devices that only allow for a nasopharyngeal or oropharyngeal specimen collection method or both. The lateral flow device must use one of the following specimen collection methods:
anterior nares swab (either with or without a throat option)
mid turbinate swab (either with or without a throat option)
Lateral flow devices submitted with a specimen collection method higher up on the list will be prioritised for validation (for example, lateral flow devices that use an anterior nares swab will be prioritised for validation over lateral flow devices that use a mid turbinate swab or saliva). A lateral flow device will only be considered for validation when all lateral flow devices with a higher priority specimen collection method have been considered for validation.
2. The instructions for use (IFU) or other packaging should allow for both asymptomatic testing and symptomatic testing. The manufacturer must be able to substantiate their claim for asymptomatic testing with clinical performance data.
3. The IFU or other packaging should not restrict the administration of the lateral flow device to medical personnel or healthcare professionals only. The manufacturer must be able to substantiate their claim with clinical performance data.
4. The lateral flow device must be specific for nucleocapsid antigens.
5. The manufacturer must be able to provide multiple pack sizes, as required by DHSC, with flexibility to adapt to DHSC customisation requirements for packaging and IFU design.
6. The manufacturer agrees to an ongoing programme of assessment of their lateral flow device against new variants of concern and understands that DHSC contracts will have prescribed obligations regarding the in-silico analysis of their test’s performance with respect to common mutations (including variants of concern).
7. The manufacturer must demonstrate the capability, or a clear path to obtain the capability, to print an individual QR code and unique identifying number onto each cassette.
Secondary selection criteria
To be considered for validation, a lateral flow device must conform to at least one of the secondary selection criteria. The secondary selection criteria are as follows:
1. The lateral flow device is CE marked or UKCA marked for ‘self test’, that is, the lateral flow device can be performed by any individual at home without receiving prior training. You can find out more about CE marks and UKCA marks.
2. The lateral flow device is designed with the lay user in mind. The lateral flow device is in a format with multiple features clearly designed to simplify use and reduce the risk of user error.
3. The time required for a ‘T-line’ to be fully developed is less than 7 minutes.
4. The lateral flow device offers quantifiable benefits with regards performance or confirmation of test validity, equality and inclusion (E&I) or other. One of the following are needed to meet this criterion:
the lateral flow device is ‘ultra sensitive’. In other words the lateral flow device shows a one-log improvement in sensitivity over current lateral flow devices (currently 1 x102PFU/ml). Manufacturers will be required to provide details of the novel or innovative technologies that increase the sensitivity above current lateral flow devices. To be accepted for validation the claimed sensitivity must be supported by detailed scientific evidence that has been subjected to peer review
the lateral flow device has a feature that demonstrates it has been run on a human sample, for example a human antigen specific ‘C-line’
the lateral flow device provides specific and tangible design features that would improve ease of use for groups with recognised challenges using lateral flow devices
5. The lateral flow device offers the potential to significantly reduce the use of single use plastics and plastics destined to landfill. One or more of the following are needed to meet this criterion:
the bulk of the lateral flow device is biodegradable and will not generate micro-plastics
the lateral flow device has a clear and credible route to recyclability
the lateral flow device is manufactured from non-petrochemical derived materials for example bio plastics and cellulose
the lateral flow device is manufactured from post-consumer or industrial recycled material
the test is designed to significantly reduce the quantity of materials required to perform the test
6. The lateral flow device makes an ongoing contribution to the development and sustainability of the domestic diagnostics industry in the UK or supports a resilient pipeline of lateral flow devices in the UK. To meet this criterion, the manufacturer or developer must conform to all the following:
a company registered in the UK that has all applicable professional licenses and insurances
the intellectual property rights are wholly owned by a UK-based company with no material risk to intellectual property rights access and use due to actions by a non-UK company or state actor
the key primary and secondary manufacturing processes are completed in UK (for example, up to and including ready to cassette test strips)
DHSC recognises that it is not possible to predict every possible innovation. If a manufacturer has developed a test with an unforeseen advantage, we reserve the right to review and permit submission for validation if the scientific consensus supports the claim.