Kazakhstan’s health ministry gave its own account of the opening on its site on Monday 14 September, four days after the WHO’s and UNDP’s releases of Thursday 10 September. The laboratory “will work within the structure of the National Centre of Expertise of the Ministry of Health”, the ministry’s sanitary-epidemiological laboratory service, it says, built by the government under the country project of the Pandemic Fund with the support of the WHO and the assistance of UNDP, and first vice-minister Timur Sultangaziyev opened the ceremony beside WHO representative Skender Syla, with Amparo Elena Gordillo-Tobar of the World Bank representing the fund’s head, Priya Basu, who sent a message.
The funding covers the wider pandemic-preparedness project; the laboratory building is one part of it. The WHO’s release of 10 September gives the Pandemic Fund grant as $19.2 million, Kazakhstan’s contribution as $34 million and partners’ as $5 million, which adds to $58.2 million for the country project as a whole, and no text gives the laboratory’s own cost. On its project page the fund prints the same sums to the dollar under its own labels, a grant of $19,202,194, “co-investment” of $34,013,007 for the government’s share and “co-financing” of $5,060,000 for the partners’, both “in kind & in cash”, under the title “Strengthening the National Capacity for Pandemic Preparedness and Response to Infectious Disease Outbreaks”, with the WHO as the only implementing entity.
The project page does not print the words Turkistan or virology, and the first steering committee, which met in Astana on 19 April 2024 with the ministry in the chair and the WHO as secretariat, set a working group “to oversee renovation of the country’s laboratories” and a project period of three years. The WHO’s readout of that meeting counts the country grant at $19 million and a separate multi-country grant at $27 million, which the fund’s site lists as a Central Asia One Health project, and names no start date and no disbursement.
Speed is the word every speaker used. The laboratory “will make it possible to substantially shorten the time of diagnostic studies, raise the availability of laboratory services for the population and strengthen epidemiological surveillance in one of the most densely populated regions of Kazakhstan”, the ministry wrote. “This is above all the speed of diagnosis and the possibility of reacting promptly to infectious threats,” Sultangaziyev said, and Syla said the laboratory “will help ensure faster access to quality diagnostics”.
The “before” gets one sentence in all three releases: until the facility opened, Turkistan region “did not have its own specialised virology laboratory, which required sending biological samples for testing to other regions of the country”. None of the three names the region that received the samples, and none gives the hours a sample spent on the road or the days a result took to come back. UNDP’s version promises to “significantly reduce diagnostic turnaround times” and prints no turnaround time.
Two state documents could hold a national norm. The first is the health ministry’s order 114 of 12 November 2021, the sanitary rules on especially dangerous infections, in the updated text on the Adilet legal database: about 120,000 characters in eleven chapters, on anthrax, tularaemia, Crimean-Congo haemorrhagic fever, haemorrhagic fever with renal syndrome, rabies, listeriosis, leptospirosis, brucellosis, the transport and burial of the dead and a formula for the protective strip around a settlement.
The order times what happens around a laboratory and never the laboratory. Final disinfection in an anthrax focus is due “within 3-6 hours from the moment of the patient’s hospitalisation” and within 24 hours at a workplace, contacts are observed for 21 calendar days, biting animals are isolated for ten, the results of observation are reported “no later than 2 (two) calendar days after the end of observation”, and brucellosis contacts are tested “every 2 (two) months during a year”. PCR appears four times, as a method for anthrax and for Crimean-Congo fever, as a confirmation criterion for the latter and for the organs of the dead, each time without a term.
The second document is the ministry’s order 257 of 11 December 2020, the Standard for the organisation of laboratory diagnostics. Point 26 of the standard says each laboratory sets and monitors its own turnaround times for urgent and routine tests, which makes the time to a result each laboratory’s own figure. The only minutes in the text belong to intensive-care express laboratories, “within 15-60 minutes” from sampling to the report of a result, and to a table of analyser tests for critical patients, where blood gases take about five minutes and troponin ten to fifteen.
The standard uses the concept. Its annex on urgent tests refers to “requirements for TAT”, the laboratory trade’s term for turnaround time, and its microbiology annex allows “delayed transport (up to 24 h)” for some samples. For PCR, for virology and for the especially dangerous infections of the 2021 order it sets nothing, so a result in Turkistan is as fast as the National Centre of Expertise decides, and no figure of the centre’s appears in any of the texts above.
Point 26 of the standard says each laboratory sets and monitors its own turnaround times for urgent and routine tests, which makes the time to a result each laboratory’s own figure.
The gap has edges. On Wednesday 21 October no figure for the time from sample to result, before or after the opening, appears in the five texts that describe the project, the ministry’s release of 14 September, the WHO’s and UNDP’s releases of 10 September, the fund’s project page and the WHO’s readout of the first steering committee, nor in the two orders. The same texts carry no capacity in tests a day, no staff number, no equipment list and no cost in tenge.
The fund’s project description does promise the thing a time norm would measure. Kazakhstan is to “establish an efficient specimen referral and transport system for priority disease specimens”, the page says, under a heading on laboratory strengthening, and it records that the country “has not conducted a Joint External Evaluation”, the WHO’s audit of a state’s capacity to detect and report outbreaks. A referral system has a clock by definition, and the clock is the figure missing from every page.
Beyond the figure, the texts leave the laboratory itself undescribed: what it tests for beyond the BSL-2 sign in UNDP’s release, whether it is a new building or one of the renovations the steering committee planned, and what it costs to run once the fund’s money is spent, in reagents, staff and contracts. The grant runs for three years from a start the readouts do not date, and the $34 million co-investment is the government’s.
One published line, the hours from a sample in Turkistan to a result, would turn the opening’s promise into a figure the next outbreak can be checked against.