Lateral thinking: Lateral flow test engineering and lessons learned from COVID-19

Fig. 1b. [Budd et al., 2023]: Lateral flow tests. Timeline of key advances in lateral flow testing. WHO, World Health Organization; HIV, human immunodeficiency virus; RDT, rapid diagnostic test; AMR, antimicrobial resistance.

A new review paper led by our UCL researchers brings together an international group of world-leading experts to reflect on the lessons learned from COVID lateral flow test use worldwide, and to shape the future research agenda for the next generation of lateral flow tests for emerging infections and antimicrobial resistance.

Lateral flow tests (LFTs) were adopted at an unprecedented scale during the COVID-19 pandemic, enabling access to testing beyond healthcare settings, including self-testing, without the need for specialized or costly equipment. LFTs can detect analytes in a variety of different clinical samples and provide rapid results within minutes. The acceptability and feasibility of large-scale testing with LFTs for clinical and public health purposes was well demonstrated during the COVID-19 pandemic.

The paper, published in the first edition of the journal Nature Reviews Bioengineering, discusses the implications and the potential important role of LFTs for decentralized testing of infectious diseases, including diseases of epidemic potential, the ‘silent pandemic’ of antimicrobial resistance (AMR), and other acute and chronic infections. The authors highlight that ‘Disease X’, referring to a serious global epidemic caused by an unknown pathogen, will necessitate an even more agile approach to LFT development and preparedness.

The review, led by Professor Rachel McKendry, brought together experts in the fields of infectious disease diagnostics, bioengineering, molecular medicine, digital medicine, nanotechnology, global health and artificial intelligence. The large interdisciplinary team of authors are based across world-renowned clinical and research institutions as well as public health and industry groups including UCL (i-sense), Harvard University, MIT, Imperial College London, Scripps Institute, Africa Health Research Institute, FIND, UCLA, Great Ormond Street Hospital, Africa CDC, Newcastle University, Glasgow Caledonian University, London School for Hygiene and Tropical Medicine and UCL Hospital.


Fig. 3. [Budd et al., 2023]: Lessons learned from COVID-19. a, The map shows the global distribution of regions in which a COVID-19 self-testing policy was in place, was being considered or was being piloted as of March 2022, adapted from the World Health Organization (WHO)b, Rapid adoption of lateral flow tests (LFTs) in England, following their introduction in 2021, surpassing polymerase chain reaction (PCR) use. Data from the UK Coronavirus Dashboard 2.

Professor McKendry says, “Our review highlights the major inequalities in access to testing with only 0.4% of the 3 billion COVID-19 tests performed through to mid-2022 conducted in low-income regions. This raises ethical concerns and limits our collective ability to respond to the pandemic. Moreover, lateral flow tests exist for only 50% of the WHO priority list of diseases of epidemic potential. We recommend the building of a global network of lateral flow research and manufacturing hubs to accelerate the development of high performance tests and strengthen our ability to respond to future pandemics.”

First author, UCL PhD student Jobie Budd, says, “The narrative review paper examines lessons learned from the COVID-19 pandemic to inform the design and bioengineering of next-generation LFTs to strengthen future diagnostic resilience. The ability of LFTs to detect clinically relevant levels of virus in a rapid and affordable manner, and interrupt chains of transmission was proven during the COVID-19 pandemic. The review examines new technologies that could enable LFT testing for a wider range of diseases and argues that their development should be prioritised along with vaccines and other preventative measures.”

Bill Rodriguez, CEO of FIND, says, “LFTs are a core diagnostic technology for the world. The review identifies the key issues that need to be addressed to ensure that COVID-19 and other LFTs can be available equitably for everyone, including improving access to well characterized samples, enhancing test accuracy, enabling digital connectivity, demonstrating cost-effectiveness, overcoming regulatory delays, and especially developing regional manufacturing capabilities in low- and middle-income countries.”

Professor James J. Collins, based at MIT and Harvard University, says “The COVID-19 pandemic brought to the fore significant gaps in our diagnostic arsenal. Our review piece highlights how the diagnostic community responded successfully to the pandemic, as well as the challenges that remain as we prepare for the next outbreak.”

Researchers discuss bioengineering approaches in LFT development, such as use of nano- and quantum materials (such as nanodiamonds), nucleic-acid-based LFTs, CRISPR and machine learning. The review determines that bioengineering approaches will play a key part in increasing the sensitivity and specificity of LFTs, improving sample preparation, incorporating nucleic acid amplification and detection, and enabling multiplexing, digital connection and green manufacturing, with the aim of creating the next generation of high-accuracy, easy-to-use, affordable and digitally connected LFTs.

Geraint Rees (UCL Vice-Provost) commented, “This timely review, led by UCL researchers, is a key paper highlighting the successes and the remaining challenges of lateral flow test (LFT) use worldwide. This work will be instrumental in shaping the future LFT landscape with regards to approaches to LFT development and epidemic preparedness.”


Link to review paper (Budd et al., 2023)


This article was first published by i-sense 



  1. Use of SARS-CoV-2 antigen-detection rapid diagnostic tests for COVID-19 self-testing. WHO (2022).
  2. England Summary | Coronavirus (COVID-19) in the UK. (2022).


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