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New Covid-19 Testing Guidance to Equitably Protect Most Vulnerable Communities in U.S.

Even as vaccinations ramp up, testing remains a critical strategy to stop outbreaks and identify future variants quickly

Washington, DC | March 15, 2021 — As vaccination efforts slowly ramp up across the U.S. and more states and communities start to reopen, testing remains a critical proactive strategy to control local outbreaks, monitor for variants, and end the pandemic. Yet, vulnerable communities at greatest risk for Covid-19 often have limited to no access to pharmacies and health systems that provide the foundation for testing and vaccination networks. A new report, State and Local Testing Strategies for Responding to Covid-19 Outbreaks in Communities: Considerations for Equitable Distribution, by the Duke-Margolis Center for Health Policy, with support from The Rockefeller Foundation, provides important considerations for equitably prioritizing testing resources to communities at greatest risk as states and local governments face shortages of testing and ancillary supplies. It also includes longer-term strategies for controlling Covid-19 after the surge in cases subsides to stop any emerging outbreaks and identify new variants.

“Testing is and will continue to be a critical component of responding to Covid-19 outbreaks in the short term and managing the pandemic in the long term,” said Dr. Mark McClellan, Director of Duke-Margolis. “We need to reduce both the barriers to testing and the inequities of who is being tested. Close coordination and engagement with communities is crucial at every step of the process.”

“As the pandemic enters its second year, we must ensure that protective measures reach communities most impacted by the virus,” said Andrew Sweet, Managing Director of Covid-19 Response and Recovery at The Rockefeller Foundation. “States and localities must prioritize an equitable distribution of both Covid-19 testing and vaccinations to keep all Americans safe.”

Building on Duke-Margolis’ Covid-19 testing framework published in September 2020, this new report calls on states and local governments to increase access to testing resources that reach communities, both in the short and long term. To achieve this goal, states and localities must prioritize equity in their supply, personnel, and capacity in the following ways:

  • Use risk assessments, data, and qualitative information from communities to identify neighborhoods and communities of people who are at highest risk for infection, transmission, and consequences of transmission, including communities of color, areas of low income, and rural areas;
  • Strategically increase community-based testing at permanent diagnostic testing centers and through mobile, pop-up, and surge testing to address acute outbreaks;
  • Identify and allocate resources needed to expand testing to sites that serve communities and reduce social barriers to testing;
  • Remove barriers to testing, increasing trust and accessibility, and co-locating additional needed services;
  • Engage communities by listening to and understanding their specific testing barriers, and facilitating true coordination and collaboration around decision-making, planning and implementation of testing plans.

This report is the fourth in a series of Covid-19 testing protocols and guidelines led by Duke-Margolis and supported by The Rockefeller Foundation, including:  Risk Assessment and Testing Considerations for Reducing SARS-CoV-2 Transmission in K-12 Schools released in October 2020, which formed the basis for the testing protocols implemented in six pilot projects, and Risk Assessment and Testing Considerations for SARS-CoV-2 Transmission in Congregate Care released in January 2021.

About the Duke-Margolis Center for Health Policy

The mission of the Robert J. Margolis, MD, Center for Health Policy at Duke University is to improve health, health equity, and the value of health care through practical, innovative, and evidence-based policy solutions. For more information, visit and follow us on Twitter @dukemargolis.

About The Rockefeller Foundation

The Rockefeller Foundation advances new frontiers of science, data, and innovation to solve global challenges related to health, food, power, and economic mobility. As a science-driven philanthropy focused on building collaborative relationships with partners and grantees, The Rockefeller Foundation seeks to inspire and foster large-scale human impact that promotes the well-being of humanity throughout the world by identifying and accelerating breakthrough solutions, ideas, and conversations. For more information, sign up for our newsletter at and follow us on Twitter @RockefellerFdn.

Media Contacts:

Patricia Green, Duke-Margolis Center for Health Policy
(301) 520-6482

Ashley Chang, The Rockefeller Foundation
(212) 852-8451