As the Access to COVID-19 Tools Accelerator (ACT-A) and other stakeholders consider market interventions to support the development of rapid diagnostic tests for COVID-19 and accelerate access to these tests in low- and middle-income countries, the 2012 buy-down of Cepheid’s Xpert MTB/RIF tuberculosis (TB) test provides helpful lessons learned.

This brief examines the background and unexpected consequences of the Xpert MTB/RIF buy-down; applies lessons learned to the ongoing development of COVID-19 diagnostic tests and efforts to scale up access to these tests; and provides recommendations and pro-access conditions that should be applied to R&D funding, buy-down, and other market intervention agreements for COVID-19 diagnostics.