What next for pandemic research?

With normal life unlikely to resume until a coronavirus vaccine is found, it is unsurprising that research in this area is dominating headlines around the world.

“There is an awful lot of money blowing in from different directions for potential treatments, diagnostics and vaccines, but we are still at an early stage of development,” observed Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development.

“We still need to be having lots of shots on goal with this because the failure rate of these candidates for treatment will be so high,” said Professor Kaitin.

The high-profile potentially game-changing studies have, however, overshadowed an explosion of pandemic research elsewhere. The UK Research and Innovation website currently lists more than 220 funded projects, which explore everything from analyses of infectious disease spread and economic forecasts of the lockdown’s impact to how cemeteries might be expanded at short notice and parks designed for exercise.

That swift response follows the funding body’s decision in February to make available £24.6 million for rapid research projects alongside the big-money commitments to vaccine research, including a £210 million investment in the global Coalition for Epidemic Preparedness Innovations announced in March, part of a £744 million commitment towards coronavirus research.

In the US, emergency funding legislation has released an additional $1.8 billion (£1.47 billion) to the National Institutes of Health for Covid-19 activities. But the National Science Foundation, which does not fund any clinical research, has also received $75 million to spend on studies that will help “prevent, prepare for, and respond” to the virus.

Meanwhile, the European Commission has pledged a total of €1.4 billion (£1.24 billion), including €675 million of Horizon 2020 funds, towards coronavirus R&D, with some €220 million directed at non-vaccine projects, which include population health studies, the use of robotics in healthcare, and assessing the mental health impact of lockdowns.

That kind of sustained investment in research across a number of disciplines beyond science cannot come too soon for some scholars, who believe that the historic under-investment in the broader questions posed by pandemics have led to an unhealthy reliance on a small number of scientific voices.

“This crisis has certainly exposed a knowledge gap in UK science,” said Robert Dingwall, founding director of the University of Nottingham’s Institute for Science and Society, of the lack of recent research into pandemics, in particular work related to the sociology of medicine.

“Apart from a bit of work on Ebola by anthropologists, there has been no sustained investment in social science or social history around pandemics – and that has fed into the policymaking process,” explained Professor Dingwall, a member of the UK government’s New and Emerging Respiratory Virus Threats Group, who is now based at Nottingham Trent University.

He added that there was a “strong case for more programmes on epidemics that link social sciences more closely to medical and physical sciences”.

Applying sociological insights to epidemiological modelling would, he believes, lead to more accurate forecasts. For instance, how different countries register deaths can make a huge difference to any mathematical model used to predict coronavirus mortality, said Professor Dingwall.

“In the UK, we have gone for scrutiny [in registered death figures] over speed following the murders by Harold Shipman. But speed is prioritised in France – a consequence of the heatwave in 2003, when it took a long time to realise elderly people were dying,” he explained.

“So plugging French or Italian data into a UK model without understanding how they register deaths or how the Italian system funnels people into hospital to die means you will probably overestimate the number of deaths we’ll see in the UK,” said Professor Dingwall.

“Some of these things are known, but as soon as there is a crisis there is a reversion to a top-down approach involving a scientific advisory process that depends heavily on a ring of scientists from a small number of fields,” he continued.

For some, the dominance of epidemiological modelling has been the most problematic, in particular the weight given to the Imperial College London report in mid-March that predicted that 510,000 people in the UK could die from the coronavirus unless lockdown measures were introduced.

The influence of that report – regarded as heavily influential not just on the UK government’s lockdown policies but on those of US officials, too – will lead to unparalleled scrutiny and study of such modelling, many predict. For Chris von Csefalvay, a US-based epidemiologist, that conversation will be vital for the future of this newly powerful discipline.

“Governments have generally made judgements based on facts – albeit with extrapolation – so this era of model-driven decision-making is entirely new,” explained Mr von Csefalvay, who said scholars and politicians alike must therefore “learn how to make critical sense and interrogate these models”.

“It matters if – as in the case of Imperial – a model has 450 different parameters and a lot of these are quite arbitrary,” he continued, saying that “people who are making huge decisions need to understand what is going on with these systems”.

Releasing the Imperial group’s detailed workings would be useful in defending epidemiological modelling against attacks from those who blame it for the economically devastating impact of the lockdown, he added. “There will probably be calls to defund academic epidemiology, which would be throwing the baby out with the bathwater,” said Mr von Csefalvay.

Philip Thomas, professor of risk management at the University of Bristol, echoed the call for more scrutiny of the epidemiological models used by governments.

More broadly, the UK government’s advice relied too heavily on a “very narrow field of scientists, often from epidemiology”, with ministers paying too little attention to longer-term consequences of the lockdown, he said.

“Keeping the reproduction rate [of the coronavirus] below 1 is a policy for economic bankruptcy, but it has been allowed to happen because there is a very narrow view of science focused on controlling disease alone without considering how this will affect livelihoods,” said Professor Thomas.

A more nuanced approach to the pandemic would acknowledge that the lockdown could end up costing more lives than it saves, continued Professor Thomas, who has argued that a fall of 6.4 per cent in gross domestic product would mean more years of life lost than saved. “It is not just livelihoods being destroyed – the lockdown is also costing lives, and there will be a big loss of life,” he suggested.

Pandemic research should explore these difficult questions of health economics and how much a year of life is worth to avoid an over-reliance on any one specialist area, said Professor Thomas.

“Epidemiology can be a strange, very parochial space that does not stray too much out of its area,” he claimed. “Those with medical qualifications are quite suspicious of modellers – we need to bring these groups and others together to get the economics right.”

Scholars entering this field might also look beyond Western universities for answers, others insist. Can US and UK scholars learn from west Africa, where researchers have been focused for years on controlling epidemics?

Nigeria’s rapid introduction of mass coronavirus testing has led to invidious comparisons with the response of Western governments. But these comparisons are not particularly useful, said Iruka Okeke, professor of pharmaceutical microbiology at the University of Ibadan.

“In Europe, many nations were starting from scratch, so ramping up testing was difficult,” said Professor Okeke, an expert in lab capacity. “In Nigeria, it’s not unusual to have a disease emergency, so there is not much that needs to be switched on – it’s on continually,” she explained.

That said, Nigeria’s deployment of university laboratories into the Covid-19 operation might have lessons for the West, suggested Professor Okeke.

“A lot of disease testing is done in university labs,” said Professor Okeke, whose laboratory is “carefully vetted” by the Nigeria Centre for Disease Control (NCDC) to run polio tests, with others co-opted into the Covid-19 fight. In contrast, the UK relied on three large national testing centres, which took weeks before they were operating at the required scale while dozens of UK labs lay empty.

Chikwe Ihekweazu, the NCDC’s director general, said the “various strategies that have been adopted by countries [will] vary according to context, resource availability and other indicators” and “there is never a ‘one size fits all’ for infectious disease outbreak response”.

Pandemic studies will, it seems, test researchers' ability to operate across national and disciplinary boundaries like never before. And social science research will play a central role, believes Professor Kaitin, from Tufts.

“In the US, the 9/11 terror attacks changed the way we lived,” reflected Professor Kaitin. “I suspect this crisis will also change how we operate and integrate as a society. That is worthy of study because we need to change the way we live – as we are, as societies, prone to these pandemics.”

jack.grove@timeshighereducation.com