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Are we prepared for the next pandemic?
Professor Brian Cox and a panel of experts discuss COVID-19 and whether we are prepared for the next pandemic.
Where or when could it happen? How could we control it? What would we do differently?
In this episode, a live studio audience quizzes world-leading scientists and doctors working on the frontline, specialising in infectious disease, vaccines and protecting us from the next deadly outbreak.
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A Question of Science is a groundbreaking series of panel discussions where experts from different fields respond to your questions, sharing the scientific perspective on society’s most pressing questions.
A Question of Science is a BBC Studios production for the Francis Crick Institute.
Brian Cox: Hello, I'm Brian Cox and this is A Question of Science here at the Francis Crick Institute. In each episode, we assemble a panel of world-leading experts to tackle your questions about some of the biggest scientific challenges we face today from AI to climate change, from treatments for cancer to the science of ageing. And today we're talking about a subject that has had a major impact on all of our lives, and which continues to pose one of the biggest threats to our civilization. I'm tempted to say beyond our own stupidity, which is clearly the biggest threat.
I'll be asking whether we are prepared for another pandemic. The World Health Organization estimates that COVID-19 killed more than 7 million people worldwide, and the knock-on health effects have been immense. But the true figure could be many, many times more. It also spawned a whole new era of misinformation, which is still having an impact today.
So today I'm joined by four experts who will help us unpick what we learned from the COVID pandemic and whether it has helped us prepare for the next one. So our panel, could you introduce yourselves please?
Tess Lambe: Hi everyone. I'm Tess or Professor Teresa Lambe. I'm based at the University of Oxford. I'm the co-designer of the Oxford AstraZeneca vaccine, and I continue to make vaccines against emerging and outbreak pathogens. So those viruses you haven't heard about and I hope to keep it that way.
Wendy Barclay: My name is Wendy Barclay. I'm a professor of virology working at Imperial College London, and I try to understand why some viruses jump from animals into humans and how they might learn to spread amongst us.
Emma Wall: And I'm Emma Wall. I'm a consultant in infectious diseases at University College Hospital and a research scientist here at the Crick, and I lead a partnership between the Crick and UCLH on COVID-19.
Kevin Fong: And I'm Professor Kevin Fong. I'm a professor of Public Engagement and Innovation in the Department of Science, Technology, Engineering, and Public Policy at UCL. I'm the newly appointed Chief Medical Officer of UCL partners. I'm an anaesthetist and also specialise in intensive care. Oh, and during the pandemic, I was seconded as National Clinical Advisor in Emergency Preparedness, Resilience, and Response to the COVID-19 incident.
Brian: And this is our panel. Wendy, if I could start with you, for a definition, we're talking about pandemics. So how do we decide when a pandemic has started? What is a pandemic?
Wendy: I mean, a pandemic is just a very big outbreak. So there's a new pathogen or a pathogen that's reemerged. So it could be a virus, a bacteria, or fungi, something that's harming us and it's infecting many people, but more importantly, it's spreading and it's spreading into different geographical regions across different countries, possibly across the whole world.
Brian: How does a virus, let's say, begin to spread to pandemic proportions?
Wendy: We know that there are viruses everywhere: in animals, in plants, in, you know, tiny little squidgely animals at the bottom of the sea that people can now find it when they sequence them. Most of the time, those viruses don't infect humans because viruses are what we call obligate parasites. They have to interact with their hosts. So we don't catch viruses regularly from our pets or from other animals that we come into contact with.
But occasionally, we become exposed to a virus that's, if you like, 'ready-made', a person could be exposed in the rainforest to a virus that hasn't really seen a human before, but it's ready to jump and in it goes, or more likely, a virus undergoes some form of mutation, which allows it to learn, if you like, how to infect humans and spread between us.
Tess: Just to put it into some kind of perspective, there are over 50 outbreaks in the African continent every year. This is not an unusual event. This continues to happen. It's those viruses that can and do spread that we need to worry about. And while I make vaccines and we continue to do that as my day job, there's a lot of things that we can do to intervene, to stop that spread that don't need medicinal interventions. So public health measures are really, really important.
Brian: That's quite a surprising figure perhaps to many people. So that's 50, roughly, give or take, viruses that are transferring between species or new viruses to humans, at least, as far as we are aware?
Tess: They're not always new. So Ebola virus hasn't gone away. In the last four years I've been involved, no, in the last three years, I've been involved in the least four different outbreaks. They continue to spread and it's the intervention of finding the cases and the context of those cases that is stopping that from becoming a pandemic.
Kevin: And it's interesting, isn't it, of the sort of characteristics that a virus has to have to have pandemic potential because, I mean, we talk about Ebola, but part of the reason it hasn't caused such a global problem is because it generally, unfortunately, kills the host too quickly for them to be able to travel and spread.
And so you sort of have to have this magic assembly of variables, don't you? So it has to be virulent enough to cause some problems, but not to virulent the host dies before they're moved anywhere, has to be able to move from person to person usually. And usually you want to have some sort of ease of transmission and so it's sort of very rare, I guess, that you get something that's able to spread as easily as COVID-19 did.
Emma: So I would say also that before I began studying viruses, I was studying bacteria. And the biggest pandemic arguably the world has ever seen was the Black Death, which was a bacterial pathogen, which still exists today, but hasn't, fortunately, caused such spread again. We don't really know why it stopped. It's a very intriguing question.
And the other pandemic that we are actually all staring in the face every day is antimicrobial resistance and bacteria that are resistant to all of our antibiotics and the spread of that is actually equally terrifying to a new virus and potentially has the possibility to kill more of us.
Brian: And I suppose the question that follows on is this number, there are a lot of potential pandemics out there, very few of them turn into pandemics. The question clearly is how well are we prepared? So maybe historically first, how well were we prepared for the coronavirus pandemic?
Kevin: Yeah, this is gonna be a long and career-limiting answer. So we, in this country, I don't think we had very good initial conditions here. And from the perspective of the health service, you know, you need a functioning health service with quite a lot of capacity to be able to take on a pandemic of the type that we faced.
Although you hear so much about how much money we spend on healthcare, actually, as a fraction of GDP per head of population, we are average expenditure and we get average outcomes. You get what you pay for. And compared to the Group of Seven nations, the wealthiest nations in the world, we are second last, I think we're only underspent by Italy in that number.
We had fewer beds, we had fewer doctors, we had fewer nurses per head of population. And when it comes to critical care, we were woefully under-provided. And so with no spare capacity in the system to take on that pandemic was impossibly hard for us. And I'll just give you this figure for intensive care beds.
On the eve of COVID, on the date when the World Health Organization defined COVID as a disease of concern, we had something like 3,000 available intensive care beds, of which about 83% were already filled. So there's no headroom there. And it was a testament to the remarkable frontline workforce that we were able to expand that number at all. But it cost us.
Brian: And I suppose a related question, that's preparedness for once the pandemic has taken hold, but there's also the structures that we have in place globally as well as in the UK to detect the new viruses or bacteria. So how well did that system work?
Emma: I think we were able to detect the event as it came up. And what was really brilliant that we hadn't really planned for but was really happened fast, was the data sharing amongst scientists and Chinese scientists who uploaded sequences of viruses to the internet, to these global repositories where other scientists could easily download those sequences, look at the virus, and immediately start designing a vaccine. And that's what Tess did and her team did so brilliantly.
And so that data sharing and that capability, that has been built, that is currently being undermined, unfortunately, globally by the withdrawal of funds for surveillance systems. The WHO has an excellent emphasis on one health, which is actually we can't just look after humans, we need to look after animals, we need to look after the ecosystem. And here at the Crick, we host the WHO's Worldwide Influenza Collaborating Centre and they have surveillance sites in chicken markets in Chittagong in Bangladesh, and in pig markets in Vietnam.
But overall preparedness of our understanding of how these animals spillover events and how our systems for securing food, looking after animals, and encroaching into wild spaces are actually facilitating the zoonotic transmission and the surveillance systems to pick up the next event, I'm not sure.
Brian: And then I suppose, Tess, that the next part of that chain is detection and then sequencing and then vaccine. So how well were we prepared to make that transition?
Tess: Let's start with the ‘were’, because I'm conscious we're sounding a little bit depressing, I think.
Brian: Yeah, but we'll get to the future.
Tess: I don't know that that's gonna be any better. So...
Brian: Spoiler.
Tess: There was a preconception that viral vectors, the Oxford AZ vaccine technology or RNA came out of the blue. That they happened overnight. We'd been working on a particular technology, the viral vectors, for 10 to 15 years. We'd made a vaccine against a related virus, MERS, Middle Eastern Respiratory Syndrome. So we had the knowledge of how to do this.
Did we know that the vaccine would work? Regardless of what you've read about Oxford people thinking they know everything, we didn't know. And that's what you need clinical trials for. I hate to say this because I know, and it's certainly for me and I'm sure lots of people in the audience, it doesn't feel like we were lucky, but we were lucky, we were lucky that we could detect the virus, that we could sequence it, and that we could make vaccines. And there's no guarantee that the next event is going to be as easy to treat, to contain, or to make a decent vaccine against.
Brian: Yes, I suppose there is a feeling that because the vaccines came reasonably quickly, then somehow, it's almost like an automated process now. So you get the sequence, you will develop a vaccine.
Tess: 100%, and I think that's a little bit of what depresses me. We had the right people in the right place at the right time to be able to go and go fast. And a lot of people sacrificed an awful lot. Lives were lost. Frontline workers did an amazing job. And I think there's almost a reliance on that ability for the next time around. And all I see at the moment is walls going up, shutters coming down. The geopolitical position that we're in at the moment means that that global collaboration that allowed us to go fast is not there to allow us to go fast again for the next time.
So if you were to ask me if we are in a better position now, I would say that we've learned a lot. There's lots of things that we could implement. It doesn't mean that we're actually doing that though, unfortunately.
Brian: I think we'll drill down into those issues later I think with the audience questions. But I just want to come to you, Wendy, on that initial question which is, historically speaking, were we well prepared for the, were we expecting it, I suppose is another question?
Wendy: I mean, from the virology point of view, we've been expecting another pandemic and almost certainly a respiratory-borne virus to cause it because we have a record throughout the 20th century, certainly of influenza virus pandemics. In fact, now that you dig back, there were almost certainly coronavirus airborne pandemics around about that time as well that maybe were not acknowledged because we didn't have the technology to really know what they were.
So we've known that this was going to happen and let's say that for influenza, which is a prime candidate for the next pandemic, we are not unreasonably prepared. A lot of preparation had gone on around the world, including in the UK, to work out how we would as quickly as possible make a vaccine against a new strain. What drugs we could possibly use to help people in hospitals and how we would diagnose the virus rapidly.
That said, when it actually happens, none of that is really fast enough and all of it needs refining because as Tess says, you can't stop learning, you can always improve on these things and each new virus that jumps out and surprises us can be quite different in what you actually need to make the best version of your vaccine, for example. That's why people like us on the stage want to do this kind of research in what we call peace time, which is now, out of the pandemic period. So it's not in a panic, if you like, or much as things go very fast and people work together, what you actually need to do is to rehearse all of these pandemic responses.
For example, each year when we know there will be seasonal outbreaks of respiratory diseases, including viruses that we can kind of practise on and then we will be as best prepared as we can be. But look, nature may surprise us yet.
Brian: Thanks. So let's take our first question from the audience, which is about what happens after a pandemic.
Amanda Wild: My name is Amanda Wild and I am a nurse. I was working on a respiratory ward during COVID and I would like to know what the long-term effects of the pandemic are on society once the acute stage is over?
Emma: So I think there's two parts to that question in terms of health effects. I work in the UCLH Long COVID Clinic, which was the first clinic that was set up in a van by my colleagues going round London in 2020. And we're still seeing people suffering from long-term health consequences directly from COVID in the form of Long COVID.
Also, we've seen a global uptick in other diseases which we didn't expect. So a global uptick in heart attack, a global uptick in stroke, and a global uptick in autoimmune diseases. And really interestingly in teenagers, a global uptick in type one diabetes. And we've always thought that these diseases may have had a viral trigger, but we've never been in a science situation where actually there was the new virus, which we didn't have any immunity to. And now we can look at the consequences. And actually, I suspect that in the future we'll find that lots of diseases we currently consider non-communicable to actually have had a viral trigger.
The other piece is the impact on their healthcare workforce and all the patients with all the other diseases who had all of their care put back. And we hear endlessly about waiting lists, but behind those waiting lists are people with chronic illnesses, cancers, joint problems, in pain, needing surgery, and you've got a shrunken healthcare workforce, some of whom are off with Long COVID. And actually, 10% of our patients in the Long COVID Clinic are healthcare workers.
And so we've got a debilitated and demoralised exhausted workforce being put under huge pressure to deliver more and more and more healthcare in a system which is struggling to cope with the backlog as well as treating all the new diseases that we're seeing.
Brian: I suppose there are two elements to this that you could take the question either way. There's the long term effects on an individual that had the disease and then the long-term effects on society caused by things like the damage to the health service and so on.
Kevin: Let me start by saying that we talk a lot about intensive care and that's the bit that I spent probably most of the COVID response involved with. But that was only really the most visible part of the impact of COVID on the health service and the respiratory wards that you worked on. The impact was at least as bad, if not worse. And that cascaded out into the communities, our community care, our primary care, all of it took the brunt.
And the problem with that is there is a residual price to pay for that. In 2022, I think one in every nine nurses that work for the health service left the service. Our workforce is now significantly younger and less experienced than it has been 15 years ago. And so what you have now is a second public health emergency that is partly born out of the way that we responded to the first public health emergency that was COVID.
Brian: We're gonna turn to the future now. 'Cause, Wendy, you mentioned that your research is in animal viruses jumping into humans. And we have a question on that subject now, particularly about frozen viruses.
Ana Dorrego: Yes. Hello, my name is Ana Dorrego. And I would like to know what's the panel's opinion on climate change and the potential release of viruses that have been frozen in ice for ages? Will they ever become a threat and will climate change play a role more generally in driving the spread of existing viruses? Thank you.
Wendy: So take it in two parts. The first is - are we worried that, you know, bodies in the permafrost are going to thaw out and release their horrible viruses from hundreds of years ago? It's not inconceivable, but I would say it's the least likely of all events from where the next pandemic will come. Again, going all the way back to the famous Spanish Flu of 1918, people have tried to understand that by actually digging up bodies from the Arctic circle and trying to recover viruses from them, and no real live virus has ever been recovered. You can see fragments of the genetic material inside the people who are buried as, who sadly lost their lives in that pandemic so long ago.
And from that, you can piece together a lot of molecular information to understand why it was such a horrible pandemic. But actually, when people have tried using modern technology with the best methods out, there's no virus left there. That's not to say that, you know, somewhere in the permafrost there isn't something of that nature. But at the same time, there are, you know, real people being exposed to viruses in remote parts of the world or in cities every day from where the next pandemic could more likely arise.
In terms of climate change itself, I think you make a very good point. I mean, Tess has already said, "Look, these events are speeding up", and they're also adding up as well as, for example, insects come further north, we may well find nasty viral diseases which are currently limited to areas where mosquitoes thrive, head back in our direction. Things like Dengue, Zika virus you will have heard of which caused devastation in Brazil a few years ago. Those kinds of viruses, I think we can definitely expect to head our way as the climate warms up and we need to be prepared for those because they could be the cause of the next pandemic.
Brian: Just to ask you as a panel, what are some of the viruses circulating now that are concerning to you and to the community?
Emma: My biggest concern at the moment while that all those viruses are really concerning is H5 in the US because what we are seeing unfold in the United States at the moment is we know all the things we need to do to prepare and protect ourselves and we're seeing none of those things happening. And that's quite worrying, to put it as an understatement. So it's a situation that we're obviously all watching very, very carefully, but in real time, we're watching lessons that we have learned and do know how to do not being done.
Brian: So the H5, what is that? Is it a coronavirus?
Tess: No, that's a flu.
Brian: A flu virus.
Wendy: That's a highly pathogenic avian influenza virus. So all flu begins life in either a bird or a bat and then jumps either directly into people to cause the next pandemic or maybe goes through some sort of intermediate host. Very similar to the story that we now understand with coronaviruses making those jumps. There are often intermediate hosts with which humans have much more contact. And I would say that the cow is definitely an intermediate host with which humans have much more contact than the wild birds where this virus started life.
Brian: I actually have a question related to that asked by Leon Costello. The question is, "Considering the significant role of an animal agriculture in transmitting pathogens between animals and humans which has contributed to past epidemics, should we rethink and reform the way animals are farmed?"
Wendy: The way that we farm is important. So I mean, there's quite a lot of evidence amassing that the cow flu has been spread at least between cows in the United States by rather poor sanitation of the milking machinery, which has spread the virus from cow to cow through just basically dirty practices. So cleaning up our acts, making sure that we don't feed one animal to another or mix the waste of one animal to another. It seems obvious to us, but I think there are a lot of things that we can do to sort of minimise at least those risks.
Brian: And you did some work on chickens, didn't you? So another approach?
Wendy: Yes, another out-there approach, I would say, would be to think about whether or not in the future we can make animals using precise gene editing who don't get these viruses anymore. So we understand that chickens are A) very vulnerable to flu but also can pass their flu under humans often with severe disease consequences.
So what if we could make chickens, that we could feed people with, but that couldn't catch the flu from the wild birds that sometimes spread the virus in through the water, for example, to the chickens. We've shown in principle at least that you can create a gene-edited chicken which is refractory to that.
Brian: Yeah, and Tess, I suppose many people say what, just vaccinate, so vaccinate all the cows in America, for example.
Tess: Yeah. We absolutely could do that and I think that will likely be a strategy they're considering if not deploying and actually vaccination against rabies, Rift Valley fever, other types of diseases in animals prevents the spread to humans. We do need to think about the added benefit as well because you're basically keeping a food supply intact.
I think when we're talking about farming, we need to have a recognition that the farming practices that we're looking at and looking to change are the ones in high income countries. It's going to need a different approach in low, middle income countries because these are small homesteads where the animals roam freely and this is your economy, this is how you stay alive. So when we are thinking about these types of interventions, there may be a two-pronged approach we need.
Brian: Well, thank you. So we have another question about preventing pandemics.
Vivian Christogianni: Hi, I'm Vivian Christogianni. So my question is do we have currently have effective monitoring systems in place to identify fast-spreading viruses in their early stages? If so, what is the potential impact of implementing such technologies on global survivor rates and how would governments ensure their application effectiveness?
Kevin: What we know about all of these pandemics is once the genie's out the bottle, it's really difficult to contain. And so what you want to do is detect at an early stage so you can get source isolation and contact tracing and all that stuff to work for you. Once it's prevalent at a high level in your population, actually that doesn't help you. And it was distressing to me to see after the pandemic, you know, after all that we'd learned for us to sort of switch off so much of that infrastructure and it is expensive to maintain but you need to maintain it. You need to take some effort to maintain it in a minimally viable state so that it's really there in a sort of so-called just add water configuration.
You know, 'cause what we did, I mean, it would be like, you know, if we had the first day of the Battle of Britain and you'd watch these waves of planes come around and you've sent them back again and you thought, "Right, that's it. Let's just dismantle all the radar. We're done." And that's not where we are. We have to have better early warning and that is all about surveillance and that's your first line of defence.
Wendy: The question's well placed and I think we face all of these problems. You can't survey everything all of the time. But I mean, during the pandemic, I think we got better at it and I think there are some fantastic medics largely, in hospitals, in certain parts of the world. And I would actually, again call out China as being pretty good at this now at calling out if something unusual comes in and then doing a battery of tests for at least the usual culprits. So if an avian flu has jumped into humans in certain parts of the world, I think we'd find it pretty fast now and that can then be a, you know, a good red alert for what to do.
Tess: And we do need a degree of surveillance in countries where these outbreaks start. So the UK is generally not where these types of outbreaks start. So for me, investing in China, Africa, and other countries where these outbreaks continuously happen is where I would like to see the money spent.
Emma: Absolutely. I completely agree. I would add one last point that actually one of the things we showed here at the Crick where we ran a testing pipeline for Northwest London and 10 hospitals and 98 care homes was when we went back to look at all the surveillance data for the healthcare staff who were required to swab themselves once a week is we found viruses up to a month before they were declared a variant of concern by the WHO.
So the healthcare worker population was seeing these viruses early. And so one of the things that I think is really important to implement or be able to scale up rapidly is surveillance in your healthcare workers, partly to protect them so they know they're testing and they can stay away from the hospital if they test positive, but also because that's actually where your virus is gonna turn up in your workforce.
Brian: We've got an audience question now about vaccines.
Sam Holyman: Hi, I'm Sam Holyman. I want to know if the global cooperation that accelerated the COVID-19 vaccine development could help streamline affordable vaccine rollout for other diseases. Thank you.
Brian: Tess.
Tess: So I was involved, well, I co-designed the Oxford AZ. I was involved in all of the preclinical work and then led the teams for the clinical, the immunology readouts. We were a bunch of academics that were impassioned to make a vaccine that would be at a price point that could be afforded in low and middle income countries. And that's what we did.
And we had a great partner with AstraZeneca who did provide the vaccine at a not-for-profit for those types of countries, low and middle income countries. So it can be done. I would like to say that we could do it again and I would like to hope that there would be a vaccine manufacturer out there that would partner again. But if you look at the huge profits that other companies made, I think it's a hard lesson to learn and go by.
Brian: I mean, could you see a world where we could invest a bit globally in the UK and in the US and elsewhere and be in a far better state when the next one comes along?
Tess: 100%, absolutely. And there are organisations out there that are trying to do that. So CEPI, the Coalition of Epidemic Preparedness and Innovation, they are investing for vaccines for the next pandemic and they are helping bolster infrastructure where these pandemics happen, so in Africa and elsewhere.
Do I think that the geopolitical position that we're facing at the moment helps that, probably not. Do I still have friends in the US that I would call tomorrow if there was a pandemic? 100% because when that pandemic hits, we're gonna forget about the politics. The scientists will, anyway, and we'll just get on with the job.
Brian: Let's stay on the subject of vaccines now because the next question is about vaccine safety.
Joanna Rogers: Hi, I am Joanna Rogers and my question is, since COVID, I've had various friends read articles that have said some of the vaccines were not as safe as we were told. Is this true?
Brian: Well, Tess, I think that's-
Tess: That's one for me. So it is true that a vaccine normally takes five to 10 years to design, develop and test. And largely that's because of the money and the time that it takes to do clinical trials. You go through different stages, you've got a phase one, two, three and what you tend to do is after the phase one, you pause and then you consider whether it's a viable product. You go onto phase two, you pause. And as you go through each of these stages, the money goes up, the amount of time goes up.
So the risk that we took during the pandemic was financial and it was only financial. You never put your volunteers at risk. I have to say that, but it's so intuitively obvious to me. Yeah. So what we did was of waiting till we had the results from the phase one, we'd already started making the vaccine for the phase two and the phase three. So it meant that the UK government, our partners AZ, Serum Institute, lots of other people took a huge financial risk. And that was the only risk we took. The testing that would be done routinely for a clinical trial was done during the pandemic. And that is the only way you would develop and test a vaccine.
Brian: Risk perception is famously something that a general public, a general population has difficulty with 'cause I suppose this is part of the preparedness for the next pandemic. What do you think we should be doing in order to address things- that, you know, vaccine hesitancy, is that a problem, a growing problem?
Wendy: We are living in today a place where misinformation can propagate and people find it difficult to trust scientists. So I think we have a real problem on our hands. Like I say, I don't have a solution, but what we have to do is to, I think, as scientists, keep telling what we know in the most straightforward way that we can, as we've been saying here, the story, for example, about vaccines is that you're trying to protect lives against a very serious disease.
And also, I mean, there is this, I always think with flu, the vaccine is a very interesting story to tell because what you're really asking with a vaccine is for people to do something for the greater good in a sense, and I'm maybe naive and optimistic, but I actually think that, you know, when you ask a child, for example, to take the live attenuated spray of flu vaccine up their nose, in all honesty, that's not because they need the vaccine, but it's because they won't then take the virus home to their elderly granny or grandpa and make them sick with it. And I think we have to tell those stories a little bit more as well. We have to perhaps reach out to people's good nature a little bit and ask them to understand what we're doing.
Tess: There's a responsibility for us to get up there and say, "This is the truth as we know it. It's going to change because we're scientists. We ask questions and we keep pushing forward." But not everybody's going to believe me because of my gender, because of what I look like. And we need to engage with those communities and we need to engage with community leaders, faith healers, and other. And we need to listen to what their difficulties are. And we need not to dismiss and not hit them with facts. We need to really listen and be open with the way that we address their concerns. And that's the only way that we're going to get into those marginalised minorities.
Brian: We do have a question actually, which is absolutely related to this.
Stephanie Lapitan: Hi, my name's Stephanie Lapitan. As you've been saying, it was evident that the COVID-19 pandemic contributed to public fear and distrust from medical professionals and scientists on top of our governments. How do you think the public perception surrounding medical and scientific experts will be affected by this in a future pandemic? And have we learned anything about how to combat distrust and misinformation?
Emma: One of the things I really learned is that it's really important, as Tess says, to keep getting calm, reasonable, sensible voices out there, but also listening, making sure information is in the right language, to speak to the right communities, engaging with community leaders. But it's also important for us to understand that the platforms that are spreading the disinformation, it's monetized. People make money from it, it's a business and it's a lucrative one. So actually how we implement legislation or controls around that dissemination and the so-called viral spreading of misinformation, I think is really, really, really important.
Kevin: When we talk about the pillars of defence against pandemics, we talk about the vaccine platforms, we talk about surveillance, but we rarely talk about the need to engage a public in the behaviours and the uptake of the countermeasures that we produce. And I think we're complacent about science engagement. I think that, you know, we spend an awful lot of money researching science and not an awful lot of money, almost none, engaging the public in that and fostering trust. And you can't just do that again on the eve of a pandemic.
Brian: I suppose you could argue it's not only public engagement but political engagement because the politicians are elected representatives, also the deliverers of messages as we saw during the pandemic.
Kevin: Yeah. And sometimes I like to drop the word public from my role of public engagement because I actually, I think it's just engagement full stop because public engagement suggests that our engagement within the academy and between us and the politicians is intact already. It's absolutely not. And so it is just engagement that we need to train people in.
Tess: I'm just jealous you got training. I fundamentally agree that actually we need to continue to train our ecosystem of scientists to be better communicators. Prior to the pandemic, I thought science spoke for itself, it doesn't. You have to be able to get out and talk to anybody and I used to practise on my children and if they understood me, it was good.
Brian: Wendy?
Wendy: I think your granny as well.
Tess: Yeah.
Wendy: It's about being able to reach really diverse people and I think your point though, Tess, is really well made in that you have to listen to people but also we need diverse people speaking as well so that there's somebody for everybody, somebody needs somebody to relate to.
Brian: We've looked backwards at the COVID pandemic and forwards to the next potential pandemic. It's an inevitable pandemic. But the next question sums all this up very nicely.
Neb Hatt: Hi, my name is Neb Hatt. My question is, do you think the response to the next pandemic will be better? Will lockdowns be faster? Will the medical advice be clearer? Will lockdowns be maintained for longer? And will we be more prepared to follow restrictions? Thank you. That's very good. Who wants to start? Are you optimistic?
Kevin: I think you can tell from most of my answers so far this evening...
Brian: We'll start with the most pessimistic and then move along the panel.
Kevin: There's a few things there. We have an opportunity to make the next time better. It's not too late. We learned a lot of lessons. Those lessons were some of the hardest lessons that we've ever had in any branch of science or any branch of medicine. And you know, we owe it to the people who are part of that, which is everybody, to preserve that, you know, those lessons are written, in some cases, in the blood of the people who went through this. So we owe it to them. There's an opportunity here to do it. But at the moment, I think we're slightly squandering that opportunity.
Brian: There are some, if we unpick the questions, 'cause some of the assumptions might be contestable. Like, will the medical advice be clearer? So could it have been clearer or was it actually quite clear? When we were facing a difficult situation.
Tess: Yeah, I was...for that one. Everybody assumes that scientists know everything. I don't. I don't know what I'm having for dinner tomorrow. I don't know what state the house is going to be in when I get home. It's not a lie if I tell you what I know now and then I learn something else and I need to change my advice.
And I think there were bad actors, deliberate bad actors who span that into a narrative that we were containing information, that we were not being truthful. And I'm saying we as scientists and medical practitioners and other and I don't know how we communicate that effectively now so that when the next pandemic happens and when this happens again because a pandemic by its nature, you're going to learn things during the journey, that we gather and gain more trust and momentum. But I think there is a degree that we have to do it now, truthfully.
Brian: Yeah, I felt this was very important 'cause, Emma, I saw this as I, if you're a research scientist, you saw research being done in real time. So you start with a virus about which you know very little or nothing and then you have the questions, don't you? Is it airborne? Is it transmitted on surfaces? So I could see that process and I thought it was very impressively communicated, but as Tess said, to someone who is not aware of the process of research, it can be disconcerting if you get a scientist saying one thing, of course, you get a scientist saying one thing one day and one thing the next because you are learning.
Emma: Yeah, so I think that that was definitely a problem. And it was partly the pace of the change in the advice and that led to lots of people getting fatigued. Is it this group? Are we allowed to be in a bubble this week? Are we allowed to do this? Or what should I do? I don't know. Consult the internet. Can granny come around? I don't know. When you're faced with that overwhelming sort of changing information dynamic, it's really, really tiring. And being able to communicate that change and the reasons for that change, I think, are really important.
The other thing that I would say is that it was really thinking back about how we do that better. I think that the basic thing I think we could really invest in is science education for the world's global population and better understanding of science, basic science. Lots of children don't even do a science GCSE, they're supposed to, but they might not pass at a great level. And there's no expectation that you're actually really understanding science is important with actually, as human beings. We should all understand a bit more about science. And the other thing is critical thoughts. So people to be able to take information and think, "Actually, is that true or not?" Rather than passively just accepting something's true.
Wendy: Where the problem comes is if people don't understand where the numbers have come from. And again, probably being naive and optimistic, I would like to be more honest with the public and explain why did we say that five days was the right amount of time to isolate for after you were first testing positive?
Very interestingly, I was involved at the end of COVID with some discussion with science advisors from across Europe. And you know, embarrassing to say that different European countries all had a different number of days. That was very uncomfortable because, you know, obviously the public were reading that in France it would be six days, but in the Netherlands, it might be four.
So I think we have to explain where the numbers come from, how we get them, the scientific process, as Emma was saying. I think there is a general lack of understanding about how we as scientists work, how we might change our minds when new evidence comes to light and how we would then update that into the models and how the modellers then use that information to come out with the best consensus.
Kevin: And I do wanna pick up that point about modelling actually, because it did get a bit of a bad name. But the modellers themselves are very happy to say all mathematical models are wrong, but some are useful and they have humility about what they do. And we absolutely needed it in our armamentarium. We needed to have a shape of what the future looked like, no matter how uncertain, because otherwise we couldn't scale a response. And you know, our question talks about will lockdowns be faster? I think we got mired in this sort of polemic between lockdown forever and let everyone run free.
And one of my roles in the pandemic was to work with the joint modelling team at Public Health England. And I came in that work to think of what is the optimal solution here? And it isn't a single thing, it isn't lockdown, it isn't a vaccine. I came to think of it as like this complex, super complex plane in sort of multidimensional hyperspace. And that's what you're trying to find. And to do that, to do that, you've got to have the modelling, you've gotta have the epidemiology, you've gotta have the virology, you've gotta know what the vaccinologists are getting up to. You've gotta understand the behaviours in the population and all of that has to come together. And then maybe you can have a solution to this thing that is less damaging to us medically and less damaging to the economy. So that's what you are aiming for.
Brian: I think this is a really important question from Fadash El-Shanoi, given what we've spoken about, which is how can we as ordinary individuals contribute to the awareness and preparedness for the next pandemic?
Wendy: We can listen to scientists but ask questions. We have to admit, Tess is right, that everyone's jaded by the thought of pandemics. But I'm afraid we can't just pack them away in a box and pretend that they're going to go away. They're not. So we have to big up, we have to face up to it. We have to educate ourselves more and more and we have to be, if you like, curious and eager for nuances.
Brian: If we’re talking about more investment in research, for example, I suppose there’s a spin-off argument that the improvement in our ability to develop vaccines for other areas, even going as far as certain cancers and so on, has been immense. So the investment has not been lost and it wasn’t just about vaccines.
Tess: 100%. And I’m actually going to take a little bit of umbrage about ‘ordinary people’. We’re all ordinary people. There’s nobody extraordinary in here, on this stage or elsewhere. And actually, at the beginning of the pandemic, people were worried that it was going to turn into 28 Days Later, where the worst possible outcome, the worst of people would come out. And you saw some of the best of us and you saw some absolutely heroic acts. And I think we need to focus on that. Some of the technology that we’ve developed and some of the learnings that we’ve had during the pandemic have put us in a better place for innovations for all sorts of diseases, not just for the next pandemic.
Kevin: I absolutely agree with Tess. The COVID was the best of us. And in many ways. And the vast majoirity of people were part of an enormous and quite inspiring collective response, all the way through the public. And you know, I think we can continue that and we can recognise that we are all in this in one way or another, this whole thing together, And that is how we prepare ourselves for next time. And that’s how we get through the next time, if and when it comes – or when it comes.
Brian: Well, thank you very much, that’s all we’ve got time for. Please thank our panel, Professor Tess Lambe, Professor Wendy Barclay, Dr Emma Wall and Professor Kevin Fong.
