1 00:00:01,450 --> 00:00:07,810 Good afternoon, everyone, and welcome to the latest in a series of conversations from the Oxford Martin School, 2 00:00:07,810 --> 00:00:16,360 where we are exploring the lessons and opportunities from the COVID pandemic, a series that we're calling building back better. 3 00:00:16,360 --> 00:00:19,450 And in a moment, I'm going to introduce our guests this afternoon. 4 00:00:19,450 --> 00:00:24,550 Professor Charles Bundarra and Charles is going to be talking while we're going to be discussing some of 5 00:00:24,550 --> 00:00:31,330 the issues around health care in and what the pandemic will mean to health care going into the future. 6 00:00:31,330 --> 00:00:41,110 And Shasta suggested that we call this conversation. The walls are coming down and we'll sort of explain what that means in in the moment. 7 00:00:41,110 --> 00:00:46,660 Those of you who are viewing this conversation through the crowd, cast her programme, 8 00:00:46,660 --> 00:00:51,220 are able to ask questions and you'll see to the bottom right of your screen. 9 00:00:51,220 --> 00:00:58,870 But that is a button which you can press there, and we really encourage you to ask questions. 10 00:00:58,870 --> 00:01:10,030 And after about 40 minutes and I'll be looking at the questions and summarising them to ask charts and also within that function, 11 00:01:10,030 --> 00:01:14,110 you can vote on other questions. So we have a series of questions. 12 00:01:14,110 --> 00:01:22,600 If the ones you are particularly interested that I put two chairs, then then please vote down below. 13 00:01:22,600 --> 00:01:32,200 So Charles Chaz's, professor of translational medicine in the Nuffield Department of Medicine here in Oxford but has a broader role in the university. 14 00:01:32,200 --> 00:01:34,930 He's Pro Vice-Chancellor of Innovation, 15 00:01:34,930 --> 00:01:43,180 and it's particularly appropriate that Chaz has that position because he has background both in academia and in industry and intel. 16 00:01:43,180 --> 00:01:52,480 He moved to Oxford. He was vice president and head of biology at Glaxo Smith Kline, where he is responsible for many drug discovery programmes. 17 00:01:52,480 --> 00:01:56,980 In this conversation, as I said, I want to explore some of the broader lessons from the COVID pandemic, 18 00:01:56,980 --> 00:02:06,040 but I want to begin just by finding out the bit about Chaz himself and his research interests and what is happening in Oxford. 19 00:02:06,040 --> 00:02:10,630 So Charles, can I get you to describe what are the fun things happening in your lab at the moment? 20 00:02:10,630 --> 00:02:14,900 What is your research group particularly working on? 21 00:02:14,900 --> 00:02:21,020 Well, let me share with you, Charles, maybe three things that I hope might be of interest to the audience. 22 00:02:21,020 --> 00:02:32,630 Firstly, we're building in Oxford the new Centre for Medicines Discovery, and this is really building on the minds of the university, 23 00:02:32,630 --> 00:02:41,510 in the medical school and our collective networks in industry and patient groups, etc., etc. So that's a really exciting initiative. 24 00:02:41,510 --> 00:02:48,920 It was actually the brainchild of Richard Cornell, is the head of the Nuffield Department of Clinical Medicine. 25 00:02:48,920 --> 00:02:59,060 And within that, we're focussing on a number of therapeutic areas where we've already got a significant effort focussed on dementia, 26 00:02:59,060 --> 00:03:03,700 but we're going to expand that under John Davis leadership to mental health. 27 00:03:03,700 --> 00:03:14,600 Of course, that's a massive problem at the moment. We're also building a large after an end to our old time during health and disease, 28 00:03:14,600 --> 00:03:23,130 when etc. We've got a very large effort on rare diseases that why he was leading and he's just built a major link. 29 00:03:23,130 --> 00:03:27,270 With King Abdullah Aziz University in Saudi Arabia, of course, 30 00:03:27,270 --> 00:03:37,230 rare diseases are a major focus that and we're trying to use machine learning and A.I. to catalyse new drugs for rare diseases. 31 00:03:37,230 --> 00:03:41,730 We've also got Alex Bullock leading a major effort on inflammatory diseases, 32 00:03:41,730 --> 00:03:47,490 working with lots of geneticists, lots of clinicians in Oxford, lots of disease experts. 33 00:03:47,490 --> 00:03:52,080 So those are some of the sort of signs these things we're very excited about. 34 00:03:52,080 --> 00:04:02,340 We're also over the past couple of years, we've been building a national network to focus on multimorbidity associated with ageing. 35 00:04:02,340 --> 00:04:06,360 So we're all aware ageing societies massive problem. 36 00:04:06,360 --> 00:04:15,000 In the next 20 years, we're going to have a 120 percent increase in the number of pensioners with diabetes. 37 00:04:15,000 --> 00:04:22,530 We're going to have one hundred and eighty percent increase in the number of pensioners with cancer and many of these elderly patients, 38 00:04:22,530 --> 00:04:31,410 they tend at the moment, well, firstly, they have four, five, six more morbidities and often they're taking different drugs for each of them. 39 00:04:31,410 --> 00:04:34,740 So they're taking a whole cocktail of Smarties every day. 40 00:04:34,740 --> 00:04:42,150 And we now believe it may be possible to generate if you like a drug to treat multiple morbidity. 41 00:04:42,150 --> 00:04:46,440 So we're building this national network with the University of Dundee, 42 00:04:46,440 --> 00:04:52,900 the Medicines Discovery Catapult in Manchester, the University of Birmingham as cells and the cricket centres. 43 00:04:52,900 --> 00:04:58,950 That's very exciting. Beverley Vaughan is directing that initiative from Oxford. 44 00:04:58,950 --> 00:05:04,230 And then maybe the third thing I think might be of interest to the audience is that we're 45 00:05:04,230 --> 00:05:10,500 trying to make it easier for our students and our academics to translate their research, 46 00:05:10,500 --> 00:05:15,330 to commercialise it, to create new enterprises, to create impact. 47 00:05:15,330 --> 00:05:24,720 You know, all of our funders, governments, charitable, philanthropic, they are looking to us to create impact. 48 00:05:24,720 --> 00:05:30,210 So benefits for patients, for society, for industry, for economy. 49 00:05:30,210 --> 00:05:35,110 So we're trying to make it easier for the students and academics to translate their research. 50 00:05:35,110 --> 00:05:43,690 And and of course, you're aware that four or five years ago, we set up the Oxford Science Innovation Fund specifically for that, 51 00:05:43,690 --> 00:05:55,230 and this is specifically for Oxford researchers to translate and commercialise their findings from the lab into society, essentially. 52 00:05:55,230 --> 00:06:02,190 So those are three areas that Centre for Medicines Discovery a national effort on multimorbidity associated with 53 00:06:02,190 --> 00:06:11,220 ageing and trying to create more impact from the great research that's being done across this great university. 54 00:06:11,220 --> 00:06:18,840 That's fascinating. If one thinks about the sort of pipeline of research from the curiosity driven 55 00:06:18,840 --> 00:06:24,660 much more basic research all the way through to real drug may get into clinics. 56 00:06:24,660 --> 00:06:30,600 At what stage should a university such as Oxford engage with the pharmaceutical industry? 57 00:06:30,600 --> 00:06:34,080 Much research is obviously funded by public bodies, 58 00:06:34,080 --> 00:06:43,830 and then you have perhaps a pre competitive space and then you have the space where specific companies get in from from your sort of vantage point, 59 00:06:43,830 --> 00:06:48,270 both from industry and within academia. What's the best way to do that? 60 00:06:48,270 --> 00:06:52,990 Are we doing it right at the moment, both in Oxford and more generally? 61 00:06:52,990 --> 00:06:58,570 It's a great question, Charles, I mean, you know, just this morning, 62 00:06:58,570 --> 00:07:06,820 I had a conversation with some colleagues from Johnson and Johnson and Alex Bullock and Brian Marsden were with us. 63 00:07:06,820 --> 00:07:12,940 And in that, we were talking about this major project on inflammatory diseases, 64 00:07:12,940 --> 00:07:19,300 identifying new genes that are associated with inflammatory diseases, generating tools, 65 00:07:19,300 --> 00:07:27,610 working with lots of clinicians who have got access to patient material, patient cells, patient privacy, 66 00:07:27,610 --> 00:07:35,230 working with sort of technologists at the Rosalind Franklin Institute in Harwell, Jim Naismith, etc. 67 00:07:35,230 --> 00:07:46,540 That's the project now is that I mean, you could argue that sort of trying to work out what completely novel genes do in biology. 68 00:07:46,540 --> 00:07:55,450 I mean, that's very basic fundamental research. But we were having a conversation with Johnson and Johnson because they are interested. 69 00:07:55,450 --> 00:08:03,040 I mean, you know, in the past two decades, we've done lots of large scale human genetic studies, 70 00:08:03,040 --> 00:08:09,860 and now we need to try and take that data and we need to try and make sense of it. 71 00:08:09,860 --> 00:08:16,300 We need to understand what the role of these different genes or different proteins are in biological pathways. 72 00:08:16,300 --> 00:08:19,960 And ultimately, we can work out what role they have in disease. 73 00:08:19,960 --> 00:08:30,220 So I think what I'm trying to say is that their industry is potentially working with us on very basic fundamental research, 74 00:08:30,220 --> 00:08:37,720 trying to understand human biology. I think the the other comment you made around free competitive research, I mean, 75 00:08:37,720 --> 00:08:45,100 I do think that the pharmaceutical industry appreciates that it can't discover 76 00:08:45,100 --> 00:08:51,640 a new drug for Alzheimer's or schizophrenia or osteoarthritis on their own. 77 00:08:51,640 --> 00:09:00,010 They realise they just don't have enough resources. They realise they don't have access to sort of great academic innovations. 78 00:09:00,010 --> 00:09:10,360 They want access to lots of clinicians. They need access to patient material, they want access to national patient resources, et cetera. 79 00:09:10,360 --> 00:09:19,790 And so they recognise that working with academics, clinicians and especially in places like Oxford, they can maybe catalyse some of that work. 80 00:09:19,790 --> 00:09:27,680 So and as as part of the SGC that I'd be looking after for the past 13 or so years, sorry, 81 00:09:27,680 --> 00:09:35,770 if you can just explain SGC, the FCC is so the FCC is basically an international public private partnership. 82 00:09:35,770 --> 00:09:44,440 We've got funding from lots of government agencies. Charitable agencies, patient groups tend large pharmaceutical companies, 83 00:09:44,440 --> 00:09:50,560 and what we've been doing there is pooling resources, pooling expertise, pooling infrastructure. 84 00:09:50,560 --> 00:09:58,990 We've been working on completely novel genes and novel proteins, and we've been generating novel tools. 85 00:09:58,990 --> 00:10:07,360 So high quality tools. These are basically tools for early drug discovery and we've been generating them together. 86 00:10:07,360 --> 00:10:11,410 But importantly, these tools we've made freely available to the world. 87 00:10:11,410 --> 00:10:15,400 We've given them away to academics. We've given them away to biotechs. 88 00:10:15,400 --> 00:10:23,650 We've given them away to pharma companies and said, you know, these are large, private multinational pharmaceutical companies. 89 00:10:23,650 --> 00:10:25,840 They are giving us funding. 90 00:10:25,840 --> 00:10:36,280 They've been giving us access to their compound collections, their expertise, their ideas, and we've been working together to generate new tools. 91 00:10:36,280 --> 00:10:42,790 And the reason for doing that is so that we can enable lots new biology all over the world. 92 00:10:42,790 --> 00:10:49,990 And if we have a better understanding of biology, then hopefully we will be able to accelerate new treatments for patients. 93 00:10:49,990 --> 00:10:50,650 So, 94 00:10:50,650 --> 00:11:00,820 so there is an example of pharmaceutical companies investing in very early research through large public private partnerships that was not suspect. 95 00:11:00,820 --> 00:11:08,840 We could chat about this for the next 30 minutes, but I want to move on to COVID before coming on to some of the broader lessons learnt. 96 00:11:08,840 --> 00:11:15,370 I partly used to toss a little bit from your ringside seat as Probe B C for innovation and within the 97 00:11:15,370 --> 00:11:23,110 medical division about how this university has reacted to the challenges that the pandemic had put up. 98 00:11:23,110 --> 00:11:27,550 And certainly from my point of view, you look at the recovery trial, 99 00:11:27,550 --> 00:11:34,210 which led to the discovery of the use of dexamethasone and then the ongoing vaccine research 100 00:11:34,210 --> 00:11:39,640 that's now in phase three as two really good examples of how this university staff, 101 00:11:39,640 --> 00:11:44,410 other universities have stepped up to the plate here. How did it work? 102 00:11:44,410 --> 00:11:50,980 What were these groups within the university that just reacted to the challenge and bottom up goes on with it? 103 00:11:50,980 --> 00:11:58,970 Did you sort of within the use? Of course, the hierarchy, did you facilitate it and it just seems that from my perspective, 104 00:11:58,970 --> 00:12:04,280 the university reacted very quickly and I'm interested to know how it happened. 105 00:12:04,280 --> 00:12:13,400 So I think we could have a two hour conversation. I mean, I have to say, I think it's a source of great pride. 106 00:12:13,400 --> 00:12:17,450 I mean, what has happened in this university in the past seven eight months? 107 00:12:17,450 --> 00:12:22,490 And it isn't just in the medical sciences division, it's in implicit in social science. 108 00:12:22,490 --> 00:12:26,000 And I'm sure there's things in humanities and social sciences. 109 00:12:26,000 --> 00:12:33,380 I'm thinking of all the great stuff Melinda Mills has done with the face coverings, cetera in terms of NPLs. 110 00:12:33,380 --> 00:12:42,860 I'm thinking of this new test that Professor Chewy, you know, the director of Oscar in China. 111 00:12:42,860 --> 00:12:44,370 You know, he's developed this test. 112 00:12:44,370 --> 00:12:52,130 He set up a social enterprise called Oxford, said it's now being acquired by this Hong Kong based company called Prenantes. 113 00:12:52,130 --> 00:12:58,970 And now they're implementing that test at Heathrow Airport and also in Hong Kong, et cetera. 114 00:12:58,970 --> 00:13:07,730 I mean, this is a nucleic acid, land based test where we can get an idea about the virus within a matter of minutes. 115 00:13:07,730 --> 00:13:17,150 And then, of course, in Ship C in physics was telling us that Achilles communities in in the physics department an absolute genius. 116 00:13:17,150 --> 00:13:22,310 I mean, he's he's taken viruses and he's put fluorescent labels on them. 117 00:13:22,310 --> 00:13:29,330 And again, you know, you can detect them within minutes. And you know, these are some of the technologies that are happening. 118 00:13:29,330 --> 00:13:33,290 And then of course, you mentioned, you know, the vaccine has had I mean, 119 00:13:33,290 --> 00:13:40,250 everybody across the world is looking at Oxford and looking at people like Adrian Hill and Sarah Gilbert and 120 00:13:40,250 --> 00:13:45,830 Andrew Pollard and probably asking them on a daily basis when we're going to get access to that vaccine. 121 00:13:45,830 --> 00:13:52,070 I mean, that's that's just been a phenomenal success story. The recovery trial, you're I mean. 122 00:13:52,070 --> 00:13:56,570 Well, Martin Landray and Peter Horby have done there is just amazing in sort of. 123 00:13:56,570 --> 00:14:00,200 And now that they've got others, I think they're thinking of looking at aspirin, 124 00:14:00,200 --> 00:14:07,250 they're looking at into beta interferon as well, and they've got other things coming through. 125 00:14:07,250 --> 00:14:11,630 Mark Feldman, you know, who's one of the gods of this university? 126 00:14:11,630 --> 00:14:17,410 He's been pushing anti-TNF. He's initiated a trial in the UK, has initiated a trial. 127 00:14:17,410 --> 00:14:18,860 And this all happen. 128 00:14:18,860 --> 00:14:27,170 I mean, was it just really good research groups that stepped up to the plate or was there something more organised in the response? 129 00:14:27,170 --> 00:14:33,120 Well, maybe I could answer that in a couple of ways, and I think firstly. 130 00:14:33,120 --> 00:14:37,530 One thing I learnt many years ago, Charles, you can't tell brilliant people what to do, 131 00:14:37,530 --> 00:14:44,670 and Oxford is full of brilliant people and what and they are so passionate about their ideas. 132 00:14:44,670 --> 00:14:49,080 They have a sense of urgency. They're so creative, they want them to succeed. 133 00:14:49,080 --> 00:14:57,000 And Oxford is a very Bottom-Up organisation. The reason Oxford is so brilliant is because these brilliant people just push their brilliant 134 00:14:57,000 --> 00:15:02,460 ideas and do brilliant things and all that sort of stuff that's happened in terms of top down. 135 00:15:02,460 --> 00:15:07,720 I mean, Patrick Grant, I think, did something quite phenomenal at the start of the year. 136 00:15:07,720 --> 00:15:12,750 I'm sorry, just to interrupt. Patrick Grant is the Pro Vice-Chancellor for Research. 137 00:15:12,750 --> 00:15:25,830 Absolutely. And so men at the start of the pandemic February March, many of philanthropists alumni gave donations to the university. 138 00:15:25,830 --> 00:15:35,940 These were unrestricted. So Patrick set up this COVID research fund, put out calls for projects that are going to have a short, medium term impact. 139 00:15:35,940 --> 00:15:40,710 I think he received something like other than sort of 260 applications. 140 00:15:40,710 --> 00:15:46,080 They funded about 90 of them, so about 30 percent of them they funded, and that's been wonderful. 141 00:15:46,080 --> 00:15:55,390 So that was done in a sort of a top-down way. But I think the other comment in response to your question, Charles, which I think is insightful. 142 00:15:55,390 --> 00:16:02,420 This university, I mean, for 30 years, we've been investing in global health. 143 00:16:02,420 --> 00:16:11,560 You know, we've had institutes in Vietnam and Thailand and Kenya, etc etc. We've Adrian Hill had the vision, 144 00:16:11,560 --> 00:16:22,300 the foresight to set up the Jenner Institute absolutely focussed on vaccines on people with lots of expertise, exploring lots of vectors, et cetera. 145 00:16:22,300 --> 00:16:27,430 We also have a clinical buy manufacturing facility. I think very few universities have that. 146 00:16:27,430 --> 00:16:34,450 So we had these infrastructures within the university. We had this sort of density of expertise. 147 00:16:34,450 --> 00:16:39,340 And so when the pandemic happened in January, February bang, we were in that. 148 00:16:39,340 --> 00:16:46,000 I mean, I think I've heard John Bell say from getting the gene sequence for COVID and 149 00:16:46,000 --> 00:16:51,820 getting something into man into humans was we did that in less than 100 days, 150 00:16:51,820 --> 00:17:03,070 which is absolutely awesome. So I think the reason we've been able to respond so well in this pandemic is great people, 151 00:17:03,070 --> 00:17:10,030 lots of infrastructure, lots of technologies and resources that we could immediately apply. 152 00:17:10,030 --> 00:17:18,940 And I think also we've got lots of people who just frankly, I think in the past six, seven, eight months, you know, I just think they haven't slept. 153 00:17:18,940 --> 00:17:21,880 And I've heard Sarah Gilbert getting up at 4:00 in the morning. 154 00:17:21,880 --> 00:17:30,070 But I'm sure that applies to, you know, Peter Obi and Martin and Andre and many other colleagues. 155 00:17:30,070 --> 00:17:42,490 So let me ask you what this might mean as a sort of broader lesson for the universe in our education systems. 156 00:17:42,490 --> 00:17:49,300 Looking up ahead? I'm sorry. I'm just getting some feedback, which is why I'm stammering a little bit. 157 00:17:49,300 --> 00:17:55,180 And of course, Oxford is universities has responded, but there have been other universities as well Imperial College, 158 00:17:55,180 --> 00:18:00,200 many universities in the states and the way we fund medical research university. 159 00:18:00,200 --> 00:18:14,080 It's typically through research council grants, foundation grants and things like that should research funders, both governmental and foundations. 160 00:18:14,080 --> 00:18:21,370 Think also about that sort of side effect of research funding, which is building, building, research, 161 00:18:21,370 --> 00:18:28,240 resilience, almost national resilience so that one has the capacity to respond to a pandemic. 162 00:18:28,240 --> 00:18:33,880 I don't think that's sort of really being considered in the past. But is it something looking ahead? 163 00:18:33,880 --> 00:18:44,140 We're likely to get further pandemics, I'm afraid, going into the future that should be a more conscious part of the decision making of how we 164 00:18:44,140 --> 00:18:50,110 maintain medical researchers and at least in the country like the UK or the US or Europe. 165 00:18:50,110 --> 00:18:56,470 Let me try to answer that in three ways. Firstly, I think in the UK, I think we've been pretty good. 166 00:18:56,470 --> 00:19:04,390 I mean, I think all research leaders have had the vision to sort of invest in and create these platforms, 167 00:19:04,390 --> 00:19:09,190 like the Rosalind Franklin Institute clinical biomanufacturing facility. 168 00:19:09,190 --> 00:19:13,780 They've created some amazing national resources like UK Biobank. 169 00:19:13,780 --> 00:19:19,960 And then, of course, in the university, you know, I'm not sure who was it who made those decisions, 170 00:19:19,960 --> 00:19:28,060 but setting up these global health institutes all over the world as part of the Nuffield Department of Clinical Medicine, I thought that was a genius. 171 00:19:28,060 --> 00:19:32,920 So I think it has been happening in the UK and we've been fortunate. 172 00:19:32,920 --> 00:19:36,460 I think the second thing is, I think you use the word resilience. 173 00:19:36,460 --> 00:19:44,200 I mean, I've tended Charles to think of preparedness and Gavin screens, and you're probably aware is pushing hard. 174 00:19:44,200 --> 00:19:47,950 And I think again, he's the head of the medical division. 175 00:19:47,950 --> 00:19:52,090 Forgive me, Charles. I'm just not from outside. 176 00:19:52,090 --> 00:19:55,300 Oxford may not recognise names. Absolutely well. 177 00:19:55,300 --> 00:20:02,920 And Gavin is pushing hard to create an Oxford, now an institute for global health and pandemic preparedness. 178 00:20:02,920 --> 00:20:09,730 And I think we absolutely need to do that. As you say, you know, we're going to have other pandemics. 179 00:20:09,730 --> 00:20:19,090 I mean, since the start of this century, we've had eight or nine or 10, you know, H1N1, swine flu, avian Zika, tsars, et cetera, et cetera. 180 00:20:19,090 --> 00:20:25,180 There's going to be others, you know, two or three years ago, you know, I had Bill Gates talking about, you know, 181 00:20:25,180 --> 00:20:30,670 we're going to have a pandemic or Tony 5G talking about, we're going to have a pandemic so we can predict them. 182 00:20:30,670 --> 00:20:38,050 But I think, you know, if there's been some lessons for us is that we weren't well-prepared for this know. 183 00:20:38,050 --> 00:20:44,440 And I'm not just thinking of ventilators and PPE and hospital beds, et cetera, et cetera. 184 00:20:44,440 --> 00:20:50,140 You know, we didn't have therapeutics and stuff like this, et cetera. So I think we do need to be prepared. 185 00:20:50,140 --> 00:20:54,960 Can I share Charles a reflection and something? 186 00:20:54,960 --> 00:21:05,490 I've thought a lot about in recent months, and I know you're very keen on this as well, so, you know, antimicrobial resistance. 187 00:21:05,490 --> 00:21:14,250 Sally Davies has been the former chief medical officer, now president of Trinity in Cambridge for the past six, seven, eight years. 188 00:21:14,250 --> 00:21:23,700 She's been saying We have a crisis at the moment, 700000 people a year are dying because they're resistant to existing antibiotics. 189 00:21:23,700 --> 00:21:31,740 In 2050, that's going to be 10 million. If we don't come up with a new generation of antibiotics in the next, however many years, 190 00:21:31,740 --> 00:21:37,890 it's going to cost the world a loss of global production of 100 trillion dollars or something. 191 00:21:37,890 --> 00:21:45,230 I think that was the figure that Jim O'Neill produced in his report three or four years ago. 192 00:21:45,230 --> 00:21:54,300 You know, in the past seven or eight months. Its cost governments all over the world, trillions of dollars. 193 00:21:54,300 --> 00:21:56,170 This pandemic. 194 00:21:56,170 --> 00:22:06,850 You know, that have had to pay for, you know, building new hospitals, making sure we got PPE, ventilators, looking after the vulnerable, 195 00:22:06,850 --> 00:22:17,560 safeguarding jobs, protecting companies, supporting industries and in the future, they're going to have to deal with the consequences of long COVID. 196 00:22:17,560 --> 00:22:21,430 They're going to have to deal with the consequences of increased mental health. 197 00:22:21,430 --> 00:22:28,570 They're going to have to deal with the consequences of educational gaps that we've had in our school kids and so on and so forth, et cetera. 198 00:22:28,570 --> 00:22:33,130 But it's the governments that have ended up paying trillions of dollars that 199 00:22:33,130 --> 00:22:37,600 whenever I talk to my colleagues around AM or what are we going to do immediately? 200 00:22:37,600 --> 00:22:41,890 I get comments. Oh, the commercial models, broken pharma won't do it. 201 00:22:41,890 --> 00:22:46,810 There isn't a return on investment. We need to shift that narrative. 202 00:22:46,810 --> 00:22:51,190 You know, in this pandemic, in the past six, seven, eight months, 203 00:22:51,190 --> 00:22:58,240 I think pharma share prices have probably just gone up and up and up, whereas the governments are paying out trillions of dollars. 204 00:22:58,240 --> 00:23:02,400 So we need to start thinking about. 205 00:23:02,400 --> 00:23:13,680 If if we don't invest, then there's a failure to actually being prepared is going to cost us trillions in the future. 206 00:23:13,680 --> 00:23:19,530 So I don't know how we make that happen, but Jim O'Neill made the comment in his report. 207 00:23:19,530 --> 00:23:26,700 You know, if you had $10 billion, he's sure you could come up with a new generation of antibiotics. 208 00:23:26,700 --> 00:23:31,750 Why aren't we doing it if we think it's going to cost the world trillions of dollars in the future? 209 00:23:31,750 --> 00:23:34,590 So am I. It's like climate change. 210 00:23:34,590 --> 00:23:44,520 It's a sort of insidious creeping threat rather than COVID 19, which sort of hits us within a couple of weeks and we were in in lockdown. 211 00:23:44,520 --> 00:23:54,730 Do you think that sort of ironically, it's easier to mount a rapid response against something that is so quick and so obvious, 212 00:23:54,730 --> 00:24:03,910 much harder to do something against Armagh, where policymakers can put that off? 213 00:24:03,910 --> 00:24:08,890 Yeah. I don't know the answer to that, Charles, but I think, you know, 214 00:24:08,890 --> 00:24:18,640 we could predict the pandemic and we were caught on the back foot and we've had to play catch up and we've done not a bad job in some of these areas, 215 00:24:18,640 --> 00:24:23,980 like hospital beds and ventilators and testing and so on and so forth. 216 00:24:23,980 --> 00:24:33,310 But, you know, the AMA is another crisis coming, and I'm not worried about return on investment for pharma. 217 00:24:33,310 --> 00:24:40,800 I am worried about the cost of failure to come up with a new generation of antibiotics for the governments. 218 00:24:40,800 --> 00:24:51,740 Mm-Hmm. And you know, so instead of thinking of return on investment for pharma, I'm more worried about the cost of failure for government. 219 00:24:51,740 --> 00:24:54,950 This may be a question that's a bit too soon to ask you, 220 00:24:54,950 --> 00:25:01,400 but if you look at the way Oxford and the other major research universities have responded to the pandemic, 221 00:25:01,400 --> 00:25:08,660 and again, we've talked about some of the great things that have happened. Is there something you wish had been different from the start? 222 00:25:08,660 --> 00:25:16,160 So if we threw ourselves back two or three years for four or five years and could have built built 223 00:25:16,160 --> 00:25:22,610 some resilience that we would have been in a better place in February and March to begin research? 224 00:25:22,610 --> 00:25:32,640 Are there any lessons yet about what we? What might have been better if we'd thought about it a bit more clearly in advance? 225 00:25:32,640 --> 00:25:37,370 To be honest, I mean, across this university, we've been very lucky that. 226 00:25:37,370 --> 00:25:44,450 You know. So many of our sort of local superstars are now sort of household names. 227 00:25:44,450 --> 00:25:52,170 You know, people like Sarah Gilbert and Adrian Hill and Martin Landry and Andrew Pollard, etc., you know, they've done an awesome job. 228 00:25:52,170 --> 00:26:02,240 I'm not sure as a university we could have done much better, actually. But you know, one thing that I have asked myself the question, 229 00:26:02,240 --> 00:26:08,340 and I don't know the answer to this, Charles, because I don't know the data in detail, but. 230 00:26:08,340 --> 00:26:15,840 What I have thought is sort of if we look at the number of deaths in the UK or in France or Spain or Italy, 231 00:26:15,840 --> 00:26:20,490 it's roughly the same, but it's significantly more than Germany. 232 00:26:20,490 --> 00:26:32,010 And Germany is significantly more than Vietnam, Taiwan, Hong Kong, Singapore, Japan, and I'm thinking, why is that? 233 00:26:32,010 --> 00:26:41,280 You know, we've got great universities, we've got a wonderful NHS, we've got lots of great innovators and entrepreneurs, et cetera. 234 00:26:41,280 --> 00:26:48,090 Why is that? And clearly, those countries in the Far East, they were much better prepared. 235 00:26:48,090 --> 00:26:55,340 You know, they had test and trace and isolate in place. They've had relatively few deaths compared to us. 236 00:26:55,340 --> 00:27:02,250 And I thought to myself, sort of, I know we've been playing catch up with that test and trace and so on and so forth. 237 00:27:02,250 --> 00:27:09,560 I can't help but think, why could why didn't we just copy the. If they had it in place, why couldn't we just copy it? 238 00:27:09,560 --> 00:27:13,940 And again, I don't know the details of why and where and so on and so forth. 239 00:27:13,940 --> 00:27:20,130 But that's a question I've asked myself. You know, could we not have done better on that? 240 00:27:20,130 --> 00:27:26,490 And do you think that is a difference in the technology and the sort of health infrastructure? 241 00:27:26,490 --> 00:27:32,760 Or is it a difference in the way societies are structured in different societal norms? 242 00:27:32,760 --> 00:27:39,720 It's a cliché, but that countries in the Far East sort of. 243 00:27:39,720 --> 00:27:46,020 Less reticent, excuse me, less reticent about being told to do things by their governments. 244 00:27:46,020 --> 00:27:50,580 I think you've hit the nail on the head, Jones. I really do think that. 245 00:27:50,580 --> 00:28:00,300 And you know, I think here is a situation where you can have an individual perfectly healthy, infected, 246 00:28:00,300 --> 00:28:11,500 asymptomatic, and he or she inadvertently can pass on the virus to somebody else who will die. 247 00:28:11,500 --> 00:28:17,380 And, you know, often we have discussions about sharing data and so on and so forth. 248 00:28:17,380 --> 00:28:26,230 I think in a situation like this where if I can do something inadvertently leading to the death of somebody else close by, 249 00:28:26,230 --> 00:28:35,240 I should be willing to share my data and. Yes, so. 250 00:28:35,240 --> 00:28:40,460 I'm not sure that answered your question, but I think your last name. 251 00:28:40,460 --> 00:28:48,320 Mm-Hmm. And the recovery trial has had the advantage of working in a country with the National Health Service, 252 00:28:48,320 --> 00:28:53,090 where to varying degrees, different hospitals are linked together. 253 00:28:53,090 --> 00:29:01,670 So one can set up those trials very much faster than in countries with a more disaggregated health system. 254 00:29:01,670 --> 00:29:09,500 How much of a difference does that make? And again, looking at lessons into the future, could we have been more joined up? 255 00:29:09,500 --> 00:29:16,540 Could we have got those trials running faster and more efficiently? 256 00:29:16,540 --> 00:29:22,240 I suspect if we had the resources, we could have done things for more resources, we could have done things faster. 257 00:29:22,240 --> 00:29:28,720 I agree with you, you know, the fact that we've got a National Health Service puts us in a prime spot. 258 00:29:28,720 --> 00:29:36,960 But I think the other thing is that, you know, we have got some amazing clinicians. 259 00:29:36,960 --> 00:29:41,790 Who, you know, they run clinics in the in our local hospitals. 260 00:29:41,790 --> 00:29:46,920 They're running research labs. They're teaching in the university. 261 00:29:46,920 --> 00:29:49,200 They're running departments. 262 00:29:49,200 --> 00:29:59,730 And I think those individuals having them working in local hospitals and within the university and really pushing some of these innovation agendas, 263 00:29:59,730 --> 00:30:08,880 I think that's really helped. So I'm thinking of people like Andrew Pollard and Martin Landray and Peter Albie, etc. And, you know, 264 00:30:08,880 --> 00:30:14,610 and Peter Ratcliffe, who used to be my boss when he was head of the Nuffield Department of Clinical Medicine. 265 00:30:14,610 --> 00:30:20,490 I mean, this guy was running a clinic. He was running a research lab in the university he was teaching. 266 00:30:20,490 --> 00:30:25,470 He was running a massive department, and he still managed to make time to get a Nobel prise. 267 00:30:25,470 --> 00:30:32,490 I mean, the guy does it, I don't know. But but you know, I think it's we've got those sorts of people. 268 00:30:32,490 --> 00:30:38,390 I think the other thing was that and again, I think this is a Sally Davis initiative. 269 00:30:38,390 --> 00:30:47,910 13, 14 years ago, she decided to set up these biomedical research centres funded by the National Institute for Health Research. 270 00:30:47,910 --> 00:30:55,000 And this is when Sally Davies had the equivalent of Chris with his job as the chief medical officer in the U.K. in the U.K. 271 00:30:55,000 --> 00:31:04,670 and now there's biomedical research centres were basically set up for the researchers in university to work with clinicians, 272 00:31:04,670 --> 00:31:11,690 et cetera, in the hospitals to help accelerate new therapeutics for patients in the NHS, 273 00:31:11,690 --> 00:31:17,030 new diagnostics, new biomarker, new devices, et cetera, et cetera. 274 00:31:17,030 --> 00:31:22,670 It was really reinforcing that bridge between the university and the local hospital. 275 00:31:22,670 --> 00:31:25,010 And I think those have been a wonderful success. 276 00:31:25,010 --> 00:31:36,210 One of the key challenges, you know, has been heading up the the BRC, I think, for the first 10, 11 years and then Helen McShane is now heading the. 277 00:31:36,210 --> 00:31:46,620 So let me ask a question which goes back to your speciality of drug discovery and also the sort of link between the public and private sector. 278 00:31:46,620 --> 00:31:59,130 So it's been if you look at the molecules that have been developed against COVID, it has been quite slow apart from dexamethasone, a few others. 279 00:31:59,130 --> 00:32:04,680 We've yet to see any that have had a major effect on clinical outcomes. 280 00:32:04,680 --> 00:32:13,020 We have the promise of monoclonal and other things coming which may arrive next year. 281 00:32:13,020 --> 00:32:21,420 Are you? Well, let me ask you questions. Are you optimistic about new drug therapies coming on stream next year? 282 00:32:21,420 --> 00:32:31,470 And are they likely to be small molecules while they likely to be these more sophisticated monoclonal Typekit approaches? 283 00:32:31,470 --> 00:32:35,760 And we've been talking a lot about the universities. 284 00:32:35,760 --> 00:32:46,260 Has pharma reacted as well as it could in this area? So let me try to answer that in a couple of ways. 285 00:32:46,260 --> 00:32:53,910 Firstly, I mentioned Mark Feldman and the anti-TNF said, This is a class of drug trials you're probably aware is to give me a chance. 286 00:32:53,910 --> 00:33:03,420 Mark Feldman is an academic at the university, who is the guy who set up the Kennedy Institute here in Oxford eight nine years ago. 287 00:33:03,420 --> 00:33:09,810 He, when the Kennedy Institute was in Imperial College. For that, 288 00:33:09,810 --> 00:33:15,690 he discovered this class of drugs called anti-tumor necrosis factor and and these 289 00:33:15,690 --> 00:33:22,890 drugs are used to treat inflammatory bowel disease and rheumatoid arthritis. It's completely transformed the lives of these patients. 290 00:33:22,890 --> 00:33:32,370 And incidentally, that class of drugs has sold more than $300 billion, and they have not even become generic yet. 291 00:33:32,370 --> 00:33:37,470 You know, it's it's amazing $300 billion. It's an eye watering sum. 292 00:33:37,470 --> 00:33:41,730 But. Iron Mark is very optimistic. 293 00:33:41,730 --> 00:33:48,240 I am also very optimistic that that class of drugs is going to have benefit in these patients. 294 00:33:48,240 --> 00:33:56,410 So as we know Charles, we've talked about sort of an inflammatory cascade in these patients. 295 00:33:56,410 --> 00:34:02,760 You know, when around about the time they're hospitalised and then they go into ICU, et cetera, et cetera. 296 00:34:02,760 --> 00:34:08,340 So Mark is looking to see if he can dampen down that inflammatory cascade. 297 00:34:08,340 --> 00:34:10,140 So he's working with Duncan Richards. 298 00:34:10,140 --> 00:34:15,810 Like I said, I think his clinical trial in the U.K., I think they're getting some initial data before the end of the year. 299 00:34:15,810 --> 00:34:21,710 So I'm optimistic about that. In terms of small molecules, I think we have been slow. 300 00:34:21,710 --> 00:34:31,980 You know, generating antibodies is a lot of selective antibodies is a lot faster than generating a selective small molecule inhibitor. 301 00:34:31,980 --> 00:34:34,020 So I'm not too surprised by that. 302 00:34:34,020 --> 00:34:40,950 And a lot of the stuff that's been happening at the moment is is repurposing if you like existing drugs in other indications. 303 00:34:40,950 --> 00:34:46,220 Aspirin, dexamethasone, remdesivir, etc., etc. 304 00:34:46,220 --> 00:34:54,170 But the one project that I would flag up is again is an Oxford project led by Dave Steward, Frank Blundell, 305 00:34:54,170 --> 00:35:01,100 Martin Walsh, etc. And this is something that they've been doing at the diamond light synchrotron at all. 306 00:35:01,100 --> 00:35:09,410 Well. And so what they've done is they've taken the protease from COVID, the main protease involved in replication. 307 00:35:09,410 --> 00:35:16,250 They've screened it using a new platform that they've developed at the synchrotron called X Chem. 308 00:35:16,250 --> 00:35:22,430 And they've identified, I think, 74 75 molecules that bind to this protein. 309 00:35:22,430 --> 00:35:29,450 And then these molecules they shared them with the whole world literally made them freely available to the whole world. 310 00:35:29,450 --> 00:35:35,960 Now they've got chemists all over the world working on these molecules, trying to improve them. 311 00:35:35,960 --> 00:35:38,840 So this is they call this the moonshot project. 312 00:35:38,840 --> 00:35:47,030 This is a way of crowdsourcing global chemistry to accelerate the generation of new therapeutics, etc. So I mean, 313 00:35:47,030 --> 00:35:54,360 what Dave and Martin and Frank and I think near London in Israel have done, that project is just awesome. 314 00:35:54,360 --> 00:35:59,590 So that's maybe a bit about small molecules, but. 315 00:35:59,590 --> 00:36:09,190 We've been concentrating on pharmaceutical interventions and research, because that's very much your speciality. 316 00:36:09,190 --> 00:36:13,930 But before going to questions which you will in a few moments. 317 00:36:13,930 --> 00:36:25,390 Can I ask you to speculate a little bit on how you think the pandemic will change the delivery of health care right down at the level of primary care? 318 00:36:25,390 --> 00:36:35,350 I mean, the obvious change we've seen is that people are now much more willing to consult their doctor over the internet than they they have before. 319 00:36:35,350 --> 00:36:44,440 And certainly the primary care people I talked to have been surprised by how easy it has been for many of their patients to do that. 320 00:36:44,440 --> 00:36:47,560 Looking ahead, do you think that health care delivery, 321 00:36:47,560 --> 00:36:56,790 both primary care and hospital care is going to be reshaped by what we've gone through this last year? 322 00:36:56,790 --> 00:37:01,920 Yeah, I mean, it's interesting, Charles, I mean, I think. 323 00:37:01,920 --> 00:37:10,890 Some of the positives, if there are any in the past few months is, I think more people appreciate the importance of science and technology. 324 00:37:10,890 --> 00:37:14,850 I think they appreciate the value of universities. 325 00:37:14,850 --> 00:37:22,470 I think we all are becoming more and more used to using the internet and digital health and, you know, 326 00:37:22,470 --> 00:37:29,920 GP's looking at patients on the screen like this, etc. So some of those things are definitely going to stay. 327 00:37:29,920 --> 00:37:44,400 I hope, I believe that I think we will be putting more effort into preparing for some of these pandemics or crises in the future. 328 00:37:44,400 --> 00:37:53,910 I hope that's a massive lesson that will stay with us, and I hope it will also stay with the politicians and the funders, etc. 329 00:37:53,910 --> 00:37:56,610 I think one other thing that is already happening, 330 00:37:56,610 --> 00:38:04,770 I think more and more people are thinking about earlier diagnostics and I'm talking about other disease areas. 331 00:38:04,770 --> 00:38:11,460 I mean, I I do worry that when we're trying to treat Alzheimer's patients or cancer patients, 332 00:38:11,460 --> 00:38:19,530 I think we we get access to the patients too late when when the cancer's already spread over the body and or in Alzheimer's, 333 00:38:19,530 --> 00:38:24,330 you know, there's big holes in the brain, et cetera, because so many neurones have died, et cetera. 334 00:38:24,330 --> 00:38:29,220 I think it's just too late. We need to catch these diseases much sooner. 335 00:38:29,220 --> 00:38:31,980 We need to be able to diagnose them much sooner. 336 00:38:31,980 --> 00:38:40,500 I think if we do that, we're much more likely to be able to treat them, maybe prevent those diseases happening. 337 00:38:40,500 --> 00:38:46,560 So I think diagnostics and prevention is going to be a major effort in the future. 338 00:38:46,560 --> 00:38:54,840 And in fact, another one of our. Oxford superstars, Raymond Dwek working with Nichols, it's one in biochemistry. 339 00:38:54,840 --> 00:39:03,730 They've this they've set up an effort with some collaborators in China basically trying to develop diagnostics for liver disease. 340 00:39:03,730 --> 00:39:11,830 So non-alcoholic fatty liver disease. Apparently, there's almost one and a half billion individuals on the planet with that. 341 00:39:11,830 --> 00:39:20,480 And of course, many of them are likely to go on to get liver cirrhosis and liver cancer ultimately as well. 342 00:39:20,480 --> 00:39:24,760 So one and a half billion patients? It's phenomenal. Said Raymond. 343 00:39:24,760 --> 00:39:33,160 And they call it developing diagnostic. I do strongly agree there, and I think that in as much in, you know, 344 00:39:33,160 --> 00:39:39,640 it's a cliche that war the development of novel technologies largely to help people kill each other. 345 00:39:39,640 --> 00:39:51,340 But the pandemic will see just a radical move forward off of diagnostics, which would have happened anyway, but will just be compressed. 346 00:39:51,340 --> 00:39:57,460 But moving on to questions, and I do want to just push you a bit on health care delivery and how that will change, 347 00:39:57,460 --> 00:40:04,930 and partly because the Sarah Slovak asked this question, which has had the most votes so far. 348 00:40:04,930 --> 00:40:11,410 It is interesting that health has health care here is being discussed in terms of research and industry partnerships. 349 00:40:11,410 --> 00:40:19,600 Will this help us to understand and think through how health care should, can, should or must be delivered post-COVID? 350 00:40:19,600 --> 00:40:29,500 So again, another question around the delivery. Maybe I'm not the best person to answer that question, Charles, but let me have a go. 351 00:40:29,500 --> 00:40:38,430 You know, if I think back to one of the biggest lessons for me over the past few months, if I think back to January, February. 352 00:40:38,430 --> 00:40:47,700 And I'm talking about the vaccine. Sarah Gilbert, Adrian Hill, lots of expertise in the Jenner Institute. 353 00:40:47,700 --> 00:40:54,540 A couple of years earlier, they'd set up this company called Vaccine Tech in February March. 354 00:40:54,540 --> 00:41:03,120 Regis Professor John Bell, the head of our medical school, Gavin Screeds, and our vice chancellor Louise Richardson got involved. 355 00:41:03,120 --> 00:41:12,000 John Bell, of course, had access to his network at the Gates Foundation UK government funders. 356 00:41:12,000 --> 00:41:16,980 And then, of course, he also knew the CEO of AstraZeneca, Pascal Soriot. 357 00:41:16,980 --> 00:41:23,130 They all got together and said, We're not talking here about making money. 358 00:41:23,130 --> 00:41:28,080 We're talking here about getting a vaccine as quickly as we possibly can this pandemic. 359 00:41:28,080 --> 00:41:33,180 So lots of stakeholders single goal, single vision. 360 00:41:33,180 --> 00:41:39,960 Charles, it is absolutely amazing what those guys have done in six, seven, eight months. 361 00:41:39,960 --> 00:41:46,350 What they've done is six, seven eight months would normally have taken six, seven, eight years. 362 00:41:46,350 --> 00:41:47,680 Sorry to interrupt you there, Charles. 363 00:41:47,680 --> 00:41:54,780 I was just going to ask, do you think that is something that can only happen in an international emergency such as a pandemic? 364 00:41:54,780 --> 00:42:00,600 Or do you think that what we have learnt from this very rapid response might be transferable, 365 00:42:00,600 --> 00:42:05,250 for example, to antimicrobial resistance developing new antibiotics? 366 00:42:05,250 --> 00:42:11,950 A big challenge you mentioned earlier? I think we've got to apply these lessons to other areas. 367 00:42:11,950 --> 00:42:16,210 I think, you know, if there's a lesson that in people like you to get this lesson, 368 00:42:16,210 --> 00:42:21,530 but you know, if you've got a big problem, it's difficult, it's expensive, it's risky. 369 00:42:21,530 --> 00:42:28,870 It's it's going to take a long time to time to crack that it makes sense that you bring everybody together, bring together all the stakeholders. 370 00:42:28,870 --> 00:42:35,050 So I just mentioned that universities, funders, government regulators, industry. 371 00:42:35,050 --> 00:42:44,140 But I think we also need to think about working with other countries, you know, sort of many of the problems that we're trying to tackle. 372 00:42:44,140 --> 00:42:51,340 There are equally problems in the US, in China and India, in South Africa and Brazil, et cetera, et cetera. 373 00:42:51,340 --> 00:43:00,280 So somehow we need to create more global international partnerships focussed on some of these big global challenges. 374 00:43:00,280 --> 00:43:09,280 So and I also think that sort of in terms of the academia industry interface, I think industry is good at certain things. 375 00:43:09,280 --> 00:43:17,660 It's good at and I'm talking about the pharmaceutical industry. They are good at things that require scale and infrastructure. 376 00:43:17,660 --> 00:43:22,820 High throughput screening, lead optimisation, regulatory toxicology. 377 00:43:22,820 --> 00:43:31,040 The really big clinical studies of phase 2B, Phase three and marketing in academia in this phase, 378 00:43:31,040 --> 00:43:40,580 we're good at accessing academic innovations, accessing clinicians, accessing patient material, accessing national patient resources. 379 00:43:40,580 --> 00:43:45,530 So if we can put the two together, we increase the probability of success. 380 00:43:45,530 --> 00:43:56,840 I mean, the AstraZeneca Oxford vaccine, there is no way this university could manufacture three billion samples and distribute them to people. 381 00:43:56,840 --> 00:44:02,900 And to do these really large clinical studies with what is it, twenty five thousand individuals? 382 00:44:02,900 --> 00:44:13,190 I mean, it's it's we just don't have the resources, we don't have the infrastructure, we don't have the people to do it. 383 00:44:13,190 --> 00:44:24,440 So I think we have to partner. Absolutely. I want to ask you a question that has now four votes sent Tim to Moscow was the person who put it up first. 384 00:44:24,440 --> 00:44:32,030 Your framing of the problem suggests that there will be a post-COVID moment in the future, but this may not be true. 385 00:44:32,030 --> 00:44:37,010 And I think that's a fair criticism. How will? 386 00:44:37,010 --> 00:44:44,450 Well, let me ask you, do you think that we will essentially get rid of of the virus? 387 00:44:44,450 --> 00:44:48,950 Or will this be a case of a virus that we have to deal with? 388 00:44:48,950 --> 00:44:56,330 And again, what will that do to both health research and health delivery? 389 00:44:56,330 --> 00:44:59,630 I think this virus is with us now forever. 390 00:44:59,630 --> 00:45:07,370 I mean, I think we're going to have to probably end up having a vaccine every year, just like we do with the flu virus. 391 00:45:07,370 --> 00:45:18,290 And so I think we are going to have to alter our behaviours, but I'm very optimistic that we are going to come up with better therapeutics. 392 00:45:18,290 --> 00:45:24,740 So in time, I hope we will get back to some sort of normality like we were in December last year. 393 00:45:24,740 --> 00:45:33,170 In fact, I think I read a recent article from Peter Obi said that sort of the fatalities in phase war, 394 00:45:33,170 --> 00:45:39,870 you know, in March, April, May was, well, I think he came up with a figure of 30 percent. 395 00:45:39,870 --> 00:45:44,810 And now in the second wave, it's almost half of that because we do have better treatments. 396 00:45:44,810 --> 00:45:51,980 We clinicians know how to look after these patients. So I'm confident things are getting better and better all the time. 397 00:45:51,980 --> 00:45:55,840 And I think it's important to remember just how nursing care has improved. 398 00:45:55,840 --> 00:46:03,500 And sometimes we forget about just how important that aspect of health care is, just any sort of general topic. 399 00:46:03,500 --> 00:46:11,450 Yolanda Smith says What challenges does it mutate? Mutating virus pose for vaccines and I don't know what you think, chance. 400 00:46:11,450 --> 00:46:17,840 But of course, corona viruses mutate so much less than other viruses, such as flu, 401 00:46:17,840 --> 00:46:24,170 that this low mutation rate is pretty much on our side for this question. 402 00:46:24,170 --> 00:46:30,020 Although you said that like flu will need to vaccinate, we might need to vaccinate once a year. 403 00:46:30,020 --> 00:46:34,670 That's more of the waning of the immune system, rather than in the case of flu. 404 00:46:34,670 --> 00:46:41,810 You're getting new viral challenges. Is that a fair answer to this question? 405 00:46:41,810 --> 00:46:47,540 I think I couldn't have given a better answer. Well, I think you should sit on this side. 406 00:46:47,540 --> 00:46:56,660 Certainly not. But I'm not going to ask you a question which is much more in your area, which was totally pumped up Poisson. 407 00:46:56,660 --> 00:47:05,990 What are most important barriers to suspend? What's the most important barriers to developing and supplying novel, broad spectrum antiviral drugs, 408 00:47:05,990 --> 00:47:11,570 which could be tested and hopefully used to reduce mortality and morbidity in future pandemics? 409 00:47:11,570 --> 00:47:21,350 And I guess I'd also ask you, do you think there are broad spectrum antiviral drugs out there that will be useful for many potential pandemics? 410 00:47:21,350 --> 00:47:26,960 I don't think they're out there, but I know many colleagues across the world who are trying to develop them, 411 00:47:26,960 --> 00:47:33,080 and the way they're trying to develop them is by targeting some of the host proteins. 412 00:47:33,080 --> 00:47:40,310 So if you like the human proteins as opposed to targeting specific proteins on different viruses, 413 00:47:40,310 --> 00:47:44,750 they're actually targeting proteins in us, if you like. 414 00:47:44,750 --> 00:47:51,500 And I think that that is a very good strategy, and I know Dave Stewart is thinking about that. 415 00:47:51,500 --> 00:48:04,880 So. Again, I'm optimistic, I think this pandemic has been a bit of a shake up for many of us, and we built lots of new networks and collaborations. 416 00:48:04,880 --> 00:48:11,220 And and I'm sure we will maintain them and treasure them. 417 00:48:11,220 --> 00:48:15,840 So there is a question here from John Rosenfield. 418 00:48:15,840 --> 00:48:28,140 What is your opinion about the ethical issues of the SARS-CoV-2, the COVID 19 challenge tests and to amplify that, 419 00:48:28,140 --> 00:48:36,300 although you said, quite rightly, we have moved in vaccine development at an astonishing speed. 420 00:48:36,300 --> 00:48:41,190 One might argue one could have gone even faster if one had done challenge tests, 421 00:48:41,190 --> 00:48:47,250 and that is deliberately infecting people, but of course, with massive ethical issues there. 422 00:48:47,250 --> 00:48:56,860 Do you have a view on that to address John's question? I mean, I mean, theoretically, Charles, of course, you're absolutely right. 423 00:48:56,860 --> 00:49:03,550 But, you know, I don't think any of us would want to, even if in fact a young, 424 00:49:03,550 --> 00:49:13,030 healthy individual if we don't have a treatment for the infection in case something goes wrong. 425 00:49:13,030 --> 00:49:19,030 And and I think that's basically what held things back. But again, I'm not the expert in this area. 426 00:49:19,030 --> 00:49:27,130 I mean, Adrian Hill, Sarah Gilbert, Helen McShane, they're the sort of the geniuses in this university that we can ask that question to. 427 00:49:27,130 --> 00:49:34,510 I know, I know Adrian is keen to do some of those challenges as devil's advocate. 428 00:49:34,510 --> 00:49:47,350 We ask young men to go into battle when society has a need to be defended and the the odds of serious injury and death that 429 00:49:47,350 --> 00:49:59,690 they face are arguably much higher than the risk of getting serious disease by being infected by COVID when you're young. 430 00:49:59,690 --> 00:50:06,380 On the ethics side, do you think it's it's a very good question. 431 00:50:06,380 --> 00:50:12,560 I suppose the question for me is, I mean, I'm not young anymore, but would I? 432 00:50:12,560 --> 00:50:21,500 My son is twenty five years old. And would I like somebody to infect him with a virus that we know is fatal? 433 00:50:21,500 --> 00:50:27,550 And as a parent? I wouldn't. I think that's a very good answer. 434 00:50:27,550 --> 00:50:31,360 I'm going to ask you the question that now has the most votes, 435 00:50:31,360 --> 00:50:41,410 six votes and it may be one that you want to knock back to me were the likely knock on effects of cancelled and postponed health care activities, 436 00:50:41,410 --> 00:50:47,140 elective surgeries, outpatient clinics, etc., etc. Understood reasonably well. 437 00:50:47,140 --> 00:50:51,250 Were they understood reasonably well when lockdown decisions were made? If not, 438 00:50:51,250 --> 00:51:01,090 how can these effects be understood and incorporated into modelling studies to better weigh up the pros and cons of social distancing measures? 439 00:51:01,090 --> 00:51:05,440 Charles, I'm happy to have a go at that one, but let me go to you first. 440 00:51:05,440 --> 00:51:17,950 My only sense and Charles, you're more expert in this than I am, but my sense is that some of our NHS leaders were. 441 00:51:17,950 --> 00:51:28,630 I've been a little surprised at how many patients did not come forward with their non-COVID conditions in the first wave. 442 00:51:28,630 --> 00:51:35,170 That's my sense because I, you know, whenever I sort of read anything these days, 443 00:51:35,170 --> 00:51:44,050 there's a real emphasis on saying to patients, if you've got a lump, etc., come forward, the NHS is still open for you. 444 00:51:44,050 --> 00:51:48,040 And I think this lockdown that we've all gone into today, 445 00:51:48,040 --> 00:51:56,590 I think that's partly about ensuring that we've got sufficient capacity in the NHS to look after potential COVID patients, 446 00:51:56,590 --> 00:52:04,420 as well as the patients that we routinely expect to see that a non-COVID at this time of the year. 447 00:52:04,420 --> 00:52:11,740 And I would agree with you there and to directly answer Toby's question. 448 00:52:11,740 --> 00:52:19,150 I think that many of the modelling groups now due to now do explicitly try to bring these end and in particular, 449 00:52:19,150 --> 00:52:27,880 the modelling group that is that is a collaboration between the MRC statistics unit in Cambridge and the NHS. 450 00:52:27,880 --> 00:52:33,880 I think they're trying to get to incorporate those processes as much as possible, 451 00:52:33,880 --> 00:52:39,370 but it is difficult because it depends on people's attitudes towards seeking health care. 452 00:52:39,370 --> 00:52:49,480 So it's something that's far harder to model because it involves human behaviour than if one's just looking at a as a purely epidemiological process. 453 00:52:49,480 --> 00:52:57,160 But thank you, Toby. That's a really good question. How is life going to develop for the elderly? 454 00:52:57,160 --> 00:53:03,250 Are the walls coming down for them? This is a question from Christian Lange camp. 455 00:53:03,250 --> 00:53:09,960 Are the walls coming down for them? Are the walls going to stay up for them much longer for the young ones? 456 00:53:09,960 --> 00:53:15,720 What a fabulous response, actually, I mean, I suppose when I was thinking of the walls coming down, 457 00:53:15,720 --> 00:53:21,330 I've been thinking very much, for example, in our own institution, in the university. 458 00:53:21,330 --> 00:53:30,630 I see a lot more collaboration across disciplines, across departments, across divisions. 459 00:53:30,630 --> 00:53:43,050 And I also see us as an institution, collaborating much more with industry, with regulators, with government, with funders, et cetera. 460 00:53:43,050 --> 00:53:50,610 And I also see in the future a lot more collaborations with other countries, so international. 461 00:53:50,610 --> 00:53:56,650 So when I was thinking of the walls coming down, I mean, I'm not somebody who likes barriers anyway. 462 00:53:56,650 --> 00:54:07,140 I look, I was thinking of all of those walls in the national discipline department, all divisional, institutional, different stakeholders, et cetera. 463 00:54:07,140 --> 00:54:10,830 But your question is a good one, actually. I mean, I've not really thought of that, Charles. 464 00:54:10,830 --> 00:54:14,640 Maybe you could have when I to push you on something. 465 00:54:14,640 --> 00:54:20,310 You said that because I agree with you that many walls have come down. 466 00:54:20,310 --> 00:54:27,060 But if you look at some parts of the pharmaceutical industry, especially in the states, 467 00:54:27,060 --> 00:54:38,590 then there has been and there hasn't been data sharing and there has been a lot of IP protection for obvious reasons and things. 468 00:54:38,590 --> 00:54:43,690 Have the walls come down as much as you would like in those circumstances? 469 00:54:43,690 --> 00:54:49,390 Well, the thing is, Charles, I mean, I you know, at the end of the day, these are commercial organisations, 470 00:54:49,390 --> 00:54:58,120 and the only way they're going to survive is if they generate new medicines and then they can sell enough of them to pay for all of their failures. 471 00:54:58,120 --> 00:55:06,010 I mean, as we know Charles, you know, 90 percent of the molecules we take into phase one never make it to the market. 472 00:55:06,010 --> 00:55:14,740 And you know, the attrition rate is so high. Most of our ideas do not translate from the lab into the clinic, et cetera. 473 00:55:14,740 --> 00:55:18,190 Now, of course, it upsets me. For example, was it? 474 00:55:18,190 --> 00:55:26,020 Last year, Novartis launched a new gene therapy for spinal muscular atrophy. 475 00:55:26,020 --> 00:55:31,660 So this is a single injection, and they are charging two point one two. 476 00:55:31,660 --> 00:55:38,240 Five million dollars. Two million dollars for a single injection. 477 00:55:38,240 --> 00:55:48,070 Now how many people can afford that? And in fact, I've also read that Novartis have now set up some lottery system so you can buy a lottery ticket. 478 00:55:48,070 --> 00:55:52,460 And if you win, then you can have this gene therapy for free, etc. 479 00:55:52,460 --> 00:55:55,660 And to me, that's very, very uncomfortable. 480 00:55:55,660 --> 00:56:06,910 But the thing is, Charles, there's nothing I can do to persuade or influence what pharma companies charge for new therapeutics. 481 00:56:06,910 --> 00:56:11,740 I don't think even Charles Godfrey or John Bell or Louise Richardson, 482 00:56:11,740 --> 00:56:19,330 it can influence what Pascal Scarrow decides to charge for AstraZeneca vaccines or drugs, et cetera, et cetera. 483 00:56:19,330 --> 00:56:29,860 But I think what we can do as academics, as scientists, as clinicians is we can think about how do we drive down the costs of that platform, 484 00:56:29,860 --> 00:56:35,260 that technology or increase the probability of success in the clinic. 485 00:56:35,260 --> 00:56:43,360 So instead of 90 percent of things failing in the clinic? If 80 percent failed or 70 percent fail, that will be a massive step forward. 486 00:56:43,360 --> 00:56:53,140 And if we can drive down the cost of gene therapy by tenfold, ideally 100 fold, then of course it becomes a lot better. 487 00:56:53,140 --> 00:56:58,630 Now, I'm not criticising Novartis because I think what they've done is awesome. 488 00:56:58,630 --> 00:57:06,450 You know, if any of us had a child with asthma, we would want to pay that two point one to five million dollars. 489 00:57:06,450 --> 00:57:15,610 But but I think as scientists, as academics, it's our duty to try and drive down the cost of that platform, that technology. 490 00:57:15,610 --> 00:57:20,350 And it is an extraordinarily difficult question because drug discovery is extremely 491 00:57:20,350 --> 00:57:25,630 expensive and it's too easy to say that it shouldn't be done in the commercial area. 492 00:57:25,630 --> 00:57:30,820 I guess it's just an interesting question about whether a drug discovery during 493 00:57:30,820 --> 00:57:38,110 a pandemic when so much depends on it might be might need different rules. 494 00:57:38,110 --> 00:57:43,390 But I don't have an answer to that, and I'm afraid I'm going to have to bring the conversation to a close here, 495 00:57:43,390 --> 00:57:52,180 chance, because we're coming up against our time limit and just before thanking you for a fascinating talk. 496 00:57:52,180 --> 00:58:01,030 I'll mention that we have over the next few weeks at this same time on UK time, it's five p.m. on Thursday, 497 00:58:01,030 --> 00:58:06,100 a series of other talks about what pandemics mean, what the pandemic means for different areas. 498 00:58:06,100 --> 00:58:12,370 And next Thursday, we have reimagining urban mobility after COVID 19. 499 00:58:12,370 --> 00:58:19,870 My colleague Jim Hall is going to be leading a discussion with Tim Treinen and Jenny Middleton. 500 00:58:19,870 --> 00:58:28,190 Let me. Go back to you, chaps, thank you so much for finding the time to talk to us this evening. 501 00:58:28,190 --> 00:58:38,360 It's been really fascinating to hear your views on what COVID 19 means for the future of of of of the health system. 502 00:58:38,360 --> 00:58:45,740 Many universities have reacted wonderfully to the pandemic, and it's great that Oxford, this is one of them. 503 00:58:45,740 --> 00:58:54,110 And with your senior position both in the university and the medical division, I hope you take tremendous satisfaction from that. 504 00:58:54,110 --> 00:59:01,760 So chance many thanks indeed. And let me thank everyone who's tuned in to listen to us on the YouTube or Chromecast channels. 505 00:59:01,760 --> 00:59:07,430 And thank you in particular for those of you who ask questions or voted on different questions. 506 00:59:07,430 --> 00:59:11,450 So many thanks. Indeed. Thank you, Charles. Thank you very much, Charles. 507 00:59:11,450 --> 00:59:14,716 All the very best by everyone.