Good afternoon, everyone, and welcome to the latest in a series of conversations from the Oxford Martin School,
where we are exploring the lessons and opportunities from the COVID pandemic, a series that we're calling building back better.
And in a moment, I'm going to introduce our guests this afternoon.
Professor Charles Bundarra and Charles is going to be talking while we're going to be discussing some of
the issues around health care in and what the pandemic will mean to health care going into the future.
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.
Those of you who are viewing this conversation through the crowd, cast her programme,
are able to ask questions and you'll see to the bottom right of your screen.
But that is a button which you can press there, and we really encourage you to ask questions.
And after about 40 minutes and I'll be looking at the questions and summarising them to ask charts and also within that function,
you can vote on other questions. So we have a series of questions.
If the ones you are particularly interested that I put two chairs, then then please vote down below.
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.
He's Pro Vice-Chancellor of Innovation,
and it's particularly appropriate that Chaz has that position because he has background both in academia and in industry and intel.
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.
In this conversation, as I said, I want to explore some of the broader lessons from the COVID pandemic,
but I want to begin just by finding out the bit about Chaz himself and his research interests and what is happening in Oxford.
So Charles, can I get you to describe what are the fun things happening in your lab at the moment?
What is your research group particularly working on?
Well, let me share with you, Charles, maybe three things that I hope might be of interest to the audience.
Firstly, we're building in Oxford the new Centre for Medicines Discovery, and this is really building on the minds of the university,
in the medical school and our collective networks in industry and patient groups, etc., etc. So that's a really exciting initiative.
It was actually the brainchild of Richard Cornell, is the head of the Nuffield Department of Clinical Medicine.
And within that, we're focussing on a number of therapeutic areas where we've already got a significant effort focussed on dementia,
but we're going to expand that under John Davis leadership to mental health.
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,
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.
With King Abdullah Aziz University in Saudi Arabia, of course,
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.
We've also got Alex Bullock leading a major effort on inflammatory diseases,
working with lots of geneticists, lots of clinicians in Oxford, lots of disease experts.
So those are some of the sort of signs these things we're very excited about.
We're also over the past couple of years, we've been building a national network to focus on multimorbidity associated with ageing.
So we're all aware ageing societies massive problem.
In the next 20 years, we're going to have a 120 percent increase in the number of pensioners with diabetes.
We're going to have one hundred and eighty percent increase in the number of pensioners with cancer and many of these elderly patients,
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.
So they're taking a whole cocktail of Smarties every day.
And we now believe it may be possible to generate if you like a drug to treat multiple morbidity.
So we're building this national network with the University of Dundee,
the Medicines Discovery Catapult in Manchester, the University of Birmingham as cells and the cricket centres.
That's very exciting. Beverley Vaughan is directing that initiative from Oxford.
And then maybe the third thing I think might be of interest to the audience is that we're
trying to make it easier for our students and our academics to translate their research,
to commercialise it, to create new enterprises, to create impact.
You know, all of our funders, governments, charitable, philanthropic, they are looking to us to create impact.
So benefits for patients, for society, for industry, for economy.
So we're trying to make it easier for the students and academics to translate their research.
And and of course, you're aware that four or five years ago, we set up the Oxford Science Innovation Fund specifically for that,
and this is specifically for Oxford researchers to translate and commercialise their findings from the lab into society, essentially.
So those are three areas that Centre for Medicines Discovery a national effort on multimorbidity associated with
ageing and trying to create more impact from the great research that's being done across this great university.
That's fascinating. If one thinks about the sort of pipeline of research from the curiosity driven
much more basic research all the way through to real drug may get into clinics.
At what stage should a university such as Oxford engage with the pharmaceutical industry?
Much research is obviously funded by public bodies,
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,
both from industry and within academia. What's the best way to do that?
Are we doing it right at the moment, both in Oxford and more generally?
It's a great question, Charles, I mean, you know, just this morning,
I had a conversation with some colleagues from Johnson and Johnson and Alex Bullock and Brian Marsden were with us.
And in that, we were talking about this major project on inflammatory diseases,
identifying new genes that are associated with inflammatory diseases, generating tools,
working with lots of clinicians who have got access to patient material, patient cells, patient privacy,
working with sort of technologists at the Rosalind Franklin Institute in Harwell, Jim Naismith, etc.
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.
I mean, that's very basic fundamental research. But we were having a conversation with Johnson and Johnson because they are interested.
I mean, you know, in the past two decades, we've done lots of large scale human genetic studies,
and now we need to try and take that data and we need to try and make sense of it.
We need to understand what the role of these different genes or different proteins are in biological pathways.
And ultimately, we can work out what role they have in disease.
So I think what I'm trying to say is that their industry is potentially working with us on very basic fundamental research,
trying to understand human biology. I think the the other comment you made around free competitive research, I mean,
I do think that the pharmaceutical industry appreciates that it can't discover
a new drug for Alzheimer's or schizophrenia or osteoarthritis on their own.
They realise they just don't have enough resources. They realise they don't have access to sort of great academic innovations.
They want access to lots of clinicians. They need access to patient material, they want access to national patient resources, et cetera.
And so they recognise that working with academics, clinicians and especially in places like Oxford, they can maybe catalyse some of that work.
So and as as part of the SGC that I'd be looking after for the past 13 or so years, sorry,
if you can just explain SGC, the FCC is so the FCC is basically an international public private partnership.
We've got funding from lots of government agencies. Charitable agencies, patient groups tend large pharmaceutical companies,
and what we've been doing there is pooling resources, pooling expertise, pooling infrastructure.
We've been working on completely novel genes and novel proteins, and we've been generating novel tools.
So high quality tools. These are basically tools for early drug discovery and we've been generating them together.
But importantly, these tools we've made freely available to the world.
We've given them away to academics. We've given them away to biotechs.
We've given them away to pharma companies and said, you know, these are large, private multinational pharmaceutical companies.
They are giving us funding.
They've been giving us access to their compound collections, their expertise, their ideas, and we've been working together to generate new tools.
And the reason for doing that is so that we can enable lots new biology all over the world.
And if we have a better understanding of biology, then hopefully we will be able to accelerate new treatments for patients.
So,
so there is an example of pharmaceutical companies investing in very early research through large public private partnerships that was not suspect.
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.
I partly used to toss a little bit from your ringside seat as Probe B C for innovation and within the
medical division about how this university has reacted to the challenges that the pandemic had put up.
And certainly from my point of view, you look at the recovery trial,
which led to the discovery of the use of dexamethasone and then the ongoing vaccine research
that's now in phase three as two really good examples of how this university staff,
other universities have stepped up to the plate here. How did it work?
What were these groups within the university that just reacted to the challenge and bottom up goes on with it?
Did you sort of within the use? Of course, the hierarchy, did you facilitate it and it just seems that from my perspective,
the university reacted very quickly and I'm interested to know how it happened.
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.
I mean, what has happened in this university in the past seven eight months?
And it isn't just in the medical sciences division, it's in implicit in social science.
And I'm sure there's things in humanities and social sciences.
I'm thinking of all the great stuff Melinda Mills has done with the face coverings, cetera in terms of NPLs.
I'm thinking of this new test that Professor Chewy, you know, the director of Oscar in China.
You know, he's developed this test.
He set up a social enterprise called Oxford, said it's now being acquired by this Hong Kong based company called Prenantes.
And now they're implementing that test at Heathrow Airport and also in Hong Kong, et cetera.
I mean, this is a nucleic acid, land based test where we can get an idea about the virus within a matter of minutes.
And then, of course, in Ship C in physics was telling us that Achilles communities in in the physics department an absolute genius.
I mean, he's he's taken viruses and he's put fluorescent labels on them.
And again, you know, you can detect them within minutes. And you know, these are some of the technologies that are happening.
And then of course, you mentioned, you know, the vaccine has had I mean,
everybody across the world is looking at Oxford and looking at people like Adrian Hill and Sarah Gilbert and
Andrew Pollard and probably asking them on a daily basis when we're going to get access to that vaccine.
I mean, that's that's just been a phenomenal success story. The recovery trial, you're I mean.
Well, Martin Landray and Peter Horby have done there is just amazing in sort of.
And now that they've got others, I think they're thinking of looking at aspirin,
they're looking at into beta interferon as well, and they've got other things coming through.
Mark Feldman, you know, who's one of the gods of this university?
He's been pushing anti-TNF. He's initiated a trial in the UK, has initiated a trial.
And this all happen.
I mean, was it just really good research groups that stepped up to the plate or was there something more organised in the response?
Well, maybe I could answer that in a couple of ways, and I think firstly.
One thing I learnt many years ago, Charles, you can't tell brilliant people what to do,
and Oxford is full of brilliant people and what and they are so passionate about their ideas.
They have a sense of urgency. They're so creative, they want them to succeed.
And Oxford is a very Bottom-Up organisation. The reason Oxford is so brilliant is because these brilliant people just push their brilliant
ideas and do brilliant things and all that sort of stuff that's happened in terms of top down.
I mean, Patrick Grant, I think, did something quite phenomenal at the start of the year.
I'm sorry, just to interrupt. Patrick Grant is the Pro Vice-Chancellor for Research.
Absolutely. And so men at the start of the pandemic February March, many of philanthropists alumni gave donations to the university.
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.
I think he received something like other than sort of 260 applications.
They funded about 90 of them, so about 30 percent of them they funded, and that's been wonderful.
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.
This university, I mean, for 30 years, we've been investing in global health.
You know, we've had institutes in Vietnam and Thailand and Kenya, etc etc. We've Adrian Hill had the vision,
the foresight to set up the Jenner Institute absolutely focussed on vaccines on people with lots of expertise, exploring lots of vectors, et cetera.
We also have a clinical buy manufacturing facility. I think very few universities have that.
So we had these infrastructures within the university. We had this sort of density of expertise.
And so when the pandemic happened in January, February bang, we were in that.
I mean, I think I've heard John Bell say from getting the gene sequence for COVID and
getting something into man into humans was we did that in less than 100 days,
which is absolutely awesome. So I think the reason we've been able to respond so well in this pandemic is great people,
lots of infrastructure, lots of technologies and resources that we could immediately apply.
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.
And I've heard Sarah Gilbert getting up at 4:00 in the morning.
But I'm sure that applies to, you know, Peter Obi and Martin and Andre and many other colleagues.
So let me ask you what this might mean as a sort of broader lesson for the universe in our education systems.
Looking up ahead? I'm sorry. I'm just getting some feedback, which is why I'm stammering a little bit.
And of course, Oxford is universities has responded, but there have been other universities as well Imperial College,
many universities in the states and the way we fund medical research university.
It's typically through research council grants, foundation grants and things like that should research funders, both governmental and foundations.
Think also about that sort of side effect of research funding, which is building, building, research,
resilience, almost national resilience so that one has the capacity to respond to a pandemic.
I don't think that's sort of really being considered in the past. But is it something looking ahead?
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
maintain medical researchers and at least in the country like the UK or the US or Europe.
Let me try to answer that in three ways. Firstly, I think in the UK, I think we've been pretty good.
I mean, I think all research leaders have had the vision to sort of invest in and create these platforms,
like the Rosalind Franklin Institute clinical biomanufacturing facility.
They've created some amazing national resources like UK Biobank.
And then, of course, in the university, you know, I'm not sure who was it who made those decisions,
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.
So I think it has been happening in the UK and we've been fortunate.
I think the second thing is, I think you use the word resilience.
I mean, I've tended Charles to think of preparedness and Gavin screens, and you're probably aware is pushing hard.
And I think again, he's the head of the medical division.
Forgive me, Charles. I'm just not from outside.
Oxford may not recognise names. Absolutely well.
And Gavin is pushing hard to create an Oxford, now an institute for global health and pandemic preparedness.
And I think we absolutely need to do that. As you say, you know, we're going to have other pandemics.
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.
There's going to be others, you know, two or three years ago, you know, I had Bill Gates talking about, you know,
we're going to have a pandemic or Tony 5G talking about, we're going to have a pandemic so we can predict them.
But I think, you know, if there's been some lessons for us is that we weren't well-prepared for this know.
And I'm not just thinking of ventilators and PPE and hospital beds, et cetera, et cetera.
You know, we didn't have therapeutics and stuff like this, et cetera. So I think we do need to be prepared.
Can I share Charles a reflection and something?
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.
Sally Davies has been the former chief medical officer, now president of Trinity in Cambridge for the past six, seven, eight years.
She's been saying We have a crisis at the moment, 700000 people a year are dying because they're resistant to existing antibiotics.
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,
it's going to cost the world a loss of global production of 100 trillion dollars or something.
I think that was the figure that Jim O'Neill produced in his report three or four years ago.
You know, in the past seven or eight months. Its cost governments all over the world, trillions of dollars.
This pandemic.
You know, that have had to pay for, you know, building new hospitals, making sure we got PPE, ventilators, looking after the vulnerable,
safeguarding jobs, protecting companies, supporting industries and in the future, they're going to have to deal with the consequences of long COVID.
They're going to have to deal with the consequences of increased mental health.
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.
But it's the governments that have ended up paying trillions of dollars that
whenever I talk to my colleagues around AM or what are we going to do immediately?
I get comments. Oh, the commercial models, broken pharma won't do it.
There isn't a return on investment. We need to shift that narrative.
You know, in this pandemic, in the past six, seven, eight months,
I think pharma share prices have probably just gone up and up and up, whereas the governments are paying out trillions of dollars.
So we need to start thinking about.
If if we don't invest, then there's a failure to actually being prepared is going to cost us trillions in the future.
So I don't know how we make that happen, but Jim O'Neill made the comment in his report.
You know, if you had $10 billion, he's sure you could come up with a new generation of antibiotics.
Why aren't we doing it if we think it's going to cost the world trillions of dollars in the future?
So am I. It's like climate change.
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.
Do you think that sort of ironically, it's easier to mount a rapid response against something that is so quick and so obvious,
much harder to do something against Armagh, where policymakers can put that off?
Yeah. I don't know the answer to that, Charles, but I think, you know,
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,
like hospital beds and ventilators and testing and so on and so forth.
But, you know, the AMA is another crisis coming, and I'm not worried about return on investment for pharma.
I am worried about the cost of failure to come up with a new generation of antibiotics for the governments.
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.
This may be a question that's a bit too soon to ask you,
but if you look at the way Oxford and the other major research universities have responded to the pandemic,
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?
So if we threw ourselves back two or three years for four or five years and could have built built
some resilience that we would have been in a better place in February and March to begin research?
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?
To be honest, I mean, across this university, we've been very lucky that.
You know. So many of our sort of local superstars are now sort of household names.
You know, people like Sarah Gilbert and Adrian Hill and Martin Landry and Andrew Pollard, etc., you know, they've done an awesome job.
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,
and I don't know the answer to this, Charles, because I don't know the data in detail, but.
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,
it's roughly the same, but it's significantly more than Germany.
And Germany is significantly more than Vietnam, Taiwan, Hong Kong, Singapore, Japan, and I'm thinking, why is that?
You know, we've got great universities, we've got a wonderful NHS, we've got lots of great innovators and entrepreneurs, et cetera.
Why is that? And clearly, those countries in the Far East, they were much better prepared.
You know, they had test and trace and isolate in place. They've had relatively few deaths compared to us.
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.
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?
And again, I don't know the details of why and where and so on and so forth.
But that's a question I've asked myself. You know, could we not have done better on that?
And do you think that is a difference in the technology and the sort of health infrastructure?
Or is it a difference in the way societies are structured in different societal norms?
It's a cliché, but that countries in the Far East sort of.
Less reticent, excuse me, less reticent about being told to do things by their governments.
I think you've hit the nail on the head, Jones. I really do think that.
And you know, I think here is a situation where you can have an individual perfectly healthy, infected,
asymptomatic, and he or she inadvertently can pass on the virus to somebody else who will die.
And, you know, often we have discussions about sharing data and so on and so forth.
I think in a situation like this where if I can do something inadvertently leading to the death of somebody else close by,
I should be willing to share my data and. Yes, so.
I'm not sure that answered your question, but I think your last name.
Mm-Hmm. And the recovery trial has had the advantage of working in a country with the National Health Service,
where to varying degrees, different hospitals are linked together.
So one can set up those trials very much faster than in countries with a more disaggregated health system.
How much of a difference does that make? And again, looking at lessons into the future, could we have been more joined up?
Could we have got those trials running faster and more efficiently?
I suspect if we had the resources, we could have done things for more resources, we could have done things faster.
I agree with you, you know, the fact that we've got a National Health Service puts us in a prime spot.
But I think the other thing is that, you know, we have got some amazing clinicians.
Who, you know, they run clinics in the in our local hospitals.
They're running research labs. They're teaching in the university.
They're running departments.
And I think those individuals having them working in local hospitals and within the university and really pushing some of these innovation agendas,
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,
and Peter Ratcliffe, who used to be my boss when he was head of the Nuffield Department of Clinical Medicine.
I mean, this guy was running a clinic. He was running a research lab in the university he was teaching.
He was running a massive department, and he still managed to make time to get a Nobel prise.
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.
I think the other thing was that and again, I think this is a Sally Davis initiative.
13, 14 years ago, she decided to set up these biomedical research centres funded by the National Institute for Health Research.
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.
and now there's biomedical research centres were basically set up for the researchers in university to work with clinicians,
et cetera, in the hospitals to help accelerate new therapeutics for patients in the NHS,
new diagnostics, new biomarker, new devices, et cetera, et cetera.
It was really reinforcing that bridge between the university and the local hospital.
And I think those have been a wonderful success.
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.
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.
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.
We've yet to see any that have had a major effect on clinical outcomes.
We have the promise of monoclonal and other things coming which may arrive next year.
Are you? Well, let me ask you questions. Are you optimistic about new drug therapies coming on stream next year?
And are they likely to be small molecules while they likely to be these more sophisticated monoclonal Typekit approaches?
And we've been talking a lot about the universities.
Has pharma reacted as well as it could in this area? So let me try to answer that in a couple of ways.
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.
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.
He, when the Kennedy Institute was in Imperial College. For that,
he discovered this class of drugs called anti-tumor necrosis factor and and these
drugs are used to treat inflammatory bowel disease and rheumatoid arthritis. It's completely transformed the lives of these patients.
And incidentally, that class of drugs has sold more than $300 billion, and they have not even become generic yet.
You know, it's it's amazing $300 billion. It's an eye watering sum.
But. Iron Mark is very optimistic.
I am also very optimistic that that class of drugs is going to have benefit in these patients.
So as we know Charles, we've talked about sort of an inflammatory cascade in these patients.
You know, when around about the time they're hospitalised and then they go into ICU, et cetera, et cetera.
So Mark is looking to see if he can dampen down that inflammatory cascade.
So he's working with Duncan Richards.
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.
So I'm optimistic about that. In terms of small molecules, I think we have been slow.
You know, generating antibodies is a lot of selective antibodies is a lot faster than generating a selective small molecule inhibitor.
So I'm not too surprised by that.
And a lot of the stuff that's been happening at the moment is is repurposing if you like existing drugs in other indications.
Aspirin, dexamethasone, remdesivir, etc., etc.
But the one project that I would flag up is again is an Oxford project led by Dave Steward, Frank Blundell,
Martin Walsh, etc. And this is something that they've been doing at the diamond light synchrotron at all.
Well. And so what they've done is they've taken the protease from COVID, the main protease involved in replication.
They've screened it using a new platform that they've developed at the synchrotron called X Chem.
And they've identified, I think, 74 75 molecules that bind to this protein.
And then these molecules they shared them with the whole world literally made them freely available to the whole world.
Now they've got chemists all over the world working on these molecules, trying to improve them.
So this is they call this the moonshot project.
This is a way of crowdsourcing global chemistry to accelerate the generation of new therapeutics, etc. So I mean,
what Dave and Martin and Frank and I think near London in Israel have done, that project is just awesome.
So that's maybe a bit about small molecules, but.
We've been concentrating on pharmaceutical interventions and research, because that's very much your speciality.
But before going to questions which you will in a few moments.
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?
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.
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.
Looking ahead, do you think that health care delivery,
both primary care and hospital care is going to be reshaped by what we've gone through this last year?
Yeah, I mean, it's interesting, Charles, I mean, I think.
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.
I think they appreciate the value of universities.
I think we all are becoming more and more used to using the internet and digital health and, you know,
GP's looking at patients on the screen like this, etc. So some of those things are definitely going to stay.
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.
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.
I think one other thing that is already happening,
I think more and more people are thinking about earlier diagnostics and I'm talking about other disease areas.
I mean, I I do worry that when we're trying to treat Alzheimer's patients or cancer patients,
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,
you know, there's big holes in the brain, et cetera, because so many neurones have died, et cetera.
I think it's just too late. We need to catch these diseases much sooner.
We need to be able to diagnose them much sooner.
I think if we do that, we're much more likely to be able to treat them, maybe prevent those diseases happening.
So I think diagnostics and prevention is going to be a major effort in the future.
And in fact, another one of our. Oxford superstars, Raymond Dwek working with Nichols, it's one in biochemistry.
They've this they've set up an effort with some collaborators in China basically trying to develop diagnostics for liver disease.
So non-alcoholic fatty liver disease. Apparently, there's almost one and a half billion individuals on the planet with that.
And of course, many of them are likely to go on to get liver cirrhosis and liver cancer ultimately as well.
So one and a half billion patients? It's phenomenal. Said Raymond.
And they call it developing diagnostic. I do strongly agree there, and I think that in as much in, you know,
it's a cliche that war the development of novel technologies largely to help people kill each other.
But the pandemic will see just a radical move forward off of diagnostics, which would have happened anyway, but will just be compressed.
But moving on to questions, and I do want to just push you a bit on health care delivery and how that will change,
and partly because the Sarah Slovak asked this question, which has had the most votes so far.
It is interesting that health has health care here is being discussed in terms of research and industry partnerships.
Will this help us to understand and think through how health care should, can, should or must be delivered post-COVID?
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.
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.
And I'm talking about the vaccine. Sarah Gilbert, Adrian Hill, lots of expertise in the Jenner Institute.
A couple of years earlier, they'd set up this company called Vaccine Tech in February March.
Regis Professor John Bell, the head of our medical school, Gavin Screeds, and our vice chancellor Louise Richardson got involved.
John Bell, of course, had access to his network at the Gates Foundation UK government funders.
And then, of course, he also knew the CEO of AstraZeneca, Pascal Soriot.
They all got together and said, We're not talking here about making money.
We're talking here about getting a vaccine as quickly as we possibly can this pandemic.
So lots of stakeholders single goal, single vision.
Charles, it is absolutely amazing what those guys have done in six, seven, eight months.
What they've done is six, seven eight months would normally have taken six, seven, eight years.
Sorry to interrupt you there, Charles.
I was just going to ask, do you think that is something that can only happen in an international emergency such as a pandemic?
Or do you think that what we have learnt from this very rapid response might be transferable,
for example, to antimicrobial resistance developing new antibiotics?
A big challenge you mentioned earlier? I think we've got to apply these lessons to other areas.
I think, you know, if there's a lesson that in people like you to get this lesson,
but you know, if you've got a big problem, it's difficult, it's expensive, it's risky.
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.
So I just mentioned that universities, funders, government regulators, industry.
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.
There are equally problems in the US, in China and India, in South Africa and Brazil, et cetera, et cetera.
So somehow we need to create more global international partnerships focussed on some of these big global challenges.
So and I also think that sort of in terms of the academia industry interface, I think industry is good at certain things.
It's good at and I'm talking about the pharmaceutical industry. They are good at things that require scale and infrastructure.
High throughput screening, lead optimisation, regulatory toxicology.
The really big clinical studies of phase 2B, Phase three and marketing in academia in this phase,
we're good at accessing academic innovations, accessing clinicians, accessing patient material, accessing national patient resources.
So if we can put the two together, we increase the probability of success.
I mean, the AstraZeneca Oxford vaccine, there is no way this university could manufacture three billion samples and distribute them to people.
And to do these really large clinical studies with what is it, twenty five thousand individuals?
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.
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.
Your framing of the problem suggests that there will be a post-COVID moment in the future, but this may not be true.
And I think that's a fair criticism. How will?
Well, let me ask you, do you think that we will essentially get rid of of the virus?
Or will this be a case of a virus that we have to deal with?
And again, what will that do to both health research and health delivery?
I think this virus is with us now forever.
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.
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.
So in time, I hope we will get back to some sort of normality like we were in December last year.
In fact, I think I read a recent article from Peter Obi said that sort of the fatalities in phase war,
you know, in March, April, May was, well, I think he came up with a figure of 30 percent.
And now in the second wave, it's almost half of that because we do have better treatments.
We clinicians know how to look after these patients. So I'm confident things are getting better and better all the time.
And I think it's important to remember just how nursing care has improved.
And sometimes we forget about just how important that aspect of health care is, just any sort of general topic.
Yolanda Smith says What challenges does it mutate? Mutating virus pose for vaccines and I don't know what you think, chance.
But of course, corona viruses mutate so much less than other viruses, such as flu,
that this low mutation rate is pretty much on our side for this question.
Although you said that like flu will need to vaccinate, we might need to vaccinate once a year.
That's more of the waning of the immune system, rather than in the case of flu.
You're getting new viral challenges. Is that a fair answer to this question?
I think I couldn't have given a better answer. Well, I think you should sit on this side.
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.
What are most important barriers to suspend? What's the most important barriers to developing and supplying novel, broad spectrum antiviral drugs,
which could be tested and hopefully used to reduce mortality and morbidity in future pandemics?
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?
I don't think they're out there, but I know many colleagues across the world who are trying to develop them,
and the way they're trying to develop them is by targeting some of the host proteins.
So if you like the human proteins as opposed to targeting specific proteins on different viruses,
they're actually targeting proteins in us, if you like.
And I think that that is a very good strategy, and I know Dave Stewart is thinking about that.
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.
And and I'm sure we will maintain them and treasure them.
So there is a question here from John Rosenfield.
What is your opinion about the ethical issues of the SARS-CoV-2, the COVID 19 challenge tests and to amplify that,
although you said, quite rightly, we have moved in vaccine development at an astonishing speed.
One might argue one could have gone even faster if one had done challenge tests,
and that is deliberately infecting people, but of course, with massive ethical issues there.
Do you have a view on that to address John's question? I mean, I mean, theoretically, Charles, of course, you're absolutely right.
But, you know, I don't think any of us would want to, even if in fact a young,
healthy individual if we don't have a treatment for the infection in case something goes wrong.
And and I think that's basically what held things back. But again, I'm not the expert in this area.
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.
I know, I know Adrian is keen to do some of those challenges as devil's advocate.
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
they face are arguably much higher than the risk of getting serious disease by being infected by COVID when you're young.
On the ethics side, do you think it's it's a very good question.
I suppose the question for me is, I mean, I'm not young anymore, but would I?
My son is twenty five years old. And would I like somebody to infect him with a virus that we know is fatal?
And as a parent? I wouldn't. I think that's a very good answer.
I'm going to ask you the question that now has the most votes,
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,
elective surgeries, outpatient clinics, etc., etc. Understood reasonably well.
Were they understood reasonably well when lockdown decisions were made? If not,
how can these effects be understood and incorporated into modelling studies to better weigh up the pros and cons of social distancing measures?
Charles, I'm happy to have a go at that one, but let me go to you first.
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.
I've been a little surprised at how many patients did not come forward with their non-COVID conditions in the first wave.
That's my sense because I, you know, whenever I sort of read anything these days,
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.
And I think this lockdown that we've all gone into today,
I think that's partly about ensuring that we've got sufficient capacity in the NHS to look after potential COVID patients,
as well as the patients that we routinely expect to see that a non-COVID at this time of the year.
And I would agree with you there and to directly answer Toby's question.
I think that many of the modelling groups now due to now do explicitly try to bring these end and in particular,
the modelling group that is that is a collaboration between the MRC statistics unit in Cambridge and the NHS.
I think they're trying to get to incorporate those processes as much as possible,
but it is difficult because it depends on people's attitudes towards seeking health care.
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.
But thank you, Toby. That's a really good question. How is life going to develop for the elderly?
Are the walls coming down for them? This is a question from Christian Lange camp.
Are the walls coming down for them? Are the walls going to stay up for them much longer for the young ones?
What a fabulous response, actually, I mean, I suppose when I was thinking of the walls coming down,
I've been thinking very much, for example, in our own institution, in the university.
I see a lot more collaboration across disciplines, across departments, across divisions.
And I also see us as an institution, collaborating much more with industry, with regulators, with government, with funders, et cetera.
And I also see in the future a lot more collaborations with other countries, so international.
So when I was thinking of the walls coming down, I mean, I'm not somebody who likes barriers anyway.
I look, I was thinking of all of those walls in the national discipline department, all divisional, institutional, different stakeholders, et cetera.
But your question is a good one, actually. I mean, I've not really thought of that, Charles.
Maybe you could have when I to push you on something.
You said that because I agree with you that many walls have come down.
But if you look at some parts of the pharmaceutical industry, especially in the states,
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.
Have the walls come down as much as you would like in those circumstances?
Well, the thing is, Charles, I mean, I you know, at the end of the day, these are commercial organisations,
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.
I mean, as we know Charles, you know, 90 percent of the molecules we take into phase one never make it to the market.
And you know, the attrition rate is so high. Most of our ideas do not translate from the lab into the clinic, et cetera.
Now, of course, it upsets me. For example, was it?
Last year, Novartis launched a new gene therapy for spinal muscular atrophy.
So this is a single injection, and they are charging two point one two.
Five million dollars. Two million dollars for a single injection.
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.
And if you win, then you can have this gene therapy for free, etc.
And to me, that's very, very uncomfortable.
But the thing is, Charles, there's nothing I can do to persuade or influence what pharma companies charge for new therapeutics.
I don't think even Charles Godfrey or John Bell or Louise Richardson,
it can influence what Pascal Scarrow decides to charge for AstraZeneca vaccines or drugs, et cetera, et cetera.
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,
that technology or increase the probability of success in the clinic.
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.
And if we can drive down the cost of gene therapy by tenfold, ideally 100 fold, then of course it becomes a lot better.
Now, I'm not criticising Novartis because I think what they've done is awesome.
You know, if any of us had a child with asthma, we would want to pay that two point one to five million dollars.
But but I think as scientists, as academics, it's our duty to try and drive down the cost of that platform, that technology.
And it is an extraordinarily difficult question because drug discovery is extremely
expensive and it's too easy to say that it shouldn't be done in the commercial area.
I guess it's just an interesting question about whether a drug discovery during
a pandemic when so much depends on it might be might need different rules.
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,
chance, because we're coming up against our time limit and just before thanking you for a fascinating talk.
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,
a series of other talks about what pandemics mean, what the pandemic means for different areas.
And next Thursday, we have reimagining urban mobility after COVID 19.
My colleague Jim Hall is going to be leading a discussion with Tim Treinen and Jenny Middleton.
Let me. Go back to you, chaps, thank you so much for finding the time to talk to us this evening.
It's been really fascinating to hear your views on what COVID 19 means for the future of of of of the health system.
Many universities have reacted wonderfully to the pandemic, and it's great that Oxford, this is one of them.
And with your senior position both in the university and the medical division, I hope you take tremendous satisfaction from that.
So chance many thanks indeed. And let me thank everyone who's tuned in to listen to us on the YouTube or Chromecast channels.
And thank you in particular for those of you who ask questions or voted on different questions.
So many thanks. Indeed. Thank you, Charles. Thank you very much, Charles.
All the very best by everyone.