What has been the most challenging aspect of being Deputy Chief Medical Officer during a global pandemic?

I’ve reflected on this before now and said very sustained levels of hard work and extended hours are always difficult and so are high levels of responsibility – but when you get the combination of all three, that’s really is hard.

There are relatively few senior doctors in government. There are relatively few who are specifically trained in respiratory virus infections, and because of that a great amount of things come to the doctors that do exist, of which I’m one. On top of that there is a huge amount of responsibility, because it’s been this very difficult balancing act all the way through really, in terms of doing what is needed for public health but no more than is needed as we know that restrictions are damaging to people, economies and societies.

'Would providing more vaccination support to developing countries help to control the development and spread of new variants?

Certainly I think it’s absolutely right that there has to be global ambition for getting vaccines to all populations and the UK is definitely playing its part in that. On top of that, in terms of the emergence of variants, we aren’t quite clear on the science yet, whether variants are more likely to occur in a population that is under-vaccinated, or actually, in a population that is well-vaccinated (due to selection pressure), or if indeed the status of vaccination of a population makes no difference at all and these variants are essentially random occurrences.

You’ve become famous for your range of creative analogies to explain complex public health issues. How important is the public communication of science to you? How much of a role has it played in helping to shape health behaviour during the pandemic?

It’s always mattered to me that whatever you do in medicine, if your patient doesn’t understand what you are saying or doing, or advising them, then they certainly won’t do it. They won’t understand, or go along with it. So from that perspective, you’re just expanding that argument from: ‘I need to make sure my patient understands how I’m thinking and why I need them to do X, Y and Z, or to take X, Y and Z’, to a population level. People in every community need to understand, in terminology they can understand, what is going on and why. I think it’s pretty pointless in doing high quality science if you can’t actually explain it to the people who are the ultimate recipients of that advice.

Do you think the public’s view of science/experts has changed as a result of the pandemic and scientists in advisory roles being more visible via the televised briefings?

Yes. First of all, those televised briefings, which have been very important in keeping the public up to speed on what is going on, they have forced scientists into public prominence, in a way that was never the case before. They’ve also given the public a thirst and hunger for data, and for wanting to understand data, and therefore it’s never been more important to present it as accurately as you can. And I think, the public have probably realised too – what science has done for us in terms of getting us out of the hole we were in in terms of the vaccines. And I think this has changed the world forever. But I think in academia, there will be a much bigger emphasis on quality communication with the public in the future.

How important has the role of University research been during the pandemic?

Three super big examples.

First of all – the Oxford AstraZeneca vaccine would never have made it through to regulation as quickly if it had not been for the UK vaccine network having invested a lot of money with Dame Sarah Gilbert’s group back in 2016 to get them off the ground in developing a candidate (a vaccine) for Middle East Respiratory Syndrome (MERS) , which is another novel coronavirus.

The prototype vaccine produced with that 2016 money was Adenovirus-based vector vaccine, which has become the technology that the Oxford AstraZeneca vaccine for coronavirus has used. So, from that perspective, a huge leg up and head start from the Government through the UK Vaccine Network, but it was University research that brought that to fruition. And if you think about the RECOVERY trial, the world’s largest clinical trial which brought us that really early discovery in June 2020, that dexamethasone was a life saver, that was government funded, but Universities led the study right across the UK. And if you think about our current booster programme – this is my third example, we’ve decided to use for our booster programme (where possible) messenger RNA (mRNA) vaccines - from Pfizer and Moderna. The study that delivered all that was published in the Lancet last week – it was a university run study and it was called CovBoost, and evaluated seven different booster vaccines or doses, to find out which ones are the best for the current circumstances.

So, University research has been critical. What I would say, is University research doesn’t happen on its own and the National Institute for Health Research has underpinned all of these activities and is an absolutely critical partner.

Have you still been able to find the time to get involved with research while in your Deputy Chief Medical Officer role?

Yes, but it’s been difficult. In the 2009 swine flu pandemic I ran a research activity from Nottingham called Flu-Cin – which was the Influenza Clinical Information Network and that was replicated for this pandemic in Co-Cinand it was run by Professor Callum Semple who, at the time of Flu-Cin was a more junior academic partner in our group. So one project has flowed from the other and I’ve been involved as a senior academic in that, and in quite a few of the vaccine studies – CovBoost and ComCov. I have been quite central to the design of those two studies.

What advice would you give to yourself as a first year student at the University?

Enjoy it and get involved in everything the campus has to offer. Particularly the sport side and just realise what a privilege and a luxury it is to be able to set aside three to five years of your adult life, before the world of work and employment really cuts in. Just immerse yourself in learning and just enjoy learning for what it is.

Predictions for 2022 - will it be better than 2021? Will we ever return to pre-pandemic normal or do variants like Omicron mean that some elements of Covid will now be a way of life?

Prior to Omicron emerging, my view was that we would have a fairly bumpy winter, or bumpy in places, but that we would hit calm water around March 2022. But if we did that, there would still be the future threat at that point of a variant that would destabilise things. What’s actually happened now is that the variant with the potential to destabilise things has come before we got to March 2022. I think it’s going to give us a number of difficult months ahead, how difficult, it’s impossible to say at the moment. It depends really on how our vaccines are affected and whether they will still mainly do the job they were meant to, or whether we will have to formulate new ones. That’s just an unknown at the moment and if Omicron does give us more of a problem, then I think we are in for a few months of difficulty, before things settle down, but it might be after March 2022.

But this is all pure, pure speculation. We don’t have enough proper data yet to give an accurate prediction; that’s a point I really need to emphasise, is that we face massive uncertainty at the present moment.

Charlotte Anscombe - Media Relations Manager - Faculty of Medicine and Health Sciences
Email: charlotte.anscombe@nottingham.ac.uk
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