Covid-19 makes the future of UK clinical research uncertain

Studies discontinued

It’s not just cancer that’s being affected by the pandemic but the whole of medical research. William van’t Hoff, chief executive of the UK government funded National Institute for Healthcare Research (NIHR)—the largest national clinical research funder in Europe—says that almost 90% of its non-commercial research has been paused because of the pandemic, although over half of its commercial research is still ongoing.

He tells The BMJ, “We absolutely recognise the impact that this [pausing of studies] has had for patients, but also for researchers who have been severely affected. I’m sure that in the short term they will understand this, but in the medium term we want to be ready to get going again.”

Van’t Hoff says that, as far as possible, NIHR will look to extend research contracts and have “an open mind” on whether it will continue to fund additional research costs beyond existing schedules. But he acknowledges, “Some research, very sadly, will not continue. It may be expired, the situation may have changed, the science may have moved. That’s regrettable, but there is a willingness to do our best to consider what is feasible.”

Fundraising hole

Medical research charities, most of which do not benefit from endowments or government grants, are undoubtedly taking the most severe hit from the covid-19 pandemic.

In an open letter 1 to its researchers, Cancer Research UK said that a huge drop in donations—resulting from shop closures, cancellations of mass fundraising events, and legacy reductions in the wake of the covid-19 crisis—had left a £120m hole in its income from fundraising (box 1). The charity has postponed any new funding commitments while the pandemic is ongoing, meaning that no new research projects will be funded for “at least the first half of this year.”

Many other charities are facing similar struggles: Action Medical Research, the Motor Neurone Disease Association, and the Alzheimer’s Society are among those that have launched emergency fundraising appeals to try to compensate for losses in fundraising income.

Five years lost

Charlie Swanton, Cancer Research UK’s chief clinician, who is a group leader at the Francis Crick Institute and professor of oncology at University College London Hospitals, tells The BMJ that his research on cancer is now on hold because of covid-19.

Swanton’s research laboratory looks at how cancers evolve and develop drug resistance. Four parallel studies that his team were conducting are now on hold, including the large national Tracer X trial, a 10 year programme tracking the standard of lung cancer care for patients in a hospital setting, with patient follow-up at five years.

“In a worst case scenario we’ve potentially lost five years,” he tells The BMJ. “I’m very concerned that a substantial part of the study will have to be repeated to be able to get to the original sample size that we had planned.”

His team’s experience is not uncommon across the clinical research sector. He says, “All colleagues that interface with the clinical environment are going to be very badly affected by this, and their research work is going to be hindered. It’s unavoidable, and we understand why this is happening.

“But it is terribly sad from many angles to think that progress in cancer research is going to be severely impaired as a result of this crisis. And that’s just cancer research; you can imagine that the same would hold true for any area of medicine.”

Shifting focus

In the meantime, the UK’s clinical research focus has pivoted sharply towards covid-19 (box 2). UK Research and Innovation, the national funding agency for science and research in the UK, has moved to refocus its activities and to streamline applications for new research, including publishing guidance for researchers who currently hold grants, on how they might repurpose their funds for covid-19.2

The Wellcome Trust (which, unlike many research charities, is funded from endowments) has committed $50m (£40.5m; €46.4m) to set up a joint covid-19 Therapeutics Accelerator initiative with the Gates Foundation and Mastercard,3 to coordinate research efforts and remove barriers to drug development.

Most researchers at Swanton’s lab have been redeployed at a new covid-19 testing lab, which he helped set up at the Crick Institute to help boost capacity to test NHS staff for coronavirus. It’s here that he says his focus will be until his other work can recommence.

“To cut a long story short, my research life has been put on hold,” explains Swanton. “Getting over this crisis is our most critical and important goal right now. That’s why we’ve repurposed the laboratory, and we are working with many others at the Crick to focus purely on supporting and helping the NHS.”

Van’t Hoff says that, like the whole of society, the covid-19 crisis has forced the whole research sector to “rethink the way we do things,” which he believes is no mean feat. “It’s incredibly impressive to me how joined up the health system and the health research organisations have been to try and speed up the access, volume, and delivery of research to help patients, the country, and the NHS,” he says.

Swanton voices similar sentiments, but he’s also anxious about what the future holds. “The coronavirus question dominates everything, and the length of time this goes on will directly influence the number of obstacles that exist to set the lab up again when we all come back eventually,” he says. “If this goes on for six months or more, we could be looking at a very different world from a research perspective when it comes to the financial resource to keep Britain’s research and development engine going. That is a big concern to us.”