Mission Possible

The new paper “Mission Possible”[1], identifies a critical juncture in which UK health and industrial policy leadership will have lasting effects on future levels of disease prevention and pandemic preparedness. It argues that positive momentum to improve on the past has been lost through a combination of waiting on the outcome of the COVID-19 Inquiry, the political and economic turmoil of 2022, and a state of flux in policymaking.

In his foreword to the discussion paper “Mission Possible” the Chair of the House of Commons Science Innovation and Technology Committee, Rt Hon Greg Clark MP describes how the UK’s rapid development and deployment of COVID-19 vaccines was based on an Industrial Strategy agreed three years earlier. He reflects that:

“What followed a public vindication of strategy, has been, extraordinarily, a dismantling of many of the elements that contributed to that success.”

This new paper supports his assertion that there is still time for this dismantling to be reversed. That the UK’s life sciences ambitions are still ‘mission possible’ but there is a brief window of opportunity to be used, building this into a much broader post-pandemic policy response that delivers action on the most obvious systemic failures on preventable ill-health and pandemic preparedness.

The COVID-19 virus will never be “over” even though the global emergency is over, and nations will be responding to its effects for years to come. The virus pinpointed weaknesses in policies and systems that warrant concerted corrective action. In time the official COVID-19 Inquiry may prompt change, but in the meantime there seems a worrying loss of momentum in responding to the most obvious strategic flaws. The UK political and economic turmoil of 2022 seem to have disrupted the heightened sense of mission for the delivery of an ambitious life sciences policy. The mission-based rhetoric remains, but the determination to deliver against the mission seems to have been lost amidst the turmoil.

In the foreword to the 2017 Life Sciences Industrial Strategy Professor Sir John Bell argued that:

“to deliver the potential for economic growth, through the projects and programmes outlined in this strategy, there will need to be oversight of this programme over the next five years.”

Five years later, however, he was to say that:

“Now our clinical research environment is much worse than it has ever been in my memory.”

The collapse in industry-sponsored clinical trials since 2019 reinforces this point.

The rise and fall of the Vaccines Manufacturing and Innovation Centre (VMIC) is symbolic of a failure to match “science superpower” rhetoric with reality. The 2018 decision to create the VMIC was announced in 2018 (with what now seems extraordinary foresight), to fill a gap for partnerships in innovation and manufacturing. As policy shifted, however, it was repurposed into a manufacturing plant, that never came on stream, then it was sold. Today it remains an empty shell. The recent Government review of the Vaccines Task Force glossed over the demise of the VMIC, and carefully ignored its original purpose from 2018 within its Industrial Strategy for the life sciences. In the Review it appears as if the project emerged from the pandemic, not from any prior assessment of need. The genesis of the VMIC was a classic exercise in identifying a classic market failure, that could be corrected through public-private partnership. Its demise seems a return to classic state short-termism.

The symbolism of the high potential followed by a loss of strategic purpose is hard to ignore. Similarly, the UK came ridiculously close in 2022 to losing the records of those 500,000 people who had consented out of pure altruism to join the National Vaccine Research Registry during the pandemic and to remain part of research.

Worries over the UK’s prioritisation of scientific collaboration were heightened by an equivocal approach to association with the EU Horizon Europe research and innovation programme. This became apparent when the EU’s “political conditions” for association were met with agreement of the Windsor Framework in February 2023. For six months it seemed a realistic prospect that the UK government could decide that association would not represent value-for-money. Association with Horizon from January 2024 and action on the recommendations of the O’Shaughnessy report on commercial clinical trials offer some hope that there is a growing recognition that action is needed.

To renew the life sciences mission and seize the window of opportunity after the pandemic renewed leadership is required urgently in three areas:

• 1)  Policy
  The “science superpower” rhetoric needs to be better matched in consistent daily decision making. The pandemic added to the problem of resurgent NHS waiting lists for elective treatment. These are (once again) a pre-election political priority. Having embedded clinical research in front-line practice in 2020, embedding research in front-line practice in an NHS in recovery requires dedicated and careful, but determined, leadership.
• 2)  Prevention
  The pandemic highlighted a “cycle of exclusion” that must be broken. Amidst the headline success on COVID-19 vaccine uptake there are lessons to be learnt from significant variations in uptake, alongside a worrying decline in routine vaccination. These variations put vulnerable communities at excessive risk in a pandemic.
• 3)  Preparedness
  Whilst the Vaccines Task Force has been described as a “model” for other initiatives, it is not clear what lessons have been learnt from this unique approach for future emergencies. The best aspects of this novel approach should be incorporated into practice, made explicit in the Treasury “Green Book” so that future administrations can be guided by a “pandemic playbook”.
  
  Evidence suggests that pandemic risks are increasing, such that “pandemic preparedness” should feature permanently in the list of ministerial responsibilities.
  
  Trust in government, in the NHS, and in science are vital aspects of pandemic preparedness, but can be lowest in some of the most vulnerable population groups. The unequal take-up of vaccines and participation in the vaccine registry reflect these underlying disparities. Trust needs to be central in any strategy for future preparedness.

In time the official COVID-19 Inquiry will report, offering valuable and detailed analysis of the pandemic and the UK response. In politics the collective memory can be short, however, and a critical juncture to make a tangible difference on the most obvious aspects of policy, prevention and preparedness seems to be slipping away.

Seizing the moment is still possible.