After a bruising two years in which the UK failed to prove its resilience to a pandemic, the government hopes to re-cast the nation as a scientific superpower: a country that has built on the lessons of the crisis to deliver better research, more precision healthcare, and a more streamlined pathway to new drugs and vaccines.
But the government’s decision to substantially cut back on free Covid testing, as part of Boris Johnson’s “living with Covid” strategy, already threatens to undermine pioneering trials and coronavirus surveillance that are the envy of other nations. Together, they are crucial for understanding how drugs keep patients out of hospital, how immunity is holding up in vulnerable care homes and hospitals and how the epidemic is unfolding around us.
The Oxford University-backed Panoramic trial is one of the largest and most important clinical studies under way in the UK. More than 10,000 people have signed up to help researchers work out who will benefit most from Covid antivirals. While clinical trials showed that drugs such as molnupiravir can substantially reduce hospitalisations among vulnerable patients, most participants in the trials were unvaccinated.
Panoramic aims to help researchers get a grip on how antivirals work in the UK population – where most people are vaccinated but many remain vulnerable because of old age or underlying health conditions. The results should underpin what doctors expect to become a central pillar of Covid care – providing antivirals to vulnerable people within days of symptoms coming on. Currently, 1.3 million people in the UK have been identified as eligible for antivirals, but the number may grow as the Panoramic results come in.
That is if the trial goes ahead as planned. Health officials believe Panoramic needs free lateral flow tests for the over-50s and vulnerable adults under 50 until at least September, but free tests will end on 1 April with a possible exception for those aged 80 and over and people with compromised immune systems. If the trial needs more tests, the funding will have to be culled from other budgets.
Another important project being put at risk is UCL’s Vivaldi trial. During the pandemic, Vivaldi has provided vital information on levels of infection and immunity among care home staff and residents, the latter among the most vulnerable in the country. The study links to lateral flow and PCR test results in the national testing programme to measure vaccine effectiveness and reinfection rates in residents and staff. With free testing dramatically scaled back, much of the intelligence that informs decisions on the need to re-vaccinate staff and residents, especially when new variants arise, will be lost.
Similar concerns surround the UK Health Security Agency’s Siren study which draws on Covid test results to assess how swiftly tens of thousands of healthcare workers are reinfected with Covid as the epidemic unfolds – and so shed light on how quickly immunity is waning among frontline hospital staff.
Amid concerns that it might be scrapped entirely, the Office for National Statistics Covid infection survey has seemingly been spared, but to what extent is unclear. The survey provides the most reliable weekly picture of the UK’s Covid epidemic. As free community tests are ended, the survey will become even more valuable, but it is also due to be scaled back, raising questions about how clear a picture health officials will have of the UK situation in the months ahead.
The loss of most free testing in the community and the expected scaling back of the ONS survey could both have an impact on one area where the UK is truly world class. Swabs from both feed into the nation’s impressive genomic surveillance effort which has served as an early warning for new variants not only for the UK but for the world. The surveillance is only as good as the testing it taps into though. Without free tests, the next warning may not come so fast.