As a consultant and Professor of Sociology at Nottingham Trent University, Robert Dingwall is one of the UK’s leading sociologists. He has advised British governments on pandemic policy for close to two decades and as part of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), he has worked with the government on their response to COVID-19. We spoke to him about how the pandemic has impacted clinical trials, the challenges of vaccine development in the UK and the idea of Zero COVID.
What lessons has COVID-19 taught us about how we run clinical trials?
The COVID-19 trials have shown that it is possible to move at greater speed and in closer collaboration with regulators. However, it will be necessary to evaluate the cost-effectiveness of doing future trials as quickly and to review whether there is a danger of regulatory capture if regulators get too close to the company.
What do you think will be the long-lasting impacts on how trials are run?
I am sure that the ways in which trials have been managed through collaborative online working will become permanent, increasing speed and reducing co-ordination costs. There is probably a limit to this because the COVID-19 trials were able to build on an infrastructure of personal connections and trust that had already been established through face to face interactions at conferences and other professional events. Online contacts do not replace or renew this social capital.
With new variants appearing and will inevitably continue to do so, what are the challenges to running vaccine studies for them?
There is a challenge to communicate the way in which variants are normal. This is just how evolution works as viruses explore their ecological niche without escaping it. In some ways, the experience of previous vaccines, like measles, has been misleading because they dealt with relatively stable viruses. When the industry talks about mutation, this has connotations of horror movies rather than an entirely normal biological process. It may be possible to run simulation studies that help to define the space occupied by a virus and to think about how to design vaccines that address the space rather than one specific variant.
How can we maintain public confidence in the management of vaccine development?
The lessons of the Boeing 737 MAX in a comparably safety-critical industry should be taken seriously. The pharmaceutical industry has a strong interest in sustaining a system of regulation that is perceived to be independent and thorough. If the regulators are resourced to act at greater speed through closer dialogue with the industry, the public must not have grounds to think that quality is being compromised.
Will ‘Zero COVID’ ever be possible and is this something we should even be trying to achieve?
Zero COVID is a slippery concept. Sometimes it seems to mean eradication and sometimes to mean elimination or suppression within one country, sustained by strict border controls. Only one virus (smallpox) has ever been eradicated. COVID-19 does not meet any of the requirements for eradication: easy diagnosis; easy containment; easily deliverable vaccine; lifelong immunity after vaccination.
Elimination or suppression can only be achieved at an unacceptable cost in social, psychological and economic terms. It demands that a whole society pivot to focus on COVID-19 control regardless of any other harm or any other social good. It is more realistic to accept that COVID-19 will sit alongside 30 other human respiratory viruses as a generally mild endemic infection, provided that population immunity, and personal protection, levels are sustained by vaccination.