Professor Sir Leszek Borysiewicz, Chair of Cancer Research UK, looks back on the crisis so far.
My clinical and research background is in infectious diseases and how our immune system responds to viruses. Indeed, I came to cancer research through the study of virus-associated cancer. In all my years, I have never seen a pandemic of such scale and impact as COVID-19. Almost every person on the planet has been affected. We have lost loved ones prematurely and the vast economic and other consequences will further impact on health and wellbeing.
Is it a surprise that something like this happened? We must remember that there are new viruses emerging all the time. The difference with this one is it is so very infectious and, as we’ve seen, can spread rapidly in populations. As such, it overwhelmed health services, devastating their capacity to respond quickly and adapt to the ever-changing environment. Almost no health service in the world was immune because the capacity required to withstand such a pandemic is hard to maintain in normal circumstances. What’s more, COVID-19 is a new strain of the coronavirus, so we’ve had to learn as we go and no one had any pre-existing immunity. The virus has been operating on an entirely clean sheet. A lot of planning has gone into the possibility of a devastating influenza outbreak, but this is not influenza. It is something quite distinct.
In the face of a pandemic, action needs to be taken swiftly and decisively. But different countries have had divergent views on the virus from the extremes of denial to accepting a degree of impact but refusing to shut down the economy, to implementing lockdown but with varying degrees of compulsion. This depends on available resources, as well as cultural and political influences. South Korea was able to quickly roll out extensive testing and contact tracing due to the country’s experience with SARS. In poorer countries, lockdown has simply not been practicable. This has made the problem entirely more complex.
Building on what we know now
However, there is some good news among the bleakness. We do have some understanding of coronavirus in its other forms – for example, it’s been a veterinary problem in small animals for some time and has been countered by vaccines. Furthermore, SARS and MERS emerged in China and the Middle East recently and have been successfully supressed with effective vaccines. This, together with the rapid advances already made since the epidemic started, gives us a reason for optimism. We know the biological make-up of this and other coronavirus strains, we know how they work inside cells and we know a lot about the DNA sequences that make up their genome. That has given us a head start on developing a vaccine and potential treatments for this strain. It will take time, however, and the measures we’ve had to endure have helped buy that time, while also protecting hard-pressed health services.
But the next problem we face with developing vaccines and treatments is that of scale-up. It’s one thing to produce an experimental vaccine that might work in a clinical trial, it’s quite another to produce 10 billion doses, ensure that it’s built to the correct standard and distribute it effectively worldwide. Am I optimistic that we will overcome these problems? I take comfort in the fact that we’ve already learnt an enormous amount in such a short period of time and that when a problem like this hits, the global research community can come together and collaborate – something we see all the time among our Cancer Research UK community. In my view, an effective vaccine could well be available within nine months. It’s our best hope of bringing the pandemic under control, but also preventing resurgence, which is notorious in infections such as these.
Why do I say nine months when the news says 18? My estimate relies on three things:
- the global scientific community truly collaborating, across borders and disciplines to share knowledge and findings
- that same community redirecting vaccine production capacity to focus on this virus, particularly involving the pharmaceutical industry
- individuals having to accept less certainty around side effects than would normally be the case
Of course, there are big problems with these caveats and if they are deemed insurmountable, the 12 to 18-month estimate may end up being more accurate.
Our role in the global response
So, we know what must be done. But who will help achieve it? The answer is each and every one of us. By social distancing, we’ve been able to reduce the reproduction rate of this virus and if we continue to do so, it will peter out entirely, in turn reducing the pressure on the healthcare system. It’s a complex problem but the maths are simple.
I also believe we at Cancer Research UK have a vital role to play. We have a large number of clinical staff among our research community and while business as usual research was paused, many volunteered to return to the frontline to help combat COVID-19.
We’ve also offered capacity in our institutes and laboratories. We’ve heard from Sir Paul Nurse, Director of the Francis Crick Institute, about how the institute repurposed its labs to become a diagnostic testing centre and its researchers are now pursuing incredible new science into how the virus spreads. Testing in and of itself will not stem the number of new cases but it can help to safely return NHS and key staff to their life-saving duties and will be a vital element in tracking new outbreaks as lockdown measures continue to ease, alongside large-scale human contact tracing. I’m very proud that some of our institutes are vital cogs in the testing machine.
And then our researchers have expertise – spanning the entire breadth of the biological research landscape and beyond. This expertise will be hugely valuable in the fight against COVID-19, as we seek completely novel and innovative ways to understand more about the virus and find weaknesses to exploit.
Cancer is still with us
But, amid all of this, please let us not forget one very important message. Just because COVID-19 has reared its ugly head, it does not mean that cancer has taken a holiday. We’ll continue to see the same number of new cancer cases emerging, but due to a drop in referrals and people not feeling able to attend their clinic for check ups, these may be diagnosed later than they normally would. We must ensure that cancer services are available to those who need them, that any delays in treatment and diagnosis are kept to an absolute minimum and that our vital work in finding new treatments and improving existing ones is not put on the backburner ad infinitum. People with cancer rely on us and serving them remains the primary purpose of Cancer Research UK.
People with certain types of cancer are at slightly higher risk from COVID-19, so we also need to provide support for those people and those looking after them. We are helping to monitor how people with cancer are affected by the virus, how the pandemic has affected the treatments that they receive and have put pressure on the Government to mass test and to establish ‘COVID-free’ spaces where cancer patients can be treated safely. It’s also been our responsibility to ensure the transference of reliable information at a time when fake news abounds. Our nurse helpline and patient information departments have worked hard to achieve this.
Taking its toll
As lockdown begins to lift, we must remember the huge indirect impact of the pandemic – COVID-19 is taking a huge toll on our charity. We predict a 20-25% decline in income this financial year. This will hugely impact the funding we can provide to researchers whose life’s work is to beat cancer. But I truly believe we can help in the response to the COVID-19 outbreak, while also upholding our mission to look after the 1.7 million people in Britain living with cancer.
We must prevent the NHS and any healthcare service in the world being totally inundated with this sudden increase in demand for intensive care support during this first wave and any future wave of the virus. Capacity must be restored to ensure that people with cancer and other diseases are still receiving the best care. And we need to ensure there isn’t a dramatic knock-on effect on the survival, life-expectancy and treatment of people with cancer into the future – that we’re not derailed because of a hopefully short-term pandemic.
I repeat, cancer has not taken a holiday throughout this pandemic. Our mission to support people affected by cancer and fund life-changing research remains absolutely critical. Thank you for standing with us and supporting our emergency appeal, if you feel able to do so.
As told to Joanna Lewin, Philanthropy Communications Editor