The Nuffield Department of Medicine has had an outsized impact
On 30 January 2020, just a month after a “novel coronavirus” was identified in Wuhan and while there were still only 82 cases confirmed outside China, an emergency meeting was held in an Oxford department.
The Nuffield Department of Medicine (NDM) is a heavy hitter when it comes to global health. It has about 3,000 employees, a thousand or so in Oxford itself and the rest scattered around tropical medicine units around the world — crucially, including places like China, Vietnam, Thailand. Jeremy Farrar, the head of the Wellcome Trust, worked with Nuffield in Vietnam. Others, such as Peter Horby, a professor of emerging infectious diseases, had also worked in Hanoi. Experiences with previous coronavirus outbreaks, SARS and MERS, was fresh in the minds of several of them.
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That meeting on 30 January happened after Horby went and told Richard Cornall, the head of the NDM, that the coronavirus was likely to be devastating. Professor John Todd, a professor of precision medicine at the Wellcome Centre for Human Genetics, an NDM subdivision, was there that day. “Peter went to Richard,” he told me, “and said we need to claw together all the existing expertise in structural biology, immunology, vaccine production, project management, administration.” That meeting led to a huge mobilisation of resources and expertise, from very early on in the timeline. Among those present was Sir John Bell, former head of NDM who would go on to advise the government during the pandemic.
This is relevant because now, looking back, the Oxford medical departments, and most notably the Nuffield, have had a huge and outsized impact on the course of the pandemic. Last week, I wrote about Ivermectin. It’s an antiparasitic drug which may or may not work to improve outcomes for Covid patients.
What’s interesting, though, is that — as I said — there is a major clinical trial looking into whether it works or not. The PRINCIPLE trial, as it is called, is recruiting thousands of patients to properly examine the drug’s impact. It’s an innovative design: patients who are suffering symptoms can recruit themselves onto it and will receive either normal care, or normal care plus ivermectin which they will get from their GP. It is also looking at the use of favipiravir, an antiviral, and a corticosteroid, budesonide (often used to treat asthma) for Covid. PRINCIPLE is run by the NDM’s sister organisation, the Nuffield Department of Primary Care Health Sciences.
It is not the only major trial to come out of Oxford. RECOVERY, which established that the cheap steroid dexamethasone substantially improved outcomes — and showed that tocilizumab and remdesivir could save lives as well — was set up by the NDM and Nuffield Department of Population Health. It is estimated that by March, the use of dexamethasone had saved about 22,000 lives in the UK alone, and perhaps a million lives globally. “Oxford knows how to run large-scale trials,” says Todd. “The secret to a large-scale trial is to keep it simple.”
And the Oxford-AstraZeneca vaccine, which will probably be the biggest lifesaver of all — a low-cost, effective, easily stored and manufactured vaccine — was developed by scientists at the Jenner Institute, a part of NDM.
By the time of the January meeting, Sarah Gilbert of the Jenner Institute had by that stage already started work on a vaccine — a Chinese scientist having already made the Covid RNA sequence available. But she needed a million pounds immediately to sign up with a manufacturer to get the clinical trials underway; Cornall, recognising the urgency, offered to underwrite the funds out of the NDM, rather than wait for grants. The vaccine trials, led by another Oxford medical scientist, Andrew Pollard, got under way soon after.
That meeting also led to the use of Oxford’s Diamond Light Source particle accelerator to work out the structure of the spike protein when a synchrotron in China broke down; NDM’s connections with Chinese scientists allowed them to step in at short notice. The department has also been hugely involved in sequencing the variants: Todd mentions a sequencing machine breaking down on Christmas Eve, and a staff member driving from Oxford to Cambridge’s Sanger Institute at 9pm to use one there. “People were working 16-hour days,” he says.
The point is not to say that the Nuffield Department of Medicine did this single-handedly. Universities around the UK and the world have been hugely involved in the fight against Covid — Todd mentions UCL and Edinburgh, and many others did great work. But it is worth noting that there was a particular concentration of expertise in the NDM at that point early last year, and that single, emergency meeting allowed it to spot the problem early on, and, by the most conservative of estimates, to help save millions of lives.