Covid-19 has led to innumerable research initiatives internationally. Many of these are interdisciplinary; involving academic, industry, and frontline clinical researchers. In a recent opinion piece, Mike Clarke described many of the potential challenges of well meaning initiatives that may, nonetheless, represent duplication of effort and unfortunate diminishing of resources. [1] However, there are further aspects that warrant discussion if resources are to be best expended and opportunities for widespread benefit best grasped.
First, although obvious, it remains important to highlight the protective role of appropriate institutional review boards and ethical oversight of research led by enthusiastic clinical and academic investigators. Irrespective of the potential merit of any individual programme of work, and claims of evident extenuating factors, the commitment of investigators in their search for novel insights into covid-19, associated respiratory illness, and medical or device innovations must remain bounded within the parameters of best practice. [2] All usual procedures should be maintained, including consent and patient data protection. Urgency does not trump patients’ rights or safety.
Second, researcher expertise and knowledge is important; but so is recognition of individuals’ limitations. Investigators tend to be affiliated with universities and healthcare settings. As such, clinicians have unique insight into patients, health promotion, and disease behavior. Having obtained suitable approvals (above), they can access biological samples that are essential for laboratory-based and trial studies. Academic researchers often have expertise in study design, analysis, data interpretation, and access to advanced technological tools. In collaboration, significant advances can be made in fighting disease through drug and medical device developments. But once novelty and invention is achieved (and intellectual property protected as appropriate), the expertise to manufacture these new innovations and to make them available widely lies within industry. Universities do not own factories, and commercial acumen combined with ability to navigate complex regulatory and supply chain needs are critical to success.
Third, there can be too much innovation, which can lead to cycles of new product and process introductions without time to evaluate before the next iteration arrives. [3] This can lead to uncertainty and lack of confidence in new products or procedures. At a time when health systems globally are struggling to cope with overwhelming numbers of patients, it is important that stress is reduced and energy conserved and focused on critical activities. Of course, innovation has been needed to provide inventive ways to supply and disinfect healthcare workers’ PPE, and to ensure reservoirs of test reagents. But it is increasingly evident that there will soon be respite and opportunities to reflect on achievements. Before the inevitable second wave of SARS-CoV-2 in parallel with seasonal flu during the coming winter, there will be time to consider where research attention should be focused, and to evaluate the success or otherwise of those contingency innovations we found necessary to survive the onslaught of early 2020. Based on that analysis, we can develop intentional, proactive, coordinated (rather than reactive) research initiatives to allow us the best chance to address the immediate priorities for innovation identified by the WHO and others. [4,5]
Colum P Dunne, professor and director of research, Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
Suzanne S Dunne, Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
References:
1.Clarke M, “How can we avoid research waste during the covid-19 pandemic and plan for the future?” 2020
https://blogs.bmj.com/bmj/2020/04/21/mike-clarke-avoid-research-waste-covid-19-pandemic-plan-future/
2.https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-practice-in-research/good-practice-in-research
3.Gottfredsom M, and Aspinall K, “Innovation versus complexity: what is too much of a good thing?” 2005 Harvard Business Review 83(11):62-71.
4.https://wellcome.ac.uk/press-release/sharing-research-data-and-findings-relevant-novel-coronavirus-covid-19-outbreak
5.https://www.who.int/blueprint/priority-diseases/key-action/Roadmap-version-FINAL-for-WEB.pdf?ua=1