Professor Landray co-founded the COVID-19 RECOVERY Trial with Professor Sir Peter Horby from the Nuffield Department of Medicine at the start of the pandemic. This is a large-scale international clinical trial that identifies treatments for people with COVID-19. Here he reflects on setting up the trial at rapid speed, on the importance of collaboration, and on how his team are adopting their pandemic-related approaches for other diseases.
If you go back to the beginning of the pandemic, we had a brand-new virus, and a disease that was killing one in four people who went into hospital. We had a huge public health problem with absolutely no known treatments. We knew we had to try and find treatments among the drugs that were already sitting in the cupboard being used for other things.
We chose to involve every single acute hospital in the country in research, and many of them had never done research before. We’ve included and involved tens of thousands of patients in the most difficult of circumstances. As a consequence, we’ve got results at a speed which is unprecedented.
Saving lives at speed
We went from writing the protocol, the recipe if you like, right through to recruiting the first participant in nine days – that would normally take nine or even 18 months. We got the first answers in under 100 days. And perhaps the highlight was that, when we announced the results at lunchtime on 16 June 2020, they were NHS policy in every single hospital in the country by teatime.
Our big achievement was to get really clear and compelling answers about which treatments work and which ones don’t. And we managed to do so in a timeline that has saved hundreds of thousands, if not millions of lives – in this pandemic, not the next one. The results have been instantly actionable not just in the UK but around the world.
We’ve now found a total of four drugs which save lives, and these are in widespread use. Just as importantly, we found that another six treatments which had been widely used and promoted have no benefits. As a consequence, their use has been abandoned – saving resources and protecting patients from potential harms of ineffective therapies.
Strength in collaboration
We’ve seen over the last couple of years that collaboration, partnership and networking are key. We couldn’t have got the RECOVERY trial up and running for COVID-19 as quickly as we did, in nine days, if it weren’t for the fact we were already building on people’s expertise, which had been gained over 20 years.
You also need long-term investment in education, training, growth and infrastructure – that really matters when one wants to tackle these big issues – and in particular when one suddenly needs to do so in a crisis.
I think that in so many areas over the last couple of years the most successful projects – the ones that have delivered international, global health improvements – have been those that were carried out in partnership and in collaboration and with networking, both within the University and with others across the country and around the world, and long may that continue.
The RECOVERY approach post-pandemic
There is a huge burden of common diseases that have nothing to do with the pandemic: heart disease, cancer, dementia, depression, arthritis. Just because they don’t grab the headlines like a pandemic, it doesn’t mean that they’re any less of a problem, and it doesn’t mean that treatments are any less needed.
The trick now is to build on all those things that the RECOVERY Trial has now shown us are possible: to get clear, compelling answers by involving a broad range of people and doing so in a timely fashion. That is even more important as we go ahead and think about the burden of longstanding diseases.
Here in Oxford Population Health, we’ve been working on these sorts of trials for cardiovascular disease for several decades and are expanding our approach to address other major health conditions, such as dementia. Our collaboration with Peter Horby and the Pandemic Sciences Institute is growing as we prepare for future outbreaks. As I reflect on my experience of the past two years and turn my attention to the future, my ambition is to expand large, efficient, affordable and inclusive randomised trials to address the big problems that face individual’s health and, indeed, society.