I beg to move,
That this House has considered the role of immunology research in responding to the covid-19 outbreak.
Thank you for calling me to speak, Dr Huq. I thank the Backbench Business Committee for allowing me the opportunity to highlight one of the many successes for this nation. Unlike yesterday, the Minister will have an easy ride in responding to my comments, and hopefully to the comments of other Members as well.
Every one of us across this great nation of the United Kingdom of Great Britain and Northern Ireland recognises the good work that has brought about the vaccines, to deal with covid-19 in a way that could never have happened if we had still been in the European Union. I am not looking for any discussion about Brexit, but we had the independence to roll out the vaccines. The Government had the foresight to do that, and the Prime Minister put the Minister for Covid Vaccine Deployment, who is present, in charge of making that happen.
Every one of us recognises that the Minister and his team across the whole of the United Kingdom, in co-operation with all the regions of Scotland, Wales and Northern Ireland, have made this happen. We are eternally grateful to them for that. I wanted to put that on the record first, because it is so important to say that we are where we are today because of the strategy of our Government, the work of the vaccine Minister and—I say this as a Christian—the prayers of God’s people. We have seen the championship of community working together.
I participated in a Westminster Hall debate over in Portcullis House; it is so nice to come back to the real Westminster Hall and to claim my seat in this corner of the room. Hon. Members have asked me why I sit here. It is because I always sit here—I think my name is written on the seat. We had a fantastic debate in Portcullis House on the issue of communities working together, and many of us took the opportunity to speak of how our communities had come together. As elected
representatives, we can all subscribe to the belief that whenever the chips are down, the goodness of people always shines through. From a community point of view, I am able to convey some of the good things from my community, and I know that others can do so as well. I have been double-vaccinated, as I suspect everyone present has been. The many victories that have happened behind the scenes should be celebrated.
The topic of the debate is immunology research into covid-19, and I thank the Library for its very helpful briefing. Page 3 gives a really good introduction to the subject:
“immunology has changed the face of modern medicine…From Edward Jenner’s pioneering work in the 18th Century that would ultimately lead to vaccination in its modern form (an innovation that has likely saved more lives than any other medical advance), to the many scientific breakthroughs in the 19th and 20th centuries that would lead to, amongst other things, safe organ transplantation, the identification of blood groups, and the now ubiquitous use of monoclonal antibodies throughout science and healthcare.”
Immunology has helped our great health service to move forward. I asked for this debate some time ago, and I want to put on the record our thanks to the immunology experts and scientists. I am going to mention a lot of people in this debate today, because there are a lot of people to thank; I apologise in advance if some people are not mentioned, but that is not because we have forgotten about them. I recognise that, singly and as a team, we all came together to make this happen.
I will then speak to some of the successes that immunology research has had during the pandemic in furthering our understanding of covid-19 and the effects that SARS-CoV-2 has on our immune systems, as well as developing the technologies and therapeutics that are currently allowing us to emerge from lockdown restrictions and return to normal life—this here is the normal life we had prior to covid-19 in Westminster Hall. As I progressed around Westminster Hall, the House of Commons and the House of Lords and Portcullis House, I noticed these wee circles on the carpet. I wondered what they were all about, but then I realised: that is where the wee “Keep two metres apart” signs were. They have all gone away.
Normality is returning for a number of reasons, and I know that the Government and the Minister are committed to returning to normality in every way we can. Yesterday in the House, I asked the Minister how we can better have an agreed covid vaccine strategy within the four regions where one size fits all, as I put it. It would be nice to see that, although I know that the restrictions differ; I know that Scotland is going to do something different, as the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) may mention shortly. Lots of things have been happening, but from a news and media point of view it would have been nice at least to have had the same strategy for everywhere across this great United Kingdom of Great Britain and Northern Ireland.
Over the past 18 months, immunology has had a disproportionately large effect in driving forward our understanding of the science of, and helping us to recover from, the covid-19 pandemic. Immunology has built our understanding of how the body responds to covid-19—and, crucially, has delivered us highly safe and effective vaccines. We all know that. I have had the vaccine, as have others: it does not give us the ultimate
assurance, but it gives us a 96% or 98% assurance of being safe and secure, which I believe is our way out of the pandemic.
Immunology is the linchpin linking together many of the sciences that have been used in tackling the covid-19 pandemic, such as virology, respiratory science and epidemiology; for the latter, immunologists have been working with epidemiologists to help make their mathematical models more accurate. I chair the all-party parliamentary group on respiratory health. We have recently had an inquiry on this issue and have done a number of things relating to respiratory health. Through the work of my constituency office, I have become aware of so many people who have issues in relation to asthma, chronic obstructive pulmonary disease or other respiratory problems. I am aware of those issues, and I am interested in them.
We know that a multitude of different reactions of the immune system manifest themselves through the many different symptoms and severities of covid-19 that have been observed—from the acute disease right the way through to long covid, which more and more people are reporting they are suffering from post-infection. I have had a number of people contact me about long covid; I am not sure whether there is a real understanding of how long covid affects people, and why it affects some people and not others.
A lady in my constituency contacted me just the other day, looking for some advice about her job and where she stands. Legally, there may not have been the protection that she had hoped for, but I think the Government have set in process a benefit system whereby if a person has a health condition that prevents them from working, they can claim employment and support allowance, personal independence payment or universal credit. I was pointing her in that direction, but this lady had been perfectly healthy. She worked in a wee bakery just down the street from my office. I got to know her quite well. I had not seen her about as often, but I thought that that was maybe because we were working different shifts.
Perhaps in his response the Minister could give us some idea about how we can help those with long covid. There are a number of them out there—not just that lady, but others who have contacted me recently; we got them on to benefits and tried to help them through the system. However, what that lady really wants, and what they all want, is to return to work and to normality. It may be some time before that happens. The benefits system is in place at least to help them financially, but we need to do more so that they can deal with the issues themselves, now and in the future.
Significant patient benefit and public health improvement directly demonstrate the huge value of investing further in immunology research. The Library paper referred to the
“Important research questions that will take time to answer”.
Research and development are working towards having in place vaccines and responses to diseases as they happen. I will comment on that later. The important research questions that take time to answer are:
“What is the rate of asymptomatic spread, and how does this contribute to transmission? What proportion of infected individuals mount a protective immune response? How long is natural and vaccine immune protection likely to last? What immunological
factors correlate with protection to SARS-CoV-2 by vaccines and how effective are vaccines at protecting older people? What is the role of immunogenetics in SARS-CoV-2 infection and what can this tell us about potential therapeutic targets?”
Those are all key questions for those involved in R&D, and they are clear. They help us to prepare for the future. In the research that I did—I want to refer to it later on—I found that R&D was actually working towards this vaccine even before the disease came about. When the Government announced the vaccine, there had already been a number of years of investigation and research and development into this particular subject matter.
Some of the questions that the UK Coronavirus Immunology Consortium were asking were as follows:
“How long does immunity from COVID-19 last? Why are some people’s immune systems better able to fight off the virus?”
That relates to those who can recover quickly and those who have long covid.
“Why do some people’s immune responses cause damage, especially to the lungs? How does the virus ‘hide’ from the immune system and how can this be tackled?”
Right across the United Kingdom of Great Britain and Northern Ireland, again, perhaps the Minister can give us his response to this question as well.
Ulster University in Northern Ireland was working in partnership with some of the larger pharmaceutical companies on vaccine research. How important we all believe those R&D partnerships between universities across the whole United Kingdom—including Ulster University in Northern Ireland, obviously—are in bringing about some of the vaccines that we have!
Vaccines, of course, are no doubt having the most effect on people’s day-to-day lives. Immunology has made other important contributions to the science of covid-19. That includes diagnosis, for example, through antigen testing; the screening of antibodies to determine whether people have had covid-19 previously; and prognosis and patient stratification, such as triaging patients and seeing who will benefit from early ventilation and therapeutics. Why is it, for instance, that, as I heard one of the experts on BBC news say this morning, someone can be free of the symptoms of the disease but unknowingly be a carrier of it, even though they are vaccinated? Again, there are questions to be asked.
Immunology research during covid-19 has been supported well by Government, funding agencies and institutions. Our Ministers and our Prime Minister made it a priority. That is why we are where we are today, to the envy of much of the world. Immunology, especially population-based studies of actual immune responses in real people with and without disease was already a real strength of UK research to start with, and we should be grateful for that. The population-based research is facilitated by standardised procedures for researchers to access patients and their samples across the UK through the NHS. Again, we are eternally thankful for all that. The National Institute for Health Research played a major role in bringing together academic researchers and clinical services during the pandemic, and has played a crucial role in ensuring that we learn as we go, in real time. I especially thank the NIHR for that contribution. Many others have contributed as well, but the NIHR did a fantastic job.
The rapid adaptation of our funding processes to ensure that the Government research funding flowed to
collaborative groups of researchers who were well placed to deliver answers to crucial questions quickly was also a major strength. For example, UK-CIC, which I have mentioned, is another visionary group that strategised, planned and responded in a positive way. Its UK-wide study was launched to tackle some of the key questions about the immune system’s response to SARS-CoV-2 and help us control the covid-19 pandemic. It received some £6.5 million in funding over 12 months from UK Research and Innovation and NIHR; that is the largest immunology grant awarded for tackling the covid-19 pandemic. Critically and crucially, it also incorporated a large element of patient and public involvement, bringing laypeople and those who had covid-19 into the scientific process in a scheme of work run by the British Society for Immunology. UK-CIC was funded in a way almost unique to covid-19 research, to encourage collaborative team science, individually but also through teamwork, sharing ideas, coming together, working together, and partnering. Rather than research groups competing against each other, which could have happened, the consortium brought them together with a singular target, a singular goal, and a way of doing it better together.
In UK-CIC some 20 of the UK’s leading immunology research institutes, including Ulster University in Northern Ireland—again, team UK of GB and NI working together in a very positive way—are funded as a consortium and are focused on five themes: primary immunity, protective immunity, immunopathology, cross-reactive coronavirus immunity and immune evasion. Its successes and novel discoveries are numerous. We look at that collective and how 20 different groups came together and how they solved problems collectively. We are four regions of the United Kingdom of Great Britain and Northern Ireland, but we can share the ideas, so we can have the ideas in Scotland in Northern Ireland, Wales or England, and vice versa.
UK-CIC has contributed to the development of covid-19 therapeutics through exploration of the role for interferon therapy and determining the effectiveness of dexamethasone. It has made a major contribution to vaccine development studies including through showing that an extended dosing schedule is more effective than, for instance, a three-week interval. It has shown that there is a stronger antibody response to mRNA vaccines such as Pfizer and that there are stronger cellular immune responses to vaccines such as AstraZeneca. Furthermore, it has curated the largest collection of covid-19 post-mortem tissue in the world, so the evidential base is significant and ready for further investigation. It has defined the four main sub-types of inflammation in covid-19 and opened up avenues for further investigation of therapeutics. It is not just about today; it is about tomorrow and that is what I love about where we are. We are already preparing for the next one. I know the Minister will respond to that because he knows vastly more about it than I do and will be able to explain and explore that for us. UK-CIC has found that our T cell immune responses are likely to overcome mutations in the virus and remain effective. This is an incredibly complex subject matter, and so important as we look to the future and whatever comes our way.
The UK Coronavirus Immunology Consortium model has proved highly effective, and should be strongly considered as a blueprint for future funding of research. Perhaps the Minister will give his thoughts on that. I believe that it is vastly important that we do that. A
number of strengths of doing research that way were identified, including avoiding duplication of research, with complementarity built into the project design instead; the standardisation of protocols, to allow science to move forward more quickly; and the ability to carry out larger studies by using patient samples from multiple sites. Again, the teamwork and connectivity brought everyone together. That led to more robust findings being produced and more diverse patient cohorts, as well as regular engagement between groups in the consortium, helping to engender ambition and to foster a sense of scientific community, working better together.
Retaining that funding model will ensure that the infrastructure is already in place should another pandemic event occur. We hope that it does not, but we did not expect the last one; we have to be prepared for the next. That is what the debate is also about: to thank the Minister, our Government and others for our response and to ensure that we are equipped and ready for the future. That infrastructure would also tackle other societal and public health challenges, such as antimicrobial resistance, cancer immunotherapy, and ageing and dementia. In the debate on social care the other day in the House, many referred to dementia, Alzheimer’s and Parkinson’s as diseases that are perhaps more prevalent in society now than in the past. I can vouch for that, as I seem to be dealing with more of those issues in my constituency. Again, these are complex matters, and it is about working better together to try to address them.
No debate on immunology research and covid-19 in the UK would be complete without talking about the world-leading work done by the University of Oxford team in developing the Oxford-AstraZeneca vaccine. We are eternally grateful for all that they have done. It was not until 11 March 2020 that the World Health Organisation declared covid-19 to be a global pandemic, but the work that preceded the release of the Oxford-AstraZeneca vaccine had begun years before. I referred to that earlier, and it is the truth: the Oxford team began its work in 2015. I do not know whether many people know that. I did not until I researched the issue.
That work was funded by the UK Vaccine Network, a partnership between the Department of Health and Social Care and UK Research and Innovation’s Medical Research Council and Biotechnology and Biological Sciences Research Council, to find a vaccine for middle eastern respiratory syndrome, an illness caused by a different coronavirus. Not all the research was in place, but it was during this time that the team fine-tuned the adenovirus vaccine platform, and in 2018 the vaccine entered safety trials and was shown to cause no adverse responses while eliciting both cellular and antibody immune responses, and the trials suggested that two doses would be more effective than one. The lessons learned at that time could be initiated for our response to covid-19 when it started just last year.
The MERS virus has a spike protein on its surface similar to the SARS-CoV-2 spike protein, which meant, along with the previous testing of the vaccine platform technology, that the Oxford team already had an adaptable vaccine that had been tested and proved to be safe in humans. People should be made more aware of that information when they say, “You’ve brought this in. You’ve vaccinated everybody. Where’s the trial?” Well, the research started in 2015 and the trials started in 2018, then were adapted to deal with this particular
virus. We should be encouraged by what has taken place. The vaccine has been tested and proved to be safe in humans.
Once the Chinese investigators had shared the genomic sequence of SARS CoV 2, it could then be inserted into the adenovirus to produce the prototype covid-19 vaccine that entered into human trials in April 2020—about the time that covid-19 restrictions came into play. The ability to deliver such a vaccine at pace was a product of long-term funding through UKRI over more than a decade, which ensured there was an existing vaccine platform technology, alongside optimised manufacturing methods.
The Oxford-AstraZeneca vaccine development was also facilitated by a £2.6 million UKRI-NIHR rapid response grant in March 2020, just at the time we needed it. Again, our Government were in place to do that at the right time. That provided funding to conduct pre-clinical investigations and phase 1 and 2 trials, and to scale up production of the vaccine to 1 million doses by summer 2020. The researchers and all those involved were able not only to produce a cure but initiate production at the level that was needed. How grateful we are for all those superhuman efforts to bring out the vaccine to immunise the whole of the United Kingdom of Great Britain and Northern Ireland, and help third-world countries.
That is truly demonstrative of previous immunological research into infectious diseases speeding up our response to SARS-CoV-2. However, after the previous outbreaks, research into these viruses tapered off, which hampered our ability to respond to SARS-CoV-2 with as much information as we would have liked. That was unfortunate. The gaps in knowledge at the beginning of the pandemic led to some of the decisions that were made in public policy and, indeed, some mistakes that, perhaps with hindsight, could have been avoided. We have all made mistakes in life—I include myself in that, and I am sure everyone is the same—and we would change them, but we make decisions at the time that we make them.
We must not make the same mistakes again. Instead, we must continue to invest in SARS-CoV-2 and covid-19 research, immunological and otherwise, so that we are properly prepared should an event like this happen again. We should be ever thankful for where we are. Coronaviruses have particular pandemic potential, as they are able to replicate efficiently on entry to the human population and are thought by experts to be the biggest threat, so we need to get ready for the future. I know the Minister will give us some of his thoughts about how we are doing that so we are ahead of the game when it comes to responding to whatever the future may hold.
The covid-19 pandemic has also acutely illustrated that the importance of both global disease networks and global disease surveillance cannot be overstated. With the truncation or termination of many non-covid-19 immunological research projects that formed the basis of these networks and surveillance due to cuts to the official development assistance budget, it is through investing in covid-19 immunology research that we can build international collaboration, as has happened in the past, and use those relationships to ensure that we are more prepared for future infectious disease outbreaks. Perhaps the Minister can tell us a wee bit more about
how we are working internationally. Again, we can do that to everyone’s advantage. We should not be claiming it for ourselves; we can do that with other countries, and do it better together.
Of course, there are still many questions surrounding covid-19 that remain unanswered, including major ones like what the longevity of vaccine-mediated immunity will be and why some people contract long covid and others do not. I refer again to the constituent I spoke about this week. Covid-19 is unlikely to disappear completely, so it is crucial that we invest in discovering the answers to those and other key questions.
If we revert to pre-pandemic-style grant funding for covid-19 research, we will lose the progress that we made on the R&D infrastructure and the good will of the research community, which is needed to tackle these challenges properly. I seek an assurance from the Minister that we will not revert to that, but we will move forward and give the commitment that the R&D sector clearly wants. We must ensure that the current levels of funding are continued. Small studies that look at small numbers of people are not robust enough to achieve statistically significant results that can inform patient care and policy. We need to ensure that the R&D success of the past is a policy and strategy for the future. We must continue to conduct studies at the same scale, with the involvement of hundreds of thousands of people. That is the success of the covid-19 vaccine, and that is the success we want for all other pandemics that come along, to ensure long-term immune monitoring that can be applied to real-world questions and situations.
There has been an immense investment in immunology and covid-19 research over the past 18 months, which has allowed the UK to achieve some truly impressive bench-to-bedside science, such as vaccines that have gone from the laboratory to people’s arms in record time. I know there has been lots of research into how that is done, and we can only be truly impressed by it.
There has also been great leadership from the Government’s chief scientific adviser, Sir Patrick Vallance, and chief medical officer, Professor Chris Whitty, in driving forward conditions that have led to the progress and discoveries made. The pandemic has illustrated the importance of the NHS. We all love the NHS and we know how important it is. There is not a debate where we do not revere what it has done for those it has helped to heal, save and make better, and for the comfort it gives people when they need it most. It is vital to ensure that is not forgotten in future, as it allows science to operate at a huge scale.
We owe a debt of gratitude to the scientists and researchers of many different disciplines, including immunology, for their work during the pandemic. The fruits of their labour can be seen everywhere from the vaccine roll-out to today’s better survival rates for covid-19 patients in hospital, for which we are thankful. It reminds us that the work going on in labs across the country has a tangible effect on everyday life in this country. It is the working together and the investigations and tests done in universities and pharmaceutical companies with the financial backing of our Government and the push from the vaccine Minister and his team. We must ensure in the post-pandemic future that UK R&D is properly funded and given the resources needed to continue having a positive effect for everyone in society.