The COVID-19 pandemic is the greatest challenge in peacetime for more than 100 years and impacted everyone, everywhere.
World leaders navigating the complexities of a global pandemic depend on researchers and scientists for guidance and insight. Put simply, science and research has never been more important.
At the forefront of research around the world
The scientific community has shown an unprecedented combination of dedication, collaboration and transparency to help tackle the crisis. As a small but specialist institution, LSHTM has punched above its weight to make a vital contribution to national and international efforts, from modelling the spread, control measures and impact of the virus, to tracking attitudes and sentiments around vaccines, and revealing the extent of the harsh inequalities in society that COVID-19 has exposed and exacerbated.
Since LSHTM’s response to the West African Ebola epidemic (2014-16), an institutional priority has been to strengthen research and education on emerging infections and preparing for and responding to epidemics. It has built strong networks and vital collaborative partnerships with organisations around the world. This meant LSHTM was in a unique position to act when a novel coronavirus emerged at the end of 2019 and rapidly spread across the world.
On 6 February 2020 LSHTM held its first meeting of a new institutional taskforce to coordinate research efforts, enabling new initiatives to get under way at speed. Researchers worked around the clock to generate vital data on COVID-19, control measures, and its potential impact. Research activities have spanned the molecular to the global, the theoretical to the applied, and the analytical to the political. Understanding how transmissible COVID-19 is, and how quickly it might spread, was crucial information for policymakers in the early days of the pandemic. The estimates generated by world-leading mathematical modellers supported governments to make evidence-based decisions on how best to protect their citizens and control the disease.
The modelling team’s work early in the pandemic included calculating critical care capacity, revealing the urgent need for routine immunisation to continue during the pandemic, and examining potential response strategies for African countries. As the pandemic progressed, their work helped reveal the potential threats posed by SARS-CoV-2 variants and that Government interventions rather than weather or seasonal conditions were primarily curbing its spread.
Recognising that effective outbreak science needs to be fast, open and collaborative, LSHTM was the first institution to set up its own dedicated online repository to make research on the mathematical modelling of COVID-19 freely available. This went live on 28 Jan 2020, before the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern. Since then, modellers based in the Centre for Mathematical Modelling of Infectious Diseases (CMMID) at LSHTM have continued to produce key analyses and projections, responding quickly to developments such as the emergence of variants, including Delta and Omicron. LSHTM electronic health records experts also quickly co-founded the OpenSAFELY platform to enable secure access to millions of NHS records for vital COVID-19 research, leading to a vast output of highly influential studies including key evidence on age, disability and ethnicity as risk factors.
LSHTM laboratory scientists were also busy from the start, isolating and sequencing the coronavirus that causes COVID-19 to understand the pace and significance of any mutations. Working with partners in Hong Kong, teams led analysis of a long-haul flight that provided the first genetic evidence of in-flight transmission of the SARS-CoV-2 virus. In May 2020, LSHTM analysis of the worldwide effort to sequence the coronavirus genome revealed the scale of the genetic changes that were occurring in the virus as it was spreading across the world.
Adding value through different disciplines
While many LSHTM experts have worked on vastly complex mathematical modelling and genomic analysis, others have focused on simple yet highly effective measures that are often overlooked: hygiene practices. Launched in Spring 2020, the ‘Hygiene Hub’ linked science to action to help save lives during COVID-19 by bringing together governments, international agencies, NGOs and leading public health experts from across the world to share information and expertise to combat COVID-19. LSHTM teams also provided scientific expertise to the Hygiene and Behaviour Change Coalition – a £100m programme led by the UK government and British business Unilever providing resources, technical support, hygiene promotion materials, soap and sanitiser to low-resource settings. By April 2021, their global handwashing campaign had reached more than a billion people.
Social scientists worked to predict the impact of UK schools reopening on transmission, informing the decision to partially reopen schools on 1 June 2020. They co-developed an evidence-based theory of change for reducing COVID-19 transmission in reopened schools, which was presented to the UK Department for Education and informed guidance for schools for their safe reopening.
With COVID-19 requiring governments to develop and evaluate a vast amount of policies and guidance, they urgently needed evidence on the financing, costs and impact of COVID-19 to enable appraisal of different investments and options that would best protect the health of populations. Health economists created the C19economics platform to support policymakers and researchers working in low- and middle-income countries to plan their responses.
The COVID-19 pandemic is not just a health problem but is also fuelling an infodemic on an unprecedented scale. As rumours and misinformation about COVID-19 began to spread, particularly relating to vaccines, LSHTM experts have been uniquely placed to analyse, detect, diagnose and manage this problem by mapping public sentiment and experiences in real time. Vaccine confidence experts have been producing reports to inform global responses and working on campaigns to address possible resistance to a COVID-19 vaccine among populations in the UK and worldwide.
Staff were quick to adapt and innovate
Teams pivoted their research to address urgent needs in the COVID-19 response. Having successfully shown, pre-pandemic, that specially trained dogs could detect malaria, researchers rapidly investigated whether medical detection dogs could be trained to detect COVID-19. In May 2020 this research, funded by the Department of Health & Social Care, got under way and is now unlocking the ability to provide rapid, non-invasive testing measures for COVID-19 and high volumes of screening at points of entry and public places.
LSHTM is also home to the UK Public Health Rapid Support Team (UK-PHRST), delivered in partnership with UK Health Security Agency, and funded by UK aid from the Department of Health and Social Care. This team supports low- and middle-income countries in investigating and responding to disease outbreaks and conducts research to improve our response to future epidemics. Throughout the pandemic they deployed to support the COVID-19 response at Africa Centres for Disease Control in Ethiopia, WHO Western Pacific Regional Office in the Philippines, and WHO Nepal. The stopping of flights and rapid closure of borders globally saw the team quickly adapt to remote working, continuing the support they had initiated with colleagues overseas alongside in-person deployments where possible. Recent UK-PHRST deployments include to Dhaka, Bangladesh through WHO Global Outbreak Alert and Response Network (GOARN) where the team supported the WHO Country Office in reviewing the national COVID-19 surveillance strategy and presenting recommendations. A UK-PHRST field epidemiologist and public health microbiologist deployed to Cambodia to support the response to COVID-19 alongside colleagues in the WHO Country Office, Phnom Pehn, to manage COVID-19 case reporting, analysing multisource surveillance data, participating in field missions for outbreak investigations as well as developing guidelines for surveillance and risk assessment for COVID-19.
Approximately 1,700 of LSHTM staff (c. 50%) are based in The Gambia and Uganda. They have been providing critical frontline support to government and continental COVID-19 responses. In Uganda, researchers evaluated SARS CoV-2 rapid diagnostic tests and PCR kits, and generated the first Ugandan SARS-CoV-2 full genomes through rapid local sequencing. This helped Uganda to understand the disease, and monitor and control virus transmission. They also secured test reagents and personal protective equipment on behalf of the WHO in support of the national testing effort.
The MRC Unit The Gambia at LSHTM ran the country’s only COVID-19 diagnostics centre and this remained so until June 2020 when the National Public Health Laboratories began testing, following technical and equipment support from our laboratory team. They rapidly built three facilities to increase the number of hospital beds across the country and provide crucial clinical care for COVID-19 patients. Teams produced 3D-printed PPE and cloth face masks in collaboration with local businesses, and supported the Gambian Ministry of Health’s preparations for the national COVID-19 vaccination programme. LSHTM experts also created a rumour-tracking app to identify and combat misinformation about COVID-19 circulating among the populations in The Gambia and neighbouring Senegal.
In Zimbabwe, severe economic pressures on the health system, poor retention of healthcare staff due to low salaries, and doctor and nurse strikes were leading to hospital closures and increased death rates. This was exacerbated by the few remaining staff often not coming to work due to COVID-19 or lack of personal protective equipment. The team in Harare established and led a special COVID-19 service at the main hospital and crowdfunded so that all staff could be paid a salary top-up and continue working, ensuring the service operated effectively and saved lives.
As global focus and resources have prioritised COVID-19, this has had indirect effects and detrimental public health consequences for other important health issues such as TB, malaria, maternal and child health, setting back progress and leading to increased illness and deaths. Research has helped to understand and mitigate these impacts, and that work continues apace.
Training the future generation of global health leaders
As the novel coronavirus began to spread around the world, there was an urgent need to share knowledge that would help inform those responding to the unfolding crisis, as well as educate the general public. Now, more than ever, the world needed to understand public health.
Experts from the UK-PHRST quickly developed a new free online course ‘COVID-19: Tackling the Novel Coronavirus’, providing an understanding of the emergence of COVID-19 and the response going forward. It became the second largest ever course launched on FutureLearn with more than 208,000 users from 189 countries when it first ran in March-April 2020.
The team working on training dogs to sniff out COVID-19 also developed a suite of educational resources for children and teenagers to educate, empower and inspire. They worked with famous children’s author and illustrator Lydia Monks to create a new, reassuring character called ‘Dr Dog’ to support young children and families. For older children (ages 6-12), ‘Hans’ was created as a fun character explaining the science behind coronavirus and interpreting government advice into easy-to-understand guidance. For teenagers and young adults, the team created a four-week online course available for free via the Open University’s Open Learn Create platform.
LSHTM experts also provided input into the e-book ‘Coronavirus: a book for children’ which was published under creative commons licence. The print edition raised £30,000 for NHS Charities Together, and the book won a FutureBook ‘Best of Lockdown’ award.
LSHTM has always proudly trained future health leaders, managers and researchers who share its mission to improve health worldwide, and this was nowhere more evident than among the hundreds of students who volunteered to help with COVID-19 research response alongside their studies. Early in the outbreak LSHTM’s Chinese-speaking students helped the COVID-19 Taskforce translate initial data and reports coming out of Wuhan, providing valuable support to our teams of mathematical modellers.
More than 1,200 members of the student and alumni community from over 40 countries volunteered to support rapid data work in response to the outbreak, supporting mathematical modellers and geographic information system experts. One such project produced a WHO database of global interventions in response to the pandemic, allowing international comparisons and informing response efforts. This gave volunteers a powerful way to develop and use their skills and give back to the global community. Volunteers said the project helped give them structure and meaning during a very challenging year.
Engagement and outreach to support public health
Research and education has only been part of the story. Many clinically trained staff and students returned to work in the NHS. Academics and alumni advised governments in the UK and many other countries, and organisations including the WHO and the Africa Centres for Disease Control and Prevention (Africa CDC). And with many staff based in Africa, they have been helping to scale up surveillance, diagnostic and testing capacity, supporting national governments and Ministries of Health on mitigation efforts, treating COVID-19 patients in specialist clinics, and strengthening Africa’s overall preparedness measures through genome sequencing to better understand the movement of the virus.
From the outset of the pandemic, experts have provided independent and authoritative advice to policymakers around the world to inform the response to COVID-19. LSHTM has 21 members on the UK Government’s Scientific Advisory Group for Emergencies (SAGE) expert advisory groups as well as three experts on WHO SAGE Working Group on COVID-19 vaccines. Then Director, Professor Peter Piot, was appointed to the post of Special Advisor to the President of the European Commission, Ursula van der Leyen, on research and innovation for COVID-19. He also testified to the UK House of Lords Science & Technology Select Committee inquiry into the ‘Science of COVID-19’, and many more LSHTM experts submitted evidence and spoke at other parliamentary inquiries on COVID-19.
A series of tools and campaigns to inform and engage policymakers researchers and the public was rapidly developed, including a hugely popular COVID-19 vaccine tracker from the Vaccine Centre which provides a database of vaccine candidates, clinical trial timelines and published trial reports.
Vaccine hesitancy experts launched Team Halo, a campaign on TikTok and Instagram where scientists working on COVID-19 vaccines made short videos explaining their part in the vaccine effort.
A new podcast launched in January 2020 provided updates on the latest global situation, new scientific understanding, and thoughts on how the pandemic would evolve. LSHTM Viral became the 13th most popular science podcast in the UK on Spotify for 2020, with episodes listened to in 170+ countries around the world. In March 2020, LSHTM began a series of live Q&A broadcasts on YouTube and Twitter, giving the public the opportunity to ask questions about COVID-19 directly to our world-leading experts.
Towards the end of 2020, LSHTM joined organisations across the UK calling for a ‘Decade of Health’ as part of a campaign led by the Bill & Melinda Gates Foundation to demonstrate the importance of science, innovation and collaboration.
The impact of this wide-ranging collective response to COVID-19 has been recognised by the Queen, who recently bestowed the Queen’s Anniversary Prize on the London School of Hygiene & Tropical Medicine.
Liam Smeeth is keen to highlight that this is not just a reflection on the research talent at LSHTM.
“It’s a credit to all our staff, students, alumni and partners who have united to lessen the impact of the pandemic and make sure the world is prepared for future crises. It has been a true team effort.”
Professor Liam Smeeth, Director of LSHTM
But as welcome as this recognition is, COVID-19 is here to stay and the likelihood of more threats around the corner is high.
LSHTM is constantly looking to the future and playing its part in making sure the world is ready for the next epidemic. The new Centre for Epidemic Preparedness & Response draws on its unique position to bring together insights and innovations from around the world to help improve how epidemics are tackled wherever they might occur.
The impact of the pandemic has been far-reaching and will be felt for some time. LSHTM continues to work around the clock with partners across the globe to lessen the impact of COVID-19 and ensure that we are prepared for future crises.
We hope you enjoyed reading about our work in this feature. If you are interested in supporting projects like these and the many others we are leading to improve health worldwide, we would be delighted to hear from you. There are many ways you can make a gift to the School, from wherever you are in the world. Each and every gift we receive makes an impact, from funding scholarships, to updating our facilities or investing in new avenues of research. Whether it’s a gift of £5 or £500,000 your generosity will support our mission to improve health in the UK and around the world.