Making Science Better: Lessons From the COVID-19 Front
As the pandemic winds down the trick will be to prevent a return to science-as-usual.
As the SARS-CoV-2 coronavirus is ravaging the globe, the global scientific community is responding in an unprecedented way. The virus was quickly understood to be a grave and fast-moving threat that does not respect political or geographical borders. If science is to be effective against coronavirus, it too needs to be fast, global, and focused on the world’s needs. Science-as-normal will not do. So right under our noses, with few noticing, science dramatically transformed.
Although the pandemic is still spreading and researchers are still struggling to find answers, it’s not too early to start reflecting on this transformation. In fact, now is precisely the right time to consider some of these changes—else we may find ourselves unprepared for the next threat.
Normally science is slow, relatively closed, and often misaligned with public need. Medical drugs today take 12 years on average to go from lab bench to commercial shelf. Throughout science the peer review process adds months or even years to the time it takes research to see the light of day. And typically the outcomes are not freely available, nor are data or code widely shared.
Regarding misalignment, many observers have pointed out that roughly 90% of medical research is directed at problems that afflict 10% of the global population. Research into tropical diseases, for example, is massively underfunded compared with, say, cancer or genome mapping. Why doesn’t Big Pharma spend much on antibiotics, antivirals, and vaccines? The full answer is complicated, but the short answer is that there is more profit elsewhere. Drugs to treat the chronic conditions of an affluent, aging society are used every day, whereas (say) vaccines are typically used once.
In the short span of a few months, much of this has changed for COVID-19 science:
- Chinese scientists identified the novel coronavirus on January 7, sequenced its genome, and the next day shared this prepublication data with the world on virological.org.
- Just a few weeks later 117 academies, journals, institutes, and funding bodies agreed to share research and data regarding coronavirus, with a large group of publishers making articles open access.
- National science advisers from a dozen countries launched the Public Health Emergency COVID-19 Initiative, which led to even more openness and sharing.
- The US Department of Health and Human Services waived liability to drug manufacturers engaged in the fight against coronavirus, incentivizing such work.
- CORD-19 was born. It is an international set of data servers on which scientists can share data and use new artificial intelligence tools. It currently houses 130,000 entries.
- Scores of large technology companies such as IBM and AT&T took the Open COVID Pledge, offering free availability to and licenses over their intellectual property if used to fight coronavirus.
- Pharmaceutical companies have poured billions of dollars into coronavirus research and development.
- Journals are “fast tracking” the review process for submissions related to coronavirus.
- University teams worldwide have pivoted their research toward coronavirus.
- Governments have sponsored and fast-tracked clinical trials in partnership with private companies.
The combined effect of these changes has been to make coronavirus science faster, more open, and more aligned with public need. Research and data are flying around the globe at breakneck speed. CT scans made in Wuhan, China, show up in a research hospital in New York the next day. And the profit calculation changed for private companies once government eliminated liability and sponsored clinical trials. Companies then saw billions of people in well-off countries clamoring for a vaccine or treatment.
We are witnessing a sea change in one area of science. True, we’ve seen some journals open up their paywalls before, during the 2009 flu epidemic, 2015 Ebola outbreak, and 2017 Zika scare. But what is happening now is without precedent in terms of its scale, pace, resources, and types of incentives.
Not all of these changes are necessarily desirable. Private drug companies stand to make billions of dollars from research and development paid for by taxpayers. That may not be fair. And fast tracking or ignoring the peer review process or just working too quickly is a gamble. It risks putting information in the public domain that hasn’t been properly vetted, and this can damage policy. June 4 saw both the Lancet and the New England Journal of Medicine, two top medical journals, retract studies of treatments of COVID-19 due to concerns about data quality. The article in the Lancet was an influential one about chloroquine and hydroxychloroquine. The same goes for fast-tracking clinical trials, which is potentially catastrophic if important steps are skipped. So we won’t want to keep all the changes—and of course many are not sustainable either.
Yet a number of the changes are precisely what many groups have long sought. The World Health Organization, UNESCO, the International Science Council, and innumerable others have a vision of science as a global public good. They and scores of researchers and universities have repeatedly called for greater access to science and greater incentives to align research with the common good. Open access to research and data will, they argue, create a more equitable and effective science, allowing the benefits of research to better spread from the more developed to less developed world. For those of us who study science and wish to make it more socially responsible, the rapid transformation has been incredible. We’re witnessing a massive natural experiment in the social structure of science.
Once we identify some positive changes, however, it also raises huge questions: now that we have a glimpse of more socially responsible science, do we really want to go back to science-as-usual—and is it ethical to do so?
Coronavirus is hardly the only problem needing science’s help. Once we’ve opened the door to open access for coronavirus and appreciated its importance for the fight, how can we tolerate shutting it on malaria? Malaria kills approximately 400,000 people per year, especially the most vulnerable in global society. Why give free intellectual property licenses for work on coronavirus but not drug-resistant tuberculosis? Can data platforms such as CORD-19 be created for other diseases, or even more generally, set up permanently so that this kind of infrastructure doesn’t need to be created from scratch when the next disease strikes? There are responsible science initiatives for many of these other diseases, but what’s been achieved in three months for coronavirus science hasn’t been matched in decades for the others. Isn’t it time?
The US Civil War was almost unimaginably devastating, the deadliest war for Americans. On these battlefields medical field units made the first use of specialized ambulance wagons and created advances in anesthesia and surgery. Units divided themselves according to activity, separating surgery from convalescence, just as in modern hospitals. When the war was over, the country did not return to the earlier mode of health care. Ambulances, anesthesia, and other best practices were here to stay. Once the possibility of these improvements was demonstrated, it was undesirable and immoral to do otherwise.
The COVID-19 pandemic has been devastating, but one silver lining is that it is exposing injustices and inefficiencies in the global scientific system. Better, the grave threat has forced us to run a natural experiment on the structure of science, an experiment that is leading us to address some of these problems, such as better sharing of research. A basic principle of ethics is ought implies can. It states that one is morally responsible only for actions that one can in fact do. Everyone generally agrees that more socially responsible science is desirable.
Yet a research system that rewarded publications and personal achievement over the imperative to move quickly to solve urgent social problems has been slow to change its ways, often falling back on tropes such as “excellence” and “autonomy” as reasons to maintain the status quo. Meanwhile, a market-based approach to medical innovation failed to provide the economic incentives that could steer science more directly toward social benefit. Now we know that with our backs against the wall, science can quickly move in new and better ways. Morally, we have an obligation to improve science to better help the world’s worst off. Excuses for science-as-usual now look a lot hollower than they did a few months ago. COVID-19 has reminded us of what we all must know: to make a better world, science must respond to the needs of all humanity.