Unleashing the potential of global Britain for life sciences: Part Two
By World Pharmaceutical and Biotech Journal-
“We will only get maximum benefit for our patients and populations if we work together” – Professor Dame Sue Hill, Chief Scientific Officer for England and Senior Responsible Officer of Genomics at NHS England
Continuing a discussion on the role of global Britain in life sciences hosted by IQVIA and Public Policy Projects, chair of the webinar Angela McFarlane welcomed contributions from Professor Naomi Allen and Professor Dame Sue Hill.
Taking cautious strides
Chief Scientist at UK Biobank and Professor of Epidemiology at Nuffield Department for Population Health at the University of Oxford, Professor Naomi Allen, shared Dr Hackett’s views of the challenges facing experts, yet remained positive about Britain's position. UK Biobank has already had great success precisely because they have actioned the linkage between data and clinical trials which Dr Hackett emphasised in her presentation. It is the “size, standardisation and linkage to clinical records” of UK Biobank which enabled scientists to transform how they approach issues such as heart disease. With the data of half a million participants, polygenic risk scores (PRS) helped medical scientists realise heart disease was polygenic rather than monogenic as previously believed. Professor Allen cited a use-case where a better understanding of how heart disease is tied more closely to genetics than previously thought will help clinicians identify those at risk earlier and make treatments more viable.
Whilst Professor Allen is certain that “genomic sequencing will massively increase the potential to discover drug targets and advance personalised medicine”, she is also skeptical of the early results. This is because the PRS scores are “almost exclusively based on Caucasian data”, meaning that, if this is not rectified, members of Black and Minority Ethnic (BAME) communities are less likely to see the benefits of precision medicine. As such, the “clinical utility of these PLOS scores is not clearly established,” she argued and, in the case of cardiovascular disease amongst the general population, “only a modest improvement” was noted when genomic data was put into practice according to an article in PLoS Medicine.
Though UK Biobank serves as the “most accessible biomedical data resource in the world”, Professor Allen detailed the current and future issues with genomic data analysis. As mentioned by Dr Hackett, such vast quantities of complex data challenge understanding and increase the difficulty of analysis. Sourcing and training qualified data scientists will be a major challenge, one made exponentially more troubling in consideration of funding obscurity. Collaboration is the key but, to facilitate this collaboration, stable and high-capacity infrastructure is a necessity.
Before handing over to the next speaker, McFarlane emphasised the importance of public trust and consent in relation to the use of health data: the value is not in the data per se, but in the clinical decision-making it can inform. Exampling the public response to being asked to share their health data for research and tracking during Covid-19, McFarlane and Professor Allen were optimistic about gaining public trust. Professor Allen added that, whilst there will always exist a “natural sensitivity over genomic data”, so long as clinicians can “demonstrate [its] clinical value” patients will place their faith in genomics. Consistent feedback is Professor Allen’s recommendation, as this would showcase in real-time the impact of patients’ data in their own care and the treatment of others, ultimately helping to justify the data collection.
Driving change through NHS infrastructure
Continuing the topic of infrastructure, Professor Dame Sue Hill, Chief Scientific Officer for England and Senior Responsible Officer of Genomics at NHS England, detailed the current and planned expansion of the genomics strategy in the UK. Professor Hill began by presenting her primary aim: “to convince you that part of the reason why the UK is going to be so important in genomics research industry collaboration and precision medicine is most definitely because we have a National Health Service and the infrastructure we are putting in place in England will support that endeavor”. Gesturing at the existing NHS infrastructure which leads the world in sequencing capacity for Covid-19, and in agreement with the previous two speakers, Professor Hill advocated for even greater infrastructure development to support further genomic work.
Through the Implementation Working Groups, each of the “four nation[s]” of the UK have rallied behind the “NHS’ commitment and funding for five-hundred thousand whole-genome sequences undertaken as part of routine diagnostics […] and making it a world first”, demonstrating an existing capacity and aspiration for wide-scale collaborative strategy. This capacity exists within the NHS in the form of the Genomic Medicine Service which has already “contributed over one hundred and twenty thousand genomes from routine care”, the results of which “were all validated and returned to clinicians, and individual patients and their families”. The seven Genomic Laboratory Hubs (GLHs) which deal with this data follow the “mandated” National Genomic Test Directory, ensuring that “eligible conditions” were met and processes were completed according to pre-planned strategies. Partnership between the NHS and Genomics England, Professor Hill asserted, means not only that the capacity for British genomes is accounted for but sequences incoming from around the world are too, marking a “tripling to a quadrupling” of the budget allocated by the NHS to genomics research.
We are “already seeing significant improvement in patient outcomes” as a result of the National Genomic Test Directory she argued, adding that, with further development and budget, NHS staff would have the opportunity to “fast track” patients who need more urgent care, provide a greater degree of personalised care, and better predict “drug resistance[s]”. Her largest concern is staff training. “We need to develop our workforce” if we are to embed genomics and data collection into everyday care. Embedding genomics into everyday care and treatment would require building public and patient trust in the system, a trust most effectively built through rigorous staff training and more thoughtful execution. Professor Hill was optimistic about a pilot scheme, in partnership with GRAIL, aiming to improve the early detection of cancers in 165,000 patients. The success of such schemes, especially in relation to key public health concerns such as cancer, is how this trust will develop.
Professor Hill advocated for cooperation nationally and internationally: “we will only get maximum benefit for our patients and populations if we work together”. She was asked how the NHS can ensure it collects enough data regarding underserved communities, such as ethnic minorities. This was in relation to the research demonstrating how BAME communities had suffered disproportionately from Covid-19. Echoing Professor Allen in recognising and emphasising the importance of the issue, Professor Hill advocated for “special approaches for certain groups”, creating an airtight and inclusive strategy, and then “following it carefully”. Above all, accessibility is vital to genomics as it is only through “equitable access to genomic testing and subsequent treatments” that the practice will prove most effective.
Before moving on, a third poll was presented to attendees, inviting participants to share how likely their organisation would be to embed the UK Genomics Strategy in their research and precision medicine strategy programmes. A majority responded in favour.
Part one of the discussion can be found here.
A full recording of the session can be accessed here. Part two of the feature will be published on Tuesday 26 April 2021.
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