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Centralisation has set back the fight against covid

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In May last year, Radix published a paper called Guarded Hope in the Time of Coronavirus.  Like many others, we under-estimated the speed with which a vaccine might be developed as well as the threat from a second wave, but even then we were making the argument that, in the long term, treatments – anti-virals – would also need to be at the forefront of the global response to the pandemic.

Subsequently, even with the success of the vaccine roll out in the UK, we continue to believe in the critical importance of anti-virals.  The current tsunami of covid sweeping India demonstrates that, beyond a handful of highly developed countries with first rate health services, stopping the coronavirus, when rampant, by relying solely on vaccines and public health measures is unrealistic.

It will be near impossible to create herd immunity over the entire world population. Finding an effective anti-viral treatment that could significantly reduce the lethality of covid will be a necessary additional bullet in the armoury, not least because anti-virals are cheap and easy to manufacture, transport and deliver.

So treatments matter, but it’s taken way too long for the government to understand that.  

For example, for the best part of a year, Chelsea and Westminster Hospital Trust’s Pioneer trial – which has been seeking to evaluate the potential impact of a promising anti-viral, Favipiravir, has been de-prioritised and received little support.   The Pioneer trial is concerned with the early treatment of covid, when symptoms first develop, so as to prevent the hospitalisations that have overwhelmed health services and driven the need for lockdowns.

The trial was launched in record time, but by early May hospital admissions in the UK had fallen significantly.  Priority status was afforded by the Government to the PLATFORM, RECOVERY and PRINCIPLE studies, concerned with late treatment, and all UK hospitals were expected to recruit to these studies, so Chelsea and Westminster were obliged to work with hospitals in Brazil and Mexico where there was an ongoing stream of patients to recruit. And Pioneer was not alone.  Other anti-viral studies such as GOTHEFIX in Glasgow and many others were also left behind.    

Why?  Because the government had become hostage to the Oxford research group that has led most of the major trials for vaccines and treatments, and monopolised the process.  From the start, their focus was on saving advanced stage patients, when looking for early treatments should have been equal priority, to prevent people from getting very sick in the first place and to protect the NHS and its staff. 

Of course, it is understandable that the government was keen to concentrate efforts and there have been some useful findings from RECOVERY.  But ultimately the focus on this one study to the exclusion of many others has been self-defeating and a repeat of the mistake made in attempting initially to centralise testing, and track and trace.  Time again, the government has taken an initial decision to centralise its responses to covid only later to realise that local knowledge and a diversity of viewpoints are much more likely to succeed.

And so, a couple weeks ago, the government suddenly announced that it was setting up a taskforce to identify anti-virals specifically to be used in the early treatment of sufferers. But they are a year later than they needed to be.  Had the government been more flexible, then we might already know whether Favipiravir was safe and effective. And we have good reason for thinking it might be.  

Several trials of Favipiravir have taken place around the world.  In June last year, a trial in Russia demonstrated both its safety and efficacy.  More than 65 per cent of those who were given the drug had no more symptoms after five days, compared with 30 per cent in the control group. On that basis it was approved for use in Russia and has now been administered to hundreds of thousands of Russian patients.  What’s more, it is one of the few anti-viral drugs which can be easily taken at home, avoiding hospitalisations.  And yet here we are in the UK, twelve months in and only now is the government putting its weight behind identifying early treatments for covid.   

Now is not the time for assigning blame but we must learn from what has gone wrong in the past to maximise progress as we move forward.  This means that the government’s new taskforce must be open to solutions wherever they come from, rather than continue to focus on Oxford.  

It must make sure that all serious trials have access to the resources (including patients) that they need to establish the efficacy (or not) of their target drugs.  More broadly, the government needs to establish a principle of decentralisation in its responses to coronavirus and it needs to invest now in anti-virals as it did last year in vaccines.

Of course, the vaccine programme is to be admired, but it can only ever be one string in our bow.  And we still have nearly 7 billion people globally to vaccinate.  In contrast, effective early treatments for covid which have the potential to keep people out of hospital, require only a (relatively) few hundred million doses at a time.  

Effective anti-virals have an essential part to play, if we are to return to normal, given a disease that clearly isn’t going away any time soon.

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Radix is the radical centre think tank. We welcome all contributions which promote system change, challenge established notions and re-imagine our societies. The views expressed here are those of the individual contributor and not necessarily shared by Radix.

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Get email notifications</p></li><li id="field_2_1" class="gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_2_1'> <span id='input_2_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_2_1_3' value='' aria-label='First name' tabindex='70' aria-required='true' placeholder='First Name*' /> <label for='input_2_1_3' class='hidden_sub_label screen-reader-text'>First</label> </span> <span id='input_2_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_2_1_6' value='' aria-label='Last name' tabindex='72' aria-required='true' placeholder='Last Name*' /> <label for='input_2_1_6' class='hidden_sub_label screen-reader-text'>Last</label> </span> </div></li><li id="field_2_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_2_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_2_2' type='email' value='' class='large' tabindex='74' placeholder='Email*' aria-required="true" aria-invalid="false" /> </div></li><li id="field_2_4" class="gfield gf-conf-check gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Confirmation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_4'><li class='gchoice gchoice_2_4_1'> <input class='gfield-choice-input' name='input_4.1' type='checkbox' value='Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by &lt;a href=&quot;"mailto:[email protected]"&quot;&gt;emailing us&lt;/a&gt; or clicking “unsubscribe” at the bottom of our emails).' id='choice_2_4_1' tabindex='75' /> <label for='choice_2_4_1' id='label_2_4_1'>Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by <a href="mailto:[email protected]">emailing us</a> or clicking “unsubscribe” at the bottom of our emails).</label> </li></ul></div></li><li id="field_2_6" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_2_6' >Name</label><div class='ginput_container'><input name='input_6' id='input_2_6' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_2_6'>This field is for validation purposes and should be left unchanged.</div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='SUBSCRIBE' tabindex='76' onclick='if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} jQuery("#gform_2").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=69' /> <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='2' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_2' value='WyJbXSIsIjg1ZGYwZWM3YzAyMDRmYTcyZDYxNmIwMWJiNmFhYzVhIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'></iframe> <script type='text/javascript'>document.addEventListener( 'DOMContentLoaded', function($){gformInitSpinner( 2, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [2, current_page]);} );} );</script>
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[gravityform id=5 title=false description=false ajax=true tabindex=64]
<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_5' ><div id='gf_5' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_5' id='gform_5' action='/opinion/centralisation-has-set-back-the-fight-against-covid/#gf_5' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below'><li id="field_5_5" class="gfield gravity_head gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" ><h3>Get emails</h3></li><li id="field_5_1" class="gfield gfield_contains_required field_sublabel_hidden_label field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_5_1'> <span id='input_5_1_3_container' class='name_first' > <input type='text' name='input_1.3' id='input_5_1_3' value='' aria-label='First name' tabindex='65' aria-required='true' placeholder='First Name*' /> <label for='input_5_1_3' class='hidden_sub_label screen-reader-text'>First</label> </span> <span id='input_5_1_6_container' class='name_last' > <input type='text' name='input_1.6' id='input_5_1_6' value='' aria-label='Last name' tabindex='67' aria-required='true' placeholder='Last Name*' /> <label for='input_5_1_6' class='hidden_sub_label screen-reader-text'>Last</label> </span> </div></li><li id="field_5_2" class="gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_5_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_5_2' type='email' value='' class='large' tabindex='69' placeholder='Email*' aria-required="true" aria-invalid="false" /> </div></li><li id="field_5_4" class="gfield gf-conf-check gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label gfield_label_before_complex' >Confirmation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_5_4'><li class='gchoice gchoice_5_4_1'> <input class='gfield-choice-input' name='input_4.1' type='checkbox' value='Consent' id='choice_5_4_1' tabindex='70' /> <label for='choice_5_4_1' id='label_5_4_1'>Please keep me updated on new website content and Radix news. (We will process your data in accordance with our <span class="pp"><a href="https://radixuk.org/privacy-policy/">Privacy Policy</a></span>. You may withdraw this consent at any time by <a href="mailto:[email protected]">emailing us</a> or clicking “unsubscribe” at the bottom of our emails).</label> </li></ul></div></li><li id="field_5_6" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_5_6' >Phone</label><div class='ginput_container'><input name='input_6' id='input_5_6' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_5_6'>This field is for validation purposes and should be left unchanged.</div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' value='SUBSCRIBE' tabindex='71' onclick='if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} jQuery("#gform_5").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=5&amp;title=&amp;description=&amp;tabindex=64' /> <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='5' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_5' value='WyJbXSIsIjg1ZGYwZWM3YzAyMDRmYTcyZDYxNmIwMWJiNmFhYzVhIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_5' id='gform_ajax_frame_5' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'></iframe> <script type='text/javascript'>document.addEventListener( 'DOMContentLoaded', function($){gformInitSpinner( 5, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery('#gform_ajax_frame_5').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_5');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_5').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_5').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_5').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_5').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_5').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_5').val();gformInitSpinner( 5, 'https://radixuk.org/wp-content/plugins/gravityforms/images/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [5, current_page]);window['gf_submitting_5'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_5').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_5').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [5]);window['gf_submitting_5'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_5').text());}, 50);}else{jQuery('#gform_5').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [5, current_page]);} );} );</script>
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[gravityform id=6 title=false description=false ajax=true tabindex=999]
<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_6' ><div id='gf_6' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_6' id='gform_6' action='/opinion/centralisation-has-set-back-the-fight-against-covid/#gf_6' novalidate> <div class='gform_body gform-body'><ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><li id="field_6_5" class="gfield gravity_head gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" ><h3>Before you go!</h3> <p>Stay up to date with what's happening at Radix. 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