As head of clinical operations at Cancer Research UK, Stephen Nabarro is usually found managing first-in-human oncology clinical trials in hospitals; a vital step in medicine development that has been his bread and butter since he jumped from academia to the charity’s Centre for Drug Development more than 13 years ago.
The CDD typically works with academics, pharma and biotech sectors across the globe to take promising discoveries from the laboratory into clinical trials.
When the pandemic struck, Nabarro’s team reached out to the wider cancer research community to see how it could apply its expertise to the global hunt for effective therapies that would combat Covid-19.
They would soon become one part of a Herculean voluntary sector effort to support the UK into a post-pandemic world.
Research and kit
As the scale of the coronavirus crisis became clear, hopes were pinned on science – and a vaccine – to find a way out. Within a few days of his offer, Nabarro was approached by Dr Bobojon Nazarov, founder of biotech company Latus Therapeutics, which had partnered with another company, Ono Pharmaceutical, for the supply of a drug called Camostat.
“We jumped at the opportunity, because there was excellent scientific rationale for the potential of repurposing Camostat to block the virus entering human cells,” says Nabarro.
“Camostat should prevent the severe symptoms of coronavirus infection, which can be seen in certain cancer patients whose immune systems may be compromised while undergoing treatment.”
The team launched a drug trial under the name ‘Spike-1’, aimed at people over the age of 18 who tested positive for coronavirus, but were well enough to stay at home. By reducing the number of people who needed to be hospitalised, they could ease some of the strain on the healthcare system.
But the struggle to beat the virus was not only about preventing the NHS from being overwhelmed: it strikes at the heart of the charity’s aims, as the knock-on effect of the pandemic is a delay in cancer research and treatment.
“Helping to fight the pandemic is one of the best things we can do right now to support people affected by cancer,” says Nabarro.
While some Cancer Research UK staff members ran nationwide trials from their dining tables, others turned their living rooms into 3D-printing studios.
The shortage of personal protective equipment for NHS and social care workers made headlines throughout the pandemic, with pictures of healthcare workers in makeshift gear made from repurposed bin bags prompting difficult questions about the government’s procurement processes.
For those on the front line of the crisis, aprons, gloves, surgical masks and eye protection literally became lifesavers.
“There is this very public discussion about the lack of personal protective equipment for different health care professionals in the NHS,” says Marcel Gehrung, a PhD student at the Cancer Research UK Cambridge Institute, who investigates machine learning applications in healthcare, with a focus on medical imaging.
Earlier in the pandemic, Gehrung and his team were asked about sourcing PPE by the nurses running the Cytosponge testing facility at Addenbrooke’s hospital in Cambridge. After wondering where they could source face masks, Gehrung took matters into his own hands.
“I started talking to our institute director and director of operations, and said that we could actually use the Institute’s printers to make more visors.”
Gehrung transported the equipment, which wasn’t being used at the time, to his home in Cambridge, and has been producing visors using multiple 3D printers there ever since.
Steven Bagley, head of visualisation, irradiation and analysis at the Cancer Research UK Manchester Institute, where he develops and hosts equipment for the study of cancer, has been on the same mission, printing an average of 20 face shields a day.
“I was coming into the labs, as I need to maintain the equipment so it is still operational, and it was relatively easy to devote some of this time to 3D printing face shields,” he says.
Bagley’s work has largely been remote for the past year, with the team operating the laboratory robotic systems to collect data and analyse the images from home.
“I haven’t missed the commute,” he says, “but my role is collaborative and involves bouncing ideas off people, usually from different fields. During the pandemic this has been really missed; I’m looking forward to being able to discuss science and new developments face-to-face.”
Making space
In the first days of December 2020, the Pfizer BioNTech vaccine, and shortly after the Oxford/AstraZeneca vaccine, passed safety and efficacy tests, and were approved for use in the UK.
The race to vaccinate the nation was on and the voluntary sector again stepped up to the plate, with everything from cathedrals to museums and heritage centres repurposing spaces in readiness for the rollout.
Biomedical research charity the Francis Crick Institute partnered with University College London Hospitals to set up a large-scale vaccination centre that opened at the end of January. It sits within the Crick’s Manby Gallery, separate to ongoing research, with the capacity to vaccinate up to 1,000 people a day, seven days a week. More than 300 researchers and staff volunteered to help with the programme.
Lucy Collinson normally leads the Electron Microscopy Science Technology Platform at the research centre, a role that involves imaging across scales from as small as cells and proteins to whole organisms.
“The microscopes are like the ones you will remember from school, but on steroids,” she says. Her work is one of the key diagnostic techniques used to help understand viruses – with the first coronavirus seen and named by an electron microscopist.
Collinson put her name down to volunteer as soon as the Institute asked, describing it as an amazing opportunity to become part of a national effort. Swapping microscopes for needles as the first frontline workers walked through the Crick’s doors was an exhilarating experience, but came with a degree of trepidation. Collinson laughs at the memory of giving trained NHS staff an injection, but says most people were just happy and relieved to be there.
“We were given a lot of training and it was actually nice to just see and talk to new people,” she says. “You provide reassurance, and there’s a mood that people can see the way out of this [pandemic] now.”
Dreaming of a time beyond lockdown Collinson adds: “It would be nice to walk around somewhere that isn’t Camberwell – maybe Cornwall would be a good place to start.”
Fellow Crick staffer Maria Ocampo-Hafalla helps engage local students and schools with the institute’s work as part of the charity’s education team, but her desire to volunteer was inspired by those much closer to home.
“As someone who has family members on the front lines of our healthcare system, so many people I love are doing their very best to look after all of us,” she explains.
“It helped me do something meaningful and purposeful at a time where I felt I had so little control over so many other things. And I say that as a person speaking from a position of privilege, so it was a way to keep my family safe and to try to help people.”
She grows visibly upset as she speaks about the people she lost to the virus among her extended family, friends, and local community – a reminder of the profound and personal grief the year has brought to so many.
“If I can do something that helps another family avoid that loss I will,” Ocampo-Hafalla says. “Particularly during this time, where you don’t have the opportunity to hold their hand and to say goodbye – any sort of loss is devastating, but to have that loss without closure, it is just overwhelming.”
As a volunteer vaccinator, she also bears witness to bright moments of hope. “A lady came [to be vaccinated] with her daughter on her birthday, it was her birthday gift to herself,” she says. “Her daughter was there to document the occasion and they took photos. I was just really cheered by that interaction.”
As someone who normally keeps very busy, Ocampo-Hafalla has learned to appreciate “the miracle in the mundane”, slow down and have a chance to reflect on what’s really important.
“Some people are fighting battles you can’t see, and after living through this pandemic, one thing I can control is putting a little bit more kindness out into the world,” she says.
The volunteer drive
More than 400,000 people signed up to become NHS Volunteer Responders in a single day at the end of March 2020. Participants in the support programme, delivered by the Royal Voluntary Service, have since answered more than 1.5m requests for help with shopping deliveries, given lifts to medical appointments, made check-in and chat calls – and are now taking on stewarding shifts at vaccination sites.
Volunteer stewards help to ensure the safe and efficient movement of people throughout the site, combined with a patient advocate element to identify anyone who may need extra help and support.
Stephanie Benelli has been working at an RVS volunteer centre in Wembley since the beginning of January, after being placed on furlough from her role as a supervisor at a hotel. Supporting the pandemic effort was particularly close to her heart because she lost a close family member to the virus.
“It’s really nice to see how happy people are after receiving their jab. I met two sisters in their 80s who were living together and it was heartwarming to see their excitement at being vaccinated,” she says.
“They told me they were going to celebrate together that evening and toast being one step closer to getting their lives back. It’s such an amazing thing to be part of.”
Benelli says the work she is doing brings a feeling of being part of something bigger, describing the importance of connecting and communicating with people who may be experiencing their first interaction with someone new for many months.
Previous volunteering experience helped her prepare for her time at the vaccination centre: “I’ve worked with children and the elderly before, and finding a way to connect in a respectful way is really important: put yourself in their shoes for a moment and think about their experience.”
First-aid charity St John Ambulance has trained more than 30,000 volunteers to assist with the vaccination rollout.
Mausum Rathod has volunteered with the charity for four years, and during the first national lockdown helped to co-ordinate the deployment of ambulances across London.
“I joined the charity through the First Aid society at my university,” the 23-year-old says. “I come from a large family with lots of little cousins, so I wanted to be sure I’d know what to do if they ever needed first aid.”
A visual effects artist with credits on major films starring the likes of Liam Neeson and who has rubbed shoulders on set with Renée Zellweger and Michael Gambon, Rathod is looking forward to getting back into the field after completing her volunteer vaccination training.
“We’ve all felt the effects of the pandemic over the last year and, as St John volunteers, we’re fortunate to be able to do something to help,” she says. “It’s a step toward giving some normality back to people who’ve been stuck in their homes since last March.”
Rathod also describes a pressing need for people like her working on the front line.
“I’ve had first-hand experience of BAME patients accessing healthcare, and I feel it’s important to increase the number of St John volunteers from BAME backgrounds, to help bridge the gap with patients who may not speak English as their first language,” she says.
Bringing knowledge
More than 127,000 people in the UK have died after testing positive for Covid-19, the fifth-highest official national toll in the world. And while the country has benefited from one of the world’s fastest vaccine rollouts, with (at the time of writing) more than half of the adult population having already received at least one dose, there are disparities in the data.
BAME communities in Britain are both more likely to die from Covid-19, and more reluctant to receive the vaccines – with official data showing many people from minoritised backgrounds are not turning up.
Nearly all early recipients of the vaccines in England, as of 2 February, were white, according to analysis of NHS data by the Royal College of General Practitioners. White people were more than twice as likely to receive the jab than Black British people, and one-and-a-half times more likely than those with Asian heritage.
“The coronavirus crisis in Britain has exposed health disparities between different ethnic groups,” Kunle Olulode, chief executive of Black and minority ethnic advocacy charity Voice4Change England explains. “Black and Asian people in England are up to 50 per cent more likely to die after becoming infected with the virus, and tend to live in poor, overcrowded households and have jobs that put them at greater risk.”
This is complicated by misinformation spread through social media and messaging apps, coupled with mistrust of the government and an appalling legacy of medical experiments conducted on Black people, which have stoked vaccine hesitancy in these groups.
“When you look at things like the rollout of the polio vaccine in Lagos in the 1990s, or the testing of HIV drugs on the African continent, Black people have historically been mistreated in the name of science,” explains Olulode.
“They are concerned about putting themselves forward for something they think might be experimental. Now at this point, things aren’t actually experimental, and that’s what we need to get people to understand.”
Charities that serve BAME communities play a crucial role in overcoming this challenge, with Voice4Change England and its wider networks working to break down the understandable walls of skepticism that cut across class divides.
Olulode recently organised a live online event with several race equality groups, joined by the government’s chief medical officer, Professor Chris Whitty, vaccines minister Nadhim Zawhawi, and other senior GPs and medical experts, to discuss the specific challenges relating to vaccine uptake among vulnerable communities.
“Now we’re going into debates from the vaccine to vaccination passports, which brings new challenges,” Olulode says.
He views the pandemic as an opportunity to re-engage with a new social contract: one that will include thinking about trust in political institutions and the voluntary sector’s future role in society.
“In the BAME community there has definitely been a positive trend in terms of vaccine take-up,” Olulode says. “But when you look at the inequalities that will still need to be addressed coming out of the pandemic, people talk about going ‘back to normal’ – that ‘normal’ simply wasn’t good enough.”
When engaging with individuals and communities in the future, he says decisions should not be made under coercion, but based on trust. As the mobilisation of charities in this latest phase of the pandemic once again shows, the third sector has a vital role to play.
