Professor Dame Anna Dominiczak on launching the Lighthouse Labs — Tea & Talk Podcast

Episode 2: Professor Dame Anna Dominiczak on launching the Lighthouse Labs

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Issue Number

9

Publication Date

December 2020

Transcription


Please note transcripts have been automatically generated so may feature mistakes.

[00:00:00] Rebekah Widdowfield: Hello, and welcome to the RSEs Tea & Talk podcast series, a program inspired by the coffee houses of the 18th century, where great thinkers would come together to discuss ideas and matters of the day. I’m Rebekah Widdowfield. And I’m Chief Executive of the Royal Society of Edinburgh, which is Scotland’s National Academy.

Our mission is to advance learning and make knowledge useful. And as part of that in this series, I’ll be speaking with some of Scotland’s leading authorities on the impact of COVID-19. The conversations are with Fellows and with members of the RSEs Post-COVID Futures Commission, we’re keen to share their expertise and experience.

You can find out more about this work at rsecovidcommission.org.uk, or follow us on Twitter @news_RSE

This week, I’m speaking with Professor Dame Anna Dominiczak [00:01:00] about the setting up of the lighthouse labs as part of the response to the COVID 19 pandemic. Professor Dominiczak, is Regius Professor of Medicine at the University of Glasgow renowned for her work on cardiovascular medical science, Professor Dominiczak is currently succonded to the UK government as director of laboratories for the COVID-19 national testing program.

So who better to speak to us on this important matter? So we’re not in a coffee house, we’re both in our own homes, which explains the occasional dips in sound quality, but I’d encourage you to grab yourself a drink or something. Sit back and listen to one of Scotland’s leading experts. Talk about things that matter.

So Anna, the development of testing capacity and capability has been one of the key aspects of the response to COVID-19. Can you tell us a little bit about why testing is so important in the management of COVID-19.

Anna Dominiczak: Yes. Thank you, Rebecca. I think testing is important for every thing in medicine and for COVID it has been very very [00:02:00] important because when we started in March or no, most of our efforts to start diagnostic testing in March, we had very little capacity and we had to very, very quickly ramp up this capacity. And I think some really interesting collaborations have formed , And I think, the WHO said very, very early that testing in that early stage, when we had no vaccine, we knew it would take a long time to get to the vaccine.

The treatments were very limited. The ability to test and isolate, those positive cases has been hugely important. And I think in the UK, the lack of readiness to do hundreds of thousands of tests was very, very [00:03:00] painfully obvious in March.

Rebekah Widdowfield: And I think I’m right in saying that the lighthouse lab in Glasgow was one of the earliest to be established in UK and possibly the first large scale testing lab in Scotland, was it?

Anna Dominiczak: Yeah.

Rebekah Widdowfield: Yeah, so –

Anna Dominiczak: First in Scotland but third in the UK.

Rebekah Widdowfield: So how did that come about and what was your role in, in getting the lab up and running?

Anna Dominiczak: Um, right, so it’s usually, uh, there were some emails that came to number of us and the emails came from various sources from The Wellcome Trust from John Bell in Oxford, from in his OLS role, um, The Office for Life Sciences, but also from Number 10 to various Vice-Chancellors across the University system. And all this emails said, we need to set up more testing because there is no [00:04:00] testing. So we picked up on this and you might remember that the first laboratory was Milton Keynes.

And there was a big push to send equipment from the universities to Milton Keynes, the molecular equipment to start the building, a very large testing capability and capacity. And we quickly realized that, you know, when you take the golden triangle, Uh, there were lots of appropriate machinery there for high throughput, uh, molecular testing, eh, and all this machines landed in Milton Keynes, hundreds of them.

We quickly realized we need something in Scotland and started talking to colleagues across the country, how to achieve this and department of health and social care had emergency activity, [00:05:00] emergency funding for the testing. That was to be UK wide from the beginning, which I felt was really positive. We wanted to get involved.

We got some advice from our industry contacts. Interestingly, we have worked for years with Thermo Fisher, uh, the company that was first in providing PCR molecular testing to check the presence of RNA of the virus and they advised, and we got some other advice. And lo and behold, on the 24th of March, I received a letter from the Cabinet Secretary for Health and Sport in Scotland to ask me to stand up the laboratory, the laboratory, that was part of the network that many, many weeks later became the Lighthouse Laboratories. So we were [00:06:00] number three after Milton Keynes and Alderly Park in Manchester.

Rebekah Widdowfield: I mean, that’s incredible really, in terms of as ordinary members of the public, if you like, you know, that was literally just a day or two after, after lockdown and already there’s this phenomenal effort going on behind the scenes, if you like – and such a huge endeavor to increase testing capacity and capability so quickly.

So what were the main challenges for you and for the team in setting up the Lighthouse Lab in Glasgow?

Anna Dominiczak: So it was mostly the team. I was just, the person could receive the letters. The team did all the work. It was absolutely amazing. Over a few days, we had 800 plus volunteers who wanted to come and help.

The response was truly amazing. It was the beginning of lockdown. As you said, we have started bringing equipment from all over the [00:07:00] university and later further a field. So the PCR machines, this very large high throughput and everything else we needed, the class two hoods and other equipment started appearing in the place that we’ve chosen.

But even more importantly, the architects, as you know all about a trace in the relatively new building at Queen Elizabeth University Hospital, the building that was jointly owned. By university and the NHS and the architects and people who build the building came spontaneously to redesign the floor very, very quickly to make it into high throughput, industrial laboratory.

The equipment was brought as by magic, partially also by the army from other places in the UK. And in two, three weeks, we were ready to start doing the work. And that was [00:08:00] unprecedented in, I think, history of building laboratories and activity. And I should say that I was told very early advice by colleagues who stood up the other two.

UK laboratories to engage industry. And this was absolutely the right way to go because we academics very good in small laboratories, but in high throughput, with the ambition to very quickly ramp up to tens and then hundreds of thousands, uh, you do need industry input and that’s been hugely important.

So. The volunteers from the university, not only our, also other universities who came to do the work and this industrial design of high throughput laboratory. And that was really what happened. Also huge [00:09:00] help from across the university. Uh, colleagues from HR from, um, uh, IT Services, everybody came together.

Nobody said no, there were no, nothing was, uh, difficult. Uh, everything was done within hours. It was amazing and uplifting experience.

Rebekah Widdowfield: I mean, I mean, it sounds, and, and all the work, again, that’s done that isn’t necessarily like hugely visible behind the scenes. Like you’re saying, I mean, it’s not an insignificant workforce, is it 800 people at any time, but particularly assembled in that way

Anna Dominiczak: We didn’t involve 800 at the beginning, there was maybe 50 then 80, then 100. Now the laboratory has more than 500 people.

Rebekah Widdowfield: And are they still volunteers from their sort of day jobs? If I can put it in those terms?

Anna Dominiczak: So in early [00:10:00] times, of course there was a lockdown , the laboratories mostly didn’t work apart from work on COVID.

So colleagues from many. Molecular laboratories volunteered. Um, at the moment it’s different. There is more permanent work force, some still from the university community, but there are also other people from various walks of life because as you know, part of the work is just unpacking boxes, et cetera.

You’re not necessarily needed to have a PhD. So we’ve brought. Broader workforce and more appropriate for various activities.

Rebekah Widdowfield: I was listening to Ottoline Leyser, the new chief executive UKRI speaking the other day, and she was speaking about the research ecosystem in a, in a very inclusive and broad way that would include the people unloading the boxes in your example just there, I mean, one of the things you talked about then Anna was about the importance of industry in terms of [00:11:00] being able to advise on throughput and, and also your earlier links with Thermo Fisher that you built on. I mean, and obviously the lab laboratory is a collaboration between academia industry and the NHS, which you sometimes call it, call the triple helix partnership.

I mean, to some extent, that seems to be a bit of a hallmark of your career, those kinds of collaborations across sectors, if you like, why, why are those so important to you? And what do you think is so beneficial about having those kinds of collaborations?

Anna Dominiczak: Yes, I think that’s a very, very interesting point.

So we have been trying to build such collaborations at the University of Glasgow and greater Glasgow and Clyde , pre COVID. And in some way it worked for us for COVID that triple helix. I think it’s really key for innovation in laboratory work in diagnostics. In also therapeutics because academia comes [00:12:00] with great ideas, but they need to be implemented.

They need to work for the NHS or other health systems and Industry is the best in doing precisely this – making it applicable, truly translational, because I think otherwise there is a tendency to publish a great paper and leave it at that. And what we actually need is to embed these discoveries. Uh, into real workflow of a clinic of a GP surgery of whatever necessary or laboratory in this case and for this to do it well, to do it in practical, beneficial way.

Industry’s much better than the rest of us. And also innovation. I think. I have experienced that for [00:13:00] real practical innovation that is applicable for health service. That’s the best combination. Uh, and, and the reason for this is that industry keeps it at the cutting edge, but very applied cutting-edge. I hope that explains it.

Rebekah Widdowfield: Yes. And it’s, and I think it also, I think sometimes debunks ideas that academia is sort of all, um, ivory tower, if you like, and not connected to the real world. I mean, do you think your background and your training as a, as a medic means that you have a particular focus on the, on the practical and the translation, or is that what sort of draws you into some of the areas of work that you’re doing now?

Anna Dominiczak: It’s I think, I think being a clinician. Always focuses the mind on this real applied end of the spectrum. At the end of the day, I’ve been trained to treat patients and even in the laboratory and doing very basic research, you always have [00:14:00] this bigger picture in your mind. And I think that’s why collaborations between fundamental discovery, science and clinicians, so important to truly get to that translation, that applicability of what we do. And I think that’s been a really, really good experience pre COVID and during COVID. And I think these laboratories will stay with us. As building blocks of future diagnostic, um, excellence. I hope.

Rebekah Widdowfield: And, uh, and I mean, I think you’ve made a really powerful case there for these kinds of partnerships, but they’re not always easy. Are they? And, and sometimes there’s talk about sort of, uh, different languages and different understandings and different priorities and different timescales – COVID maybe has helped everyone work together around a very clear outcome and goal. But how, how would you in this sort of the course of normal activity sort of [00:15:00] overcome some of those tensions, if you like, or differences of language and communication?

Anna Dominiczak: I think you absolutely right. Covid made it… You know, everybody spoke the same language. There was an emergency. We all came together, I think in a pre COVID era and post COVID I hope soon. Um, There is a need to spend time to develop common language. For me, writing proposals, getting the funding, writing the grant together. It’s a really good way to recognize that common goals, common language, I’ve always been very goal orientated. And I think if you construct a good working proposal that gets funded, then people from the beginning are together and know where they going.

And that’s really, really helpful. And that’s why, although [00:16:00] some people hate writing grants. I actually always enjoyed this because it puts everybody on the same hymn sheet, which helps as the project develops, if you gifted money by which doesn’t happen often, but if you gifted money without the set of goals and programs – much more difficult.

Rebekah Widdowfield: And it sounds like you’re building in partnership right from the beginning as well, rather than having your proposal and then bringing somebody in to help deliver it.

I mean, obviously your success in leading the establishment of the Lighthouse Laboratory in Glasgow has led to your current role, overseeing all the lighthouse labs in the, in the UK. And I was just wondering sort of what insights has that given you to, to the way things work in those labs across the UK and actually, how do they come together or work together?

Are they seven separate laboratories or is this something that brings them together into more of a parts of a whole, if I put it in those terms?

Anna Dominiczak: So they’ve always been a network. And, um, they’ve always [00:17:00] been, um, teams meetings, at least when sort of more, a couple times a week. I now bring all the site directors twice a week together and together with our clinical virology advisors.

So each laboratory has NHS or university or both based senior virologists. Who advise us on processes, problems, et cetera. All these colleagues come together twice a week with my central laboratory team, which now is bigger than it used to be. It’s been really, really interesting because. As you know, there’s been a lot of criticism of this laboratories for a variety of complex reasons.

And yet when you meet the people, I’ve now visited all but one of the existing Lighthouse Laboratories and every single one is an example of [00:18:00] enormous effort, excellence, fabulous team of people working together and bringing all these colleagues together is very, very good. It is a real network across the UK. And although each laboratory is independent and has its own rules and its own ways of working, there are lots of things that they can, we all can learn from each other.

At the very beginning, the Glasgow colleagues went to Milton Keynes and Manchester to see how it’s organized. We cross validated samples early on. So there’s been a lot of very good constructive collaboration. And I definitely see all this as a network, but having from one laboratory and understanding how it feels to be in the laboratory has been hugely useful because I have been able to tell our [00:19:00] colleagues, um, in finance, in, um, other areas in HR, et cetera, how it feels from the laboratory point of view. And I hope it’s been helpful to make things easier and better.

Rebekah Widdowfield: And, and just things. I think that people who are not involved wouldn’t know, like, I mean, just what you were saying earlier about the space having to be redesigned, all these sort of different dimensions that may be, or not immediately obvious. I guess, with the labs being set up in such quick time as well, there’ve been almost natural experiments where you’ve been able to learn from each other in terms of how things are being done differently and then see what works best.

Anna Dominiczak: Yeah, absolutely. So, as I said, we stood up this laboratory in less than three weeks, which is completely impossible.

The other laboratories did similar things. Maybe later this newer labs took a little longer to develop. Uh, and I think if you do them, the miracles of this leads then quickly in, then he needs. [00:20:00] Continuous improvement. So I’ve been able, for example, in my current role to find a colleague who is an expert of continuous improvement in laboratories, and he goes to each laboratory and helps to, maybe, you know, improve efficiency, do small changes that bring smoother, easier logistics, et cetera.

And that’s been really important. And of course, Sometime between, um, late May and July, when things were easier, when there was less disease, we managed to bring automation, beautiful robots. I have fantastic pictures. So the three main, big laboratories. Introduce robotics, which allowed us to automate and to do more with less workforce and easier.

So this, these were sort of big steps. It, it didn’t [00:21:00] all stay as it was in April. We’ve developed improved, uh, made things even more cutting edge, uh, which has been very important.

Rebekah Widdowfield: And, and I mean, clearly there has been a massive increase in the number of tests that can take place each day. But as you’ve just alluding to, to yourself, testing has been a point of concern and at times controversy, um, and you, you mentioned right at the start about actually the UK, not having the capacity to do hundreds of thousands of tests, but how well do you think Scotland and the UK have been at using testing as a tool in managing coronavirus?

Anna Dominiczak: Well, as, you know, you need to do the test, get the result and then act on it. And I think it’s the acting on it has been difficult because I think people are now tired of lock down certain restrictions, et cetera. And I think, um, was the best testing [00:22:00] system. If, um, Population wouldn’t, um, isolate, um, for whatever reason, then the difficulties will mount, I think,

All that negative publicity around testing and testing and trace, sort of test and protect, whatever devolved administration you’re in, um, has made it very, very difficult because. To recruit the workforce. If you always on the first page of the newspapers and criticized heavily for maybe some things that are real and lots of things that are completely unreal and made up.

Very very difficult because young people don’t necessarily want to work in a place that is a disaster. So I think there’s been lots of [00:23:00] unnecessary negativity. We’ve been dealing with it by innovating those, uh, critics to visit the laboratories and almost inevitably. They came out hugely impressed and no longer criticizing, but you know, new critics come, I don’t manage to issue these invitations quickly enough, but we’ve had some real good, um, results.

And also. What I think hugely important, bringing NHS colleagues who were occasionally a bit wary of the strange people, taking their activity. And now, particularly in Scotland, we have perfect collaboration between NHS and lighthouse laboratories. We worked very hard on it and there’s been visits.

There’s been getting together. There’s been learning from experience. We have. Very good, um, [00:24:00] relationship with our senior virology clinical advisor. And I think by bringing people together, which is easier in Scotland. And fantastic collaboration has developed. So I think, um, very, very interesting to look at larger areas of England where still some work is needed.

Rebekah Widdowfield: I mean, one of the things that I’ve been interested in is actually. How well, different countries seem to be prepared for, um, something like a pandemic. So for example, there’s been lots of talk about the different, um, uh, numbers of ICU beds per X percent, X hundred thousand of population in term, in terms of testing.

I mean, you talked to the start about, we weren’t ready to be able to do that scale of testing, were we unusual then in the UK and that, or, or was that just, that was common to many countries that they just weren’t… scaled up to deal with something like a pandemic of this nature?

Anna Dominiczak: Well, I think nobody was really ready for this, but there were [00:25:00] countries that were better prepared from laboratory diagnostic point of view. Germany’s always given us an example. You would remember that early on Germany, quickly ramped up testing by having several smaller laboratories. Close to the sort of almost like general practitioner, so different structure, lots of small laboratories, uh, which quickly managed to do more and had the regions, et cetera.

I think it’s, it’s difficult to judge others… clearly far East – Singapore, um, other countries, um, have. quickly ramped up testing perhaps faster, slightly faster than we did, but now UK is doing more tests per [00:26:00] hundreds, thousands of population. And this network of the laboratories is really very, very strong.

So the 500,000 tests by the end of. Uh, October the capacity we hoping, and they don’t like to give precise numbers, but we working towards 800,000, uh, PCR type of tests. So the bottom three base tests by the end of December and so on, these are enormous numbers that very few countries of our size can do at the moment.

Rebekah Widdowfield: So you said you’re not going to be shorter, shorter things to do for a wee while, I mean, obviously there’s been a lot of talk recently about, about a vaccine or vaccines and I appreciate it’s still early days, but some positive news. And what does that mean longer term for testing? I mean, are the lighthouse labs time limited or do they have a, still have a role to play?

If not in Corona virus, in that sort of wider diagnostic and testing [00:27:00] work, are they something that will remain with, as you think in some shape or form?

Anna Dominiczak: So we believe, and I think there is a belief that spans NHS industry academia, UKRI, many colleagues, that there will be sustainability of what’s been built.

We can’t lose it. We can go back to not having preparedness. And I think there are two directions of travel here. Definitely some of these laboratories, maybe not all, but some will be sustainable into the future for readiness preparedness for next infection. That might come our way. I wouldn’t use the word pandemic.

I hope that will never happen again, but there will be epidemics whether viral or other infections and we will have this preparedness, that can be quickly ramped up when the need arises. But I think even more [00:28:00] importantly, and that’s something that is really exciting, we would be able to transform some of this, laboratory, uh, facilities into non-infectious early diagnostics, precision medicine.

Eh, so. The ability to diagnose early variety of cancers, cardiovascular disease, metabolic diseases. This is the same molecular diagnostics. We made need slightly different equipment, but the day the sort of industrial scale high throughput perfect, very modern cutting edge diagnostic capability, I believe will stay with us.

For non-infectious diseases as something good that has come out of COVID and that’s my not only hope we have to do it, [00:29:00] we have to achieve it. And I think there, there is a large now, group of colleagues who are pushing in this direction.

Rebekah Widdowfield: I mean, that’s actually preempted my next question, which was about actually, what can we learn from the experience and running of the labs that in terms of improving, uh, medical research and testing in the future.

And I think you’ve given a really, again, powerful example there of actually just the potential of these labs beyond coronavirus and, and I guess possibly helping address some of the backlog that will be being built up and testing around other things at the moment. Do you see a role for the labs in that, in that space?

Anna Dominiczak: Absolutely. And I think this is not to replace anything that is being built and developed in the NHS. This is to add value, to be part of it. And it will be done with NHS, but I would like to keep that industrial presence in it because I believe and academic [00:30:00] presence, of course, because. Going back to where we started the innovation, the true innovation in healthcare will happen with this triple helix collaboration.

And if you have large laboratory that is automated, that can do molecular tests very well. This would be the ability maybe for next decade or more to deliver over and above just the routine things. So. Very early testing ability to diagnose particularly cancers before any symptoms set apart. And hopefully the same with number of cardiovascular renal, um, metabolic diabetes problems. So I think that would be the perfect something good has come through this terrible pandemic.

Rebekah Widdowfield: I mean, that’s one of the things that strikes me and, and without wishing in any way to downplaying the challenges and [00:31:00] impacts of, and distress that COVID has caused, but there’s also been some, you know, huge, massive developments in our knowledge and understanding.

And then also actually the sort of more practical, um, developments that you’ve just talked about when you were talking about robotics and automation and ability to do processes differently. I mean, what advances in the science are you seeing that sort of really excite you?

Anna Dominiczak: Yes, I think, um, very interesting. So. I suppose that interdisciplinarity, that leads to things like machine learning, artificial intelligence, being really useful in things that we’ve never imagined it would be. So for example, still with covid, the reporting of results as it’s currently done does use machine learning and artificial intelligence.

The system has been trained to make [00:32:00] AI diagnosis, which is checked by humans, but it’s correct in large percentage of cases. So in very elegant way, Health service and diagnostics, and laboratories etcetera are already using things that we thought were something into the future quite recently. So I think again, applying, cutting edge from other disciplines to health care, to innovation, absolutely revolutionary, um, in, in, in a way.

We can move forward very, very quickly. And I think the vaccine, so today the news full of vaccine, it’s a miracle that you can do it so quickly. And I’ve been following the Oxford vaccine and [00:33:00] you, one would never believe that something like that could happen. And it is because of science and progress and ability to do things that even a year ago wouldn’t have been possible.

Rebekah Widdowfield: Uh, I think that’s one thing. So the acceleration of innovation and, and its application, and those partnerships, as you say, that might some of the, which were already sort of nascent, but really being developed and, and taken forward. Um, finally, a more personal question, if I may, may about what the future holds for you.

I mean, you had a. Very busy role as well before COVID is a leading cardiovascular scientist and clinical academic and where we first crossed paths and the work you’re doing, um, uh, driving forward, precision medicine in Scotland. So, um, what’s next for you?

Anna Dominiczak: Well, I don’t know. I think, um, I think, uh, COVID showed us that making very long plans might not be the best idea.

I think, [00:34:00] um, I it’s, it’s hard. What I do. I commute to London every week because it’s difficult to run a large team to lead the large team without ever seeing them face to face. I think, um, let’s get COVID out of the way. And I think then we will have the best precision medicine and hopefully Scotland will be leading on precision medicine, as I’ve always dreamt, as you know, we did an audit and health economic analysis that showed that Scotland because of our size data…

Very good response of population to participation in clinical trials, et cetera, is a perfect place to develop precision medicine. So my dream would be that post COVID Scotland will become the best small country in the world to lead on precision medicine.

Rebekah Widdowfield: [00:35:00] Well, that sounds a very positive note on which, which to end, uh, Professor Dame Anna Dominiczak, thank you for sharing your knowledge and expertise with us today on the developments of the lighthouse labs and the role of testing and the management of COVID. And, uh, we wish you every success in their continuing, uh, contribution the labs are making towards tackling COVID. Thank you.

Anna Dominiczak: Thank you so much. Thank you. It was a pleasure. Thank you very much.