November 2020 medicalnewstoday; This year’s WIRED Health:Tech conference took place online last month, in an effort to adapt to the challenges posed by the current pandemic.
A range of specialists held presentations about the latest advances in medical technology, including remote surgical systems, e-health, CRISPR technology, and the issue on everyone’s mind this year: how research can combat the COVID-19 pandemic.
In this Special Feature, we offer an overview of the panels and main takeaways from the presentations.
Throughout many of the WIRED Health:Tech presentations, the recurring theme was how technology is helping — or hindering — the fight against SARS-CoV-2, the coronavirus that has given rise to the current pandemic.
Prof. Heidi Larson — from the London School of Hygiene & Tropical Medicine in the United Kingdom — spoke of the global response to vaccines, an issue of paramount importance in the context of the pandemic.
Prof. Larson noted that according to her and her colleagues’ research — which appears in The Lancet — “people’s feelings about vaccines have become far more volatile.”
“It’s a lot more like political opinion polling. They used to be much more stable 10–20 years ago. You knew who agreed and who was less confident around vaccines, but that’s changing very frequently,” she observed.
However, she did offer some positive news:
“The overall picture is that […] there is a general trend where people are becoming a little more confident [about vaccines] than they were 5 years ago.”
According to Prof. Larson, this may be because public health specialists and communicators are more proactive in dismantling pervasive myths about vaccination over the past few years.
Nevertheless, she cautioned, “we do see that Europe remains the lowest in confidence, the most skeptical, with countries like Lithuania [where] only 19% strongly believe that vaccines are safe. The highest [rate] is [in] Finland, at 66% — and that’s just ‘strongly believe.’”
“Poland had the most significant drop in confidence in vaccines,” she noted.
She also emphasized these fluctuations in confidence in vaccines across the globe occurred before the pandemic. In the current situation, Prof. Larson said, sentiments surrounding vaccinations have become even more volatile.
“Because of the hyper-uncertainty and the whole environment of trust and distrust around the COVID vaccine, there are groups that have gotten together to resist even the COVID vaccine,” she warned.
The danger of anti-vaccination mentalities can only be mitigated by giving science more of a “human face,” Prof Larson argued:
“We need to bring together the scientific, technological advances that are so valuable, and not lose the human face, but bring that back together [with the scientific perspective]. This isn’t just a misinformation problem. This is a relationship problem. This is a cultural revolution, saying ‘we need to change, we need to get back to a more human face in the scientific and medical field.’”
Prof. Devi Sridhar — a public health advisor and the chair of the Global Public Health department at the University of Edinburgh in the U.K. — spoke of the next steps in the fight against the pandemic.
Speaking of the U.K. situation, Prof. Sridhar said that there are certain key actions that the country needs to take to put a stop to the spread of the virus more efficiently:
“I think the crucial thing is getting the testing sorted. You need to have a test turnaround time [of] less than 24 hours and have testing widely available. And also […] a strategy: What is the point of a lockdown, what [is] the point of the restrictions?”
“Other countries have used the lockdown — I’m thinking of New Zealand, Taiwan, Vietnam, Thailand, Australia […] — but they’re using the lockdown to try and eliminate the virus, to get rid of it, and then put in place checks for reimportation,” she added.
Prof. Agnes Binagwaho — vice chancellor at the University of Global Health Equity in Rwanda — went on to speak of the innovations that Rwandan authorities implemented to curb the spread of the new coronavirus in the country.
Prof. Binagwaho said that the first step was to identify both the obstacles and facilitators when it came to stopping the spread of SARS-CoV-2.
According to the expert, having a clear idea of these factors allowed the authorities to establish the best strategy for containing the spread of the virus.
Most importantly, however, according to Prof. Binagwaho, Rwandan authorities made sure to keep its citizens up-to-date with all the daily news regarding the local spread of the virus — both good and bad.
“[W]hen you need the population to do something to protect itself […] that is not usual, trust counts more than money,” she commented.
Some of the technological innovations that the country implemented during the pandemic were robots that take people’s temperatures in airports and hospitals, to limit human contact, and drones that carry supplies to areas that lack appropriate resources.
Prof. Christofer Toumazou — from Imperial College London in the U.K. — spoke of how technological advances could help during the current pandemic.
Prof. Toumazou, an electronic engineer, created DnaNudge, a fast and accessible DNA testing technology. Its original purpose was helping people understand what health conditions their genetic makeup might predispose them to, so they could make healthier choices.
At WIRED, the researcher and his colleagues said that they adapted this technology to detect COVID-19, creating tests with a turnaround time of only 90 minutes.
In the U.K., the government ordered 5.8 million such tests for state hospitals.
“Effectively, it took a pandemic for us to get a technology that’s […] prepared for personalized medicine into the hospital system. So the only way that we could ‘bulldoze’ this was through COVID,” Prof. Toumazou noted.
The researcher emphasized just how important this step may be for health, particularly for people with mental health conditions, who would not have to anxiously “wait for 48 hours in isolation” for their test results.
In a panel discussion, Dr. Indra Joshi — director of Artificial Intelligence at NHSx, the U.K. governmental unit responsible for developing national health policies — also went on to stress that advanced technology may help not just to better understand the pathology of COVID-19, but also to identify the people who are most at risk.
This, she added, could allow healthcare professionals to provide help faster to those who are likely to be the most affected by infection with the new coronavirus.
In Dr. Joshi’s view, advances in technology could therefore offer a “holistic view” of a person’s health status and risks, beyond diagnosing COVID-19.
Another panel discussion focused on recent developments in finding a vaccine against the new coronavirus.
The two participants were Tal Zaks, Chief Medical Officer of Moderna Therapeutics, and Prof. Uğur Şahin, co-founder and CEO of BioNTech.
Both Moderna and BioNTech are testing mRNA candidate vaccines, which use genetic information rather than a viral base to train the immune system against the new coronavirus.
Speaking of the advantages of an mRNA vaccine versus other forms of vaccines, Zaks said that “it is better in a number of fundamental ways.”
“The first is that because we start with genetic information, there is a component of speed that allows you to get into the clinic and then, once you’re in the clinic, scale-up manufacturing. It’s not by chance that the two leading efforts both leverage mRNA technologies,” he pointed out.
“I think the second one […] is the biological preciseness — so, when you make a recombinant protein, or you otherwise characterize a biologic, the process makes a lot of difference and a lot of things can go wrong. When you’re transmitting the [genetic] information, there’s no way for the cell to make the wrong bit. So the biological fidelity, if you will, has a higher likelihood to then translate into the kind of immune response you want.”
– Tal Zaks
“I think the last element here is it’s a very flexible platform, and this takes us a little bit beyond COVID, but the infrastructure required is relatively small and quick, which means, in the manufacturing space, you have tremendous agility that usual technologies don’t,” Zaks added.
At the time of the WIRED conference, clinical trials for the Moderna and BioNTech candidate vaccines were at similar stages. Since the two approaches have similar premises, the question arises: does this create a sense of competition between the two companies?
According to Zaks, in the context of a pandemic, this is not a valid question. “I only have two competitors here: the virus and the clock,” he asserted.
He added that should both the Moderna and the BioNTech candidate vaccines demonstrate safety and efficacy, this would be an ideal situation.
“The world needs more than one company to succeed here,” he said, noting that, if the virus is truly here to stay, as previous research suggests, more than one vaccine may become necessary in the long run.
Prof. Şahin agreed:
“The way [in which] the whole industry developed vaccines against COVID-19 […] is the best performance of collaboration. It’s important to see how people team up for collaboration. Moderna teamed up with the NIH [the National Institutes of Health], we teamed up with Pfizer, AstraZeneca teamed up with Oxford University. So there are several models of collaboration, and we have the strongest transparency in the development of a vaccine.”
“People see the data almost in real-time coming in, and people understand how [a] phase 1 trial works, how a phase 3 trial works, and Moderna and we even shared our phase 3 protocols so that everyone can see in a transparent fashion how the studies perform and how they are evaluated,” Prof. Şahin added.
The two researchers also emphasized that this sense of transparency regarding the development of new pharmaceutical products is essential in the long run. They also expressed hope that it may persist after the pandemic subsides.
When asked whether the candidate vaccine development was rushed, so that pharmaceuticals can distribute them sooner rather than later, Prof. Şahin explained that the pandemic has caused researchers to find a better, more efficient method of proceeding with clinical trials — not a less reliable one.
“One important aspect is that instead of skipping [steps] or cutting corners, we decided to do things in parallel. Usually, [in] vaccine development […] you do a phase 1 study, and maybe 6 or 12 months later a phase 2 study, and then decide whether you would do a phase 3 study,” he explained.
“This is based on minimizing the cost risk, but also based on the traditional way [in which a vaccine] is developed. It is not the best way — it is just the traditional way,” he also emphasized.
While many of the talks at WIRED Health:Tech revolved around the fight against COVID-19, some also focused on other technological advances in improving patient care.
Dr. Eric Topol — founder and director of the Scripps Research Translational
Institute — talked about using technology to make medicine “more humanistic.”
“The main objective of AI for healthcare and medicine has been to improve accuracy,” so that doctors can improve how they diagnose disease and care for their patients, he observed.
This is what is known as “precision medicine.” But Dr. Topol believes that using AI in medical practice could bring about more “far-reaching benefits.”
This could include freeing healthcare practitioners from tasks, such as filing information about their patients into digital systems, so that they can pay more attention to their patients.
“Medicine has eroded terribly — it’s a rushed job,” Dr. Topol asserted in his talk. “We see patients in a single-digit number of minutes, and that’s not enough.”
“You need the gift of time, which AI can give back so that people don’t feel so rushed and doctors and nurses and clinicians don’t feel so rushed either. […] We want to have clinicians and doctors spending more time with patients and less time [at the computer] keyboard.”
Dr. Pearse Keane — a National Institute for Health Research clinician-scientist at the Institute of Ophthalmology at University College London — spoke of how doctors could soon use AI algorithms to diagnose and treat early-stage retinal diseases — a set of eye problems that can lead to vision loss.
Dr. Keane made a similar point to Dr. Topol’s argument, stressing that so many people are affected by eye diseases in the U.K. that specialists are often overwhelmed by the sheer amount of patients waiting for diagnosis and treatment.
“Some people are essentially going blind because they cannot be seen and treated early enough,” Dr. Keane said. But “new technologies — and in particular, AI, have at least some role in addressing this problem,” he added.
Dr. Keane and colleagues from Moorfields Eye Hospital collaborated with scientists specializing in using the AI technology DeepMind, in demonstrating how to train the system to diagnose retinal diseases correctly and fast-track referrals for specialist treatment.
The researchers published the results of their study in Nature Medicine in 2018. Now, Moorfields Eye Hospital are building a new care and research center, with plans to integrate more advanced technology into this setting.
But Dr. Keane argues that clinical AI help by linking various health data, therefore offering a bigger picture of a person’s overall health status and health risks.
Dr. Mark Slack — chief medical officer and co-founder of CMR Surgical — spoke of the potential of Versius, a surgical robotic system that can help specialists carry out minimally invasive keyhole surgery.
“Is keyhole surgery better than open surgery? There are huge advantages for keyhole surgery,” Dr. Slack asserted in his presentation.
“If you have a large wound [following open surgery], about 50% of those patients will go back to the hospital. If you have a small, minimal-access wound, almost none will go back. If you have a large wound, about a fifth of patients will be required to go back into [the operating] theater if they get a wound infection […] [but] roughly 50% of complications are reduced by having keyhole surgery rather than open [surgery].”
– Dr. Mark Slack
Finally, Prof. Jennifer Doudna — a biochemist at UC Berkeley and founder of the Innovative Genomics Institute, who co-invented CRISPR technology — spoke of the revolutionary potential of gene editing. This new technology has taken the medical research world by storm.
Prof. Doudna described gene-editing technology as “molecular surgery” — “it’s a way to alter the DNA in cells and organisms in ways that allow precise correction of disease-causing [genetic] mutations and also allow scientists to do all sorts of other kinds of manipulations of genetic material on living cells and organisms,” she explained.
One way in which gene-editing tools might be helpful, she said, might be by helping treat severe blood disorders such as sickle cell disease. Other applications might be in the treatment of eye diseases or even muscular dystrophy.
The scientist explained that, besides CRISPR technology’s potential in treating disease, it could also come in handy when detecting viruses, including the new coronavirus.
She even suggested that “in the coming months,” there may be “a CRISPR-based point-of-care diagnostic” tool that could help doctors identify infections much faster.
She concluded her talk by noting that:
“The potential of this technology continues to advance. I think the keys will be delivery and control of the editing and, of course, ensuring safety, effectiveness, and access. The possibilities are extraordinary — it’s really an exciting time to be working in this field.”