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The government’s health screening advisers have not been involved in Boris Johnson’s “moonshot” project to test the entire population for Covid-19, an omission public health experts have described as “incomprehensible”.
The National Screening Committee, which advises ministers and the NHS about “all aspects of population screening”, has not been consulted on the £100bn plans for mass surveillance involving up to 10m coronavirus tests every day.
Made up of 23 doctors, academics, public health and patient representatives, the NSC normally rules on proposals for mass population screening for cancers as well as infectious diseases such as chlamydia, herpes and hepatitis B.
It reports to the UK’s four chief medical officers, and follows a strict and rigorous process, one source said, “which is not like the process we have seen put forward [for ‘Operation Moonshot’].”
“The NSC has not been involved with this in any way,” the committee’s chairman, Prof Bob Steele, confirmed to the Guardian by email.
Dr Allyson Pollock, the director of the Centre for Excellence in Regulatory Science, Newcastle University, said this was incomprehensible.
“Mass testing is screening and we have a huge amount of experts in this country who run design and run research,” she said. “This is another example of how public health has been marginalised. Why has [the health secretary] Matt Hancock not put the committee in charge of scrutinising all these proposals?”
The NSC would weigh up issues such as how results, including false positives and negatives are handled, the implementation of any mass testing programme and questions around people’s informed consent, Pollock said.
Official documents, which were leaked this week claim, Johnson believes mass testing is “our only hope for avoiding a second national lockdown before a vaccine”. They reveal tests could be mandatory “under tightly defined circumstances if required”, which is likely to spark an ethical row.
The NSC “maintains oversight of the evidence relating to the balance of good and harm as well as … cost effectiveness”, according to its terms of reference.
Prof Jackie Cassell, the deputy dean of Brighton and Sussex medical school and a public health screening expert, said: “It would be impossible to do this well without input from the screening committee – or others with similar expertise – in terms of operation, quality control, implications of false positives and the lower positive predictive value when rolling this out at scale. You need to be confident that screening expertise is brought in at every level of Moonshot.”
There are fears the programme, which is billed as being in full operation early next year if new test technology works, could cause serious social and economic problems by sending hundreds of thousands of people home to self-isolate as a result of false positives, another issue the NSC would consider.
On Friday, Jon Deeks, professor of biostatistics at the University of Birmingham, said he calculated that even with relatively low levels of coronavirus in the community of about 10 cases per 100,000 people, for every 100,000 people tested at least 150 could be wrongly diagnosed as Covid-positive.
“There is massive cause for concern that there is no screening expertise evident in the documents,” Deeks said. “They are written by management consultants and there is no mention of the harms of mass screening programmes like this. Before you start you have to make sure you do less harm than good. If this was written by one of my public health students they would fail their degree.”
There is little mention of risks in the two leaked documents – a Department of Health and Social Care-branded power point presentation, which sets out the proposal to work with the consultants Deloitte and several other private companies, and a nine-page “draft UK government mass testing narrative”.
The latter concedes: “False positive or false negative results will have different implications, depending on the use … new types of tests are likely to be less accurate, introducing some level of risk.” And it states that the mass testing “might make people behave in safer ways, by building Covid-safe routines into their daily lives, or less safely by giving a false degree of comfort”.
One source who has applied to the NSC for approval for mass screening said the committee could be slow, with decision-making sometimes taking years, which would be too slow for the Moonshot timetable. It rejects more applications than it approves and is considered by some as “conservative”.
Sage, the government’s scientific advisory group, has been asked to consider what effect mass testing would have on the R number, the measure of virus transmission, according to the leaks.
It has already published some of its views. In a consensus document published on 27 August it called for “careful consideration … to ensure that any mass testing programme provides additional benefit over investing equivalent resources into improving the speed and coverage of NHS test and trace for symptomatic cases and the rate of self-isolation and quarantine for those that test positive”.
It said the idea of using testing to enable passport style access to sports or cultural events, as envisaged in Moonshot required “superb organisation and logistics, with rapid, highly sensitive tests” and would have minimal impact on the R number. It also warned about an increase in false positives and negatives, and that mass testing “can only lead to decreased transmission if individuals with a positive test rapidly undertake effective isolation”.
Public Health England, which handles the secretariat for the NSC, forwarded inquiries about its role to the Department of Health and Social Care, which has yet to respond to request for comment.
Source: The Guardian
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