Mass Testing – an Unevaluated, Underdesigned, and Costly Mess
Tue 11:25 am +01:00, 17 Nov 2020
Mike Gill, a former regional director of Public Health England, and Muir Gray, a visiting professor at the Nuffield Department of Primary Care Health Sciences at Oxford, didn’t pull their punches in an editorial for the BMJ about the Government’s £100 billion mass testing programme.
With incidence across Liverpool already falling, attributing and quantifying any additional effect from the programme may prove complex. Instead, similar programmes are being rolled out across the country to universities and local authorities even before this pilot is complete.
The queues of people seeking tests in Liverpool suggest the initial acceptability of this pilot is high, at least to some. Its ethical basis, however, looks shaky. The council claims, wrongly, that the test detects infectiousness and is accurate. In fact, if used alone it will lead to many incorrect results with potentially substantial consequences. The context for gaining consent has been tarnished by the enthusiasm of some local officials and politicians. In the case of schools, the programme has been culpably rushed: parents have had to respond unreasonably promptly to a request to opt out if they do not want their child screened.
There is no protocol for this pilot in the public domain, let alone systems specification or ethical approval. The public has had no chance to contribute, as required by the UK standards for public involvement in research.
Spending the equivalent of 77% of the NHS annual revenue budget on an unevaluated underdesigned national programme leading to a regressive, insufficiently supported intervention – in many cases for the wrong people – cannot be defended. The experience of the National Screening Committee and National Institute for Health Research (NIHR) tells us that allowing testing programmes to drift into use without the right system in place leads to a mess, and the more resources invested the bigger the mess. This system should be designed with up to 10 clear objectives to deliver the aim of reducing the impact of covid—for example, to identify cases more quickly or to mitigate the effects of deprivation on risk of infection and poor outcomes. Progress in each objective (or lack of it) should be measured against explicit criteria. Screening programmes based on experience and on the literature relating to complex adaptive systems offer a model for rapid progress.
At a minimum, there should be an immediate pause, until the fundamental building blocks of this mass testing programme have been externally and independently scrutinised by the National Screening Committee and NIHR. In the meantime, nobody’s freedom or behaviour should be made contingent on having had a novel rapid test.
Worth reading in full.
Stop Press: A panel of scientists form universities in Newcastle, Birmingham, Warwick and Bristol sounded the alarm yesterday about the dangers of mass testing. The Mail has more.
They described it as the “most unethical use of public funds for screening” they’ve ever seen and claimed it had the potential to “actually do a lot of harm”.
The panel said it was telling that population screening for COVID-19 has not been endorsed by the World Health Organization (WHO) or the Government’s Scientific Advisory Group for Emergencies (SAGE).
At a virtual press conference today, Professor Allyson Pollock, clinical professor of public health at the University of Newcastle, said: “The evidence for screening is not there.
“The evidence around the tests is poor and weak at the moment, and needs to be improved.
“We’re arguing the moonshot programme really should be paused, until the cost effectiveness and the value for money of any of these programmes is well established.”
Also worth reading in full.
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