Correspondence with University of Liverpool re covid-19 screening in Liverpool
From: Allyson Pollock
Sent: 08 November 2020 13:20
To: Kenny, Louise
Cc: Buchan, Iain; Semple, Calum
Subject: Re: Liverpool population mass screening pilot
Dear Professors Kenny, Buchan and Semple,
I acknowledge receipt of your email of 7 November at 12:03, and Professor Kenny’s emails at 14:16 and of 8th November at 11.04 am.
I strongly believe in democratic engagement and public accountability for public health measures, which I regard as central to my work and my professional duty.
If, as you say, our concerns and questions are based on incomplete and false information, then please do set these out and I will happily consider them with the co-authors of our email. As matters stand, I see no reason to retract anything.
I look forward to hearing from you in respect of our concerns and questions detailed in our email to MPs (which followed the news announcement on Nov 3rd prior to the launch of the pilot on Nov 6th).
In the meantime we would appreciate your sending a copy of the study protocol, tests to be used, and the evaluative framework, together with details of public patient involvement and the ethics approval.
I will as requested in the 14:16 and 11.04 emails post this email together with your emails on my public website.
I will also send it to the MPs.
Yours sincerely,
Professor Allyson Pollock
From: Kenny, Louise
Date: Sun, Nov 8 2020 at 11:01 AM
To: Allyson Pollock
Cc: Buchan, Iain ; Semple, Calum
Subject: Re: Liverpool population screening pilotFrom: Kenny, Louise
Dear Professor Pollock,
I am responding on behalf of Prof Ashton, our Director of Public Health, and the entire team involved in delivering the MAST pilot in Liverpool. As you can imagine, the team are rather busy at the moment and so it falls to me to reply to your email.
By now, you will be in receipt of my own response to your email, sent yesterday and copied, as this is, to your Dean and Vice Chancellor. I will take this opportunity to reiterate my request that you retract your false assertions and/or post my response to the same on your public website.
I have already assured you that the analysis of this pilot will be conducted by University of Liverpool and a national team of leading academic collaborators, and will be utterly transparent.
I see no need to share any further information with you, given the uninvited, hostile and frankly unprofessional nature of your interactions.
Professor Louise Kenny
Executive Pro-Vice-Chancellor
Faculty of Health & Life Sciences
University of Liverpool
From: Allyson Pollock
Date: Saturday, 7 November 2020 at 17:50
To: “Ashton, Matthew”
Cc: “Semple, Calum”, “Buchan, Iain”, “Kenny, Louise”
Subject: Re: URGENT: Serious concerns about Mass screening in Liverpool
Dear Matt,
Thank you for responding, and I’m really glad to hear that there is information that you feel would answer our concerns. We were unable to find anything in the public domain that described a research design, screening pathway, participant information, GDPR safeguards, what tests are to be used, independent evaluation of test performance in field conditions etc. If these resources are available it would be excellent if you could direct me to them. The reason we wrote in the first instance to MPs was because the Tuesday’s 3rd Nov news announcement sounded very much like Moonshot Phase 1, which seemed strange after the 6 October statement by Government lawyers that Moonshot proposals would not go ahead. These appeared to us to be nationally made decisions, requiring MP attention, rather than local decisions made by Liverpool City Council or Liverpool Hospitals. Do correct me if I am wrong about this. It can be no surprise to you that we have concerns, given that we and others have published about these concerns openly in the BMJ, and there are legal challenges in progress too. I am sorry if our action has not been welcome to you. It was our professional judgement that these questions needed to be asked. As yet we have received no satisfactory answers to them.
We are also concerned that following interviews yesterday and today on the BBC the public now believe the tests being used in Liverpool are tests of infectiousness, which as you know they are not. Also there has been reporting in the Financial Times today in relation to Liverpool that 80% of cases are asymptomatic. It would be good to know the source of this figure, how robust the denominator is, and whether selection or ascertainment bias is at play. SAGE has given a more cautious estimate of 23%. We feel that it is important to acknowledge the many uncertainties.
We look forward to seeing the answers to our questions and corrections being issued to the BBC.
Very best wishes,
Allyson
From: Kenny, Louise
Sent: 07 November 2020 14:16
To: Allyson Pollock
Cc: Buchan, Iain ; Semple, Calum
Subject: Re: Liverpool population screening pilot
Professor Pollock,
As a follow-up- I note with interest that you are posting replies to your email on your personal website: https://allysonpollock.com
I would be grateful if you could post my reply in full immediately if you do not intend to retract your claims.
Louise
Professor Louise Kenny
Executive Pro-Vice-Chancellor
Faculty of Health & Life Sciences
University of Liverpool
From: Kenny, Louise
Sent: 07 November 2020 12:03
To: Allyson Pollock
Cc: Buchan, Iain; Semple, Calum
Subject: Re: Liverpool population screening pilot
Dear Professor Pollock,
I was dismayed and disappointed to receive your email and the notification contained within it that you had already contacted a series of MPs and public officials in the Liverpool region, and the national media, about our pilot MAST programme.
Your concerns are noted but as you are no doubt now aware, they are largely founded on incomplete and false information. With respect, you have not been party to analysis of the performance of the platform we are using in this pilot. Furthermore, you have not been party to the very detailed planning that we, the University of Liverpool, have undertaken to ensure the success of this pilot and minimise risk to the participants. Had you contacted myself or indeed any of my colleagues involved in this programme, we would have been happy to discuss the details and allay your concerns. Indeed, several academic colleagues from across the country have done just this and their challenge has been both welcome and constructive.
In contrast, your uninvited intervention was clearly intended to harm this critically important initiative by undermining public confidence. In the middle of a public health crisis, I find your actions both deeply unprofessional and highly unethical. My colleagues across Liverpool, including our DPH, whose earlier email response I have attached to this, share my opinion of your intervention.
The University of Liverpool is leading on the analysis of this pilot and we will be publishing this in an open and transparent manner in due course. Had you had the professional courtesy to contact my team, rather than the media, we would have been happy to furnish you with correct facts and offer reassurance on all the points outlined in your correspondence, which I hope you will now retract as publicly as you first posted it.
Yours sincerely,
Professor Louise Lenny
Professor Iain Buchan
Professor Calum Semple
Professor Louise Kenny
Executive Pro-Vice-Chancellor
Faculty of Health & Life Sciences
University of Liverpool
From: Allyson Pollock
Date: Thursday, 5 November 2020 at 21:25
To: “Kenny, Louise”
Subject: Liverpool population screening pilot
Dear Louise Kenny,
We have not met although I hope we will one day. I am a clinical professor in public health at Newcastle University.
Many of us in the field of public health have grave concerns about the proposals for Liverpool ‘ mass screening programme as part of Operation Moonshot.
As you will be well leaving aside the whole issue of the tests, screening is a complex public health intervention that needs careful thought and at the very least the guidance of the UK National Screening Committee before any proposal is implemented.
We have written to local MPs to set out some of our numerous concerns. I am enclosing our letter.
If we can be of any help please let us know.
Best wishes
Allyson Pollock
• Garston and Halewood Constituency – Maria Eagle MP
• Riverside Constituency – Kim Johnson MP
• Walton Constituency – Dan Carden MP
• Wavertree Constituency – Paula Barker MP
• West Derby Constituency – Ian Byrne MP
Dear
Asymptomatic Covid-19 screening in Liverpool
We are writing to you in response to the apparently hurried decision to begin population-wide testing in Liverpool, as part of the £100 + billion ‘Operation Moonshot’, in order to “find positive cases and to break chains of transmission” (Government Press Release, 3rd November 2020).
This announcement is inconsistent with the SAGE advice at its 56th meeting on 10 September 2020 that it had “high confidence” that “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area”. This chimes with WHO guidance to focus on contact tracing and identification of clusters, and which does not recommend mass screening. Proposals for mass screening in their current form will undermine this priority.
Searching for symptomless yet infectious people is like searching for needles that appear transiently in haystacks. The potential for harmful diversion of resources and public money is vast. Also of concern are the potential vested interests of commercial companies supplying new and as yet inadequately evaluated tests. If the programme is to proceed, then the contracts awarded, or advertised, should be made public, including their cost to the public purse. (The government is already facing a judicial review for failing to publish covid-19 contracts, brought by your fellow MPs Debbie Abrahams, Layla Moran and Caroline Lucas with the Good Law Project.)
There is currently no evidence demonstrating that SARS-CoV-2 screening can bring benefit cost-efficiently, and experience shows that unless screening is delivered as a systematic programme with quality assurance for every step of the pathway then any theoretical benefit will not be realised in practice, even where a benefit is possible.
We would like to ask you what has been decided, and how were decisions reached, regarding the types of tests to be used, what exactly are they aiming to detect, and how has their accuracy been evaluated? We understand that the Liverpool pilot is likely to use a direct LAMP test (Optigene) and a lateral flow assay (Innova). Currently there is little or no evidence of the accuracy of either of these tests from their use in presymptomatic and asymptomatic cases, or in field settings. There is substantial uncertainty as to whether they can detect the lower viral loads that are likely in symptomless people, which appears to be the aim of this mass pilot. If the tests fail to detect cases, then the programme will waste resources and time, and give people false reassurance which could increase transmission. Similarly, the false positive rates of these tests have not been established in community use and neither have the implications for contact tracing services. Evaluations of other similar tests by the WHO has suggested between 1% and 5% of people without infection may get false positive findings. This means that if 1 in 100 people tested in the pilot have asymptomatic infections, as few as 1 in 5 of those getting positive results will actually have Covid-19 – and 4 out of 5 would be false positives and they and their contacts would unnecessarily be told to isolate.
The accuracy of tests for identifying symptomless infection in a healthy population need to be evaluated in a pilot study with proper research design to assess the extent to which asymptomatic people contribute to overall case-loads, whether they play a significant role in transmission, and whether screening can help. We see no evidence that the Liverpool has such a research design.
It appears unclear what will happen when people test positive, and negative, whether there will be clinical oversight in interpretation of the results and whether the results will be sent to patients’ GPs and integrated with medical records. What will people be offered? What will they be instructed to do? What support structures are in place to achieve this? It is also unclear how this programme will be integrated into, and affect, the track and trace system, which is already performing poorly.
Are all the above considerations documented in a format suitable for the lay public to understand as part of an opt-in informed consent process? Is there an option to withdraw from the scheme at any stage, including freeing people of any study requirements? Are participants afforded the right to access their information, to know with whom it is being shared, and to request its deletion – in line with GDPR and the Data Protection Act?
These are just some of the questions and issues that are concerning us and that need to be pursued, along with asking the government to explain why they are acting inconsistently with SAGE’s advice. We urge you to do so as soon as possible.
If we can be of any assistance, please do not hesitate to contact us.
Yours sincerely,
Allyson Pollock
Professor of Public Health, Newcastle University
Anthony J. Brooks
Professor of Genomics and Bioinformatics, Leicester University
Louisa Harding-Edgar, General Practitioner and Academic Fellow in General Practice. Glasgow University
Angela E. Raffle, Consultant in Public Health, Honorary Senior Lecturer in Public Health, Bristol Medical School Department of Population Health Sciences, University of Bristol
Stuart Hogarth, Lecturer, Department of Sociology, University of Cambridge.