Queen Mary University of London – Written evidence (LSI0082)

 

Preamble

  1. Queen Mary University of London (QMUL) is pleased to respond to this call for evidence, informed by its close collaboration with NHS partners.

 

  1. QMUL is a mid-sized university (ca. 23,000 students and 4000 staff) with an outstanding reputation for the quality of its research, spanning medicine, life and physical sciences, social sciences and the humanities. In the 2014 Research Excellence Framework (REF) exercise, it ranked 9th amongst multi-faculty institutions for the quality of its research. The medical faculty of QMUL, the Barts and the London School of Medicine and Dentistry, is one of the world’s leading medical schools (for example, it is ranked third in the UK for research citations in the medical field (Elsevier)).

 

  1. QMUL works closely – in both education and research – with Barts Health NHS Trust (BHT), which includes St Bartholomew’s Hospital in the City of London, the Royal London Hospital in Whitechapel and other sites. BHT serves a population of several million people in East London and beyond, and has particular strengths in the areas of cancer, cardiovascular and trauma treatment and care. The first two areas benefit from collaboration across UCL Partners (for example, the state-of-the-art Barts Heart Centre) and the Royal London is one of three designated major trauma centres in the Capital.

 

  1. QMUL also works closely with primary care providers in the East London boroughs of Tower Hamlets, Newham and Hackney – covering a population that is amongst the most deprived in the UK in terms of socio-economic and health indicators. Particular progress has been made in coordination the of digital health records.

 

  1. QMUL is a founder member of UCL Partners, an Academic Health Sciences Centre and Network, providing a further basis for interaction with partners in academic research and clinical delivery.

 

Introduction

  1. The term “life sciences” is extremely broad. This submission relates to “health life sciences” as defined by Sir John Bell in the 2011 Life Sciences Strategy: “the application of biology and technology to health improvement, including biopharmaceuticals, medical technology, genomics, diagnostics and digital health.”

 

  1. Here we consider, in particular, opportunities in translational health life sciences (meaning the conduct of basic research with a view to early application to patient care) that are most effectively promoted by close coordination of academic, clinical and industrial research.

 

  1. The relevance of this submission to specific questions in the Call for Evidence (CfE) is noted in paragraph 29. We place special emphasis on the opportunities that can be realised through close collaboration between universities, the NHS and the UK life sciences industry (pertinent to questions 1, 3, 10, 11, 12 in the CfE). We also note (at the relevant points in this submission) the correspondence between our key points and the recently published Life Sciences Industrial Strategy (LSIS).

 

  1. The UK university sector is very strong in global terms. Twenty-three UK universities are included in the world top 150 [Times Higher Education, World Rankings 2017] and 13 UK medical schools are ranked in the global top 100 (both including QMUL).

 

  1. A number of the world’s leading pharmaceutical companies (such as GlaxoSmithKline, AstraZeneca, Pfizer, Novartis and Hoffman-La Roche) conduct substantial research and development activity in the UK, benefitting from close collaborations with universities and from the supply of highly qualified graduates.

 

Genomic Medicine

  1. The extraordinary recent (and continuing) developments in very rapid determination of an individual’s gene sequence – and the equally remarkable reductions in cost – have opened the possibilities of genuinely personalised medicine and of improved understanding of genetically inherited diseases (and inherited pre-disposition to specific diseases) on a population-wide scale.

 

  1. The National Health Service (organised by nation within the UK) in principle provides an opportunity (arguably unique and certainly unusual in comparison with major competitor countries) to exploit new possibilities in genomic medicine by enabling the linkage of longitudinal health care records and genetic data across large populations, including family groups. In practice, it is increasingly widely recognised that the study of populations of 3-5 million is most likely to be immediately productive.

 

  1. In this context, “exploitation” has several facets: (i) developments in the basic science of genomics (and, increasingly, “post-genomics” – see paragraph 15) such as to establish the UK in a leading position internationally; (ii) early translation of discovery to better-informed and innovative clinical treatment; (iii) commercial developments that contribute to enhanced industrial activity with associated financial benefits.

 

  1. The UK’s activities in this area include the pursuit of the national 100,000 genomes project through Genomics England (hosted by QMUL), and regional initiatives such as East London Genes and Health, a QMUL-led programme that is one of the world’s largest community-based genetics studies, aiming to improve health among people of Pakistani and Bangladeshi heritage in East London by analysing the genes and health of 100,000 local people.

 

  1. Parallels with basic discovery science in lesser organisms indicate that human genetic sequencing, while significant in immediately informing personalised medicine, will be important also in providing the foundations for “post-genomic medicine” where propensity to disease and responsiveness to treatment will be recognised as a function of an individual’s “proteome” (the composition and dynamics of cellular proteins) and “metabolome” (the equivalent entity for metabolites) as well as their genome. Thus, in the future, clinical care will be informed by an individual’s phenotype as well as their genotype. It is essential that the conditions are established now to facilitate the development of this next frontier in personalised medicine. This will require a clear commitment to the support of multi-disciplinary research, drawing on the skills of the chemist, the bioengineer, the data scientist and others. (Note the recommendation in the LSIS of the coordination of inter(multi)disciplinary expertise through capitalising on the recent establishment of UK Research and Innovation – UKRI.)

 

  1. Human genome sequencing poses significant ethical and legal issues, and presents new challenges to the relationship between researchers and human subjects. Addressing these issues and challenges requires the expertise of social scientists and humanities scholars; accordingly, multi-disciplinary approaches are required. Furthermore, full use must be made of experience developed over recent years in public and patient involvement in scientific research.

 

  1. Arguably, the UK is uniquely placed to satisfy the requirements to develop and benefit from genomic medicine, benefiting from its highly regarded multi-faculty universities, the coordinated healthcare system provided by the NHS, and the presence of world-leading companies in the pharmaceutical and informatics industries. The opportunities – as yet, far from fully realised – of this tripartite arrangement are clearly recognised in the LSIS.

 

  1. The need to process genomic data and to correlate with healthcare records poses a huge challenge in “big data”. The complexity will be vastly increased when multi-dimensional “post-genomic” data is added in the future, posing both an enormous challenge to data scientists and exciting opportunities for the bioinformatics industry.

 

An Example of Realisation of this Opportunity

  1. Recognising this potential, QMUL, Barts Health Trust, primary care providers and other collaborators have come together to create the Life Sciences Initiative in Whitechapel, East London.

 

  1. On land bought from Barts Health Trust by QMUL, the University and partners will (following a recent agreement (subject to legal contract) between Trust and University) develop 40,000 square metres of space for research, innovation, education, and public engagement activities. The site, adjacent to the new Royal London Hospital and the QMUL Medical School, is extraordinarily well-placed for national and international connectivity, being 200m from an underground/overground/ Crossrail station.

 

  1. A particularly notable feature of the initiative is the access, via primary and tertiary NHS providers, to a population of several million that is characterised by its diversity (ethnically, socially, financially) and by its need for enhanced healthcare. For example, the communities of South Asian origin in East London show an increased incidence of diabetes and heart disease. Overall, there is a stark gap in the life (and healthy life) expectancy between East and West London (on average, men in Kensington and Chelsea live over 5 years longer than those in Tower Hamlets). The projected work builds upon the East London Genes and Health initiative (paragraph 14).

 

  1. A high level of interest in the project has been shown by the major established pharmaceutical companies and by emerging businesses in the field. Bioinformatics companies have also expressed keen interest. Thus, the operating model envisages co-location of academic and industrial research in the Whitechapel development, promoting the pace of discovery and accelerating the translation of new knowledge and approaches into clinical care and commercial development.

 

  1. The initiative will also benefit from collaborative work with other universities and a multiplicity of clinical providers. This will be facilitated by QMUL’s (and BHT’s) membership of UCL Partners (see paragraph 5), but additional collaborations within London and beyond are under discussion. (For example, East London Genes and Health already involves partnership with King’s College London.)

 

  1. The application of genomic medicine on a population-wide scale depends on the confidence felt by individual members of the community in the research organisations involved. In this instance, the long-standing commitment of QMUL to public engagement, particularly with members of ethnic minorities, combines with BHT’s and the primary carers’ record of patient engagement to provide particularly favourable conditions for large-scale participation. (QMUL is the only UK university to hold – and at gold level – a Watermark of quality from the National Coordinating Centre for Public Engagement.)

 

  1. In sum, the combination of factors supporting this development in East London give promise of outcomes including (i) the enhancement of UK prominence in this emerging field of medicine, (ii) the development of clinical approaches with early benefits to the local population, with severe healthcare needs, and beyond, (iii) the early translation of developments in basic science to commercial developments, bolstering the UK’s position in pharmaceutical and bioinformatics R&D, (iv) economic benefits to East London, with knock-on implications for the rest of the country.

 

  1. Raising the substantial sums required to realise this vision is underway, energised by an initial in-principle commitment of £100m from the Barts Charity (estimated to be 25-35% of the total required). Undoubtedly, the balance will be raised through a combination of government, charitable and industrial support, where each recognises the significance of the others’ contributions.

 

  1. We note the very close correspondence between what is envisaged here and the class of opportunities described by Sir John Bell in the LSIS as a Health Advanced Research Programme (HARP).

 

Concluding remarks

  1. This submission has focused on opportunities in the life sciences that are uniquely available to the UK, based on its combination of world-class universities, concentration of R&D in the pharmaceutical and informatics industries, and close collaboration with the NHS – affording the benefits of access to extensive and coordinated medical records. Grasping these opportunities will yield extensive social and economic benefits.

 

  1. The points made in this submission – and the example given of a ground-breaking initiative in the health life sciences – speak directly to questions posed in the CfE. Thus, the collaborative approach that we advocate has implications for the conversion of basic discoveries into improved clinical treatments (Question 1), the enhancement of the skills base (Q 3), the involvement of commercial entities of differing sizes (Q 7), and the exploitation of the attributes of the NHS (Q 9 10, 12). We argue that financial support must come from multiple sources, with appropriate coordination (Q 8).

 

  1. Experience with the Whitechapel initiative confirms both the huge potential of university/NHS/industry collaboration and the need for an over-arching government strategy to facilitate this. Over several years, the already extensive joint working between QMUL and BHT has been supplemented by a shared vision of what can be achieved in population-scale genomic medicine. Nevertheless, reflecting procedural requirements, it has taken more than three years to reach headline agreement on purchase of land from BHT by QMUL to enable large-scale development of this initiative. Such brakes on progress risk the loss of the UK’s advantage in pursuing coordinated approaches to healthcare development and associated economic benefits. There is therefore a compelling need for adoption of a reinforced national Life Sciences Strategy that transcends Government department remits (Treasury; Department of Health; Department for Business, Energy and Industrial Strategy; Department for Education) to ensure that opportunities in the national interest are seized in a timely manner.

 

15 September 2017