55 Lessons Learned About Science Communication Around the World During COVID-19
The following insights, contributed by members of the Aspen Global Congress on Scientific Thinking & Action, offer local experts' best practices for communicating about a global health crisis with the public in nuanced and regionally specific ways.
Senegal
Is the messenger as important as the message? Pandemics such as COVID-19 and the flood of online misinformation underlie the critical need to elevate the voices of African science leaders. African communities have talented experts they can rely on to access reliable information based on facts, if only the right platforms are provided to them. Not only do we need to share the right information and understand our target audiences, we must pay close attention to those who deliver our messages, when planning any communication strategies.
Fara Ndiaye, Deputy Executive Director, Speak Up Africa
Brazil
The first lesson from the current pandemic for science communication in Brazil is that there is no such thing as redundancy. It doesn't matter how many times one says or explains something—about the importance of social distancing, or the uselessness of chloroquine—there is always someone you didn't reach the first time, and someone you reached but wasn't paying attention then. You have to repeat it, over and over again. Another lesson is that it actually works. Sometimes the onslaught of misinformation can make one think that the effort is futile. It isn't: if you listen carefully, you can find the results—even if only after a lot of repetition.
Natália Pasternak Taschner, President, Instituto Questão de Ciência (Question of Science Institute)
Carlos Orsi, Editor-in-Chief, Questão de Ciência (Question of Science) Magazine
Colombia
The pandemic has exposed the strengths and weaknesses of journalism, but it is also teaching, in real time, how to do good scientific journalism. In Colombia we have good results with the strengthening of our collaborative networks and working with colleagues from other countries and other media. We listen to science and give it a voice in the media. We are also looking at information from different angles. But we are left with challenges: journalists must be trained in scientific journalism, scientific journalism needs to be across all journalistic areas, and we need to learn to rigorously fact-check.
Ximena Serrano Gil, President, Asociación Colombiana de Periodismo Científico (Colombian Association of Science Journalists)
Ukraine
Ukraine started quarantine on March 25, 2020 when there were only 10 cases of COVID-19. And already on May 22 the quarantine was weakened and economic recovery began. Kyiv Mayor Vitali Klitschko's address "Don't wander the streets" worked well in the capital, the most populated city. We also managed to develop our own PCR tests within two weeks. I managed to provide comments on the origins of the new strain of coronavirus to the leaders of public opinion and it helped to prevent conspiracy theories and to stop the panic. Aspen Institute Kyiv organized a series of online events and activities to inform society about the pandemic, to help with medical supplies, and to assist the needy. In general, the COVID-19 pandemic exposed all the shortcomings and bottlenecks of the country's medical sphere. The positive outcome is that everybody learned about PCR and realized how important good science is for society.
Nataliya Shulga, CEO, Ukrainian Science Club
New Zealand
This pandemic has highlighted how a scientific issue connects every discipline and when those from seemingly different camps work collaboratively and innovatively, a powerful alchemy can result. I think New Zealand's response to COVID-19 has shown what is possible when good science and good communication come together. We have had extraordinary leadership in this country that not only invests in science, but invests equally in the public's understanding of it. NZ citizens were brought into the process of it every single day through effective storytelling across multiple platforms. Walls between science and society melted away, and no one had to question the reasons behind what we were being asked to do to protect ourselves and each other because the science was embedded in a crystal clear story. And at the heart of that story is the message to trust in science like your life depends on it—because it does.
Gianna Savoie, Director of Filmmaking, Center for Science Communication, University of Otago
Portugal
COMCEPT tries to engage with the public in person and via digital social networks. In the week before the lockdown we organized a public meeting, some style of "Skeptics in the Pub," about the new coronavirus. The speaker was the president of a medical association and presented to the public the best data available at the moment regarding SARS-CoV-2 and COVID-19. During the lockdown, we used social media to promote reliable information about the disease, shared official data from the Government, asked the public to participate in online academic studies, and debunked conspiracy theories.
João Lourenço Monteiro, Vice President, COMCEPT: Comunidade Céptica Portuguesa (Portuguese Skeptical Community)
Australia
Australia has … so far … come through the coronavirus pandemic without suffering the appalling figures seen elsewhere: Australia's death rate per million currently stands at 4, compared with 300 deaths per million in the U.S.A.; 542 in the UK; and a horrifying 800+ in Belgium. Australia is not alone in achieving such relatively low figures, but in Australia it does seem to be thanks to a fairly (but not perfect) early intervention to stop infections through border controls and lockdowns, supported by a largely cooperative public. While early communication efforts by governments were marked by contradictions and confusion, one success has been the national broadcaster, the Australian Broadcasting Corporation, in spreading factual information through a range of media platforms. In particular are the activities of Norman Swan, presenter of ABC Radio National's Health Report, who has become a key voice of coronavirus information. His daily CoronaCast podcast quickly became one of the most downloaded science podcasts around the world, and though presentations were not without dire predictions, his softly-spoken manner generally gave science communication a voice that seemed sincere and proved reliable.
Tim Mendham, Executive Officer, Australian Skeptics
Israel
There are two salient features of the corona-related fake news in Israel: they give the reader meaning and hope. I think that if we talk more about the interface between science and moral values, we might be able to fill in the needs currently filled with prophetic, pseudo-medical, and conspiracy messages. When communicating science, a curve is not just a curve; it is also a story about solidarity.
Ayelet Baram-Tsabari, Associate Professor,Faculty of Education in Science and Technology, Technion – Israel Institute of Technology
Nigeria
COVID-19 has exposed the need to diversify the approaches and languages used to communicate science. In Science Communication Hub Nigeria and African Science Literacy Network, our scientists and fellows are using local languages to debunk science misconceptions and disinformation about COVID-19 through written articles, myth busters, and weekly webinars streamed live on Facebook and YouTube. In addition to disseminating good science, this approach has made it easier for us to understand how local communities view science and scientists, which in turn enables us to deliver content appropriate to these communities.
Mahmoud Bukar Maina, Founder, Science Communication Hub Nigeria
Czech Republic
It is not a secret in the world of science communication that, for many, accepting the facts has little to do with facts themselves. This quiet truth has been brought out into the spotlight even more so now during the pandemic. Many of us received the lesson that we must communicate with the human first before we try communicating the science to them.
Claire Klingenberg, President, European Council of Skeptical Organizations (ECSO)
U.S.A. / Mexico
The pandemic has united science communicators more than ever. It has spurred many fruitful collaborations, such as the COVID-19 Virtual Forum organized by the Mexican Network of Science Journalists with all the science communication associations in Latin America and Spain. In Mexico and the U.S., we are all fighting misinformation while keeping up to date with the freshest science, policies, and society's response. This is the time to show why science journalism is important by stepping up to the plate.
Rodrigo Pérez Ortega, Founding Member, Mexican Network of Science Journalists
Switzerland
Switzerland has managed to flatten the curve substantially and avoid a collapse of the public health system. Now that the country is slowly opening up again, the public discourse increasingly revolves around the question of "what was all this fuss about, when nothing happened?!" We have a term for this frustrating phenomenon: Pandemic Paradox. The successful management of outbreaks can lead to a decrease in public trust in communicators based on the perception that they were overreacting. However, we are aware of it and its origins are well studied, which gives us an assortment of tools to combat it.
Angela Bearth, Research Scientist, Consumer Behavior, Department of Health Sciences and Technology, ETH Zürich
Cameroon
The pandemic has recalled the vital role of science communication in times of crisis. Africa in general and Cameroon in particular have been spared for the moment from the catastrophe so feared by the whole world. This stems from the good collaboration among media, decision makers, and researchers who have positively influenced the apprehension of the threats by the general public as well as their behavior, which is a determining factor for the efficiency of the response.
Stéphane Kenmoe, Scientist, Science communicator, and television personality
Canada
Science communication is always challenging but even more so in the COVID-19 era since so much about the disease is unknown. Because of my media presence and the mandate of our Office to "demystify science for the public," I am bombarded by questions from morning to night. Unfortunately, the answers almost always have to be qualified with "ifs," "buts," and "maybes," which is not very satisfying.
I think I can confidently say that self pleasuring will not reduce the chance of contracting COVID-19 as some bloggers claim, and I can also assure people that hanging laundry on a clothesline is safe and advise them that putting the newspaper in the oven to disinfect it is a bad idea. But when questions arise about handling mail or groceries, or the effectiveness of masks, the uncertainties creep in.
Then there is the issue of the numerous conspiracy theories ranging from Bill Gates's supposed plan to decimate the population to the disease being caused by 5G antennae. This puts us in a position of having to prove a negative, which is very difficult to do. My usual approach is to ask proponents questions about the number of conspirators that would have to be involved, their possible motives and the source of the information. Sometimes if you give them the rope they will hang themselves.
Joe Schwarcz, Director, Office for Science and Society, McGill University
India
The clamp downs, the lock downs,
the prayers were all tried
Lamps were lit, plates banged, and
flowers were showered from skies
Millions were spent, sugar pills were
dispensed, grandmas' soups concocted
Herbs were boiled and breathing taught
Alas nothing worked, they all came to
naught
Millions walked, hundreds died.
All nation builders migrating to home
villages
The rulers were deaf, the nation was
blind to one of the longest shut downs
of its kind!
But nothing worked, neither the herbs
nor the sugar pills or the urine of the
mother cow!
1,300 million Indians abandoned to their fate now!
Narendra Nayak, President, Federation of Indian Rationalist Associations
U.K. / China
COVID-19 has brought the public to witness first-hand science-in-the-making in a multi-centred world and allowed the scientific community to participate in real-time sense-making with various publics on risks and responsibilities. To borrow the term from Silvio Funtowicz, COVID-19 has ushered everyone into an era of "post-normal" science communication, in which the contents being communicated are contingent, objectives conflictual, outreach global, consequences personal, and (re)actions urgent. This further highlights the need to co-develop new approaches of transnational scientific dialogue in and with China, where public engagement is still at a nascent stage.
Joy Yueyue Zhang, Senior Lecturer in Sociology, School of Social Policy, Sociology, and Social Research, University of Kent
U.S.A.
I'm inspired by the work of Avi Schiffmann, a 17-year-old high school student in Seattle, Washington, who took it upon himself to create a well-designed and up-to-do-date website for tracking COVID-19 infections and deaths from around the world. Remember when the outbreak first happened and no one could get reliable information in one place? This kid—who had been coding since he was a child—created a massive data-scraping program that allowed a centralized location for this crucial info. And it's gotten millions of views. Now that's science communication!
Lee McIntyre, Research Fellow, Center for Philosophy and History of Science, Boston University
Syria
In Syria, the COVID-19 situation is messy and unclear and lacks transparency. From one side, official numbers show only 109 cases and four deaths since the outbreak; on the other side, these numbers are widely criticized by experts as well as by the public because of low testing and lack of official communication.
The nine-year-long war has hugely destroyed the medical infrastructure in Syria and pushed the majority of medical staff to leave the country. Despite these facts, the country went into only a partial lockdown and tried to minimize interactions among its population with shy measures.
The big absence in these measures was indeed "communication." None or only a few official institutions tried to keep the population updated about the evolution of the disease inside the country. This factor pushed many civil society organizations to take over, covering topics such as self-protection, molecular biology, and pharmaceutical updates. Moreover these initiatives, mainly via Facebook, fought against misleading information such as conspiracy theories and unethical drug use. In the near future, international organizations should learn from the Syrian example and pay more attention to the impact of these volunteer-based organizations that could replace official institutions for science communication during wartime.
Mouhannad Malek, Founder and Chairman, Syrian Researchers
Spain
From the skeptical movement, we noticed that at first almost everybody was very cautious, and few dared to screw it up with loose nonsense. But right away, some started placing the blame on their favorite enemy: Trump on China, China on Trump, or electromagnetic or 5G sensitivity—allied to the anti-vaccination, flat-earth, and Germanic New Medicine leagues. And then there are the crazy remedies pulled out of a hat.
Juan A. Rodríguez, Secretary, ARP–Sociedad para el Avance del Pensamiento Crítico (Society for the Advancement of Critical Thinking); Editor, El Escéptico (The Skeptic) magazine
Argentina / Brazil
Science communication and journalism have been reinvented in South America. More people are giving their time to contribute to science communication and are also actively engaged in teaching society how to be fact-checkers. Science popularization was reborn in small movements that spread checked news that "goes viral" through WhatsApp messages where, until then, Fake News had a clear ground. Low-cost podcasts boomed, shared sometimes even in the old way, through car loudspeakers in the street. Journalists, science communicators, and researchers became more active in professional networks. They also abandoned the practice of competing against each other, creating new ways to collaborate. Now, they share hard-to-access data through virtual meetings, pre-prints, or private communication, offering experts' contacts and valuable advice. This is the new normal.
Roxana Tabakman, Health Writer and Science Journalist, Red Argentina de Periodismo Científico (RADPC) (Argentinian Network of Science Journalism); Rede Brasileira de Jornalistas e Comunicadores de Ciência (RedeComCiência) (Brazilian Network of Science Journalists and Communicators)
Japan
In Japan, the lack of outreach from scientists and science communicators during the Fukushima nuclear power plant accident following the Great East Japan Earthquake in 2011 led to a growing distrust of science professionals. In this year's COVID-19 pandemic, many scientists are disseminating information online, and science communicators at research institutions are actively providing learning tools for children who are on standby at home. While politicians have yet to learn the importance of science communication, the public is learning how to seek out the information they need.
Masataka Watanabe, President, Japanese Association for Science Communication
Jordan
In these unprecedented times, building the case for science and research is of utmost priority. Therefore, at Phi Science Institute in Jordan, we aim to handle this responsibility very seriously on the regional and global levels by providing full coverage of the latest trusted scientific news in Arabic for the Arab world; turning our Research and Innovation Summit 2020 fully virtual to connect youth and experts for science from all across the region and enable them to work on joint research projects at this hard but unique time; and working with our artificial intelligence lab on healthcare A.I. products related to COVID-19.
Safa Khalaf, Community Outreach Officer, Phi Science Institute
U.S.A.
Initial response to the outbreak in the U.S. was striking for the high degree of support for and compliance with restrictions on public activity. Scientists were centerstage in their role advising government leaders. But U.S. opinion has been shifting. There are now growing partisan divisions over the risk COVID-19 poses to public health as well as over social distancing measures aimed at slowing the spread of the disease. And, unlike years past, a partisan imprint now extends to public confidence in medical scientists to act in the public interest.
Cary Funk, Director, Science and Society Research, Pew Research Center
Romania
Governments all over the world have realized the importance of good communication with the public. And they have also realized the impact that false news and misinformation can have on their efforts. I work in promoting vaccination, and until now, antivaccine ideas were considered fringe and limited. The pandemic has shown that anyone can start to become a source of misinformation, and we need to combat misinformation quickly and efficiently. This lesson, hopefully, will not be forgotten.
Ovidiu Covaciu, Administrator, Vaccinuri si Vaccinare (Vaccines and Vaccinations); Founder, Coaliția România Sănătoasă (Romania Healthy Coalition); Producer, Sceptici în România (Skeptics in Romania)
Russia
Just a year ago, we launched a specialty in communication in medicine and biotechnology in our SciComm M.Sc. program. It's been a long time coming! Like never before, we are facing the fact that science communication matters, and the lack of information only increases fears and frustrations.
Daria Denisova, Director, Science Communication and Outreach Office, ITMO University
South Africa
Novel ways of sharing the science of COVID-19 with children: In South Africa (and many other countries) scientists have partnered with authors and illustrators to create a range of storybooks, comics, and infographics (in many indigenous languages) to help children understand the pandemic.
The pandemic is also an infodemic: As much as there is a need (and demand) for scientific expertise, misinformation may also flourish when people are scared and uncertain. Combating misinformation is a complex task. It is important to understand the reasons why rumours and false claims spread, and to be thoughtful and respectful when trying to correct them. Here is some advice.
Marina Joubert, Senior Researcher, Centre for Research on Evaluation, Science and Technology (CREST), Stellenbosch University
U.K.
As a researcher of so-called alternative medicine (SCAM), I should have expected it—but when it did arrive, it came as a surprise nonetheless. I am talking about the number of snake-oil salesmen putting their ugly heads above the parapet. After the pandemic had been declared, it took just days for the promotion of corona quackery to start: acupuncture, chiropractic, herbal tinctures, homeopathic remedies, colloidal silver, essential oils, dietary supplements, and many more. The entire panopticum of SCAM was on display. This was when I decided to relentlessly name and shame the villains on my blog (edzardernst.com). Today, I must have posted over 40 articles about the "corona snake-oil brigade."
The second surprise was positive, I am glad to say. The amount of support I received was unprecedented. Hundreds of comments were posted by people who agreed that now it was more important than ever to disclose this quackery, point out what harm it does, and prevent the public from falling for it (at one stage, my humble blog was even quoted by U.S.A. Today). Many friends and colleagues joined in and wrote about SCAM merchants attempting to make a fast buck by misleading the public. But the public was far less gullible than the charlatans had hoped. My impression is that the snake-oil craze even provided a significant boost for critical thinking. The pandemic is doing untold, tragic damage, but it has also helps to explain to consumers how crucially important real science is and how devastatingly dangerous pseudoscience can be.
Edzard Ernst, Emeritus Professor, University of Exeter
"How can we sustain this appetite for science? Highlight the WHY more than the HOW and WHAT."
Pakistan
Pakistan is actively combating the COVID-19 pandemic by effective lockdowns. People are well aware of mask and sanitizer usage and are maintaining social distancing. Treatment of those affected is being provided by government hospitals.
Qaiser Majeed Malik, Chairman, Pakistan Science Foundation
Turkey
Despite strong faith in fatalism in Turkish society, trust and confidence in sciences have unexpectedly increased since the outbreak of COVID-19. Discussion programs on TV give their prime times to scientists more than governmental authorities. The Ministry of Health got more credit than any other political actors because of its daily updates on prevention arrangements. However, social media is more useful to share information about people's corona experiences in their living environments. Personal impressions and experiences are widely circulated during the outbreak, including health conditions and daily life routines under the "stay at home" conditions. Scientific content about COVID-19 is also heavily distributed, and governmental practices are called into question by social media users frequently. Individuals become more "science citizens" both by demanding scientific information from diverse and trustworthy sources and also by producing their own content.
Çiler Dursun, Professor, Faculty of Communication, Ankara University, Scientific Coordinator, Genovate
Malaysia
A lesson I learned during the pandemic as a science communicator: it takes a crisis for the public to heed science and see it as a solution provider. Followers on my Facebook page increased by more than 2,000; subscription to my newspaper, The Petri Dish, increased among the public; and more media interviews. How can we sustain this appetite for science? Highlight the WHY more than the HOW and WHAT.
Mahaletchumy Arujanan, Executive Director, Malaysian Biotechnology Information Centre (MABIC)
Germany
The brief guide on Proper Criticism by psychology professor Ray Hyman has been crucial for effective science communication, where he explains essential points, such as not going beyond your level of competence and using the principle of charity. Beyond presenting the facts and the science, which are often later forgotten by the audience, people remember the messenger. We have learned that coming across as compassionate, credible and trustworthy gives the message a far more significant and lasting impact.
Amardeo Sarma, Chair, Gesellschaft zur wissenschaftlichen Untersuchung von Parawissenschaften (Society for the Scientific Investigation of Parasciences)
Netherlands
In the early phase of the pandemic in the Netherlands, the government opted for a moderately strict lockdown and suggested that in this way the virus that was still present would lead to herd immunity. There was massive outrage because the public understood that civilians were being sacrificed for the creation of this herd immunity. When the government subsequently explained that the creation of herd immunity was not the goal of its policy but a welcome side effect, the unrest subsided.
Cees Renckens, Chair, Vereniging tegen de Kwaksalverij (Dutch Society Against Quackery)
Rwanda
At the University of Global Health Equity (UGHE), we have worked to further our educational mission during this unprecedented challenge of COVID-19, a pandemic that reminds us of the critical importance of our mission. With our campus located in the rural north of Rwanda, it was our priority to not only continue to provide quality education—which has transitioned to fully virtual learning—but also to take extensive precautions to protect our students, staff, faculty, and the surrounding community from the virus. Given the toll of this virus and the drastic change in social norms it has created, we are conducting not only weekly physical screenings but also mental health screenings. We are grateful to report that all from our UGHE community have remained in strong health. We are grateful to keep contributing to the fight for global health equity during a time such as this.
Agnes Binagwaho, Vice Chancellor, University of Global Health Equity; former Minister of Health
U.S.A.
The pandemic has revealed that now more than ever, science communication cannot prevail until nations and states dismantle the underlying structural injustices that erode trust in science. For instance, the exploitation of racial minorities' justified distrust of the medical establishment by anti-vaccine groups has become a matter of growing concern—from the 2017 Minnesota measles outbreak after activists convinced Somali-American immigrants that vaccines cause autism to the growing present-day opposition to a COVID-19 vaccine. Still, there is hope if only those who disseminate science-based information understand that the anti-vaccine movement, and similar movements that sit at the crossroads of science and society, have never been fundamentally about evidence. It's about whom to trust.
Kavin Senapathy, Science, health, and parenting writer; Member, American Society of Journalists and Authors; Contributing Editor, SciMoms.com
Indonesia
Although the clerics all agreed that public prayer should be banned to slow the spread of the disease, many Indonesian Muslims clogged the mosque during Ramadan and Eid, completely ignoring the health and religious authorities. Some Indonesian Muslims even strongly believe that somehow the Jewish and the Chinese are the masterminds of the pandemic—a bizarre claim that Muhammadiyah, one of the largest Muslim organizations, is trying hard to debunk. Conspiracy-theory believers are still not completely convinced by counter-arguments coming from religious authorities.
Rizqy Amelia Zein, Assistant Professor, Department of Personality and Social Psychology, Universitas Airlangga
U.S.A.
I practice Stoic philosophy and have been wondering what the Stoics might have to say about how to react to a pandemic. It struck me that our current situation is somewhat analogous to something many in the ancient world had to experience: exile. When someone is in exile, their life is very different, of lower quality, and far more constrained, than what they are used to. Just like during self-isolation or lockdown in a pandemic.
So what did the Stoics do when in exile? They taught philosophy to others, like Musonius Rufus, a famous first-century teacher. And they wrote letters of consolation to their loved ones, as Seneca, also in the first century, did to his mother Helvia.
In that letter, Seneca says that Fortune comes and goes, but what remains constant, and independent of Fortune, is our character, our determination to always be the best human beings we can be. Indeed, it is in times of difficulties and setbacks that we have an opportunity to shine. As he puts it, everyone is a good pilot when the sea is calm. It's only in the midst of a storm that we see who is truly skilled. So let's think of the current storm as an opportunity to improve our proficiency at navigating life.
Massimo Pigliucci, Professor of Philosophy, City College and the Graduate Center, City University of New York
Morocco
Our communication efforts have included webinars on the environment, climate change, and inter-linkages with the pandemic, for example effects of coronavirus on biodiversity, how COVID-19 has benefitted climate, and the green economic recovery from COVID-19. Our members have also written opinion articles published in journals and media in more than ten Arab countries. These activities have attracted the attention of communities, raised awareness as the scientific material was communicated in the Arabic language, and significantly unleashed the potential of our members.
Hajar Khamlichi, President and Co-Founder, Mediterranean Youth Climate Network; Board Member, Moroccan Alliance for Climate and Sustainable Development
Iran
Iran was one of the first countries to be involved in the crisis. Widespread international sanctions have restricted the capability to control the virus. In response to the pandemic, scientific institutions, non-governmental organizations, and government agencies have facilitated the transition from this crisis by:
Akram Ghadimi, Associate Professor, Department of Popularization of Science, National Research Institute for Science Policy
Philippines
Here in the Philippines, government agencies regularly post pandemic-related visual aids through social media in order to prove a point (e.g., "The curve is flattening," "We have more or fewer cases"), except the visual aids are unintuitive, if not altogether cherry-picked: Trend lines are traced haphazardly, bar charts are not drawn to scale, and government spokespersons almost literally tell people what to believe. Instead of just mocking these visual aids, younger data scientists and statisticians have taken to social media to talk about how to interpret data and why some visual aids are badly made. These scientists use these social media posts as a starting point to help people think critically rather than accept knowledge wholesale, which fits well with how the practice of science is about questioning, critical thinking, and healthy skepticism.
Inez Ponce de Leon, Assistant Professor, Department of Communication, Ateneo de Manila University
U.S.A. / Colombia
Seven years ago, I wrote a book in Spanish called Un enemigo invisible / An Invisible Enemy. This science and adventure novel for young adults is read in several schools throughout Colombia. The plot deals with a deadly virus that gets into Miami via a howler monkey brought from Guyana in a shipment of wild monkeys for lab research. The monkey is a reservoir (whose original host is a bat) of the (fictitious) virus Canzanboria, which infects one of the young main characters. The book thus becomes a race to find out what this virus is, where it comes from, how to get a vaccine, and how to stop it—like what is happening now.
The exciting part is that, because of the pandemic, several schools are hosting videoconferences where I can talk to kids about the book and my behind-the-scenes work with real-life virus hunters—research I did in order to write the novel. These kids are hugely interested and love my explanations about the evolution of viruses, the roles they play in our life, and the fact that were it not for a virus, none of us mammals would exist.
This pandemic has opened a window for me to take the scientific process to young minds in often inaccessible places in Colombia, as well as in China (the book was translated into Mandarin). I think reaching young people is the way to achieve a well-educated and interested society that will eventually grow up to support science in a meaningful way.
Ángela Posada-Swafford, Science, environment, and exploration journalist, lecturer, moderator, and book author; Board Member, Colombian Association of Science Journalists
Ghana
Shortly after the first case was reported, various professional science societies and associations came together to form a COVID response team. The purpose was simple: to coordinate availability of scientists for media engagements. It worked well and continues to do so, making sure that people remain informed based on accurate science. It has been a lesson on coming together and communicating science collaboratively.
Thomas Tagoe, Lecturer, Physiology and Pharmacology, University of Ghana; Co-Founder, GhScientific
Nepal
In order to control the rate of proliferation of COVID-19, social distancing has been a globally accepted effective method. In order to maintain such distancing and yet continue our business as usual, information and communication technology available today is very much useful. Also, mobile technology has been easily accessible even to people living in poverty in Nepal. Therefore, we can take the widespread use of internet platforms such as Skype, Facebook, Zoom, MS Teams, Voov, WhatsApp, Kakao, Viber, WeChat, etc. for any kind of communication including for science teaching, seminars, conferences, meetings, and discussions.
Sunil Babu Shrestha, Vice-Chancellor, Nepal Academy of Science and Technology (NAST)
"During this pandemic, perhaps most confusing of all has been the unexpected ideological struggle on the fundamentals of medicine."
Sudan
When it comes to disseminating scientific information, social media can do more harm than good in a time of crisis, due to the spread of inaccurate scientific information. In Sudan, a country that is fighting the spread of COVID-19 with little to almost no resources, WhatsApp, as usual, became the main source of news about the virus for the majority of internet users. Sudanese people's phones are flooded with misinformation, including unverified home remedies (the most viral one was drinking red tea before sunrise), fake research findings that the virus cannot survive the country's climate, and conspiracy theories claiming that the virus is a lie made up by the government to close down mosques and stop people from practicing their religion freely.
All this misinformation has led to people not following recommended policies, such as non-essential travel and social distancing. In fact, it has made some people go as far as protesting in huge numbers against the government's decision to close down the borders. In areas where access to smartphones is limited, the few people who do have smartphones end up being the main source of information for the rest.
The low level of tech literacy in many developing countries, especially among elderly communities, makes people less likely to verify sources. With the continuous increase of COVID-19 cases, misinformation will pose an even more dangerous threat for many countries. Some, like Qatar and Saudi Arabia, have criminalized its spread, but implementing such strict policies isn't always possible. This is why I believe youth- and community-led initiatives in countries like Sudan can take a leading role in raising awareness about the dangers of misinformation. People here have little trust in government but are welcoming of youth work.
Lina Yassin, Programme Manager, Climate Tracker, MENA (Middle East and North Africa)
Guatemala / U.S.A.
At the Cornell Alliance for Science, we are currently highlighting how science is being used to fight COVID-19 and dispelling myths through our online platform. In Guatemala, there have been different spaces created for "science innovation" to address the challenges this pandemic brings with communication strategies that include hashtags such as #nuestrascienciarespone (our science has answers) and #cienciaGTenaccion [GT (Guatemala) science in action]. However, there is also a lot of misinformation spread through the many social media platforms used in the country. We believe we can amplify projects that bring attention to how science is pivotal in a crisis and, at the same time, dispel misinformation by circulating fact-checked pieces in Spanish for our Central American audiences.
Pablo Ivan Orozco, Policy Affairs Associate, Cornell Alliance for Science
France
During this pandemic, perhaps most confusing of all has been the unexpected ideological struggle on the fundamentals of medicine. While evidence-based medicine was demonstrating its power, a discourse combining postmodernism and medieval thinking was developing "against the method," celebrating "common sense" medicine as opposed to medicine presented as big data and big pharma.
France found itself, with its "Marseille Protocol" at the center of this tornado whose effects were felt as far as the U.S.A.–Brazil axis. At the heart of the turmoil, the French Association for Scientific Information has endeavoured to communicate daily on its public website and its internal forum the reliable sources of information enabling everyone to untangle scientific facts from unfounded rumours, to understand where the established knowledge is and where the uncertainties lie, and to remind people that medicine is not a game of poker.
Michel Naud, Director and Former President, Association Française pour l'Information Scientifique (French Association for Scientific Information)
Serbia
During the COVID-19 pandemic, the Center for the Promotion of Science was active in raising citizens' awareness of the challenges they faced. Very early on, at the end of March, the Serbian translation of the extensive database was published on the Center's portal, enabling citizens to find out what is really behind the often confusing statistics that the media conveyed to the public in a clumsy and sometimes distorted manner. In early June, a new issue of the Center's popular science magazine Elementi was released. In a special segment containing six articles accompanied by appropriate visual storytelling, eminent physicians, philosophers, data scientists, science journalists, and graphic designers addressed some important topics related to the pandemic, such as the evolution of SARS-CoV-2, data modeling, mental health of physicians and citizens, and the moral challenges with which decision-makers were faced.
Ivan Umelji, Head of the Department for Publishing and Media Production, Centar za Promociju Nauke (Center for the Promotion of Science)
Marko Krstić, Acting Director, Centar za Promociju Nauke (Center for the Promotion of Science)
U.S.A. / U.K.
At Annual Reviews, we removed access control to all of our content—everything that we have published in the past 88 years—on March 13, 2020 in response to the COVID-19 pandemic. Compared to April 2019, usage of the content in April 2020 increased more than threefold (to 3.1 million downloads worldwide). It was not just our virology and public-health related content that was read more—every field from astronomy to vision science saw a substantial uptick. Removing barriers to access reveals the breadth interest in science for the public good: in the U.S., 28 different city governments, 18 state governments, the U.S. Department of Justice, the U.S. Senate, and the U.S. House of Representatives all recorded usage, as did parliaments in scores of other countries.
Strikingly, access from less wealthy nations rose dramatically; for example, Morocco by 1,403 percent and Ecuador by 1,033 percent. This usage re-emphasizes the value of democratizing access to science across all disciplines (not just COVID-19) and parts of the world.
While the great majority appreciate their personal and public duty to reduce the chance of infection, in the face of weeks of isolation and economic hardship, many people experience angst, anger, and disbelief. Using science to help people understand the dissonances that they were experiencing, and the necessity of their sacrifice, we developed a free service called Pandemic Life as a way to relate the body of social science research to the COVID-19 pandemic. Several times a week, articles that offer insights into such matters as the benefits of social norms, how to guide children's development, dealing with isolation, and the nature of happiness are covered on social media and in a short news story, and the relevant review article is made available for a deeper dive.
This evolved into a series of online conversations called Pandemic Live, during which some of the world's foremost researchers discuss and answer questions on aspects of the pandemic. Directly connecting the public with researchers in ways that go beyond sound bites and political posturing provides a powerful way to communicate reliable science insights into health, social, and economic issues in an age of misinformation.
Richard Gallagher, President & Editor-in-Chief, Annual Reviews, Publisher, Knowable Magazine
Russia
The experience of the South Korean church spreading coronavirus has not taught us—in Russia—anything. There have been large masses of people standing in line in the Kazan Cathedral to kiss the remains of a dead saint. A number of Russian Orthodox priests have commented that you cannot catch a virus in church. The head of church public communications has stated that people should avoid massive gatherings—but religious gatherings are an exception. In the Vatican, Pope Francis was a welcome contrast, giving Easter mass behind closed doors and praying in an empty St. Peter's Square, showing by example the distancing and isolation to which we must adhere in order to save lives. Unfortunately, the Russian Orthodox church does not have such concerns for the people.
Alexander Panchin, Senior Researcher, Institute for Information Transmission Problems (Kharkevich Institute); Member, Commission on Pseudoscience and Research Fraud, Russian Academy of Sciences
U.S.A.
Vaccination has fallen dramatically in the U.S. since the World Health Organization declared a pandemic. One proposal is to use gain-framed messages. This idea builds on insights from prospect theory, which was developed by Nobel laureate Daniel Kahneman. The theory suggests that prevention and treatment behaviors are motivated better by messages with a gain than a loss frame. As applied to our current crisis, the idea is to focus on the benefits of vaccination and on doctors' offices as being safe places. Many of us know more about what our grocery store is doing to keep us safe than what our doctor is doing. Proactively addressing this can help get vaccination back on track.
Noel Brewer, Professor, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
Ethiopia
In Ethiopia, there are difficulties with governments, stakeholders, and the biomedical community regarding how media should further COVID-19 education and prevention. On March 27, 2020, the Ethiopian Ministry of Health and Ministry of Technology Innovation announced that Ethiopia made significant progress toward development of a cure for the virus: "In collaboration with Ethiopian traditional doctors and modern science research and clinical doctors, we are exploiting our indigenous and traditional knowledge and shaping it into modern science procedures to prepare a cure for COVID-19. The medicine has potential to prevent the virus, is non-poisonous, and is promising."
Following this announcement, many maverick and dissident scientists opposed the statement and said it was premature to make an announcement before a clinical trial was started and that it distracts people's attitudes from vigilance and alertness against the pandemic and politicizes the situation. The majority of Ethiopian people agree: a poll conducted through the messaging platform Telegram found that 71% of people said it was incorrect to make such an announcement before a clinical trial.
Tenaw Terefe, Assistant Professor, Faculty of Journalism and Communication, Addis Ababa University
Italy
As fake news and conspiracy theories about the coronavirus piled up every single day during lockdown, I found myself, as many other science popularizers here in Italy did, with an urge to share—with those following us on social media—analysis, critical thinking skills, and tools to overcome the craze and better understand what was happening.
Day after day, I noticed a closer bond developing with more and more people. They were not only asking the "expert" for information or insights in clearing up some new absurd claim, but they were also looking for some kind and reassuring words from someone they now perceived as a calm and rational friend, someone who could take even the wildest fears back down to earth.
Eventually, as things started to get a little easier and those who could returned to their jobs, crazier claims lost their grip, but the bond of trust between us, pop science talkers, and our audience, not only is still there, but has grown stronger. And it looks like a lot of good and promising things can come out of this.
Massimo Polidoro, Executive Director, Comitato Italiano per il Controllo delle Affermazioni sul paranormale (Italian Committee for the Investigation of Claims on the Paranormal)
Saudi Arabia
The infodemic we're currently seeing alerted me to a crucial point: the correct, reliable, and verified scientific information and evidence is widely available to all those who seek it.
In our digital age, the root cause of ignorance cannot be limited to only knowledge scarcity. A century ago, illiteracy was prevalent in the majority of the global population, and knowledge was only available to a small group of society. All of that has changed, but ignorance still prevails. The root causes must be deeper and broader.
I reckon that this particular ignorance is rooted in the wrong understanding of the scientific methodology process (making an observation, formalizing a hypothesis, experimenting, gathering data, analyzing it, and building a theory). The overwhelming majority of conspiracy theorists' arguments are based on a misconception of one of these basic principles, whether by confusing hypothesis for a theory, or lack of familiarity with methods of constructing a solid experiment, or ways of examining data and evidence, or erroneous analysis of experiments' results outside their scientific context.
Assuming the validity of this observation, the answer to all the ongoing "scientific" controversies won't be by discussing each issue separately, but by referring back to the basics of the scientific methodology, and determining the cognitive origins of this collective fault and reforming it.
Unfortunately, schools do not pay as much attention to the methodology as it deserves, but consider it as another lesson that must be finished to complete the curriculum. This has contributed to the emergence of many strange beliefs in our society without the slightest evidence or collective scrutiny. It is our role as science communicators to bring back the central role of the scientific methodology and reeducate the public about its importance and applications in our daily lives.
Faris Bukhamsin, CEO, Scientific Saudi
U.S.A. / India
Calling out scientific misinformation explicitly is critical for effective science communication. This can be an arduous task since misinformation can be generated rapidly (and at low cost!) through internet platforms. A group of scientists from top research institutes in India (the Tata Institute for Fundamental Research, Mumbai and the Indian Institute of Science, Bangalore) have set up a website with "Hoax Busters" that contains simple infographics explicitly calling out misinformation circulating in social media. This is a critical tool for science communication in a country like India where scientific literacy remains low but technology access has increased significantly (over 500 million smartphone users), leading to an explosion in the circulation of misinformation.
Abhilash Mishra, Director, Kevin Xu Initiative on Science, Technology, and Global Development, University of Chicago
Kenya
The Kenyan Government has been consistent in providing status updates with three key messages, while keeping communication short and simple:
1. Wash hands regularly with soap and sanitize often,
2. Social distancing, and
3. Wear face masks.
One other lesson is use of spokespersons trusted by communities such as faith-based leaders and local administration (not as widely, but at least this is a positive).
Margaret Karembu, Director, International Service for the Acquisition of Agri-biotech Applications (ISAAA) AfriCenter
Chad
This pandemic has shown us that we have an intimate relationship with nature and that there is an urgent need to enhance biodiversity protection. Biodiversity is a protection against the development of pandemics, and nature is our pharmacy and provides the molecules needed for both modern and traditional knowledge. Indigenous peoples have known this for centuries, living in harmony with nature, and advocating for a paradigm shift in our relationship to the environment. My hope is that this crisis will be a wake-up call for all of us. COVID-19 has demonstrated that politicians and business leaders are lost without science, and that listening to scientists can save lives.
Hindou Oumarou Ibrahim, Coordinator, Association des Femmes Peules Autochtones du Tchad (AFPAT) (Association of Peul Women and Autochthonous Peoples of Chad)
[Editor's Note: This article was originally published on June 8th, 2020 as part of a standalone magazine called GOOD10: The Pandemic Issue. Produced as a partnership among LeapsMag, The Aspen Institute, and GOOD, the magazine is available for free online.]
Questions remain about new drug for hot flashes
Vascomotor symptoms (VMS) is the medical term for hot flashes associated with menopause. You are going to hear a lot more about it because a company has a new drug to sell. Here is what you need to know.
Menopause marks the end of a woman’s reproductive capacity. Normal hormonal production associated with that monthly cycle becomes erratic and finally ceases. For some women the transition can be relatively brief with only modest symptoms, while for others the body's “thermostat” in the brain is disrupted and they experience hot flashes and other symptoms that can disrupt daily activity. Lifestyle modification and drugs such as hormone therapy can provide some relief, but women at risk for cancer are advised not to use them and other women choose not to do so.
Fezolinetant, sold by Astellas Pharma Inc. under the product name Veozah™, was approved by the Food and Drug Administration (FDA) on May 12 to treat hot flashes associated with menopause. It is the first in a new class of drugs called neurokinin 3 receptor antagonists, which block specific neurons in the brain “thermostat” that trigger VMS. It does not appear to affect other symptoms of menopause. As with many drugs targeting a brain cell receptor, it must be taken continuously for a few days to build up a good therapeutic response, rather than working as a rescue product such as an asthma inhaler to immediately treat that condition.
Hot flashes vary greatly and naturally get better or resolve completely with time. That contributes to a placebo effect and makes it more difficult to judge the outcome of any intervention. Early this year, a meta analysis of 17 studies of drug trials for hot flashes found an unusually large placebo response in those types of studies; the placebo groups had an average of 5.44 fewer hot flashes and a 36 percent reduction in their severity.
In studies of fezolinetant, the drug recently approved by the FDA, the placebo benefit was strong and persistent. The drug group bested the placebo response to a statistically significant degree but, “If people have gone from 11 hot flashes a day to eight or seven in the placebo group and down to a couple fewer ones in the drug groups, how meaningful is that? Having six hot flashes a day is still pretty unpleasant,” says Diana Zuckerman, president of the National Center for Health Research (NCHR), a health oriented think tank.
“Is a reduction compared to placebo of 2-3 hot flashes per day, in a population of women experiencing 10-11 moderate to severe hot flashes daily, enough relief to be clinically meaningful?” Andrea LaCroix asked a commentary published in Nature Medicine. She is an epidemiologist at the University of California San Diego and a leader of the MsFlash network that has conducted a handful of NIH-funded studies on menopause.
Questions Remain
LaCroix and others have raised questions about how Astellas, the company that makes the new drug, handled missing data from patients who dropped out of the clinical trials. “The lack of detailed information about important parameters such as adherence and missing data raises concerns that the reported benefits of fezolinetant very likely overestimate those that will be observed in clinical practice," LaCroix wrote.
In response to this concern, Anna Criddle, director of global portfolio communications at Astellas, wrote in an email to Leaps.org: “…a full analysis of data, including adherence data and any impact of missing data, was submitted for assessment by [the FDA].”
The company ran the studies at more than 300 sites around the world. Curiously, none appear to have been at academic medical centers, which are known for higher quality research. Zuckerman says, "When somebody is paid to do a study, if they want to get paid to do another study by the same company, they will try to make sure that the results are the results that the company wants.”
Criddle said that Astellas picked the sites “that would allow us to reach a diverse population of women, including race and ethnicity.”
A trial of a lower dose of the drug was conducted in Asia. In March 2022, Astellas issued a press release saying it had failed to prove effectiveness. No further data has been released. Astellas still plans to submit the data, according to Criddle. Results from clinical trials funded by the U.S. goverment must be reported on clinicaltrials.gov within one year of the study's completion - a deadline that, in this case, has expired.
The measurement scale for hot flashes used in the studies, mild-moderate-severe, also came in for criticism. “It is really not good scale, there probably isn’t a broad enough range of things going on or descriptors,” says David Rind. He is chief medical officer of the Institute for Clinical and Economic Review (ICER), a nonprofit authority on new drugs. It conducted a thorough review and analysis of fezolinestant using then existing data gathered from conference abstracts, posters and presentations and included a public stakeholder meeting in December. A 252-page report was published in January, finding “considerable uncertainty about the comparative net health benefits of fezolinetant” versus hormone therapy.
Questions surrounding some of these issues might have been answered if the FDA had chosen to hold a public advisory committee meeting on fezolinetant, which it regularly does for first in class medicines. But the agency decided such a meeting was unnecessary.
Cost
There was little surprise when Astellas announced a list price for fezolinetant of $550 a month ($6000 annually) and a program of patient assistance to ease out of pocket expenses. The company had already incurred large expenses.
In 2017 Astellas purchased the company that originally developed fezolinetant for $534 million plus several hundred million in potential royalties. The drug company ran a "disease awareness” ad, Heat on the Street, hat aired during the Super Bowl in February, where 30 second ads cost about $7 million. Industry analysts have projected sales to be $1.9 billion by 2028.
ICER’s pre-approval evaluation said fezolinetant might "be considered cost-effective if priced around $2,000 annually. ... [It]will depend upon its price and whether it is considered an alternative to MHT [menopause hormone treatment] for all women or whether it will primarily be used by women who cannot or will not take MHT."
Criddle wrote that Astellas set the price based on the novelty of the science, the quality of evidence for the drug and its uniqueness compared to the rest of the market. She noted that an individual’s payment will depend on how much their insurance company decides to cover. “[W]e expect insurance coverage to increase over the course of the year and to achieve widespread coverage in the U.S. over time.”
Leaps.org wrote to and followed up with nine of the largest health insurers/providers asking basic questions about their coverage of fezolinetant. Only two responded. Jennifer Martin, the deputy chief consultant for pharmacy benefits management at the Department of Veterans Affairs, said the agency “covers all drugs from the date that they are launched.” Decisions on whether it will be included in the drug formulary and what if any copays might be required are under review.
“[Fezolinetant] will go through our standard P&T Committee [patient and treatment] review process in the next few months, including a review of available efficacy data, safety data, clinical practice guidelines, and comparison with other agents used for vasomotor symptoms of menopause," said Phil Blando, executive director of corporate communications for CVS Health.
Other insurers likely are going through a similar process to decide issues such as limiting coverage to women who are advised not to use hormones, how much copay will be required, and whether women will be required to first try other options or obtain approvals before getting a prescription.
Rind wants to see a few years of use before he prescribes fezolinetant broadly, and believes most doctors share his view. Nor will they be eager to fill out the additional paperwork required for women to participate in the Astellas patient assistance program, he added.
Safety
Astellas is marketing its drug by pointing out risks of hormone therapy, such as a recent paper in The BMJ, which noted that women who took hormones for even a short period of time had a 24 percent increased risk of dementia. While the percentage was scary, the combined number of women both on and off hormones who developed dementia was small. And it is unclear whether hormones are causing dementia or if more severe hot flashes are a marker for higher risk of developing dementia. This information is emerging only after 80 years of hundreds of millions of women using hormones.
In contrast, the label for fezolinetant prohibits “concomitant use with CYP1A2 inhibitors” and requires testing for liver and kidney function prior to initiating the drug and every three months thereafter. There is no human or animal data on use in a geriatric population, defined as 65 or older, a group that is likely to use the drug. Only a few thousand women have ever taken fezolinetant and most have used it for just a few months.
Options
A woman seeking relief from symptoms of menopause would like to see how fezolintant compares with other available treatment options. But Astellas did not conduct such a study and Andrea LaCroix says it is unlikely that anyone ever will.
ICER has come the closest, with a side-by-side analysis of evidence-based treatments and found that fezolinetant performed quite similarly and modestly as the others in providing relief from hot flashes. Some treatments also help with other symptoms of menopause, which fezolinetant does not.
There are many coping strategies that women can adopt to deal with hot flashes; one of the most common is dressing in layers (such as a sleeveless blouse with a sweater) that can be added or subtracted as conditions require. Avoiding caffeine, hot liquids, and spicy foods is another common strategy. “I stopped drinking hot caffeinated drinks…for several years, and you get out of the habit of drinking them,” says Zuckerman.
LaCroix curates those options at My Meno Plan, which includes a search function where you can enter your symptoms and identify which treatments might work best for you. It also links to published research papers. She says the goal is to empower women with information to make informed decisions about menopause.
Every year, around two million people worldwide die of liver disease. While some people inherit the disease, it’s most commonly caused by hepatitis, obesity and alcoholism. These underlying conditions kill liver cells, causing scar tissue to form until eventually the liver cannot function properly. Since 1979, deaths due to liver disease have increased by 400 percent.
The sooner the disease is detected, the more effective treatment can be. But once symptoms appear, the liver is already damaged. Around 50 percent of cases are diagnosed only after the disease has reached the final stages, when treatment is largely ineffective.
To address this problem, Owlstone Medical, a biotech company in England, has developed a breath test that can detect liver disease earlier than conventional approaches. Human breath contains volatile organic compounds (VOCs) that change in the first stages of liver disease. Owlstone’s breath test can reliably collect, store and detect VOCs, while picking out the specific compounds that reveal liver disease.
“There’s a need to screen more broadly for people with early-stage liver disease,” says Owlstone’s CEO Billy Boyle. “Equally important is having a test that's non-invasive, cost effective and can be deployed in a primary care setting.”
The standard tool for detection is a biopsy. It is invasive and expensive, making it impractical to use for people who aren't yet symptomatic. Meanwhile, blood tests are less invasive, but they can be inaccurate and can’t discriminate between different stages of the disease.
In the past, breath tests have not been widely used because of the difficulties of reliably collecting and storing breath. But Owlstone’s technology could help change that.
The team is testing patients in the early stages of advanced liver disease, or cirrhosis, to identify and detect these biomarkers. In an initial study, Owlstone’s breathalyzer was able to pick out patients who had early cirrhosis with 83 percent sensitivity.
Boyle’s work is personally motivated. His wife died of colorectal cancer after she was diagnosed with a progressed form of the disease. “That was a big impetus for me to see if this technology could work in early detection,” he says. “As a company, Owlstone is interested in early detection across a range of diseases because we think that's a way to save lives and a way to save costs.”
How it works
In the past, breath tests have not been widely used because of the difficulties of reliably collecting and storing breath. But Owlstone’s technology could help change that.
Study participants breathe into a mouthpiece attached to a breath sampler developed by Owlstone. It has cartridges are designed and optimized to collect gases. The sampler specifically targets VOCs, extracting them from atmospheric gases in breath, to ensure that even low levels of these compounds are captured.
The sampler can store compounds stably before they are assessed through a method called mass spectrometry, in which compounds are converted into charged atoms, before electromagnetic fields filter and identify even the tiniest amounts of charged atoms according to their weight and charge.
The top four compounds in our breath
In an initial study, Owlstone captured VOCs in breath to see which ones could help them tell the difference between people with and without liver disease. They tested the breath of 46 patients with liver disease - most of them in the earlier stages of cirrhosis - and 42 healthy people. Using this data, they were able to create a diagnostic model. Individually, compounds like 2-Pentanone and limonene performed well as markers for liver disease. Owlstone achieved even better performance by examining the levels of the top four compounds together, distinguishing between liver disease cases and controls with 95 percent accuracy.
“It was a good proof of principle since it looks like there are breath biomarkers that can discriminate between diseases,” Boyle says. “That was a bit of a stepping stone for us to say, taking those identified, let’s try and dose with specific concentrations of probes. It's part of building the evidence and steering the clinical trials to get to liver disease sensitivity.”
Sabine Szunerits, a professor of chemistry in Institute of Electronics at the University of Lille, sees the potential of Owlstone’s technology.
“Breath analysis is showing real promise as a clinical diagnostic tool,” says Szunerits, who has no ties with the company. “Owlstone Medical’s technology is extremely effective in collecting small volatile organic biomarkers in the breath. In combination with pattern recognition it can give an answer on liver disease severity. I see it as a very promising way to give patients novel chances to be cured.”
Improving the breath sampling process
Challenges remain. With more than one thousand VOCs found in the breath, it can be difficult to identify markers for liver disease that are consistent across many patients.
Julian Gardner is a professor of electrical engineering at Warwick University who researches electronic sensing devices. “Everyone’s breath has different levels of VOCs and different ones according to gender, diet, age etc,” Gardner says. “It is indeed very challenging to selectively detect the biomarkers in the breath for liver disease.”
So Owlstone is putting chemicals in the body that they know interact differently with patients with liver disease, and then using the breath sampler to measure these specific VOCs. The chemicals they administer are called Exogenous Volatile Organic Compound) probes, or EVOCs.
Most recently, they used limonene as an EVOC probe, testing 29 patients with early cirrhosis and 29 controls. They gave the limonene to subjects at specific doses to measure how its concentrations change in breath. The aim was to try and see what was happening in their livers.
“They are proposing to use drugs to enhance the signal as they are concerned about the sensitivity and selectivity of their method,” Gardner says. “The approach of EVOC probes is probably necessary as you can then eliminate the person-to-person variation that will be considerable in the soup of VOCs in our breath.”
Through these probes, Owlstone could identify patients with liver disease with 83 percent sensitivity. By targeting what they knew was a disease mechanism, they were able to amplify the signal. The company is starting a larger clinical trial, and the plan is to eventually use a panel of EVOC probes to make sure they can see diverging VOCs more clearly.
“I think the approach of using probes to amplify the VOC signal will ultimately increase the specificity of any VOC breath tests, and improve their practical usability,” says Roger Yazbek, who leads the South Australian Breath Analysis Research (SABAR) laboratory in Flinders University. “Whilst the findings are interesting, it still is only a small cohort of patients in one location.”
The future of breath diagnosis
Owlstone wants to partner with pharmaceutical companies looking to learn if their drugs have an effect on liver disease. They’ve also developed a microchip, a miniaturized version of mass spectrometry instruments, that can be used with the breathalyzer. It is less sensitive but will enable faster detection.
Boyle says the company's mission is for their tests to save 100,000 lives. "There are lots of risks and lots of challenges. I think there's an opportunity to really establish breath as a new diagnostic class.”