Dec 19, 2020 Volume 396 Number 10267 p1941-2084
Science during COVID-19: where do we go from here?
The emergence of COVID-19 has indelibly marked science and medicine this year. Advances in epidemiology, clinical care, prevention, treatment, and the speed of vaccine development have been unprecedented, driven by global collaboration and data sharing. None of that would have been possible without the tireless work, sacrifice, dedication, and insight of scientists and researchers worldwide, from those working in laboratories to the principal investigators of clinical trials and everyone in between. But those scientific advances have also amplified deficiencies in the scientific research environment and provide important lessons for the future.
Research into topics unrelated to COVID-19 has suffered: Michael Lauer of the US National Institutes of Health has estimated that 80% of clinical trials were stopped or interrupted. Resources have been shifted to the pandemic, and many researchers were forced to suspend their own research to focus on patient care in overwhelmed hospital systems. Long-planned trials on HIV/AIDS and other infectious diseases, for example, were halted as researchers switched to studying COVID-19. It will be years before we know the true cost of these rapid changes in research priorities. There is a need to ensure that research systems have the capacity, and resilience, to adjust to new priorities while limiting the disturbance to ongoing research.
COVID-19 did not create the conditions that make life difficult for researchers early in their careers or for researchers who are women, people with families, or Black, Indigenous, and People of Colour (BIPOC). But it has exacerbated and highlighted those conditions. Health research systems have a history of undervaluing the contributions of these groups and a resistance to confronting issues of lower pay, systemic racism, and inequitable working conditions. Lockdown restrictions worldwide fell heavily on women (including researchers) who were forced to juggle working from home and child care, and BIPOC researchers face institutional racism and come from communities disproportionately affected by COVID-19. The pandemic has already led to a fall in the number of women authors on research papers and could have a long-term effect on careers in science.
The decades-old system that measures success in terms of publications and author order also needs revision. The pandemic has proven that institutions are willing and able to change incentive structures, whether by delaying or extending tenure clocks or extending or modifying research grants. Changes in incentive structures and forms of recognition are necessary, from taking preprint and other forms of research into account, to crediting data analysts, post-doctoral researchers, and other under-recognised contributors whose work is essential to the research enterprise. Scientific progress is made by the combined work of many groups, but too often it is only those at the end of the process who get the credit for the work of many. Science must develop a more thoughtful way of considering how we assess scientific activity that encompasses the whole spectrum of contributors beyond a bare handful of measures.
Open data sharing and collaborations between groups show a potential way to help eliminate the waste, burdensome bureaucracy, and duplicated effort that have been seen in COVID-19 research. It is understandable that clinician–researchers rush to gather what data they can during a pandemic. But a search of ClinicalTrials.gov shows hundreds of small underpowered trials of COVID-19 treatments, and huge numbers of retrospective studies that have attempted to answer similar questions. In the USA, fractured research and health-care systems encourage smaller trials, whereas the RECOVERY treatment trial in the UK leveraged the central administration of the National Health Service. The pandemic has demonstrated the use of data sharing and telemedicine systems to allow research to continue, and those lessons should guide researchers towards a more collaborative and digital future.
The pandemic has stimulated strong public interest in and enthusiasm for science. The advances seen this year could inspire the next generation of scientists, who have seen the potential and promise of research. Fundamentally, science is a collaborative, iterative, and incremental endeavour. It is the responsibility of all of us to ensure that we build on the lessons of 2020 so that the next generation of scientists work in an environment that is fair, conducive to success, and properly incentivised and rewarded.