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Hydroxychloroquine is being discarded prematurely in COVID-19 prevention

MORU Research

Hydroxychloroquine could still prevent COVID-19 and save tens of thousands of lives around the world, say leading scientific researchers. While it doesn’t work in treatment of hospitalised patients, it could still prevent infections. However, fraudulent data, unjustified extrapolation and exaggerated safety concerns together with intense politicisation and negative publicity may stop COPCOV, the only large, global clinical trial testing hydroxychloroquine in COVID-19 prevention, from ever finding out.

Trudie Lang Highly Commended in Vice-Chancellor Innovation Awards 2020

@Oxford Awards & Appointments

Professor Trudie Lang is Highly Commended for 'Enabling Research in Low-Income Settings During Disease Outbreaks: Implementing, Learning and Preparing' in the Building Capacity category of the University Vice-Chancellor Innovation Awards 2020.

Medicine Quality Scientific Literature Surveyor

@Oxford

IDDO and MORU released its Medicine Quality Scientific Literature Surveyor. The surveyor delivers summaries of published scientific reports on the quality of the classes of essential medicines listed below, across regions and over time. We hope it will help medicine regulators, scientists, health professionals, purchasers and officials fill critical information gaps.

New study reveals Oxford coronavirus vaccine produces strong immune response

@Oxford Publication Research

A team of scientists at Oxford University’s Jenner Institute and Oxford Vaccine Group has taken the next step towards the discovery of a safe, effective and accessible vaccine against coronavirus. The results of the Phase I/II trial published in The Lancet indicate no early safety concerns and induces strong immune responses in both parts of the immune system.

International research collaborations: how can we shift the power towards Africa?

@Oxford

The higher education sector globally has been disrupted by the COVID-19 pandemic. Academics have been discussing various aspects of the disruptions in a series of webinars organised by the University of Cape Town. One area of particular interest is how the pandemic could affect international research collaborations. The Conversation Africa’s Nontobeko Mtshali asked Professor Kevin Marsh and two other panellists to share their views.

Plug COVID-19 research gaps in detection, prevention and care

@Oxford Publication Research

The global research community asks for the right research in the right places for COVID-19. The Global Health Network, the African Academy of Sciences and UK Collaborative on Development Research release a report in Nature that calls for the use of research evidence on the optimal implementation of public health interventions for COVID-19 in varied global settings.

Can big countries realistically eliminate COVID-19 without a vaccine?

@Oxford Publication

The UK should change its COVID-19 strategy to try to eliminate COVID-19 even without a vaccine rather than simply managing the disease. New Zealand has effectively managed to eliminate the virus, but can states with much larger, denser populations that have experienced much bigger outbreaks hope to do the same? Or is it more realistic to accept that the disease is likely to continue to circulate at some level and plan for that? Lakshmi Manoharan, Medical Epidemiologist with ERGO, tells us we should focus on reducing the amount of community transmission first before allowing economic and social activity to resume as normal.

New Tropical Medicine Associate Professors and University Research Lecturers

Awards & Appointments

This year has seen a high level of recognition of distinction in the Africa and Asia Programmes and Global Health research. Many congratulations to our researchers.

ISARIC collaboration: New national study into the long-term health impacts of COVID-19 launched

@Oxford Research

A major UK research study into the long-term health impacts of COVID-19 on hospitalised patients, involving researchers from the University of Liverpool, has been launched.

New COVID-19 simulation training for smartphones helps African healthcare workers save lives

@Oxford KWTRP Research

Oxford University’s LIFE project has launched a new set of app-based training scenarios that help healthcare workers in Africa safely manage and treat cases of children with suspected COVID-19

Asymptomatic individuals shown to transmit SARS-CoV-2 infection in Vietnam

OUCRU Publication Research

Dr Le Van Tan in OUCRU, in collaboration with the Hospital for Tropical Diseases and the Department of Health, has shown that it is common for people who are infected with the virus that causes COVID-19 (SARS-CoV-2) to have no symptoms whatsoever. By testing quarantined people in Vietnam, his team was able to detect asymptomatic individuals. The virus disappeared faster from the bodies of the asymptomatic carriers than from that of symptomatic individuals, but it appeared that some of them still managed to pass the infection on to others.

Ebola vaccine approved for use by the European Commission

@Oxford Research

The European Commission has granted Marketing Authorisation to Janssen for a new Ebola vaccine, developed in partnership with the University of Oxford. The Ebola vaccine has already been deployed in the North Kivu region of the Democratic Republic of the Congo (DRC), following recommendation from the WHO’s Strategic Advisory Group of Experts (SAGE), and in Rwanda – following conditional approval in 2019 under an ‘exceptional emergency’ – as part of outbreak containment efforts in the region.

Malaria elimination at risk as Ghana economy improves

@Oxford Publication

Ghana cut malaria deaths by 65% from 2005 to 2015. In a paper published in the Malaria Journal, Rima Shretta estimates that the COVID-19 outbreak threatens this progress, as lockdowns limit access to health facilities and preventive malaria interventions have been interrupted. Ghana’s transition to a lower middle income status results in lower donor support for malaria control, and the government must step up to avert a feared rise in cases.

No clinical benefit from use of lopinavir-ritonavir in hospitalised COVID-19 patients studied in RECOVERY

@Oxford Research

The RECOVERY trial was established in March as a randomised clinical trial to test a range of potential treatments for COVID-19, including lopinavir-ritonavir, an antiviral treatment commonly used to treat HIV. There was no significant difference in the primary endpoint of 28-day mortality, and the results were consistent in different subgroups of patients. There was also no evidence of beneficial effects on the risk of progression to mechanical ventilation or length of hospital stay. The trial Steering Committee concluded that there is no beneficial effect of lopinavir-ritonavir in patients hospitalised with COVID-19 and closed that treatment arm.

UK regulator gives green light to clinical trial of hydroxychloroquine to prevent Covid-19 in healthcare workers

MORU Research

The UK regulator MHRA announced on 26 June that it would again permit recruitment to the COPCOV COVID-19 prevention clinical trial. The MHRA decision came 5 weeks after it reacted immediately to the now-discredited paper published in The Lancet suggesting harms with hydroxychloroquine, and paused recruitment of UK participants. But The Lancet paper was based on fabricated data and was swiftly retracted. After this interruption, recruitment around the globe to COPCOV can now resume.

COVID-19 and the generation, dissemination, and use of evidence. For public-health decision-making or for profit?

@Oxford

Blog by Piero Olliaro, Professor of Poverty-Related Infectious Diseases and ISARIC Director of Science, following the publication - and retraction - of scientific articles about the risks of treating COVID-19 with (hydroxy)chloroquine. This calls for the reflection on how decisions are made, how the underlying ‘evidence’ is generated and disseminated, and how exposed and vulnerable to manipulation the system we rely upon is.

Regional Social and Epidemiological Vulnerability to COVID-19 in Kenya

KWTRP Publication

Epidemics and pandemics disproportionately affect populations with greater impacts on the most vulnerable and less resilient communities. Hence Kenya’s response to the COVID-19 pandemic calls for more context adapted public health measures reflecting our improved understanding of who is the most vulnerable and their geographical location. This policy brief presents evidence on localized vulnerability indices to identify areas and people who require greater support while highlighting inequities to inform the COVID-19 response in Kenya.

Why protesting racism during a pandemic is important – an epidemiologist explains

@Oxford General

The Conversation article, by Lakshmi Manoharan, Medical Epidemiologist. Widespread protests have broken out across the US in response to the killings of black Americans at the hands of police. Demonstrations have also erupted in the UK and other countries in solidarity with the Black Lives Matter movement and in protest at these countries’ own domestic cases of institutional racism. These protests are happening in the middle of a pandemic, which raises issues regarding the spread of the virus, and also highlights deep inequalities due to structural racism and its effects on people’s health. Although health authorities rightly discourage congregations of people, these protests may be the only way for the systemically disenfranchised to have their voices heard.

Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19

@Oxford Research

The RECOVERY trial tests a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Patients were randomised to receive dexamethasone 6 mg once per day for ten days and were compared with patients receiving usual care alone. Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen only; there was no benefit among those patients who did not require respiratory support. Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.

Major medical journals retract Covid-19 studies

General MORU

On 4 June 2020, after a week of increasing scientific concern and scrutiny, first The Lancet, then the New England Journal of Medicine, retracted studies that were based on inaccessible data. The studies have been extremely damaging to chloroquine and hydroxychloroquine COVID-19 clinical trials around the globe. MORU researchers played a key role in bringing this scandal to light, whose consequences continue to play out.

No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19

@Oxford Research

A new statement has been released from Professor Peter Horby and Professor Martin Landray, Chief Investigators of the RECOVERY Trial. RECOVERY was established in March as a randomised clinical trial to test a range of potential drugs for COVID-19, including hydroxycholoroquine. The trial has proceeded at unprecedented speed, enrolling over 11,000 patients from 175 NHS hospitals in the UK. The chief investigators have concluded that there is no beneficial effect of hydroxychloroquine in patients hospitalised with COVID-19.

Clinical trials on hydroxychloroquine/ chloroquine in COVID-19. Statement in response to damaging recent events

General MORU Publication

On 4 June 2020, after a week of increasing scientific concern and scrutiny, first The Lancet, then a little over an hour later the New England Journal of Medicine, retracted studies that were based on inaccessible data, provided by the Surgisphere corporation. The studies have been extremely damaging to chloroquine and hydroxychloroquine COVID-19 clinical trials around the globe. Here is MORU’s statement in response to these events.

Mitigating the Socio-economic impacts of physical distancing in African countries

KWTRP Publication

What are the health and socio-economic impacts of physical distancing in African countries and how can they be mitigated? This work by Edwine Barasa and colleagues reviews the effects of physical distancing restrictions and recommends that African countries need to consider the broader net benefit of measures that they choose to implement and to adapt and localize their response to align with the contextual realities of the continent, and to optimize expected benefits of physical distancing, while minimizing the undesired impacts.

How Vietnam managed to keep its coronavirus death toll at zero

OUCRU

Despite a long border with China and a population of 97 million people, Vietnam has recorded only just over 300 cases of Covid-19 and not a single death. The country very quickly enacted measures such as travel restrictions, monitoring and eventually closing border with China, closing schools and increasing health checks at borders and other vulnerable places. A vast and labour intensive contact tracing operation got under way. Quarantine on such a vast scale is key as evidence mounts that as many as half of all infected people are asymptomatic.

An open letter to Richard Horton, editor of The Lancet regarding Mehra et al

General

The results of Mehra et al in The Lancet have had a considerable impact on public health practice and research, halted trials and caused considerable concern to participants and patients enrolled in randomised controlled trials (RCTs). This has led many researchers around the world to scrutinise in detail the publication and outline their concerns in this letter to Richard Horton, editor of The Lancet.

Global clinical trial of 40,000+ healthcare workers begins to test in UK if chloroquine and hydroxychloroquine can prevent COVID-19

MORU Research

A global study to test if either chloroquine or hydroxychloroquine can prevent COVID-19 in vital frontline healthcare workers will open to UK participants at hospital sites in Brighton and Oxford today.

RECOVERY How to set up a trial in nine days

@Oxford Research

The COVID-19 pandemic has seen some extraordinary medical feats and achievements, which are being rightly celebrated. Researchers at Oxford University have been at the forefront of global efforts, including the first human trials of a COVID-19 vaccine, and the world’s biggest trial of potential COVID-19 treatments, RECOVERY.

CoMo Consortium, the COVID-19 pandemic modelling in context

@Oxford Research

The COVID-19 International Modelling Consortium (CoMo Consortium) was created by researchers at the University of Oxford and Cornell University, is partnering with infectious disease modellers and public health experts from over 40 countries in Africa, Asia and America. The CoMo Consortium uses a participatory approach to provide decision-making support to policymakers, using evidence from epidemiological and economic models adapted to each country’s context.

TGHN and the Family Larsson Rosenquist Foundation launch LactaHub today

@Oxford Research

The Global Health Network and the Family Larsson Rosenquist Foundation (FLRF) launch LactaHub: an open access knowledge platform featuring scientific and evidence-based information on breastfeeding and breastmilk for health professionals

SEBCOV study launched

MORU Research

The SEBCOV study aims to produce evidence to inform public health measures such as communications, quarantine, self-isolation, social distancing and travel restrictions for the COVID-19 pandemic. This study is run in four countries: UK, Thailand, Italy and Malaysia.

Results of remdesivir trial released

@Oxford Publication Research

The results of a placebo-controlled randomised trial of remdesivir in COVID-19 patients have been published in the Lancet. Supported by the ISARIC Support Centre, scientists in China launched a trial of remdesivir in patients hospitalised with COVID-19. The results found no clinical benefit from use of the drug; however, while not statistically significant, the time to clinical improvement and duration of invasive mechanical ventilation were shorter in people treated with remdesivir.

PAL forest malaria prophylaxis study begins in Cambodia

MORU Research

The Epidemiology Department of MORU and National Malaria Control Programme, Cambodia (CNM) have begun to implement a study to assess the efficacy of prophylaxis with artemether-lumefantrine (PAL) against forest malaria in Siem Pang District, north-eastern Cambodia bordering Laos.

New Clinical Data Report from ISARIC

@Oxford Research

The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) is producing a weekly report using clinical data from its COVID-19 database. To date, this includes data from 19,809 individuals from 244 sites across 25 countries.

Safeguarding the malaria endgame in the midst of the COVID-19 pandemic

@Oxford

Blog by Rima Shretta, Honorary Visiting Research Fellow. As the COVID-19 pandemic continues its path to LMICs, its impact is likely to be even more devastating, potentially reversing recent gains made in the management of other communicable diseases. Of particular concern is the impact of the COVID-19 pandemic on malaria. COVID-19 has been slow to arrive and spread across Africa; nevertheless, there are many reasons to be concerned about malaria within the current context of the COVID-19 pandemic.

GroupMappers create real-time COVID-19 Bangladesh dashboard

MORU

The impact of COVID-19 is quite evident at present – entire countries and cities are under lockdown, offices and industries shut and academia at a standstill. However, many people in Bangladesh remain unaware or indifferent to the warnings and safety protocols that ought to be followed to stop COVID-19’s spread. Since enforcing social distancing in a densely populated country like Bangladesh is very challenging, making people aware and maintenance of hygiene are the main means to stop the spread of COVID-19.

The WWARN toolkit in action

@Oxford Research

A site team in Malawi used the WWARN Malaria Clinical Trials Toolkit for their antimalarial-antiretroviral drug-drug interaction trial with pregnant women. Clifford Banda and his staff used the CDISC-compliant WWARN REDCap data base template as the basis for their data collection and capture, and used or adapted the many WWARN standard operating procedures and their forms for various administrative, clinical, investigational product, quality, data management and safety aspects of their planned work.

COPCOV Covid-19 study prepares to begin participant enrolment

MORU Research

Less than a month after it was announced, the MORU-led COPCOV study has made quick progress and expects to begin enrolling participants by the end of April.

COVID-19 research boosted by new projects funded by UKRI

@Oxford Research

The UK government is funding 21 new novel coronavirus research studies, including a project led by Professor Trudie Lang. Research must be undertaken everywhere across the globe during this pandemic. Access and ability to undertake research should be equitable, and this research project, working through The Global Health Network, aims to support healthcare teams in low-resource settings. This is a University of Oxford led programme aiming to enable more and better research in diseases, communities and settings where evidence is lacking.

Global call for strategic planning for COVID-19 medical products

@Oxford MORU Publication

Global health experts have united in a call for governments and international organisations around the world to plan strategically for the coordinated production, equitable distribution and surveillance of COVID-19 medical products to ensure access to quality-assured medications for everyone.

The economic impact of COVID-19

@Oxford

Blog by Rima Shretta, Honorary Visiting Research Fellow. Rima outlines the direct and indirect costs of the COVID-19 pandemic which may impact the global economy.

BBC World News interviews Nick White on chloroquine and hydroxychloroquine for COVID-19: “These drugs are not harmless, they’re dangerous in over-dose.”

MORU Video

There are currently no proven vaccines or drugs to prevent COVID-19. In this BBC World News interview, MORU’s Prof Sir Nick White explains why the only way to find out if chloroquine and hydroxychloriquine work against COVID-19 is via randomised, clinical trials and how the hype over chloroquine negatively affects people with lupus and rheumatoid arthritis.

The RECOVERY Trial, which is testing potential treatments for COVID19, has recruited 1000 patients in 15 days

@Oxford Research

The world’s largest randomised clinical trial of potential coronavirus treatments is well underway in the UK as part of the race to find a treatment. A number of promising treatments are being tested and, if the science supports it, will be given to NHS patients as quickly as possible. Definitive results on whether the treatments are safe and effective are expected within months and, if positive, they could potentially benefit hundreds of thousands of people worldwide. Almost 1,000 patients from 132 different hospitals have been recruited in just 15 days and thousands more are expected to join the Randomised Evaluation of COV-id19 thERapY (RECOVERY) trial in the coming weeks, making it the largest randomised controlled trial of potential COVID-19 treatments in the world.

COVID-19 Therapeutics Accelerator awards $20 million in initial grants to fund clinical trials

MORU Research

Researchers at MORU and two institutions in the US (University of Washington and La Jolla Institute for Immunology) receive grants from the COVID-19 Therapeutics Accelerator, a large-scale initiative launched by the Bill & Melinda Gates Foundation, Wellcome, and Mastercard to speed the development of and access to therapies for COVID-19.

First global tool to track news reports of substandard and falsified medical products is live

@Oxford MORU Research

The problem of substandard and falsified (SF) medical products affects all countries but few regulatory authorities or pharmaceutical companies have policies of publicly releasing data. As a first step in tracking this global issue, IDDO’s Medicine Quality Research Group, with the MORU Tropical Health Network and supported by a grant from the Wellcome Trust, has today launched a new, free-to-use, online tool, the Medicine Quality Monitoring Globe, (MQM Globe) which maps SF news reports worldwide in real time.

First patients enrolled in new clinical trial of possible COVID-19 treatments

@Oxford Research

Oxford Nuffield Department of Population Health started a new trial of potential treatments for adults patients hospitalised with confirmed COVID-19 with the collaboration of Professor Peter Horby

Many of our researchers work on Coronavirus

Research

Researchers from across the Medical Sciences Division are working hard to combat the COVID-19 crises. With particular strengths in infectious diseases and international health, we are well placed to contribute to better understanding and effectively controlling the epidemic. Many of these researchers are affiliated with the Centre for Tropical Medicine and Global Health

The Nuffield Department of Medicine is supporting global efforts in tackling nCoV

@Oxford Research

NDM is prioritising collaborative projects for front line actions to support global efforts in tackling nCoV. ISARIC has launched a number of international resources available free of charge, through which investigators retain full control of data and samples. Gavin Screaton and Guy Thwaites are looking at neutralising antibody responses. Other NDM researchers work on vaccine development, structure, protective immune response, UK hospital settings and pathogens evolution.

Triple drug combinations effective against drug-resistant malaria

MORU Publication Research

Adding a third anti-malaria drug to current artemisinin-combination therapies (ACTs) provides effective treatment against multidrug-resistant falciparum malaria in Southeast Asia, say Oxford researchers in a study in The Lancet. Using TACTs should extend current malaria drugs so drug-resistant malaria doesn't kill millions more and derail hopes of controlling and eliminating malaria.

The experts who have guided the British public through coronavirus outbreak

@Oxford

Trudie Lang is cited as one of the five main players who have helped restore British faith in the value of experts. Trudie has consistently warned that the medical profession needs to learn lessons from the current coronavirus outbreak: “This is not going to be the last outbreak of a previously unknown disease and we have to strengthen the research capabilities of nations where new diseases emerge but which currently have the poorest ability to respond.”

Oxford joins NIHR Health Protection Research Unit in Emerging and Zoonotic Infections

@Oxford Research

From April 2020, an existing successful Health Protection Research Unit will be bolstered by the addition of collaborators from the University of Oxford. Funded by NHIR, the next phase of the HPRU in Emerging and Zoonotic Infections will build on the work already done by the University of Liverpool, the Liverpool School of Tropical Medicine, and Public Health England.

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