Coronavirus: Operation Moonshot ‘not feasible’ and ‘massive gamble,’ health experts warn

Government hoping to roll out rapid-fire Covid-19 tests that could provide a result in just 20 minutes

Samuel Lovett
Monday 14 September 2020 16:51 BST
Grant Shapps on PM's moonshot attempt: Something which doesn't exist at the moment

Boris Johnson's Operation Moonshot mass testing programme is “not feasible” and poses a “massive gamble”, health experts have warned.

Figures from Public Health England (PHE), the World Health Organisation (WHO) and those close to the project, which is expected to cost close to £100bn, have told The Independent that the programme is “flawed” and could be too ambitious in scope.

Critics have pointed out that Moonshot relies on uncertified technology that could return false positives, forcing people into unnecessary self-isolation.

The government is hoping to roll out rapid-fire Covid-19 tests within the wider community that could provide a result in just 20 minutes, but has admitted that the appropriate technology does not yet exist.

Labour said the country was “fed up of undelivered promises”, warning that “mass testing is too important to become another failed project”.

One source close to Operation Moonshot, who spoke on condition of anonymity, admitted that there was “nowhere near enough” manufacturing capacity across the UK to supply the amount of tests needed to implement the programme.

“I don’t think it’s feasible,” he told The Independent. “It’s not going to be achievable given the numbers we’re looking at. We don’t have enough suppliers at the moment.”

On Thursday morning, transport secretary Grant Shapps said that 1.2 million tests are being carried out per week at the moment, adding that there is a capacity for 300,000 per day – a far cry from the eventual daily target of 10 million.

The government no longer publishes daily testing figures, but the latest available data say 175,687 tests were reported on 2 September. On the same date, the estimated total capacity reported by laboratories was 369,937.

Currently, No 10 is aiming to increase capacity to 500,000 tests a day by the end of next month.

A second source working on the UK’s nationwide testing programme said the success of the project “rides on the new tech involved and whether we can get our hands on enough units essentially”.

Moonshot is expected to draw from a number of different suppliers for its rapid-fire tests, including Hologic, a US diagnostics company, and Oxford Nanopore, a British-based health technology firm that has already begun providing 90-minute tests for clinical settings.

Trials are also currently underway to validate other existing tests. Last week, the government pledged £500m for a new community-wide repeat testing trial in Salford, Greater Manchester, as part of pilot scheme for a no-swab saliva test. Other prototype technologies are being verified in Wiltshire, health secretary Matt Hancock said on Thursday.

But with scientists warning that a reliable at-home test has yet to be developed, questions have been raised of when and how the government will be able to deliver easily accessible testing ahead of the winter period.

A diagnostics expert at the WHO told The Independent that Moonshot was “dependent on different technologies to what are being used now [in the UK]. It’s a massive gamble”.

The source, who asked to remain anonymous, explained that some of the technologies under consideration by the government, such as the Oxford Nanopore product, were “untested” or came from companies “without much experience of medical testing at scale”.

“So it would be hard to see these getting you to those Moonshot numbers,” they added.

Dr Joshua Moon, a fellow at Science Policy Research Unit at the University of Sussex, said the government was “pinning a very large amount of hope” on technology that might not materialise for another three to six months.

“It’s highly questionable, especially when those months are the middle of winter when Covid-19 is still going to be around,” he told The Independent. “The idea of having Moonshot to allow us to have a normal Christmas strikes me as not necessarily false hope, but more as rhetoric than an actual action plan.”

One of the main questions hanging over the new project is whether the UK’s contact tracing system – which has been beset by issues since its launch in late May – will be able to adapt to an increase in nationwide testing, explained Dr Moon.

“The testing alone isn’t going to save us,” he said. “It has to be integrated into a broader contact tracing system, there has to be support for people isolating, there has to be a way of monitoring and evaluating whether compliance is happening.”

The UK’s test and trace system has been heavily criticised, with the latest figures showing that it has missed its target of reaching 80 per cent of close contacts for 11 weeks running now.

A member of a PHE health protection team that focuses on complex outbreaks similarly questioned how Moonshot would be implemented within the context of the national tracing programme.

“I cannot fathom for the life of me if they roll out Moonshot and get all these positive results, and identify probably 10 times more outbreak than now, who's going to manage them,” she told The Independent, on condition of anonymity.

“They have exactly the same health protection teams as before, barely additional staff. The recruitment push that was happening was starting to gain traction, but then they announced they’d be scrapping Public Health England.

“There is technology that has been developed, but that doesn’t mean we've got the technology to roll out something like Moonshot as a whole system.”

In terms of the danger of false positives, the PHE official explained that given the rapid nature of the new tests, which could be carried out at train stations, sports stadiums or shopping centres, it would be difficult for tracing teams to double check results if there was concern over their accuracy.

“In a normal world, if there was reason for concern, I’d go back to the lab and ask if they could say how strongly positive the result was, or if it was borderline,” she said. “I'm sure I won’t be able to do with these rapid tests.

“There are masses of issues with these rapid tests. They can be fairly sensitive but we know that they're not that specific, so if it says you've got it, it doesn’t necessarily mean you do.

“We need too make sure we've got something standardised and not all using different tests with different thresholds.

“And if we get a positive test on one of these pregnancy-styled tests, how will that feed into our health protection system? At the moment we have an automatic feed, all the new positive test results will come through. If it’s linked to a quick-fire test, then there's not going to be an automatic stream. It’s difficult to know how we'll work with it.

“There are so many questions that need to answered. There's lot of reasons why I don’t think it's feasible at the moment - and raising the hope of something that's not feasible, that can do a lot of damage. They've done it several times. I think it does a great deal of harm when you announce things so far in advance.”

Professor Sir David Spiegelhalter, a statistician at the University of Cambridge, said that those in his field were “banging their heads on the wall" at the government’s new proposal.

“Mass screening always seems like a good idea in any disease - ‘Oh yes, let’s test everybody’. But the huge danger is false positives – no tests are perfect, it is not a simple yes/no thing.” he told the BBC on Thursday.

Munira Wilson, the Liberal Democrat’s health, wellbeing and social care spokesperson, said the government “must be careful to manage expectations accordingly”.

“We all share the government's ambition to achieve a mass testing programme that would allow us to get back to some sort of normal,” she told The Independent. “But, while Boris Johnson talks up his ‘moonshot’ testing target, his government has proven unable to get even a basic test and trace system off the ground.

“They must also focus on getting testing systems right in the here and now. The current situation – with people unable to access testing at all in some cases – is simply not good enough.”

Defending Operation Moonshot in parliament on Thursday, Mr Hancock said: “I've heard the naysayers before and I've heard the people on the other side complain we'll never get testing going – and they're the same old voices.

“I'm looking forward to rolling out this programme and this work, which has been under way for some time already, I'm absolutely determined that we will get there.

“And if everything comes together, and if the technology comes off, it'll be possible even for challenging sectors like theatres to get closer to normal before Christmas.”

Boris Johnson’s official spokesperson dismissed the warnings over false positives, saying he was “not sure [of] the basis for that suggestion”, but said “rigorous” processes were in place for the approval of rapid Covid-19 tests.

He added: “What the PM talked about is the possibility of tests which are simple, quick and scalable and what’s happening at the moment is work is being carried out on the development of those tests. It’s too early to set out precisely how it would work.

“The prime minister thinks it’s absolutely right that we should pursue these potential scientific breakthroughs and that if a test can be developed that will allow us to identify people who are negative very quickly, we should of course pursue that.”

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