A team of academics who created the EAVE II public health monitoring platform have been honoured by the Royal Society of Edinburgh. The team – including researchers from universities in Edinburgh and Glasgow, and Fellow of the RSE Professor Sir Aziz Sheikh – was awarded the RSE Mary Somerville Medal at a ceremony last week.

A person standing in front of John M. Ball et al. posing for the camera
Pictured are l-r Prof Chris Robertson, Prof Sir Aziz Sheikh FRSE, Prof Sir John Ball, Dr Victoria Hammersley – picture by Stewart Attwood Photography

The first iteration of EAVE began life monitoring some 250,000 people in 2010 and 2011 during the H1N1 avian influenza pandemic. EAVE was then placed in ‘hibernation’, and when Covid-19 began to spread it was retooled to track the progress of the pandemic.

Asked by the Scottish Government to scale the original EAVE programme up to be a national platform, the team went about a national expansion incorporating GP surgery data and data on testing, vaccinations, sequencing of the virus, hospitalisations, intensive care cases and deaths.

“The result was the largest and most comprehensive health surveillance platform anywhere in the world,” explained Professor Sir Aziz Sheikh FRSE, head of the University of Edinburgh’s Usher Institute and Dean of Data, and an expert in using health data to research public health issues.

A global leader in tracking the pandemic

As the pandemic continued, EAVE II produced a litany of results. It produced the world’s first analysis on the effectiveness of the first dose of vaccines, leading to changes in policy in countries that had begun to restrict use of the Oxford AstraZeneca vaccine.

EAVE II was the first programme to show that the delta variant of the SARS-Cov2 virus was more severe than the wild-type and alpha variants.

Prof Sheikh added: “We showed that two doses were more effective against delta, which lead to an acceleration of the roll out of second dose vaccines. We teamed up with colleagues in Brazil and showed that vaccines were waning, and off the back of that the roll out of boosters were also accelerated.

“We were the second group in the world to show that omicron was less severe than delta, which contributed to the decision to postpone the planned lockdown over Christmas 2021.”

EAVE also produced some of the world’s first risk analyses about vaccines, comparing the risk of vaccinations against risks of getting Covid-19.

Prof Shiekh added: “Our analysis of vaccine side effects showed the vaccination was much safer than if you acquired the infection.”

Dr Victoria Hammersley, project manager of EAVE II, added: “It was a really big team, and it is a team award, but somebody had to have their name on the application and I am lucky that it was me.

“When we were trying to pull together the list of team members for the award we got to 68 names, but I think there were probably more like 100 people through the journey of the project.”

Meetings, information exchange and constantly shifting priorities

The running of the EAVE II when the pandemic was at its height was a mammoth task of meetings and information exchange, all the time with the pressure of trying to end the pandemic and get the country out of lockdown.

Dr Hammersley said: “For a period of about 15 months the core team was meeting twice weekly, but I know that Aziz and others were meeting daily to discuss priorities for work.

“It was a massive effort, people were working incredibly long hours at the height of the pandemic, and everybody pulled together amazingly. On a Monday morning we would get together and Public Health Scotland would inform us of the number of hospitalisations and number of deaths, and it was motivating us to work as hard as we could to try and answer these critical questions. Meeting twice weekly was really key in holding the team together.”

The use of GP data was unique in allowing much more in-depth analysis than would have otherwise been possible. The subsequent academic outputs came several months after findings were communicated to decision makers across Scotland and the UK. That said, the team has some 100 peer-reviewed publications either published or imminent. The EAVE II team has also published plain English summaries for each piece of work in an attempt to make its findings accessible to the general public.

Prof Sheikh added: “There was a very good intuitive understanding of where we were in the pandemic and the questions that needed to be prioritised, and we tried to provide as timely advice as possible, depending on where we were.

“The academic outputs have been phenomenal, but what we were keen to do is emphasise that what we were primarily trying to do was get the country out of the pandemic and move the country on.”

Dr Hammersley explained: “The meetings on a Monday morning focused our minds. In research you are working on a project looking two or three years ahead, but what we were doing on a Monday was focusing on what we were going to do that week, which is very unusual in the research world.”

There was a constant division of labour between the teams to spread the workload – not just scientifically but with various communications roles as well. Professor Chris Robertson of Strathclyde University, among a whole list of others, helped a lot of junior data scientists to contribute, and to communicate with government to make the data useful.

And what of EAVE III?

However, despite the successes of EAVE II, the future of EAVE III remains uncertain.

Prof Sheikh explained: “Putting things into hibernation, while conceptually it makes sense, in practice is not good enough.

“It took about eight months to get from EAVE to EAVE II, and that was largely due to data permissions. This is because nobody had ever done anything on this scale before so there was no precedent.

“We think what we have is unique to Scotland, nobody has this type of thing at this scale anywhere else in the world. Could we repurpose it to tackle other issues such as substance abuse, obesity, suicide, cancer, whatever else?

“Keeping that capability on the boil and pivoting at times of need. That’s what we think EAVE III would look like. That has been made clear to politicians, the Covid inquiry, committees. But we haven’t won this prize for the people of Scotland and the UK yet – people are still deliberating on it.”