This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, welcome to a special edition of The Lancet Voice. I'm Gavin Cleaver. If you're listening to this between the 21st of September and the 25th of September, then it's peer review week. All week, we're celebrating this essential part of scientific knowledge, and you'll be able to find a lot of content on thelancet.

com for the whole week. But you're here for the podcast, of course. So how has COVID 19 affected peer review? How will it change the future of publishing? What's happened at The Lancet these last nine months? Richard Houghton, Editor in Chief of The Lancet, joins me today to talk about maintaining scientific quality during the pandemic.

Richard, thanks for joining us again on the podcast. So we're going to talk a little bit today for Peer Review Week about how COVID 19 has affected peer review, what it's been like at The Lancet generally. So I guess start off by giving us a little bit of an outline. What's the kind of increase in submissions been like at The Lancet?

How many more papers are the Lancet dealing with now than they were before? 

Richard: Thanks, Gavin. Yes, we've had an avalanche to be very direct about it. By this time of year, we would normally have had about 6, 000 submissions to the weekly journal, and it's actually getting close to 17, 000. A massive increase.

If you look across the whole Lancet group, and remember we've got something like 20 plus journals, again, by this time of year, September, we would have had about 20, 000 submissions to all those journals. It's now getting close to 50, 000 submissions. It's a really huge increase in Manuscripts of all different varieties, research, reviews, letters, comments, opinion pieces, just everything has exploded.

Gavin: How many of those have had COVID in the title, would you say? 

Richard: Oh, I think pretty much all of the I would think pretty much all of the additional papers have had COVID in the title. It's been a remarkable response by the scientific community. 

Gavin: So how has peer review had to kind of change to adapt to this onslaught of papers?

Richard: Yes, peer review has been at the centre of the whole process. And to understand the answer to that question, the context is important. When this whole pandemic took off in January, we really dropped everything. in order to respond to the rapidly rising number of papers being submitted. There was a sense of urgency and immediacy about the pandemic that obviously made us all anxious and prioritise it over pretty much every other issue.

We are, we're dealing with a brand new virus, of course. And so you don't have a ready supply of experts into SARS CoV 2 because nobody knew SARS CoV 2 existed before. So you've got to go from literally a standing start and identify people who are going to be able to give you reliable and informed views.

Obviously, there's a pool of people who have done work on coronaviruses for many years, and that's obviously your first go to group. But then you have to expand that because you've also, you're dealing not just with the virus, but with the disease COVID 19. That was a brand new disease too. So you've got to go to people who are dealing with that disease, but of course they will also being.

Drawn into supporting national responses, whether at the government or policy level or on the front lines of delivering health care. At the same time as you're trying to find this new store of reviewers, you're under immense pressure to do that fast, because everybody wants their work published quickly, and we want to publish it quickly because we want it to inform the response.

This is a global pandemic. So we're getting material in from all countries of the world. So we're not just looking for experts who are based in the United Kingdom, but we need experts who are based in China, South Africa, India, the United States, Brazil, where the epicenters of the outbreak taking place and of course, while we're doing all this, which is reinventing ourselves to address COVID 19, we still have all the other material coming in.

So we do have to try and address papers that are dealing with cancer or heart disease or whatever else it might be. So in those months of January, February, March, April, it was. It was pretty chaotic actually but we made it, we got through it and we didn't miss an issue and that was a testament to the work of our editors and the work of our peer reviewers production and communications teams.

Gavin: How do you think it's affected the usual quality of peer reviewers, like a gold standard? 

Richard: Yeah people do sometimes ask, when you are in a situation like this and you are trying to move quickly, is there a danger that corners get cut and peer review quality goes down? I'd actually argue the opposite, and I've seen this in other emergencies or crises.

When you have something that's really important and genuine urgency. People pay more attention to the work. They actually read the papers with greater care. And they're even more critical about the detail than they, than a routine paper. And the reason for that is, it's human nature.

They're, they are both excited about the work that they're seeing. They know it's important. And they're also, I think reviewers are also struck by a sense of responsibility. They don't want to be a reviewer that lets a piece of work get published that could be damaging or could cause harm. So they take their responsibility very carefully.

And I think that's what editors do too. Strangely, perversely I think that the level of scrutiny goes up during a pandemic. The challenge actually is to maintain that over time because you can do that in short bursts, but can you do it can we do it now, eight months into the pandemic as well as we did it eight months ago at the start?

Gavin: Obviously the Lancet was receiving papers, like the vaccine papers that had to be published ASAP. They were of like that most scientific importance. How different is it to corral resources to publish something so fast compared to the usual system? 

Richard: Yeah, for the weekly, we do offer FastTrack where we can go from receipt to publication in four weeks, four working weeks.

So we can do it, that's the normal service we offer for FastTrack. We were having to move even faster on this particular occasion for some papers. And there you can get peer review done within 48 72 hours. Sometimes you have to go back and negotiate points with the authors and get revised papers back.

Sometimes you have to re review papers. So you can get the peer review done actually in five to six working days pretty effectively, and have an accepted paper at the end of that. And that's because, as I say, reviewers will drop everything in order to do this work. And the authors also are super responsive.

And then it's a case of editing the paper and getting it through production and ready to be posted on our website. Editing the paper we take very seriously. We see technical editing of papers as a form of peer review. And pretty much every sentence in every paper is rewritten by our You know, very highly skilled team of assistant and senior assistant editors.

But that can also be done in 48, 72 hours. In fact, we can get work published within 10 working days when we need to. And that's what we were doing with the fastest of papers that we were receiving. 

Gavin: Looking at the pandemic in a broader sense, what's really stood out for you over the last nine months?

Richard: I think at the very beginning of the pandemic, I would not have predicted that it's probably going to be in October that we will hit one million deaths worldwide. I would not have predicted that this pandemic would have killed one million people. The last time we had an outbreak of SARS, the number was far fewer, I think fewer than a thousand deaths.

In the SARS outbreak of 2002 03. So that's the first thing. Just the scale of this is beyond anything that I would have predicted. That leads you on to the second, leads me on to the second thing that, that I was pretty astonished about. Which is the multiple political failures here. And I've said this many times, but we published those five papers back in January, which was An absolute landmark set of papers which set out the contours of the pandemic as it's evolved over the last eight months.

And, the truth of the matter is that those papers were largely ignored. They were ignored by scientists, they were ignored by scientific advisors, and they were certainly ignored by Politicians and policy makers, because we wasted the month of February and early March when we should have been getting ready.

I think that was the, one of the greatest disappointments to me, that You've got a group of scientists in China who worked incredibly hard to produce those five papers. And, They were trying to write those papers, not for the purpose of getting a publication in a medical journal, but to send a signal to the rest of the world about what on earth was going on in Wuhan, and the threat that posed to the rest of the world.

And, despite the fact that they were published in the Lancet, and despite the fact that Dr. Tedros declared a public health emergency of international concern, Nothing happened. And that is, that was a surprise to me. And of course there's been an enormous effort since March, April, for the world to play catch up.

And that's been important to document and to see. But the reason why you're seeing all these, these epidemics raging through countries still to this day, is because political leaders didn't take the science seriously, and the science had some important messages to convey. So I think those are some of my surprises.

The value of science we saw across all of our journals but the connection between science and politics was disappointingly weak. 

Gavin: Do you think, given the infectiousness of this particular disease, that Catch up is possible. Would you say that the kind of the cat is out of the bag, so to speak 

Richard: in the United Kingdom our Prime Minister Talks about defeating the virus This is not a virus that can be defeated in the sense that there's going to be a winner or a loser The virus is not going to be eradicated Before Christmas or even after Christmas.

This is a virus that is living with us and We have to find a way to peacefully coexist with the virus. This is the scale of the transformation in the way we think about our lives. I don't think that's quite dawned on politicians so far. We've got to change our behaviors in the long run. And the idea that we can go back to a pre pandemic life.

is just for the birds. A vaccine will, it will be important. It will be an important tool and I hope that we get it. But no vaccine is a hundred percent safe or a hundred percent effective or can be given even to a hundred percent of people. So it will be a valuable tool, but it's not a magic bullet to eliminate the pandemic completely.

So we are renegotiating our relationship with this virus and that's requires a different mindset, I think in the way we think about the future. 

Gavin: So looking at the new normal, I guess we were talking about there in terms of like scientific publishing two pronged question, what's been the effect on non COVID papers?

And do you think some of these effects will persist over time, even, looking years and years into the future, hopefully post pandemic in a general sense anyway? 

Richard: You're right to talk about the non COVID papers. There was an effect on health systems around the world by this pandemic.

And that is that with recommending that people stay at home, people did stay at home and that's caused a huge reduction in use of cancer services. Patients living with heart disease didn't go to hospital or to their doctor when they developed symptoms. Exactly the same cost has hit the Lancet journals and I think scientific publishing more broadly.

That our attention has rightly been focused. on COVID 19, but the result of that is that we've not devoted the same amount of attention as we would to other subjects. I think we're coming back to a more balanced place now after the summer here. I think that until September we really were really focused on COVID 19.

I think now what we're trying to do is we're looking towards the end of the year, as we're looking into 2021, we're trying to balance COVID with all the other issues that we're dealing with. We've just been publishing some work on non communicable diseases, a countdown paper and a commission paper that we're beginning to, to have the space and the attention on other Bye.

Bye. You on other issues. And we'll be doing the global burden of disease later in October to give another example. I think it did have a big effect. I think in terms of the longer term impact there have been some important changes, some of which I think will stay and others I hope could stay, but I'm not so sure.

First of all, preprints. We were talking about preprints before the pandemic, but there's no question that preprint services provided a very important avenue for the rapid dissemination of preliminary findings before they'd gone to journals and gone through peer review. Preprints proved themselves.

They were a source of misinformation occasionally because people posted material that was either knowingly false. Or turned out to be false and that work had to be taken down. So we have to be careful with preprints, we have to be vigilant about them. But I think on balance they were a positive, they were certainly a very positive innovation that was widely used during the pandemic.

I think that open access accelerated as a result of the pandemic. Publishers across the world made every single COVID article that they published. Freely available openly accessible. And that was a milestone. I don't think that's ever been done before. I think the last time that was done was Ebola, but for a much shorter period of time.

And a much a much more restricted number of papers. This time we're talking about thousands and thousands of papers that are now freely archived. And that's I think that's interesting because This is, and this is the bit where I don't know how it's going to evolve. I think that what's happened with open access during the pandemic now presents something of a, of an ethical challenge to scientific publishing.

Because we've made all of this coronavirus content freely available because it's a global emergency. But it wouldn't be unreasonable to argue there are many other health emergencies in the world, not just coronavirus. So where do you draw the line? If you can make all of this material freely available for one emergency, why do you not make material freely available for another emergency?

So I, this is a personal view. I think that scientific publishing over the next year needs to rethink its purpose. Right now, I think it's going in a direction that often isn't supportive or aligned directly with the actions that societies need to take to create a safe and sustainable planet.

And I think scientific publishing needs to think much more about how it can contribute. positively, beyond just simply publishing large numbers of papers, how can it contribute substantively to those end goals? And I don't think those are questions many publishers have asked in the past. But I think they're questions that need to be asked and the pandemic provokes that.

So 

Gavin: what do you think this means for scientific publishing going forward? 

Richard: I think it's what is the purpose of scientific publishing? I very often see people talk about the pur the goals of publishing in terms of creating larger numbers of journals, or publishing larger numbers of papers or metrics which you can measure, and that's a good thing, because it's good to be able to be, certain about what you're counting.

But the purpose of publishing can't just be about the number of journals you produce or the number of papers you publish. It's got to be about something more than that. For the, if I just take the Lancet as an example, we talk about the idea of the best science for better lives. So the purpose of publishing papers in, across the Lancet group is very much tied to the idea that every individual paper it's value comes from the contribution it makes to advancing health in any part of the world.

And that's the criterion that we're judging the paper by. So we don't publish tens of thousands of papers across the Lancet group because not tens of thousands of papers don't all contribute that level to that purpose. And I think publishers My thing, we've had our minds concentrated by the pandemic, a million deaths soon to be reported.

Why are we here? What is the purpose of publishing? It's got to be about protecting and strengthening our societies. So what does that mean? So I, I. I don't think that's a conversation that scientific publishing needs to have, and I don't think it has had that very much. I think that it's, often times scientific publishing does a lot of self justification mostly in response to the open access movement.

And actually they need to talk much more about the reasons that they do what they do. And those reasons have to have societal benefit, not just benefit for publishing, publishers themselves. 

Gavin: Just to finish up then, on a personal note I guess, and then if you want to speak for your staff, how do you feel like the last nine months has affected The Lancet?

Richard: Well, Gavin, we survived. We're still publishing, and it is incredible to me. We've all been working from home, and yet still, I get a print copy of The Lancet delivered through my letterbox every week. So this is the magic that is publishing. And there is something magical about it.

We're all working on computers and writing and filing copy and editing copy and illustrations being drawn and redrawn. And it all goes into this void somewhere and is brought together as this print product that still comes. The office is open now and people are trickling back to work. Not many, no more than perhaps 10 15 people maximum a day out of 150.

I think we're still going to be working like this for many months to come. People have never worked harder than I've seen them work in the last three years. Eight months. I really, genuinely have never seen people work harder. They've, everybody's become a workaholic. At the same time as trying to juggle responsibilities with families and friends.

And that's been incredible to see. And it continues. So I think we've shown that we were resilient, pretty resilient. That we can work virtually. But I don't want to take away from the fact that it's been tough. It's been tough for people working in healthcare, in schools, and on the front lines of transportation, or delivering food.

So I don't, we weren't working on the front lines of the NHS, but we were working on a front line. And we were working on the front lines of producing knowledge that was informing and guiding the response. And that was an important front line and it was a tough front line to be working on.

So I think the pandemic has sharpened our sense of purpose. I think we know why we're here now more than we did before, because of the role that we've tried to play. It's not, and I think we've learned that it's not only about the science, it's also about the society in which we live, because this virus has exploited and accentuated inequalities, disparities in our societies.

And we now in the future have to work even harder to bring those who sit at the margins of society, who've been most affected by this pandemic. bring them center stage so that they get the due attention that they need. Richard, thank you. Thanks very much, Gavin. And it's been a pleasure talking with you.

Gavin: Thanks for listening to this episode of The Lancet Voice. We'll be back soon with a special episode featuring an interview with Peter Hotez ahead of the US election. You can obviously find our podcasts where you usually listen to your podcasts and don't forget to subscribe. Thanks again, and we'll see you next time.