In March 2020, a group of 292 Italian scientists wrote an open letter to the prime minister, Giuseppe Conte. Among them were the heads of top biotechnology and clinical research centres in Italy, and experts in molecular testing, virology and microbiology. They proposed a plan to scale up Italy’s COVID-19 diagnostic capacity by harnessing the potential of academic research centres, and offered their laboratories and personnel at no additional cost.
At the time Italy’s death rate was soaring and its hospitals overwhelmed, despite a stringent national lockdown. Patients with symptoms had to wait several days for a swab. Yet, the call remained unanswered. “We received informal news from government officials saying the proposal wasn’t viable”, recalls Andrea Graziani, a professor at the Department of Molecular Biotechnology at the University of Turin, who was among the signatories.
The proposal was discussed on March 30 at the Comitato Tecnico Scientifico (CTS) a committee of 24 experts advising the Italian government on the pandemic, led by the National Civil Protection. The minutes of the meeting, declassified several months later, show that the CTS rejected the proposal and recommended that tests were done only by the diagnostic laboratories certified and run by each region (healthcare in Italy is administered at a regional level). The committee argued that diagnostic labs were better suited than research ones for such a task, and that they would soon increase their testing capacity.
But that network was insufficient and it would take months before testing could keep up. In March, Italy was only doing about 15,000 COVID-19 tests per day. It is now doing about 230,000. The scarcity hampered efforts to trace and slow the spread of virus, especially in Lombardy and Piedmont.
It was the first of several decisions taken by CTS that, over the past year, have puzzled Italian experts who view testing and tracing as key. CTS also hesitated before giving clear advice on testing asymptomatic people. The CTS should have provided a stronger guidance on the testing strategy, says Graziani.
As a new government takes office, several scientists are expressing hope that the committee can strengthen its expertise in areas such as testing, biotechnology, and molecular biology, that will prove critical for scaling up testing and for monitoring the spread of new variants.
A narrow range of expertise
A few months after the letter from Graziani and colleagues, another proposal was made to CTS. It came from Andrea Crisanti, a professor at the University of Padua and author of one of the first studies on the role of symptomatic individuals in spreading the virus. His laboratory was behind the trace-and-test strategy that helped to suppress the first wave of outbreak in Veneto. Unlike Piedmont and Lombardy, Veneto enlisted a university centre to provide high-throughput capacity for testing.
In August, Crisanti sent the Ministry of Health a draft plan to process up to 400,000 molecular tests a day, a seven-fold increase over the national capacity. The plan, backed by 150 academics of various backgrounds, relied on heavy automation and high-throughput liquid handlers to reduce the cost and time per sample.
Crisanti did not receive any reply from the government either. Minutes of the CTS meetings do not mention any discussion about his proposal. “Such a plan was at least worth reviewing and discussing”, says Francesco Lescai, a professor of Bioinformatics at the University of Pavia with experience in developing pipelines for genetic analysis and sequencing.
A narrow range of expertise in the CTS may be one reason behind those decisions. The panel has world-class figures in pulmonology, infectious diseases, gerontology and epidemiology, but lacks critical areas of expertise in molecular diagnostics, molecular virology and high-throughput screening.
Less than half of its current members are appointed in their personal capacity, while the others are heads of health institutions who are appointed to the CTS ex officio. Only two members have a clear track record in biotechnology, but in fields unrelated to infectious diseases.
By contrast, the UK Scientific Advisory Group for Emergencies (SAGE) and its subcommittees have a wide range of expertise and include specialists in molecular diagnostics, high-throughput screening, sequencing, modeling, logistic, behavioral science and education. The French government’s advisory panel includes a digital technology specialist, anthropologists and sociologists along with the core competences in virology, epidemiology and molecular biology. The Academia Leopoldina, one of the main advisors to the German government, has several working groups that can tap from a list of more than 1,600 international members in any discipline.
While in those countries the panels are mostly called to provide strategic input and guidelines, the CTS is bogged down in minute details that could be handled by subcommittee or other agencies.
The minutes of CTS meetings (all classified until September 2020, and currently published 45 days after each meeting) report many discussions about the safety procedures for sport events, or the choice of specific gloves and masks. During a meeting in August, the panel had to clarify the concept of ‘single-serve’ in school cafeterias before discussing a detailed protocol for the safety of church choirs.
On the other hand, the CTS has sometimes provided direction on topics where its members have little to no expertise. In January, it stated that keeping students on distance learning would cause “a severe impact on [their] learning, psychology and personality”. The statement had consequences on national policies, but no member of the CTS has experience in education, child psychology or neuropsychiatry.
The panel also lacks diversity: only six of its members are women. The CTS coordinator, Agostino Miozzo, was not available for a comment.
Even Pierpaolo Sileri, a surgeon and a deputy minister of health in the previous government, has criticized the CTS in interviews citing an “excess of bureaucracy” and a lack of diversity and suggesting that its composition should be reconsidered to include a wider range of expertise.
The challenge of monitoring variants
Providing strong guidance on biotechnologies for testing and tracing is now more necessary than ever, according to Davide Ederle, president of the Italian Association of Biotechnologists. He cites the scant data that Italy is producing on the circulating SARS-CoV-2 variants, which are obtained by sequencing the virus genome and are critical to monitor the epidemics.
Italy is currently sequencing 1.3 out of every 1,000 virus samples with a median time of two months to upload the data on public repositories such as Gisaid, one of the lowest performances worldwide. By comparison, the UK is sequencing almost 40 times more samples, with a median time to deposition of 21 days. “We are only seeing the tip of the iceberg” says Lescai. “Without more coverage of the variants, we are blind”. Including people with a biotechnology expertise to the CTS would help put this issue higher on the agenda, says Ederle.