VaxSEEN

Waste comes in many forms in vaccinology - from the biohazardous to the fall-out associated with wasted opportunities. In a context as resource-constrained as global vaccine distribution and equity drives, every dose counts and every dose wasted comes at both a human-centred and environmental cost. Allocating dosages to those who do not stand to benefit - or worse, to those who may also experience elevated levels of adverse events without being conferred immunity from disease - is as unethical as it is wasteful. Meanwhile, the plastic derived nature of the vaccine supply chain and the significant energy consumption that is associated with transportation and cool-chain storage make the imprecise 'one shot fits all' approach to vaccine distribution environmentally unsustainable.

To prevent such wastage, it is essential to identify patient cohorts that will respond positively to vaccination, both in terms of vaccine benefits obtained (protection provided against critical infections) and vaccine risks avoided (side effects experienced). Our work therefore seeks to optimise distribution of vaccines themselves while also identifying those most suitable for boosters or expensive alternatives or adjuvants including monoclonal antibodies, convalescent plasma and next generation antivirals. Doing so is especially important for vulnerable patients who are typically excluded from the development trials that establish product safety and effectiveness. If undressed, these knowledge gaps will continue to have the following implications:

1. Worse infection outcomes for vulnerable patients

2. Exacerbated vaccine hesitancy: Uncertainties around vulnerable patients' personal benefit-risk profile is the most typically cited cause of vaccine refusal in these groups.

3. Inefficiencies in global vaccine distribution efforts: Limited supplies of vaccines or vaccine alternatives need to be prioritised for those set to benefit most from them - stocks are wasted otherwise. This cannot be accomplished without establishing which rare patient groups either do not respond to vaccination or are at elevated risk for debilitating adverse events once inoculated. At present, researchers, clinicians and global health agencies alike find it difficult to advise on key vaccine decisions for these complex patients - including when to temporarily suspend immunosuppressive regimens to maximise vaccine response or schedule boosters to combat waning. 

4. Calls for a more prescriptive approach to vaccination cannot be met: The prescription vaccination agenda will only be made possible when supported by differentiated and precise vaccine benefit-risk research VaxSEEN can support.

5. Elevated risks of pathogenic mutation or antimicrobial resistance: Due to their difficulty clearing infections, the immunosuppressed are common vectors for pathogenic mutation or AMR. This risk is increased when we do not know how to optimally vaccinate or treat the immunosuppressed (prophylactically or reactively). More optimistically, by identifying immunocompromised sub-groups that perform comparatively immunocompetently in response to vaccination, we can add to the evidence base required to tailor shielding recommendations in future - ensuring only those at critical risk post-infection face the social and economic consequences of doing so - and help to reduce the psychological/ fiscal burden that many patients face during times of high transmission. 

VaxSEEN has the capability to offer a real-time, open-access platform to differentiate vaccine effectiveness, uptake, and adverse effects amongst different patient populations - the first of its kind. With the support of EMIS Health, the UK Health Security Agency, Health Data Research UK and the Alan Turing Institute, VaxSEEN already links national disease surveillance datasets to identify patient groups most vulnerable to vaccine-preventable illness and at risk of vaccine failure, accelerated waning or side effects. If supported by the Cure Xchange Challenge, we have ambitions, and the capability, to extend VaxSEEN oversight to additional vaccines and provide more detailed demographic breakdowns (e.g. how subgroup vaccine benefit-risk profiles differ between ethnicity, gender, age-group, BMI, comorbidities, household income etc.) to make data more generalisable to international markets and global vaccine distribution efforts. Conversations have already begun to access US data to check the external validity of UK-based insights. The data arms of VaxSEEN are as follows:

To obtain precision data on vaccine benefit, we utilise a combination of routinely collected, pseudonymised medical record (n = 20 million; linked to health registries, hospital outcomes and vaccine records) and biological specimen data (UK-wide virology and serology sampling). Unlike comparable disease surveillance networks, this confluence of real-time vaccine uptake, national disease exposure, breakthrough infection and antibody waning data - provided with wraparound patient demographics and onward health outcomes - is unique to the RSC. Augmented by advanced clinical informatics and AI methods (NLP of free-text data, DNN for identifying/stratifying high-probability undiagnosed patients, advanced modelling of likely vaccine outcomes), this vaccine benefit dataflow provides approved researchers with a holistic and differentiable view of the vaccinated and unvaccinated experience for all patients. Our findings here already support UKHSA and the Joint Committee on Vaccine and Immunisation to make vaccine scheduling and dosing decisions for vulnerable groups and on targeting access to expensive alternatives such as monoclonal antibodies, convalescent plasma and antivirals. Such insights are as relevant for fragile contexts as they are for established medical systems. Indications of suboptimal response or widespread vaccine failure can be responded to in real-time by pharmaceutical companies and global agencies alike - a vast improvement to the retrospective work that is conducted currently. Mid-season and mid-wave recomposition is made a possibility.  

To obtain precision data on vaccine risk, these same linked medical records are used to differentiate incidences of adverse events experienced post-vaccination. However, unique to the RSC, we augment this passive pharmacovigilance dataflow with a direct-to-patient means of reporting side effects immediately post-vaccination. VaxSEEN's adverse events reporting tool is a collaboration between the RSC, EMIS Health and PeopleWith, their chosen mobile survey provider. This technology responds to changes in patients' vaccine records and invites them to share their 10-day post-vaccine experience via time-sensitive text links. Once integrated into the medical record, this novel pharmacovigilance pathway controls for issues of false recall and data capture failures while building out researchers' understanding of the time-course and severity of side effects - neither of which have yet been researched in rare patient groups.

VaxSEEN is committed to supporting the health and wellbeing of vulnerable patient groups, most notably the immunosuppressed - a group that (despite representing as much as 7% of the general population, definition depending) is typically excluded from pharmacological development trials and, thereby, underserved therapeutically. This is at odds with our scientific understanding that these patients are at greatest risk for vaccine non-response, impaired pathogenic clearance (a driver for mutation) and adverse clinical outcomes or long-term debilitation once infected with orderinarily vaccine-preventable illness.

The VaxSEEN platform will help to ensure that health decision-makers and pharmaceutical companies are provided with the evidence base needed to best serve the interests of these vulnerable patients, providing data on how the benefits and risks associated with various vaccines differ across conditions. Identifying groups at greater risk for vaccine non-response, accelerated waning, breakthrough infection and/or serious adverse events post-inoculation in this way safeguards these high-risk patients and represents a significant step towards the more prescriptive approach to vaccination that has been called for by patients and health care professionals alike. Likewise, alerting pharmaceutical companies that their products might be underserving these groups is a call to action for real-time vaccine recomposition or product redevelopment - something that, up until now, has only been possible after new waves or 'seasons' of infectiousness have already passed. This has enormous prospective benefit for preventing vaccine wastage and the financial, environmental and public health burdens associated. 

Taking a more personalised medicine approach to monitoring, vaccinating and treating the immunosuppressed and other rarified or complex patient groups have already been seen to maximise health outcomes. VaxSEEN's value in this will be especially acute during periods of high transmission, helping to inform the prioritisation of tests, shielding notices, booster doses and time-sensitive vaccine alternatives. Although VaxSEEN's constituent data flows are currently only representative of the UK population, this type of intelligence is still of significant value for lower-income settings or emergency contexts. Its insights would be highly informative to the strategic priorities of global vaccine distribution initiatives such as COVAX, the Gates Foundation and the Clinton Health Access Initiative, for example. 

Finally, presenting data on subgroup specific benefit-risk profiles in a patient-accessible manner will also contribute to wider efforts to allay vaccine hesitancy; by logging into VaxSEEN, patients will be able to obtain line of sight into the vaccine experiences of those they can really identify with. Great effort will be taken to ensure that the VaxSEEN platform is as intuitive as possible for layman users and that it contextualises all risk and effectiveness data to prevent misinterpretation. 

VaxSEEN has the capacity to extend its oversight (currently prioritising seasonal influenza and COVID vaccine surveillance) to the performance of all routine vaccine types amongst all populations, including the immunocompetent. 

The RSC is an internationally renowned source of information, analysis and interpretation of primary care data. It represents a 55-year disease surveillance legacy with UKHSA and comprises of data management, research and practice-patient-participant support teams. This partnership has won the trust and active engagement of the clinicians and patient base that makes up its over 1900 general practice membership – over 250 of which contribute to the surveillance virology and serology sampling efforts that has propped up UK disease response and public health decision-making for over half a century, most notably during the last pandemic. Its national representativeness (n = 20 million) and real-time nature (data flows are updated daily) makes it a rigorous source of intelligence for international health agencies including the WHO. 

Operating within this Trusted Research Environment, VaxSEEN has privileged access to the scale and diversity of data sources needed to tackle these questions of precision vaccination amongst the immunosuppressed. The RSC uses a combination of hashed NHS numbers and date of birth to link primary care medical records to secondary sources including birth/death registries, real-time virology/ serology and hospital outcomes. ML’s links with The Turing Institute and American institutions (NYU; Columbia) have enabled unprecedented opportunities for advanced clinical informatics, AI augmentation and comparative insight generation. Her working partnership with EMIS Health also provides VaxSEEN access to a suite of products capable of automating identification of specific patient groups in surveillance dataflows and, with their consent, onboarding them onto decentralised study. This mesh of data inputs and partnerships allows VaxSEEN to:

1. Access high-risk populations at the sample sizes needed to meet research power requirements (ensuring all resultant insights are statistically rigorous)

2. Understand wraparound variables including breakthrough infections (virology), vaccine waning (serology) and clinical outcomes (registry/ hospital data/ surveys) and

3. Appraise if trends and sub-trends observed are robust between international health markets to assist vaccine policymaking and global distribution. 

VaxSEEN leverages RSC working relationships with practice managers, clinicians, and patients and its overall track record for conducting both decentralised and in-practice clinical trials. For example, our direct-to-patients adverse events reporting work leverages existing RSC mechanisms for PPIE including focus groups and in-practice communication channels and data visualisation platforms.

Finally, ML's position within HDRUK and ongoing work advising on global health programmes for the Tony Blair Institute for Global Change gives her significant awareness of current barriers and opportunities represented by digital health innovation. Her work guiding the TBI One Shot vaccine campaign and a new Health Data Linkage work stream within HDRUK is based on ongoing collaborations with clinical interest groups from the grass-roots to most senior ranks of national and international public health decision-making. These are contacts and experiences she will leverage to ensure VaxSEEN's success.

Finally, ML’s dual US citizenship, split base between Oxford and New York and research collaborations with New York-based institutions makes her candidacy particularly suited to leveraging all opportunities afforded by the Cure XChange Challenge.

This solution is dedicated to identifying patient groups who benefit either maximally or minimally from vaccination, informing vaccine distribution and recomposition pathways and the prioritisation of alternatives/ adjuvants. Given that work by Kurzweil and colleagues estimates that the carbon footprint of a single mRNA vaccine dose injected into a patient is about 0.01 to 0.2 kg CO2 equivalents, the evidence-based approach to vaccine distribution that VaxSEEN offers is of major environmental benefit. It is our ambition to ensure that all plastic production and carbon consumption associated with global vaccine roll outs are fully justified by the benefits they afford to patients. Likewise, with ‘uncertainty about immune response given an underlying immunodeficiency’, ‘unknown long-term side effects’, and ‘lack of investigation of safety and effectiveness of vaccines in those with medical conditions’ serving as the most often-cited reasons that nearly 20% of Aberumand and colleague's immunosuppressed cohort reported they were ‘somewhat’ or ‘very unlikely’, ‘unlikely’, or ‘not planning to get vaccinated’ against COVID-19, the value of addressing such knowledge gaps for the broader vaccine hesitancy agenda becomes clear.

In terms of innovation, VaxSEEN is the first product to offer comparative vaccine benefit-risk insights - particularly those amongst rare patient types. Despite their significant heterogeneity, such risk groups have up until now been managed, and vaccinated, homogeneously. The technologies that underpin VaxSEEN are also enormously innovative, setting trends for the entire research community to adopt. For example, our VaxSEEN adverse events reporting tool collects and transfers patient data without ever providing researchers with identifiable information. This precludes the need for formal eConsent forms - something that has affected the practicality of decentralised research worldwide - and positions this method of obtaining frictionless, real-time patient data as best practice for the entire research community. 

Likewise, the RSC's vaccine effectiveness dataflow utilises a unique confluence of medical record, registry and biological sampling data - distinguishing it from comparable disease surveillance networks while ensuring our vaccine effectiveness calculations are corroborated with biological evidence (checking whether performance data is reflected in antibody production or virological swabs). Our use of advanced clinical informatics and AI-backed tools for patient identification, outcome prediction and analysis is also world-leading. 

In sum, presenting more bespoke vaccine benefit-risk profiles to patients represents major steps forward for personalised medicine, emergency disease response and the overall sustainability of both; such work will inform resource allocation in cost-constrained environments and the prioritisation of certain groups for boosting, adjuvants or alternatives including antiviral or monoclonal treatments. As a result, VaxSEEN will prevent wasteful vaccine practices while also catalysing the prescriptive approach to vaccination that is overdue. It will provide actionable intelligence on optimal vaccine brand, schedule, pacing, dose and wraparound treatments for different patient groups. VaxSEEN's early warning functionalities will also ensure that any indications of underperformance by certain vaccines will be communicated to their manufacturers in real-time to facilitate vaccine recomposition or boosting. 

Impact goals that are aligned with SDG 3 for Good Health and Well-being:

1. To improve vaccine benefit-risk transparency, maximising health outcomes in clinical risk groups while reducing vaccine hesitancy.

2. To advance prescriptive and personalised vaccination, reducing wasted doses of vaccines and their alternatives/ adjuvants by doing so.

3. To optimise the impact of vaccine equity initiatives by creating an evidence-base for effective and sustainable resource allocation amongst vulnerable patient groups.

4. To make the decision to vaccinate feel as personal as possible.

Means of achieving impact goals:

1. Launching the first iteration of VaxSEEN next year - first functionalities will include bringing together RSC vaccine effectiveness and pharmacovigilance (passive and enhanced) data streams and presenting initial benefit-risk profiles for immunosuppressed subgroups. 

2. Expand vaccine oversight and benefit-risk profiling to include performance data on additional vaccines; build out demographic differentiability of data. Scale use of mobile adverse reaction reporting tool and partner with MHRA Yellow Card to augment overall UK pharmacovigilance. Partner with ecological oversight organisations to estimate plastic/ CO2 emissions saved.

3. Expand risk group coverage to include chronic kidney disease, neurological disorders and other clinically extremely vulnerable groups (as defined by Green Book).

4. Expand VaxSEEN to US market - ensuring that insights align between two healthcare systems (nationalised vs public-private)

5. Create partnerships with additional markets and global health agencies or initiatives - explore how the VaxSEEN evidence base can benefit emergency or low-income contexts and resource allocation e.g. CEPI/GAVI/COVAX.

6. Build upon existing healthy working partnerships with pharmaceutical companies, ensuring that any indications of vaccine underperformance are perceived as constructive feedback to inform real-time recomposition. 

Metrics of impact:

1. VaxSEEN online traffic e.g. daily / weekly/ monthly site users. 

2. Expansion to other risk groups and vaccine types

3. Medical waste saved

4. CO2 emissions saved

5. Adoption and engagement with VaxSEEN adverse event reporting tool 

6. Number of countries submitting data to VaxSEEN

7. Partnerships with local implementation partners to promote and action VaxSEEN insights in sensitive settings.

8. Academic publications that cite VaxSEEN insights

9. Layman publications that cite VaxSEEN insights

10. Partnerships with high-level institutions including governments, public health agencies or initiatives (national and international), UN agencies etc. 

11. Reduced turnaround time between indications of vaccine underperformance and recomposition, boosting or targeted triage onto prophylactics.

12. Partnerships with pharmaceutical and biotechnology industries

Positive externalities (more difficult to directly link to activities but still of note)

1. Improvements to immunosuppressed vaccine uptake in countries either inputting data into VaxSEEN or where VaxSEEN data is readily available - ideally hitting WHO recommendations of over 75%. 

2. Reduced incidence of rare/ vulnerable patients in hospitalised or ICU cohorts.

3. Reduced mortality rate of rare/ vulnerable patients from vaccine-preventable illness.

5. Reduced incidence of poor or zero seroconversion in immunosuppressed blood data. 

6. Reduced incidence of breakthrough infections/ overall case rate of vaccine preventable illness in vulnerable patients. 

The protocol linked provides a detailed breakdown on the data sources available to VaxSEEN. 

These include:

1. Now n=20 million, daily-updated pseudonymised medical records. Hashed NHS numbers and month/year of birth information enables onward linkage to corresponding:

2. Vaccine registry data

3. Hospitalisation data (Hospital Episode Statistics data etc.)

4. Death registry data (cause of death etc.)

5. Broader social datasets (pollution levels/ index of multiple deprivation etc. based on general practice postcode)

This provides us with the data necessary to map out the entire arc of a patient's experience, from vaccination to outcomes, at the scale required to make powerful generalisations to underlying populations. This confluence of data has early warning system capabilities and has been a vital resource for informing vaccine strategy and pandemic preparedness and responsiveness. 

AI has numerous use-cases within VaxSEEN:

1. Case identification - including those who have not been formally diagnosed (e.g. patients yet to receive confirmatory tests but reporting constellation of symptoms most likely associated with relevant conditions)

2. Updating valuesets (intensional/extensional) 

3. Parsing of free-text medical information - clinical codification in NHS datasets is still incredibly inconsistent as overstretched health workers revert to the written word when documenting care. 

4. Modelling and stratifying vaccine benefit-risk profiles 

This confluence of massive, linked data and advanced clinical analytics is the perfect engine for precision medicine; however, we would benefit enormously from the support and guidance of the Cure XChange Challenge network to ensure it reaches its potential. 

The protocol linked elaborates on this key consideration. 

VaxSEEN utilises world-leading, pseudonymised disease surveillance flows. These are made up of sophisticated data linkages and are nationally representative with a now 20 million patient membership, and rising. As discussed, this positions VaxSEEN to reflect trends within clinical risk groups at a level that is generalisable to their underpinning disease populations. The granularity of data available to us enables us to differentiate benefit-risk outcomes on a disease, treatment, vaccine brand, and even vaccine batch basis. 

All information from computerised medical records are extracted via Apollo Medical Software Solutions (https://www.wellbeingsoftware.com/solutions/product/apollo/) and the Morbidity Information Query Export Syntax (MIQUEST) tool in accordance with standard operating procedures in data extraction, psuedonymisation and transfer. Pseudonymisation and onward data linkage is facilitated via a non-reversible 'hash' algorithm as close to source as possible. This process occurs daily to provide a real-time picture of population health. 

All VaxSEEN data are held on dedicated secure servers at the RCGP data and analytics hub in the Clinical Informatics and Health Outcomes Research Group, University of Oxford. This trusted research environment is situated behind a firewall within the University’s network. Provided that our strict deidentification and security requirements are met, VaxSEEN will facilitate opportunities for other medical record providers to submit their own data. It is our ambition to eventually host an international data pool within our own secure confines to ensure that insights obtained at the UK level can be compared to those experienced within international markets and emergency contexts where possible. 

VaxSEEN's data flows are differentiated by optimised value sets (including multiple clinical coding languages - SNOMED-CT, ICD-10, OPCS etc) to maximise compatibility across health contexts and international markets.  

We work within relevant legislation and research and information governance frameworks and are fully compliant with the University of Oxford’s ethical standards. The University is registered on the Information Commissioner’s Office Data Protection Register and is compliant with the Data Protection Act, General Data Protection Regulation, and other key data privacy and protection legislations. As required by NHS Data Security Standard 3 in the Caldicott 3 Review, all research members of NDPCHS are required to complete Data Security Awareness modules on an annual basis.

The legal basis for RSC surveillance is Regulation 3 (health protection) of the Health Service (Control of Patient Information) Regulations 2002, with some of our work with UKHSA falling under Regulation 5 (Health Promotion). Other nonsurveillance studies that use ORCHID TRE data require appropriate ethical approval. For low-risk epidemiological studies, this is through Oxford University Medical Sciences Interdivisional Research and Ethics Committee, whereas for trials or other prospective studies involving contact with patients, it is through the Integrated Research Approval Service. All nonsurveillance studies also must be approved by the independent Primary Care Hosted Research Datasets Independent Scientific Committee. The RSC also meets NHS Digital’s stringent Data Security and Protection toolkit requirements. Finally, RSC activities are restricted to conform with the data sharing agreements with member practices, who, as stated, share data for SQUIRE purposes.

While this question has been addressed above, it is important to take the time to state the theory of change that underpins our work and our confidence in our ability to achieve the upcoming impact goals already stated. VaxSEEN's theory of change is to supply a precision evidence-base on vaccine benefit-risk within and between vulnerable groups to optimise patient health outcomes, resource allocation and uptake, and support the prescription vaccination agenda.

The problem: there is currently no understanding how vaccine effectiveness (benefit) or adverse events (risk) differs between different types of immunosuppressed patients. Vaccination within this group is more trial and error than precision evidence-based at this moment in time, undermining patient outcomes, wasting limited vaccine supplies and exacerbating vaccine hesitancy and rejection. 

The solution: combining and enhancing national disease surveillance data flows to provide more personalised vaccine benefit-risk profiles for vulnerable patient groups and inform a more prescriptive, sustainable approach to vaccination in such high-risk patient groups. 

Fundamentally, our theory of change pins around the following core assumptions:

1. That vaccines and their alternatives, additions or adjuvants should be prioritised for those seen to benefit most from them

2. That evidence-based clinical decision making improves health outcomes and reduces waste

3. That personalised data improves health outcomes and reduces waste

4. That real-time data improves health outcomes and reduces waste

5. That active surveillance (e.g. direct-to-patient research) enhances passive surveillance pathways (e.g. record-based monitoring of vaccine effectiveness and pharmacovigilance)

6. That improving pharmaceutical transparency builds trust and reduces hesitancy amongst patients. 

These assumptions have been built on the basis of previous randomised control trials, observational research, patient involvement and engagement efforts, systematic review of relevant literature and partnerships with market leaders/ thought leaders in public health. 

The VaxSEEN project is based within the Royal College of General Practitioners' Research and Surveillance Centre - a non-profit organisation hosted at the University of Oxford.

The RSC has 25 full time employees, including teams dedicated to clinical knowledge, research, data and membership management. However, myriad research teams harness RSC dataflows that are housed within the ORCHID Trusted Research Environment. We have innumerable global collaborators, including international disease surveillance coalitions including Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE).

The RSC is celebrating its 55th year. VaxSEEN, meanwhile, is a 3-year old innovation within the disease surveillance network. 

Diversity, equity and inclusivity is one of the founding principles of VaxSEEN; it is wholly dedicated to understanding and safeguarding our most underserved patient groups in a sustainable manner. RSC datasets are completely nationally representative. This means our work can accurately appraise how trends differ between those with different conditions, comorbidities, socioeconomic backgrounds and other underrepresented population demographics. This constitutes a major step forward in terms of both identifying and mitigating stubborn health inequalities. 

As an organisation, the RSC's make-up maps onto these founding principles and data characteristics. Our data team is almost entirely female-identified - a major accomplishment given the male-dominance of computer science and STEM more generally. Furthermore, all primary investigators within the RSC are female. The RSC is also dedicated to advancing opportunities for early career professionals, offering a number of internship and high-impact research opportunities for undergraduate and post-graduate summer students. We also prioritise our office culture, ensuring that academic publications and opportunities are sincerely allocated based on contribution and merit - this is in stark comparison to many academic-based institutions where either primary investigators or laboratory leads dominate first authorship, op-ed or conference opportunities. By taking what could be seen as low-level cultural issues so seriously, we make it clear that diversity, inclusion and promotion on the basis of hard work and scientific aptitude will always come first. Finally, the Department of Primary Care Health Sciences at Oxford University in which the RSC is now based recently obtained its Athena Swan Gold for female advancement - this reputation is one that each and every laboratory group and associated organisation aims to protect. 

We have also specified ML's extensive background in the DE&I space and the strength of her personal and professional connection to this work and the principles of health equality and sustainability that underpin it. 

The RSC has an exceptional track record in securing high-impact partnerships with over half a century of high-valuation governmental support to our name. Our working relationship with UKHSA and its predecessor bodies has unlocked the funding, testing capabilities, laboratory space and epidemiological talent that has propelled our disease surveillance to best practice nationally. We are now placed within high-level decision making bodies including national vaccine surveillance groups with inroads to both the Joint Committee on Vaccination and Immunisation and the Department of Health and Social Care. This will enable quick actioning of VaxSEEN intelligence. 

Commercial partnerships with major clinical record companies have also proven valuable for scaling the work and impact of the RSC and, by extension, VaxSEEN's potential. Both the UK's largest clinical record companies - EMIS and TPP - are supporting our surveillance efforts. As discussed, their affiliation also provides access to their full technology suite as well as additional data capabilities.

Finally, our international network of research partners positions the RSC and all spin-out initiatives as world leading intelligence. 

The structure of the RSC is also highly impactful. Unlike comparative disease surveillance networks, our practice liaison team is dedicated to providing our membership with a single point of contact for triaging all data or research issues. Likewise, our research team plans and executes the decentralised efforts that the RSC and VaxSEEN are uniquely placed to deliver and our data team provides both internal and external researchers with required extracts. Our data team includes SQL and Tableau specialists who are adept at converting datasets and research analytics into real-time dashboards for practices, health agencies and private partners alike. This experience will be leveraged when moving VaxSEEN from its pilot phase to that capable of delivering national intelligence for health agency use and, potentially, licensing by the private-sector. 

We are looking for advice on prospective means of securing ongoing funding for the VaxSEEN platform. 

The RSC itself is currently well-funded, meaning the data inputs of VaxSEEN are secure for the long term. However, funding specific to VaxSEEN is required to secure RSC talent for this project on a more full-time basis and to aggregate its dataflows into a dedicated dashboard. 

At this moment in time, the financial sustainability of the RSC is primarily assured by ongoing government contracts. However, the 55 year track record of securing this support is demonstrative of the value of the RSC to UK disease surveillance efforts and of the stability of our future. Although the exact financial value of these contracts is not appropriate for disclosure, publicly-available transparency documents provide illustrative monthly sums (over £50k in February 2022). 

We have also seen great success securing high-value, multi-year grants from global public health interest groups including the Wellcome Trust, EU Horizon 2020, the NIHR, the ECDC, WHO-Europe etc. We also have established working relationships with global pharmaceutical and biotechnology companies including AstraZeneca, Eli Lily, GSK, Sanofi, Seqirus, Takeda, Novo Nordisk and Roche. These relationships will be crucial for the design of any pharmaceutical oriented versions of VaxSEEN that can be licensed to ensure its ongoing financial security. 

As an Oxford-MRC iCASE Scholar, ML has received funding from EMIS Health, the Medical Research Council, the Tony Blair Institute for Global Change and the Alan Turing Institute.

Although the non-profit nature of the RSC would make monetising its data difficult (our data depends upon the ongoing trust of our clinicians and goodwill of patients), a freemium service of targeted insights for relevant pharmaceutical companies might be one acceptable way forward to retain the VaxSEEN project as a key RSC priority - with membership consent. Ensuring the financial sustainability of VaxSEEN is essential for the ongoing rigour of its intelligence, however, and its ability to scale into (and harmonise with) international markets or accept additional data sources. 

We will also look to seek programmatic support from funders including UN and national health agencies, COVAX, CEPI, the Gates Foundation and GAVI. Cure XChange Challenge support will help strengthen these applications no end. 

VaxSEEN's operating costs are currently met by the funding associated with ML's Medical Research Council iCASE Industrial Award ($80k over 4 years).

$50,000 would be sufficient for securing RSC talent on this project on a more full-time basis and for executing a VaxSEEN MVP (real-time tracking of observed flu/ COVID vaccine benefit-risk for clinical risk groups, broken down by vaccine type, dosage, batch number). At this stage, our priority is to launching the MVP and obtain proof of concept that RSC dataflows can be successfully augmented, aligned and displayed via dashboard for public-private benefit. A freemium model will also be investigated using this funding with private-sector specific insights included on a configured version of the platform - however, such work is incredibly sensitive due to public skepticism regarding monetising health data in anyway - and would require complete transparency and acceptance amongst our membership. 

ML would represent VaxSEEN at the Cure Residency; as a dual citizen with a US-based family, she already splits time between New York and Oxford. Being provided with a formal US workspace would be invaluable for ML's comparative work between UK and US health ecosystems. This is being conducted to ensure that VaxSEEN insights hold in comparative markets. UK data challenges (poor codification at scale) are reversed in the US (excellent codification, poor linkage and low sample sizes); combining the insights of the two covers blindspots and amplifies research generalisability and power. She has struggled to do this effectively from co-working spaces and hot desking in US institutions - the legitimacy that the Cure XChange Residency provides, as well as the consistent working space, would skyrocket her progress in accessing and handling US data while socialising the project with key US healthcare players. 

We are also most excited about the additional technical guidance and training this residency offers and the opportunity for collaboration within the office space of like-minded changemakers. We would welcome any chance to upskill within AI, enriching its application to our datasets while thinking about what our data might be able to offer to wider use-cases including diagnostic LLM projects (e.g. MedPaLM). 

ML would also gratefully receive all mentorship available, particularly amongst those with direct experience of converting dataflows utilised for academic purposes into digital resources that can benefit the international community.