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Within weeks of the pandemic starting, the Nuffield Department of Medicine (NDM) began antibody testing as part of the UK’s ONS COVID-19 Infection Survey. The platform successfully tested millions of blood samples over three years, providing invaluable information on how vaccinations and previous infections affect the chance of getting COVID-19 again.

The COVID-19 pandemic has had a profound impact across the UK and the world. In April 2020, the COVID-19 Infection Survey, led by the University of Oxford and funded by the UK Health Security Agency, was commissioned by the  discover how many people in the UK had COVID-19 at a given time or had previously caught COVID-19, and monitored individuals’ response to COVID-19 vaccinations.

Over the course of three years, swab samples were taken from the same participants each month and tested by the UK’s Lighthouse Labs to determine whether they were positive for COVID-19 at a given point in time. Blood was also taken from a subset of these participants and was sent for antibody testing to NDM’s serology platform. The data was then analysed, with the results giving a national-level picture of infection and immunity, informing UK government policies.

This remained important as more people got vaccinated and the study needed to monitor how many people were still getting COVID-19, with or without symptoms. The study also needed to monitor how vaccinations, and having had the disease before, affected the risk of getting COVID-19 in the future – to work out who might need vaccinating again in the future. Overall, over 535,000 people from around 260,000 households across all four nations of the UK took part in the study.

Professor Sarah Walker, Professor of Medical Statistics and Epidemiology at the Nuffield Department of Medicine and co-lead of NDM’s Modernising Medical Microbiology consortium, was Chief Investigator and Academic Lead of the project. In Oxford, a diverse team of clinical and non-clinical staff was led by Professor Derrick Crook, Professor of Microbiology at NDM and co-lead of Modernising Medical Microbiology. The team brought together expertise in anti-viral humoral immunity, the production of high-quality antigens, and clinical microbiology and infectious diseases.

Within weeks of the pandemic being declared by WHO, NDM was able to develop a serology testing platform. The manual assay that helps in the detection of antibodies was developed within two months and was automated within six months in collaboration with the Oxford University Hospitals NHS Foundation Trust (OUH). At peak, healthcare workers within OUH were receiving and unpacking upwards of 6,000 blood tubes a day, seven days a week.

In total, 3,478,000 assays were run as part of the serology study. In line with the changing path of the pandemic, the UK Health Security Agency is currently reviewing its approach to COVID-19 surveillance and survey data collection was paused in March 2023.

Although the vast majority of samples assayed were from this project, samples from other sources such as OUH, UK Biobank, the Antenatal seroprevalence study, NHS Blood/Transfusion service Convalescent Plasma study, Oxford Vaccine Group, RECOVERY trial, NHS Blood and Transplant, Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia, were also tested.

Prof Walker said: ‘The serology data collected has been crucial to work out how vaccinations and previous infections affect the chance of getting COVID-19 again, and to monitor COVID-19 immunity at the population level. This would have been impossible without the selfless contribution of hundreds of thousands of people taking part, providing finger prick blood samples, across all four nations of the UK.’