1 November 2018

From Prof Andreas Diacon to all TASK staff

I am picking up that many of you are worried about the future of TASK. We all know that the workload in clinical research goes up and down with projects that open and close. Sometimes studies last longer and grow bigger than expected and sometimes they are delayed or do not start at all. Some grants create a constant income and some studies pay only at the end. At TASK we have always been fortunate that new projects were coming up when others were closing and that we never had to reduce staff numbers when work was scarce.

The income of TASK largely depends on the number of completed patient visits for which we can invoice. In good times we can accumulate funds and in times with fewer visits the reserves can bridge a gap in income. Those of you working at Central and Brooklyn must be all too aware of the recent decline in the numbers of subjects recruited for studies. By now even follow-up visits have become rare, yet new projects are not ramping up. We have been monitoring this carefully, and a few weeks ago we came to realise that the reserves could not carry the less busy sites through the holiday period.

To avoid having to switch off the lights all over TASK we started a campaign to reduce expenses and salary cost, and we have made adjustments to the management structure. As you can imagine, estimating income in advance is a moving target. It is hard to figure out how long the reserves can last until we really know how many patients we can put on studies, how many drug packs we can dispense, how many databases we can fill, how many course participants we can count and how many samples we will be able to process.

Two directors are making their positions available. One is leaving us and the other will remain as a consultant. Many of you have agreed to work reduced hours or have shown flexibility to work at different sites or have even taken unpaid leave. This helps a lot to limit costs. Every single subject screened or put on a study increases income and this is just as helpful. The outlook is better for next year. We know that a large vaccine trial will start at Central and that a MDR prophylaxis study will start at Brooklyn. At Delft we have a study ongoing that will not stop too soon and we are hopeful to add another one in early 2019. The EBA ward at TCRC will be busy all year. We will, in time, generate additional income by providing data management and pharmacy services to sponsors and sites outside TASK. We will also be offering audit services and look at expanding laboratory capacity.

Looking back, it appears to me that we were riding the wave of a few successful new TB drugs that entered testing at TASK five to ten years ago. Bedaquiline, delamanid, pretomanid and linezolid have now found their way into the community. We can be proud of that, but it also means that the critical research for these drugs has been completed. I am hopeful because a second wave of new drugs with fancy code names is now in testing at TCRC, and if those agents go further there will be considerably more studies until they also become part of routine treatment. Also, the one vaccine that we recently tested showed promising results. More clinical testing will be needed to make progress in that field.

So, in summary, one can say that after more than 10 years of growth and a series of successes the TASK bus has for the first time experienced a bump in the road. At this point we anticipate that less than 10% of current staff will still be leaving in the next weeks. The savings made will steady us until work will pick up once again next year. To avoid similar challenges in future we will look at making more project-dependent contracts. This means that only key functions will be permanent positions and provide stability, while other roles will be filled for the duration of a project and rolled over to the next project as long as there are projects available.

So, while I am not worried about TASK myself there are never any guarantees. Research is a journey with uncertain outcomes. Spectacular successes and monumental failures we can have, but stability is hard to come by. We will be working on that, but the only certainty is that nothing is really certain, even at TASK.