Examination of Witnesses (Questions 1-19)
PROFESSOR SIR BRIAN FOLLETT, MR PETER ALLEN, MR DAVID BLACK, PROFESSOR IAN MCCONNELL AND DR JENNY MUMFORD
WEDNESDAY 16 OCTOBER 2002
1. Professor Follett, we are breaking every rule in the book by starting early, which I always find is an extremely good tradition. Inevitably, quite a lot of questioning will be about vaccination or non-vaccination so it would be very helpful in your responses always to make clear whether we are talking about the situation as it was coming up for two years ago and where we are now, in terms of what is possible and what is not possible, otherwise we can get a lot of confusion. I am very anxious that we should focus on, first of all, what were the options available at the time and, secondly, how have things moved on since then, so that if we were to face the same problem in the future we know what is available to us. So my first question is, in the light of your investigations and your contacts with the department, if this afternoon somebody discovered a pig with a problem in an abattoir in Essex, or elsewhere, are we any better prepared and armoured to deal with that than we were 18 months ago?
(Professor Sir Brian Follett) Thank you, Chairman. I note that changes to import regulations were announced around in on 1 October, which is 19 months after the event. Perhaps that answers the question in some senses. If we have a potential outbreak of a disease, the first thing to say (and I will get it out of the way quickly) is that I hope in some senses we do have these scares not infrequently, for it really is rather important that we demonstrate to ourselves within the EU that the surveillance system is good enough to detect all the negatives. These diseases in that sense can be so mis-diagnosed. As to whether we are better equipped to deal with an outbreak if it occurred this afternoon, I am not sanguine. We have received in the Spring an interim contingency plan from DEFRA and, in the middle of the summer, an interim contingency plan from the Scottish Executive. However, in that sense they continue along the general lines that were used during the 2001 outbreak. Our report looked forward. I really, as you wish to emphasise then and what is available now, need to stress that the remit of our committee was to look forward and, therefore you will find very little in our report relating to the 2001 outbreak. That is because we stuck to our remit of looking forward. If you take our package, which we eventually came up with, I suppose it is summarised in the recommendations and in Chapter 9. If we work our way through those we shall find out this afternoon whether we are any better equipped with rapid diagnostics, equipped both politically and practically to undertake emergency vaccination and whether we are equipped with the necessary control over movement restrictions. All of that will become clear, I think, in the next hour-and-a-half, but I am not sanguine.
2. When you say equipped "politically and practically" would you like to amplify each of those?
(Professor Sir Brian Follett) Yes, I would. I think what we learned over the course of the period of the year that we devoted to this was the realisation that however you combat these outbreaks it will be contentious for somebody. One stakeholder will be unhappy with a particular way forward. Therefore, we came to the conclusion that one had to be prepared, in a political sense, beforehand. If one was to employ mass culling now, it was a contentious issue which needed, in that sense, to have been approved at least in principle. Similarly with all other aspectsemergency vaccination, restrictions during peace-timeall of these features people feel very strongly about. Our first recommendation says "We recommend the UK Government bring before Parliament for debate a framework for the contingency plans covering the principles involved in handling outbreaks of infectious exotic diseases . . ." We envisage, perhaps following the Dutch model, that behind the overarching contingency plan will lie a series of detailed plans for the individual diseases. I imagine we will focus on foot and mouth but I hope that at the end we might spend two minutes on all the other nasty diseases that are likely to attack us. We imagine a suite of detailed plans, and that is really the political aspect. As far as the practical aspects are concerned, we will come to those, but they relate to being equipped on the ground to carry out, for example, mass emergency vaccination or the implementation of rapid diagnostic methods.
3. During the outbreak, of course, opinions became very polarised and the impression was often given that there were here two completely different responses available to government: one was a mass culling response, the other was an entirely different route, which was a route of vaccination. Do you believe that that was an over-simplification of the situation as it presented itself at the time? How would you characterise the choices available at the time?
(Professor Sir Brian Follett) I think the choices that must have been available were essentially similar to those which are available now, with one great change: that the technical and scientific advances for emergency vaccination have been considerable over the last year. We can accept that they are considerable because they have changed the OIE regulations. I would think that to change OIE/WTO regulations means that somebody at a fairly high level is convinced of the need for a change. I do not want to be drawn into 2001 and will not be drawn in because our report is not, in that sense, about 2001, and you met Dr Anderson at, I guess, your last meeting before the summer break. However, I go back to my point that unless one is well-organised beforehand with all the available tools in one's workshop, knowing that each one has been approved for use and one has a plan which allows one to pick the right tool for the right kind of disease outbreak, then one is going to be in trouble.
4. Your conclusion, at the moment, when you said you are not sanguine, is that you do not think that the Government is yet in a position to do that.
(Professor Sir Brian Follett) We only have an interim contingency plan. On 22 July the Secretary of State admitted that she would need to redesign the contingency plans in the light of the two reports. We understand that DEFRA may be making a statement at some point in the next two weeks. We, of course, know nothing about what has happened over the last twelve weeks.
5. A final point: when you talk about the change in the OIE (that is the International Epizootics Office) you are referring to the acceptability of vaccination product in trade. Is that right?
(Professor Sir Brian Follett) Yes, I am referring to something which we characterised and dealt with in an entire chapter because we thought that it underpins so much of the debate that is going on and, particularly, the contentious nature. In Chapter 4 on page 41 we list the changed conditions as a result of the OIE meeting in May 2002. In essence, what that boils down to is that previously if one used emergency vaccination to stamp out the outbreak there was a fairly long period thereafter when one was at a trade disadvantage. Naturally, for countries which export meat and meat products on a massive scale, that was seen as a no no. After these regulations, however, that disadvantage is now reduced to 90 days. I think that is really a very important political step forward, which of course is allowed to occur because of the scientific developments which have occurred largely since the outbreak of foot-and-mouth in the EU in 2000.
6. Professor Follett, in your opening remarks you used a rather chilling phrase. You said that there are other "nasty diseases that are likely to attack us". There was an element of certainty in those words, that you thought that there would be other animal disease problems coming towards us in addition to the continuing worry as to whether there will be another outbreak of foot and mouth. You hoped that we would probe you on that. Can I take this opportunity, in the context of contingency planning, to ask you why you convey to me that sense of certainty that there would be other diseases? What might they be and how does the contingency planning process take into account other threats which currently we may not have experience of?
(Professor Sir Brian Follett) I do not think I can give you a complete answer to that last part of your question because I do not think that we have seen contingency plans for all the potential risk diseases. However, contingency plans do exist within the EU and, therefore, also within the UK for dealing with the major hazards apart from foot-and-mouthof which the most obvious is classical swine fever. Why I gave a fairly chilling answer to your question is that these diseases are around, there is evidence that they are movingsome of themcloser to us. The classical swine fever virus is now in the wild European boar populations in parts of Germany. Therefore, now it is in that reservoir it is jumping back in to domesticated pig populations in Germany on a fairly regular basis. Short of taking out all the wild boar it will not be possible to remove it. In another case, which is blue tonguea particularly nasty disease which kills a very high proportion of the animals that get it (it is a sheep disease)that virus cannot be caught directly (it is a bit like malaria, you get bitten by a midge) and we have not got the virus. Our midges (a) are not thought to be able to carry the virus and (b) the virus has not got as far as us, but it has crept across from Africa into Southern Europe in the last decade. I feel as if I am hogging it. Could I ask Professor McConnell, perhaps, to comment on some of the diseases that are likely to attack us?
7. Could I just ask Professor McConnell if, in responding, he could just say a word about who is actually monitoring what is going on with the disease patterns around the world? The WHO, for example, in human disease terms, makes forecasts of what is going to come in terms of the winter flu outbreak, or where there is an outbreak of something particularly nasty. Do we have a parallel organisation doing that for animal diseases?
(Professor McConnell) I will come to that in a minute. I think that the point we want to get across is that these days we live in a global farm, and the threat of exotic disease is always therein some cases it can be a plane ride awayand you cannot afford to be complacent about it. That is why you need a contingency plan in place and a well-developed and rehearsed contingency plan. In many respects the sort of contingency planning that we want to see for foot and mouth has generic issues in it which apply to the other exotic diseases. You will have to ask the question why has Britain been uniquely susceptible within Europe with respect to viruses such as FMD and CSF? We know where the BSE problem came from and I suppose that was a unique situation as far as the UK is concerned. All countries are at risk, however, and therefore the other diseases which we may see you should be prepared for. In the case of some of the ones that Sir Brian has mentioned, although there may be a factor with things like global warming and increased movement of animals, you have to be aware of that. That brings me on to your question on surveillance. There is worldwide surveillance through the FAOthe Food and Agriculture Organisation. Also, the OIE through its network of laboratories across the globe, do have a responsibility for surveillance. There is a problem, however, and that is that in any of these countries there is a delay, part political and part poor science, that results in those viruses creeping around and people not being on top of it immediately. There is a need for a more honest assessment by all these OIE laboratories of the risk posed and the identification of the viruses that cause that risk being clearly identified. There also is the case that the OIE needs better resourcing of its laboratories so that they are in a pre-emptive position to diagnose and be accurate about the diagnoses and issue early warnings. Pirbright plays a very important role in that respect. In answer to who does it, it is a global responsibility by networks of OIE laboratories which need to be properly resourced, financed and consulted. There is a problem, I think, although we are not the Anderson Committee, that the level of awareness and the level of understanding about the spread of these diseases was not made the best use of, and we hope that in the future we can make better use of the expertise in our own laboratories.
(Dr Mumford) Mr Chairman, on that point it might be worth mentioning that there has been an initiative between the Department of Health and DEFRA to undertake risk assessments and develop contingency plans on zoonotic diseases, where humans and animals are involved. West Nile Fever would be an example of that because of the awareness that the spread of the disease in the USA has caused.
(Professor Sir Brian Follett) Can I finish by saying that we have tried to pick this up in two recommendations: one says "undertake a systematic analysis of the information available on the relative threats to the UK from a range of diseases . . ." etc; and then, really more importantly, we propose an EU-wide (since these are EU issues not UK issuesand we need to bear this in mind) risk assessment unit and centralised database on surveillance and disease data, and a review of the bodies that provide early warning. So we identify a weakness here. The other part, which is critically important, is how any information from such an EU-wide risk assessment unit is then translated within the individual Member States into appropriate and measured action. Those are vital words. It is no good crying wolf all the time, in that sense. We all understand these things, and that applies not just to diseases, but, on the other hand, we need to be assured of that. I hope that DEFRA will provide, and the EU will ensure through its directive, that we have that kind of surveillance, and not just for FMD but the other diseases.
8. Can you just outline for me, hopefully quite quickly, what contingency planning you feel DEFRA has now undertaken since the outbreak and, more particularly, should be undertaking?
(Professor Sir Brian Follett) I do not think I can answer your question, sir. I have had no personal links with DEFRA for some months now, so I do not know, beyond their interim contingency plan, what they have developed. However, I hope that what we shall see is that they have taken into account the kind of things listed in Chapter 9, which are all the background issues you need to take into account, and will have, in a sense, ticked them off by saying "On import controls we are doing this, on improved farmer/veterinary surveillance we are doing that". I cannot give you an answer to it.
9. Can I look at something else you said there, which was if and when there is another outbreak one of the problemsand I am paraphrasing this so tell me if I am getting it wrongis that there is unlikely to be any consensus over what actions need to be taken. Now, that may not be any different from other aspects of the way in which government has to evolve policy, but we knowand I know we are not looking backwardsfrom the history of foot and mouth which hit us recently that what made the policy evolution so difficult was (and I could say this, on the ground) that there was no agreement; that people felt terribly strongly that whatever stance they took was right. How do you, on the basis that you know there will still be this conflictbecause I think it is a myth to pretend that everybody has now swung towards vaccination, in the same way that it is a myth that everyone felt that the culling approach was right at the outsetdevise contingency planning to take account of the level of conflict over what you want to do?
(Professor Sir Brian Follett) I think we come back to our first recommendation, that the only organisation I know that I voted for in my life that is supposed to deal with these issues is Parliament, and that the principles need to be established. Our essential model is that a contingency plan comes to it and it says "In future we shall employ culling and we predict and expect that we shall be doing culling at this level for these diseasesthat is the infected premises and the dangerous contacts around it." Our evidence, which we quote in here, suggests that society will accept a level of culling as an ethical measure to put down diseases, provided that that level is relatively small. There are some technical issues with improving what is called the "dangerous contact identifications", so that you do not take out 20 premises when there are one or two, and there are technical issues that at that point can be raised as to how fast can you diagnose these infected premises and dangerous contacts? I would like, at some point, to talk, if we can, about diagnosis because speed is of the essence in combatting all these diseases. Just as I use that as an exemplar for what you might call culling, you can use the exemplar for the arguments that one would use for emergency vaccination, for the degree of movement restrictions and for the degree one might or might not close the countrysideall of the various components. It seems to me that we have as a society in Europe and in the UK to debate these and come up with a resolution forwhat might one paraphrase from the Army"the rules of engagement". Those rules of engagement must surely be established before outbreaks. Our plea is really about recommending a Bill before Parliament to trigger that debate. You cannot have those debates during an outbreak. We already know you cannot change the rules of engagement in the middle of the war. I think that you need those to empower the executive, and I think it is important. The real shift over the last 30 years, it seems to me, in society is the growing suspicion, and we therefore need to find better ways of empowering the executive to make those decisions. You gentlemen are experts on this and you may know better ways; the only way we thought of was that we use the Houses of Parliament.
10. Can we talk about emergency vaccination, which you said has made great strides and which attracted media attentionand there is a long-running argument? Emergency vaccination is whatjust localised vaccination?
(Professor Sir Brian Follett) Yes. Let me set the scene and then ask my colleagues on the right here to deal with it. The only way that we could see to handle these diseases is by vaccination. Other methods of holding the disease back by drugs, for example, do not seem to be realistic, at this stage, nor are they likely to be for the next decade. So vaccination is important. You could, of course protect your animals by routinely vaccinating them. After all, our concerns over bio-terrorism and smallpox is that for many younger people in the roomnot me, I suppose, being rather oldthey are not protected against an outbreak of smallpox whatsoever. They are a naive population, hence the concerns. That is the policy that the country has adopted for the last century in the case of foot and mouth and in the case of classical swine fever. The trouble is that the vaccines which are available for routine vaccination are deficient in one way or anothernot completely deficient but deficient enough that one would not recommend their widespread use. What we do is deal with that and we recommend very strongly that there be an internationalit has to be internationalresearch programme put in place in order to develop a vaccine that will provide sterile, lifelong immunity against all strains of the virusto use the formal phraseology. If I put that to one side and say that at this stage we do not recommend routine vaccination of our animals unless a number of things changeand we list a number of things that might change, and if we were being attacked every three months we might change our policy on thatwe then come to how we handle an outbreak, which is really what we have all been at for the last year. That is where we felt obligated for a variety of reasons, not least from society, to look at the precise state of emergency vaccination. My colleagues Ian McConnell and Jenny Mumford led the charge on that, and from it they concludedand David Byrne, the EU Commissioner, has said this in a speech on 13 Septemberthat they believed we should now move emergency vaccination to the forefront of policies for containing this disease, notas he puts itas a last resort, and I would concur with what David Byrne says. Perhaps I can pass to Ian who can tell you how it works on the ground.
11. First, can I ask you what you are actually saying, because your endorsement is a bit mealy-mouthed, in the sense that you have got basic immediate strategies like the emergency cull and stopping movement, and you need rapid diagnosis, but then you say ". . . should now be considered as part of the control strategy from the start of the outbreak." That is not saying "it should be used", just "considered". Why not come out boldly and say "should be used"?
(Professor Sir Brian Follett) I think we thought, from our standpoint, "be considered" in English parlance was quite strong and was rather a push, but if you would like me to say "be used" I think we willwith one exception: there are about half-a-dozen issues that do have to be resolved before you can actually move from "be considered" to "be used". I think we should talk briefly about the reasons why it is not an absolutely open and shut case even now.
12. Let us go back to the initial question, which was how does it operate in the field? You were going to answer that. Professor Follett said he was passing the floor to you to tell us, in the case of an outbreak, how vaccination would be applied. Then there is the other question about the exceptions.
(Professor McConnell) Let us look at a contemporary example, the 2001 outbreak in the Netherlands. The strain was known and the vaccine banks were ready, so emergency vaccination was deployed and they were able to vaccinate because they put in place vaccination teams. They were able to vaccinate something like 750,000 pigs within the space of a week. So where the will is there and where the culture is there to use emergency vaccination it can and it should be done. It was done in the Netherlands. What confused the people in the Netherlands, and they never quite understood it, is why having vaccinated all these animals do we then have to go in and kill them? That is because of the regulations, which people could not understand, to regain the privileged position of disease-free status without vaccination, so all of the animals subsequently vaccinated had to be killed. In veterinary medicine it is a ludicrous position to go killing perfectly healthy, vaccinated animals. Those animals could have gone into the food chain, and later we can get into the spurious arguments raised by the food industry as to why you cannot eat vaccinated meat.
13. How widely are you going to vaccinate? I want to be clear on that point.
(Professor McConnell) If you have an outbreak the first thing you need to do is identify the agent and, using all the information you have on the spread of that epidemic, about the demography of the local populations and about the particular risk factors, define, on the basis of that outbreak, what you are going to vaccinate. A rule of thumb would say you would vaccinate everything within 10 kilometres' radius, but of course you want to use the powerful tools of modelling and demography of animal population to define in any particular outbreak what and who you are going to vaccinate. There are different risk groups. So each epidemic will never be the same. Therefore, the data emerging is one which you must assess. I think, to come back to the question about being mealy-mouthed about vaccination, I do not think we were mealy-mouthed at all; we say fairly explicitly that vaccination should be used as a tool of first resort and I think the public would demand nothing less in future epidemics. It is a question of breaking down, if you like, the cultural objections which have prevailed in the past. I think I was reading through your last encounter with Dr Iain Anderson where you talked about the "silo culture", which is to resist any idea of vaccination. I think that silo culture needs to be abolished. Vaccination works and has been proven to work even in the most recent outbreaks.
14. Are we in a position to do it if there was an outbreak now?
(Professor McConnell) If we had an outbreak of O pan Asia all over again, yes. There are 67 million doses of vaccine throughout the EU in vaccine banks. You have to ask the question why are we spending money on vaccine banks if we do not intend to use the damned stuff?
15. Can you just explain one thing to me? You make a very plausible case, but in the case of our last outbreak the disease had escaped and it got to all kinds of places before there was a full study to identify which parts of the country had actually got it. One of the key arguments seemed to be if you did ring-fence an area and start vaccinating, could you be sure that you had actually contained the disease? Unless you have some kind of movement ban instantaneously or you have a discovery of the disease at a fixed location with absolute certainty that it has not got beyond that fixed location, then I cannot quite see how the vaccination programme you have just described would actually necessarily work. Convince me that I am wrong.
(Professor McConnell) I think experience, particularly from the Netherlands, is one argument I would use to convince you that you are wrong. Obviously, you never run controlled experiments in the middle of an epidemic; you do not say "We will choose to vaccinate that part of the country and not this part of the country." So the success of an emergency vaccination situation, where it has been used, would be an argument that it can be used and has been used effectively to control epidemics.
(Dr Mumford) You have to have the movement bans as well. Immediately you are aware of the infection you have got to have movement bans. It does not obviate the need for these other control measures.
16. The point about our outbreak was that you had that two-week period, as we have now discovered, where there was a reservoir of disease and some of it was moving around different parts of the country. I am not clear where the Netherlands were because I do not know the detail as to whether that was a single-point outbreak and you, therefore, could use this contingency. In practical terms, if there is a delay in the discovery of the disease, can emergency vaccination still successfully be used to contain its wider spread because it sounds to me that what we are saying is that unless you have all the ducks in a row, the movement ban and everything else, it is not going to work.
(Mr Allen) I think that is quite right and that is the whole point of the report. When we are looking forward, we say that whatever tools we have can only work as part of the whole picture, and that includes not only surveillance on our own borders, but international surveillance, rapid diagnostics. It is all part of the picture, whether it is vaccination or whether it is a culling policy, and, as we saw in the last outbreak, it fails unless you have the whole contingency planning from right at the beginning and right through the whole eradication problem.
(Professor Sir Brian Follett) Yes, I think I would support that. You cannot pick one of these things and say that it is the magic bullet. You must have good understanding that the disease is coming, you must minimise the risk of it entering the country with import controls, but you will not eradicate that chance. You try to act agriculturally as a nation in ways which minimise the risk of it spreading and that is why we get into quite contentious issues related to stand-still arrangements during peacetime which are really designed to damp down the possibility of movement. Despite all of that, there will be outbreaks and the question then is what do you do. The package is as we have outlined. A virtually instantaneous movement ban is probably the single most important thing one can do. Jack up biosecurity, or enhance biosecurity is a better word, I think, so that we minimise local spread, and we might talk a bit about that because we do not understand too much. Then we envisage that one moves fast to cull out the infected premises and dangerous contacts using rapid diagnostics not to try and speed up the culling process, but speed up the diagnosis and get there more quickly so that one narrows it down. Over that very narrow window of time, and we are talking days, then one organises the emergency vaccination so that one puts down the remainder and stops it turning into an epidemic. I think it is awfully important and I wrote an opening statement which I wondered whether you wanted and in the end I wrote, "Never forget that five times in 80 years in Britain an outbreak of foot and mouth has turned into a major epidemic and in every case it has caused considerable suffering to animals, farmers and the rural economy and it has led to official inquiries". We are the fifth inquiry and I think, therefore, that we can be fairly certain that the risks are out there. Whether they have gone up or down 5 per cent is really within the detail; it is out there, all right. We need a package of measures which will hold the whole thing down. You can probably get away with one of them being slightly more defective than the others, but any idea that you can solve it with just culling or just emergency vaccination seems to me to miss the point of these kinds of diseases.
17. Is there a case for visiting emergency vaccination as soon as we have got a single case, right, bang, from the start?
(Professor Sir Brian Follett) There is actually a case that you can make out to do that, sir. Yes, you could do it.
18. Would you propose doing that?
(Professor Sir Brian Follett) Well, you questioned us and said we were being mealy-mouthed and the reason we were being careful is that we listed a number of non-trivial issues, as I put it, to be resolved before you would do it. One, we do not yet have worked out the threshold criteria for when you do use it and not all livestock farming is the same, so what you might do on the Brecon Beacons is very different from what one might do in the dairy herds in the Cheshire Plain. Secondly, we do not yet have the precise vaccination strategies and the logistics worked out, who injects the stuff, et cetera, et cetera, a really rather important and vital step. We are still waiting really, although that is weeks away, for the continental companies to work up the marker vaccines and diagnosis because at the end of the day the emergency vaccination rests on being able to distinguish animals which have been vaccinated from animals which have been vaccinated, but are also infected. Therefore, that leads on to a precise post-surveillance strategy, ghastly words, but nevertheless the words that mean every animal which has been vaccinated will have to be tested, not a difficult exercise, to find out that it has only been vaccinated. Then there are issues which are what you might call outside the technical issues which are also non-trivial, but our policy and that of the EU, as currently outlined, depends on a vaccinate-to-live policy, not a vaccinate-to-die policy which was the Dutch policy. For us, we are arguing vaccinate to live and all the animals which were vaccinated and approved okay live out their useful lives, whatever that useful life is. All of that rests on the trade implications. Now, when you look at that package, we thought it was a significant package and I know Mr Peter Allen, my farmer colleague who is on our Committee, has been involved in aspects of it and he could probably tell you something of what has happened over the last three or four months as to one aspect of it, and I think Jenny Mumford could tell you something over what has happened with the marker vaccine. If you put the package together and say two years or 18 months, that should be enough to resolve those issues, and assuming that nothing really horrific comes out from any of those, then I think we would feel rather like David Byrne in the EU Commission, that we should bring it to the forefront of disease control.
19. You are not then in a position to say now, "Vaccinate from the start"?
(Professor Sir Brian Follett) No.