Examination of Witnesses (Questions 1-19)
PROFESSOR COLIN
BLAKEMORE, DR
ALAN HAY,
PROFESSOR ANDREW
MCMICHAEL
AND PROFESSOR
ANNE JOHNSON
30 NOVEMBER 2005
Q1 Chairman: Good morning everyone. Could
I thank our panel of experts for appearing before the Committee,
and could I thank you very much indeed, Professor Blakemore, for
sending in your paper which the Committee found useful in terms
of the background to this one-off evidence session. We are grateful
to you. Could I perhaps start with you, Professor Blakemore, and
ask you what determined the timing of your visit to South East
Asia and how you respond to the criticisms that this was just
a knee-jerk reaction to the media, and that, rather than reassure
the public, you created some panic.
Professor Blakemore: It would
be a pretty fast reflex, Chairman, given that the publicity occurred
a couple of days before an expert group went to visit Vietnam
and China. I think the MRC would have to be congratulated for
being able to organise something like that in two days. The plans
for this visit had been evolving as part of our general strategy
on the issue of emerging infectious disease, particularly flu,
over really the course of a year. We first began to think about
flu in the context of new and emerging infections about a year
ago, with strategy discussions in the sub-committee of our Infections
and Immunity Board, and, indeed, we made our first contact with
the Chinese at that point, through discussions with Professor
Chen Zhu, who is the Vice-President of the Chinese Academy of
Sciences. Even those discussions included some talk of the possibility
of collaboration with Chinese scientists in the area of infectious
disease. In March this year, I wrote to a number of colleagues
in Government departments and other agencies, spelling out our
initial thoughts about MRC's contribution to work in the area
of flu, proposing that we had an expert workshop and put forward
the recommendations from that workshop, implementing them in MRC
policy. That workshop will happen next week with experts from
around the world, including from China and Vietnam, and the United
States, and that will be the final step in developing our strategic
approach to MRC's contribution. So this has been evolving for
some time, Chairman.
Q2 Chairman: What was the main purpose
then of going to South East Asia? Why did you have to go there?
What did you do there that you could not have done back at base?
Professor Blakemore: The major
infection amongst bird populations, both farm birds and wild birds,
is in South East Asia.
Q3 Chairman: Not necessarily in China
and Vietnam, but Cambodia, Indonesia and Thailand.
Professor Blakemore: That is true,
Cambodia and Thailand and so on.
Q4 Chairman: And yet you chose not
to go to those countries.
Professor Blakemore: We could
not go everywhere and we already had contacts—and, again,
some of those had been developing over a long period of time,
partly with a visit from Dr Jeremy Farrar, an English researcher
from Oxford who is based in Ho Chi Minh City in Vietnam. Those
discussions informed and helped us to plan our trip. It is worth
saying that the majority of cases of human infection have been
in Vietnam and by far the largest number of birds that are infected
are in China. Those seem to be the two natural places to concentrate
our efforts.
Q5 Chairman: We understand there
were two trips here in October: a mission taken by scientists
led by Professor McMichael and a visit by yourself. However, the
report that we received from you did not mention your activities
at all. Have you fallen out with each other? Is there something
we should know and in which the public should be interested?
Professor Blakemore: No, we are
always the best of friends within the MRC community, Chairman.
Q6 Chairman: So I understand.
Professor Blakemore: I went to
Beijing and Shanghai as part of a broader MRC delegation to China.
Some 20 MRC scientists were in China during the two weeks of our
activities there, of which the expert visit to Vietnam and South
China was only a part. There is at the moment in China a week
of activities, the UK-China Partners in Science Programme, and
as the MRC's contribution to that we sponsored a workshop on cancer
research in Beijing, with MRC scientists as well as Chinese scientists
contributing to that. I attended that workshop, also spoke to
senior colleagues in Chinese organisations, and signed memoranda
of understanding with the Chinese Academy of Sciences and the
National Natural Science Foundation of China as the underpinning
of our future collaboration. I then met with the expert delegation
in Beijing, after they had visited two or three of the locations,
so that they were able to brief me on their activities so far.
Q7 Chairman: In your report to us
you say that, as far as China is concerned, they have quite a
sophisticated research base which is looking at bird flu pandemics.
If you look at Indonesia and you look at Thailand, and particularly
Cambodia, they have very, very small research bases—embryonic,
to put it mildly—and yet you do not seem to have an interest
in those countries. Why is that?
Professor Blakemore: I would like
to hand over to my colleagues who are more expert than I am in
those areas, but I will answer briefly. Clearly, in terms of progressing
research activity it makes sense to us to build links with those
countries in which there is already expertise and quite sophisticated,
as you say, surveillance and laboratory work, as well as countries
in which we have direct contacts. For instance, one of the institutes
visited by the expert group was the Chinese Academy of Sciences
Institute for Microbiology in Beijing, the director of which,
George Gao, was a former student of Professor McMichael. It is
those kinds of linkages clearly which are very valuable in building
confidence and in building collaboration. Perhaps, Chairman, I
could ask my colleagues to respond to the particular point.
Q8 Chairman: Of course. You have
not fallen out, Professor McMichael.
Professor McMichael: Not in the
least. No, we travelled down from Cambridge together last night.
We went to Vietnam because, first of all, there have been more
human cases there than any other country. We particularly wanted
to meet clinicians who were treating cases and we had a very strong
contact with Jeremy Farrar in Ho Chi Minh City who has seen about
half the cases in Vietnam. We then moved into China. We have to
recognise that China is very, very strong scientifically. They
are building new institutes, recruiting researchers back from
the United States and Europe, and they are building very rapidly
and are building up their science base tremendously. This is a
high technology country and we were very keen to talk to them
about possible collaborations, about seeing where we might link
both clinically and in the basic sciences. That is really why
we chose those two countries. We only had a week. It would certainly
be interesting to go to Indonesia and Cambodia but Vietnam and
China seemed the most appropriate in the time we had.
Q9 Chairman: Professor Blakemore,
we understand that the MRC Infections and Immunity Board is reviewing
the Council's strategy for emerging infections and epidemic and
pandemic control. Why are you doing that now?
Professor Blakemore: As I said,
Chairman, that process began literally a year ago, in December
last year, with the first discussions in the strategy sub-committee
of that board. Professor McMichael is the chairman of the board
and will be able to comment in more detail, but those discussions
over the past year have been informing the development of strategy,
and I use this opportunity to report to you that at our high level
strategy committee meeting just yesterday we decided to recommend
to the Council that we should make a new investment of up to £10
million.
Q10 Chairman: We will come on to
cost in a minute. Are you saying that the current strategy is
deficient?
Professor Blakemore: Strategy
responds to circumstances. To the extent the circumstances are
changing, clearly strategy has to change. I think we have clearly
demonstrated that we have been very agile in responding to changing
circumstances, Chairman.
Q11 Chairman: But it was last December
when you began the strategy discussions.
Professor Blakemore: Yes.
Q12 Mr Newmark: Strategy is a longer-term
thing but tactics is a short-term solution. Strategy is where
you have a game plan and figure out what that game plan is. Tactics
is where you respond to short-term changes in that game plan.
Professor Blakemore: I accept
that, but of course strategy, like tactics, can change and should
change in response to the broader term problems. Of course we
are planning to do whatever we can on the shortest possible timescale,
because we do not know when, if it happens, a pandemic will start,
but equally we know flu is with us every year and, indeed, there
will be other pandemics in the future, so we need to make longer
term investments as well, and that is part of our plan.
Q13 Mr Newmark: Given the immediacy
of the situation, given the resources that you seem to be putting
into this, why is this review going to take until March 2006?
I appreciate it is a relatively short amount of time, but . .
. .
Professor Blakemore: There might
be some misunderstanding here. The review will not be continued
until March 2006, the process of receiving fast track applications
will. The review will essentially be completed—at least
this stage of it—and the strategy changes, as I have said—at
the end of next week, as we finish the workshop and we use that
final information gathered from the workshop to define the precise
nature of the call for proposals for work.
Q14 Mr Newmark: Given we are pretty
close to that date, are you able to say what the recommendations
are likely to be?
Professor Blakemore: The recommendations
to Council, as I have already said, are that the MRC should make
an investment of £10 million, probably in two stages, one
very rapidly and the other allowing proposals to come in that
cannot be delivered immediately. What should be covered in that
area—although, as I say, this will be followed by the results
of the workshop—would include new approaches to the development
of antiviral therapy, new approaches to vaccines, immunotherapy,
clinical observations, rapid diagnosis. There are many areas in
which we think there could be quick developments, innovative developments,
as well as longer-term research to inform the future.
Chairman: I want to keep the cost issue
separate and return to that.
Q15 Mr Newmark: I would like to change
direction slightly. My next question is to Professor McMichael.
The press notice emphasises the trip was intended to identify
opportunities for research collaboration. What plans for collaboration
have emerged? How will collaboration work in practice?
Professor McMichael: We looked
for opportunities at each place we visited. The best opportunities
I think come from, first of all, Ho Chi Minh City where Jeremy
Farrar is. He has substantial funding from the Wellcome Trust
and some funding, increasing probably, from the National Institute
of Health in the USA. But there are still parts of his programme
he would like to put forward to the MRC and we discussed that.
It is also a place where we could sponsor young scientists, both
clinical and non-clinical, to go and work and we could receive
scientists from them in MRC-sponsored universities and institutes
in the UK. In North Vietnam—and Professor Johnson could
probably speak more about this—there are opportunities for
epidemiological research with WHO there in Hanoi. In China, there
are two clinical centres we visited, one in Gwangzhou and the
other in Beijing, where there are existing collaborations on SARS,
and the You An hospital in Beijing has been designated the Beijing
centre for clinical cases of avian flu. Should they transmit into
humans on a large scale, that will be the centre. There are existing
collaborations and we could build on that, and we explored those
opportunities there. In the basic sciences, in the Chinese Academy
of Sciences' Institutes of Microbiology and Biophysics, there
are well established UK collaborations already. The heads of those
two institutes have worked in the UK in recent years and there
are opportunities for bliateral exchanges there. Finally, in Harbin
and Hong Kong: in Hong Kong there is already great potential for
collaborations with Dr Malik Peiris, who has also worked in the
UK; and in Harbin—and perhaps Alan Hay could say more about
it—that is the centre in China for the infection in birds,
and Sir John Skehel is very enthused about possible collaborations
there.
Q16 Mr Newmark: Just to get a little
more granularity in your answer, when I view collaboration there
are three forms I would look at. One is shared information, shared
research, shared intelligence. The other form is people contributing
on either side, on our side as well as theirs. And I guess the
third form is money. Would you say that is balanced all the way
through in China and in Vietnam, on all three of those criteria
I have identified?
Professor McMichael: I think so.
The first thing is the people. We need to identify potential people
who will collaborate with each other and then it is possible for
them to come to the MRC to look for funds. There may be matching
funds from the host country, particularly from China. Then research
programmes can be built up around that.
Q17 Chairman: Before I leave this
line of questioning, Professor Blakemore, could I say there is
an impression—and perhaps you will say we are hopelessly
wrong on this—of some sort of panic within the MRC in terms
of dealing with the threat of avian flu. Back in 1997 the first
cases of H5N1 were discovered in Hong Kong with six fatalities.
We seem to have a long lead-in time to this and yet there is a
huge amount of activity over the last few months. Why is that?
Is it your job to look ahead?
Professor Blakemore: I think it
is both unfortunate and unfair if you think the MRC's response
to this situation is one of panic. Certainly panic amongst the
public two or three weeks ago was being fuelled by a lot of media
interest—which you notice has passed, like the Indian summer.
I have tried to reassure you that the MRC, outside the blaze of
publicity, has been planning and developing its strategy and changing
its tactics in response to the situation over at least the past
year. Could I point out—and perhaps my colleague, Dr Alan
Hay, who is the Director of the Worth Health Organisation Influenza
Coordinating Centre at Mill Hill, should comment most on this—the
MRC has been centrally involved in research on flu, in monitoring
flu, in responding to changes in strains of flu and helping the
development of vaccines ever since the flu virus was discovered
at the National Institute of Medical Research in the 1930s.
Q18 Chairman: We are going to come
on to Dr Hay and I think that point does need to be made. Could
I turn to you, Professor McMichael. Did you cover all you wanted
to on your visit? What is there left to do? Did your visit uncover
new problems which you clearly now have to work on? Or did it
confirm what you already knew?
Professor McMichael: I think it
did both. It confirmed some of the things that we expected. We
were looking for areas where research was needed. I think we identified
those in clinical management, in epidemiology, in the issue of
the virus in birds and in the potential for future work of a clinical
trial nature, of how to treat this infection and the kinds of
things that might be possible.
Q19 Chairman: In terms of unexpected
problems, there was nothing that surprised you.
Professor McMichael: I do not
think so. My colleague Anne Johnson can probably comment. I think
probably not.
Professor Johnson: No. We were
able to speak to a lot of people firsthand—and that was
of tremendous benefit, to speak to people who had managed the
cases, to understand the situation in the area. We obviously were
able to get more detail and more firsthand information, but we
did not, I do not think, come across anything that particularly
surprised us.
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