Memorandum submitted by Ian M Jones (SAGE
01)
I am responding in my capacity as a spokesperson
during the influenza flu pandemic of 2009. I am Professor of Virology
at the University of Reading and am a frequent commentator for
the press on virus outbreaks as and when they occur. My comments
are sought and covered by the regional press, particularly BBC
radio Oxford, BBC radio Berkshire, and BBC Three Counties radio.
I also respond to national press enquiries as required be they
from radio, television or the newspapers. In addition I have provided
expert briefings for both national and international information
sources. I am registered at the Science Media Centre and about
half of the enquiries I deal with are routed from there. The remainder
come directly or via the press office at the University of Reading.
1. What are the potential hazards and risks
and how were they identified? How prepared is/was the Government
for the emergency?
The threat of an influenza pandemic, indeed
the threat of any biological agent outbreak, falls into the difficult
class of threats that are certain in the long term but uncertain
in the short to medium term. In addition, the question of severity
is one that cannot be gauged ahead of an actual outbreak. As a
result of the certainty there is almost always a preparedness
plan but there are questions around how up to date, robust, responsive
and adaptable the plan is once set in motion. In the case of influenza,
the last major pandemic occurred in 1968 so a substantial proportion
of the population has never encountered a pandemic before. In
addition the public's perception of risk today is very different
from what it was 40 years ago. A plan dating from that time would
undoubtedly have been found wanting had it been the only response
available. However, the perceived threat from avian influenza,
particularly the highly pathogenic H5N1 virus, over the last decade
has resulted in updated plans and a good level of public awareness.
This acted in support of the response to the 2009 swine flu outbreak
when it occurred and the Government was both well briefed and
well prepared when the new strain of influenza emerged in the
early part of that year. A significant downside however was the
fact that having prepared for a very severe virus infection the
response to the swine flu outbreak has subsequently been criticised
for being unduly alarmist. This is unfair but it does add fuel
to the flames of those who are sceptical of the government's ability
to correctly judge, and appropriately respond to, a significant
biological threat.
2. How does/did the Government use scientific
advice and evidence to identify, prepare for and react to an emergency?
As noted, the Government, through its agencies
and with advice from the relevant research councils and other
medical bodies, had conducted an in-depth review of the threat
of an influenza pandemic following the re-emergence of H5N1 avian
influenza from 2001 onwards. The options for the control of epidemic
disease; isolation, social distancing, restriction of movement,
availability of antivirals and the development and roll-out of
a vaccine were therefore all considered and rejected or put in
place as appropriate. A genuine difficulty is the question of
scale (and/or severity) which is almost impossible to judge, and
the upfront engagement of the pharmaceutical industry whose cooperation
is essential if the roll-out of any treatment, preventative of
palliative, is to be assured. There is much to be said for the
benefits of an active and competitive pharmaceutical industry
but the fact that it has completely displaced older notions of
state serum institutes, which at one time would have enabled a
certain amount of government controlled manufacture, means that
both drugs and vaccines are provided entirely by the commercial
sector where the guarantee of a market is the foremost drive for
the commitment to manufacture. Truly comprehensive preparedness
will always be limited by this point. What the Government SHOULD
do was a question frequently asked of me. But what the Government
is ABLE to do would have been a more useful query. More general
information that clarified the role of Government in the eye of
the public would have been useful in this respect.
3. What are the obstacles to obtaining reliable,
timely scientific advice and evidence to inform policy decisions
in emergencies? Has the Government sufficient powers and resources
to overcome the obstacles?
For case studies (i) and (ii) was there sufficient
and timely scientific evidence to inform policy decisions?
The general preparations for an influenza pandemic
have already been noted above. In the swine flu outbreak a significant
problem early on was the unreliability of the data relating to
the very first cases. The virus emerged from the swine population
in Mexico and early reports suggested a very virulent virus capable
of causing high mortality in young adults. This was reminiscent
of the 1918 influenza outbreak whose imagery had been much used
in the discussion surrounding the preparations for an outbreak
of avian influenza. In a sense therefore, the public had been
primed with the worst possible scenarios and it was difficult
to source reliable information which argued against this early
in the pandemic. The government clearly has an overseas presence
in many countries but it is difficult to judge whether or not
those bodies were able to source reliable information from the
local government or were simply passing on alarmist press reports
prior to their general release via the Internet. A review of the
reliability of overseas sources of information particularly relating
to infectious disease might therefore be a useful exercise (note:
the current alarm and confusion over the "NDM superbug"
would be another case in point).
4. How effective is the strategic coordination
between Government departments, public bodies, private bodies,
sources of scientific advice and the research base in preparing
for and reacting to emergencies?
I judge this to have been fairly good in the
case of the 2009 influenza pandemic. Bodies such as the Wellcome
Trust, the Medical Research Council and the Health Protection
Agency worked together well to ensure a relatively unified front.
The role of the Science Media Centre is worthy of particular note
as it worked quickly to counter the more alarmist elements of
the press. In terms of reacting to the emergency I would reiterate
my point about the essential role of the commercial sector as
there was some concern by the summer of 2009 over the availability
of the vaccine for the coming winter. In the event the vaccine
became available but there was certainly uncertainty over whether
a vaccine would be made, how much vaccine would be made, who would
be the primary recipients of a vaccine and whether or not a vaccine
was safe.
5. How important is international coordination
and how could it be strengthened?
This is of paramount importance to the question
of emerging infectious disease. The volume, extent and variable
routes of overseas travel is such that any notion of restricting
an epidemic outbreak to one country or another (for example by
stopping incoming flights) is essentially pointless. An accurate
risk assessment of an emerging situation can therefore only be
made by gauging the validity of the reports available in the country
of emergence and by continual and timely updates. At the same
time the availability and shipping of possible treatments, which
may be held abroad, is something which needs to be investigated
at the earliest possible moment. This is as much to prevent an
early alarmist overreaction to an emerging situation as it is
to be comprehensively prepared for a situation that will eventually
reach the UK. Timely reviews of reporting networks and the action
plans that depend on them is therefore an important part of a
constantly improving process.
Ian Jones
School of Biological Sciences
University of Reading
14 August 2010
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