Scientific advice and evidence in emergencies - Science and Technology Committee Contents

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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