Memorandum submitted by MRC Centre for
Outbreak Analysis and Modelling, Imperial College London (SAGE
46)
Apologies for the delay in responding to your
letter of 28 October. My responses to the two follow-up questions
follow:
1. You mentioned in your oral evidence (Q29
of transcript) that there were difficulties in sharing raw data
between countries. Could you please provide your views on why
this occurred?
There is little tradition of real-time sharing
of epidemiological data by public health agencies across the world.
In my view this has a number of causes: (a) concern about data
protection (inadvertent release of data on individuals); (b) limited
resources to document data to a level which makes sharing useful—the
often quoted (and somewhat justified) fear is that raw data is
complex to interpret and misinterpretation might cause confusion;
(c) fears of organisational or individual reputational damage
should errors or limitations of data be highlighted; (d) a desire
by organisations to lead on publications in the scientific and/or
medical literature which might be compromised by early release
of raw data. Together these factors tend to mean that raw data
is only shared with trusted collaborators under strict data access
agreements. This tends to preclude the more routine sharing of
data at an institutional level (eg between HPA and CDC). I would
suggest that if this is to be a priority for future crises then
effort needs to be put into building inter-agency links now—not
just at the level of high level agreements, but at the level of
staff exchanges and other long-term confidence building measures.
Where high-level agreements might be useful is in allowing high-level
briefing documents (eg SitReps) to be shared between HPA/DH and
CDC in Atlanta (and perhaps other key EU counterparts).
2. We would also welcome your views on Sir
Liam Donaldson's comments (Q33 of transcript) that there were
some problems with the use of modelling data—do you have
any insight into why this was the case?
It is unclear what is being referred to here.
My best guess is the confusion over the "65,000" deaths
figure which was issued as a reasonable worst case for NHS planning
in July. These were often reported as predictions:
http://www.guardian.co.uk/world/2009/jul/16/swine-flu-pandemic-warning-helpline
http://www.timesonline.co.uk/tol/life_and_style/health/article6716477.ece
http://news.bbc.co.uk/1/hi/8154419.stm
The release of these reasonable worst case figures
unfortunately coincided with my group publishing a paper on challenges
in estimating severity in a pandemic. While this paper was accurately
reported by the BBC (http://news.bbc.co.uk/1/hi/uk/8150952.stm
), other reports focussed on the fact that Sir Liam's official
mortality figures (29 deaths up to that week in July) were likely
to be an underestimate (eg http://www.heraldscotland.com/deaths-from-swine-flu-could-be-higher-than-reported-1.914626).
This certainly caused a degree of confusion and perhaps embarrassment
within DH. But overall I don't think any of this really reflected
a problem with modelling—the uncertainty around eventual
mortality was very large at that time. However, it did reflect
the less than optimal coordination between the SAGE group (and
its SPI-M subgroup) and the CMO's office. Had the CMO attended
SAGE meetings (and been represented at SPI-M) then I suspect the
65,000 figure might have been presented differently and less emphasis
might have been placed by the CMO on reporting weekly cases and
deaths as precise numbers. I understand that Sir Liam rejected
sitting on SAGE for fear that it would compromise his "independence".
I have to say that I fail to understand this argument—I
suspect that the academic scientists and clinicians on SAGE are
perceived as rather more independent than the CMO, and the entire
purpose of SAGE was to give the best possible independent scientific
advice to government. As one of the key consumers of such advice,
it would have been preferable that the CMO was an ex-officio member
(or indeed, co-chair). While Sir Liam was briefed on SAGE deliberations
and saw resulting documents, this would not have informed him
of the nuances of the scientific discussions that took place—such
as the issues surrounding estimation and presentation of data
on pandemic severity.
Regarding the actual "best guess"
and "reasonable worst case" estimates of severity produced
at different times during the pandemic by SPI-M, I believe Dr
Peter Grove at DH has compiled a chronology of these. The committee
may wish to request these from Prof David Harper.
I hope this addresses the committee's queries.
If I can assist with anything else, please get in touch.
Professor Neil M Ferguson
Director
29 November 2010
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