HC 499 - Scientific advice and evidence in emergencies

Memorandum submitted by the Royal College of General Practitioners
(SAGE 16)

This document offers the College’s view on how the Government used scientific advice and evidence during the swine flu pandemic in 2009. The RCGP is not responding to any of the other case studies.

The College has been involved in preparing for an influenza pandemic for a number of years. Dr Maureen Baker, RCGP Health Protection Lead, has worked closely with organisations including the Department of Health’s pandemic team and the BMA’s General Practitioners Committee to ensure that pandemic planning is put in place.

During the H1N1 outbreak in 2009, the College formed an excellent working relationship with the appointed Government "flu tsar", Ian Dalton, who used RCGP Members’ feedback on the situation to inform his discussions with Strategic Health Authority Leads in England. The College found that this feedback mechanism helped inform policy and that most issues were addressed - at least in part – by forwarding on Members’ concerns and comments.

At the time, a joint RCGP-Health Protection Agency panel was also formed to discuss how the situation was operating on the ground and to examine what guidance was required for GPs.

The following provides the College’s views on the questions outlined in the Commons Science and Technology Committee Inquiry:

1. What are the potential hazards and risks and how were they identified? How prepared is/was the Government for the emergency?

(a) The potential hazards and risks relating to the swine flu pandemic in 2009 include:

· Possible large numbers of excess deaths

· Severe pressure on the NHS and social care systems, affecting people with both flu-related and non-flu related conditions

· Supply chain difficulties for food and essential services (e.g. power)

· Public panic and the potential for public disorder

· Accelerated spread of the virus due to modern travel

· Potential side effects of the pandemic vaccine due to lack of thorough testing

The College would like a good evidence base for the potential hazards in future so that it can respond to emergency situations appropriately.

(b) Government preparation for the emergency:

The Hine1 report notes that the UK’s current central government crisis management arrangements have been in place since 2002 and have been tested in various crises and exercises and refined through those experiences. It also states that the pre-pandemic planning, set out in Pandemic Flu: a national framework for responding to an influenza pandemic, ensured that many decisions had already been made in principle prior to the pandemic and that key personnel had already had the opportunity to work together.

Our view has been that the Government was extremely well prepared for the challenge of pandemic flu. This was largely because of well-documented evidence from previous flu pandemics in the 20th century and recognition by the global public health/health protection community that failure to plan for entirely foreseeable crises - such as a severe flu pandemic - could result in far greater numbers of deaths and adverse outcomes than would be the case if effective preparations had been made.

The College is best placed to comment on preparations within the health sector - although other work had gone on in terms of dialogue with essential services, business and government agencies. Within health, there was a national clinical director for pandemic preparedness; professional advisory committees; managerial flu leads at Strategic Health Authority level; advance purchase of antivirals and advance contracts for pandemic vaccines.

2. How does/did the Government use scientific advice and evidence to identify, prepare for and react to an emergency?

For flu, once identified as an issue for preparatory work, the Government used those standing structures that it already had in place – specifically the Scientific Advisory Group for Emergencies (SAGE). Other groups were established, in particular SPI (Scientific Pandemic Influenza group) and PICO (Pandemic Influenza Clinical and Organisational group).

SAGE is a standing group that brings together scientific and technical experts and draws on their expertise to ensure co-ordinated and consistent scientific advice underpins the Government’s response to emergency situations. Membership of the group depends upon the nature of the emergency. The other structures were established as part of pandemic preparedness and individuals had worked together on preparedness. This meant that once the situation became active, there was already a pool of people with knowledge and commitment on whom the Government could draw.

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? Was there sufficient and timely scientific evidence to inform policy decisions?

In the case of pandemic flu, the College believes there were no particular obstacles – the experts had been identified in advance and were willing to contribute to the Government’s response.

There was an issue regarding the amount of time and input needed. Commenting on the situation at peak activity, I feel that pandemic work took over most of my working life and also consumed much of my leisure time. I suspect that was the case for many and this probably means that many of the individuals involved worked for institutions or organisations that were prepared to release them for at least some portion of the working week.

The RCGP Research and Surveillance Centre (RCGP RSC) - best known for its twice weekly reporting and surveillance of influenza-like illness and other respiratory diseases – was crucial during the pandemic. As we move forward this important function should be reserved. The College relies on data from epidemiological surveillance systems - such as the RCGP RSC – and this is the type of information we need to respond appropriately to emergency situations in future.

Interestingly, the Hine report states that during the early stages of the pandemic definitive scientific evidence was not always available but adds that once better data was to hand, modelling became extremely accurate. It recommends that in order to further enhance scientific advice in future pandemics, ministers and key officials should be briefed on the strengths and weaknesses of the likely available information; officials should consider whether it would be possible to derive more robust information earlier to support decision-making; and the balance of contribution in SAGE should be reviewed to ensure that it benefits from the expertise of key disciplines.

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?

In the case of pandemic flu, I feel this was extremely effective, although my view of this was as a representative of a professional organisation that was in receipt of requests for assistance. I am unable to comment on how easy or difficult it was to co-ordinate from the Government’s perspective.

Core to all of this was the effective communication cascade and regardless of the reorganisation of the health service under the new Government, we still need relevant communications from Government channels in order to act appropriately in emergency situations.

We also need effective electronic communication systems and, if impaired through a technological breakdown or reduced workforce through sickness, we would need a replacement mechanism to ensure communication continues to be cascaded.

5. How important is international coordination and how could it be strengthened?

The College believes it is extremely important and appeared to work well in terms of exchange of information and scientific developments (e.g. the virus genome; the development of vaccine; and emerging information on clinical features of the illness). The RCGP does not have any specific views on how international coordination could be strengthened.

Dr Maureen Baker CBE DM FRCGP

RCGP Health Protection Lead

Royal College of General Practitioners

9 September 2010