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Science in emergencies: UK lessons from Ebola Contents

3Responding to major disease outbreaks

Science advice

35.The main mechanism for channelling scientific advice to Government in an emergency is intended to be a Scientific Advisory Group for Emergencies (SAGE). According to the Government, a SAGE is responsible for “ensuring that timely and coordinated scientific advice is made available to decision makers to support UK cross-government decisions in COBR (Cabinet Office Briefing Room mechanism)”.56 While a SAGE is usually chaired by the Government Chief Scientific Adviser (GCSA), each SAGE is emergency-specific and has a flexible structure. The Ebola SAGE was co-Chaired by the GCSA and the Chief Medical Officer. Its establishment marked the fifth occasion that a SAGE had been convened, yet witnesses expressed concerns about the slowness with which it was assembled, the make-up of its membership, and shortcomings in its interaction with existing scientific advisory committees.

Convening SAGE

36.According to the Government’s 2011 Enhanced SAGE Guidance, a SAGE can only be activated by the Cabinet Office Briefing Room mechanism (COBR or ‘Cobra’) in support of collective cross-government responses to and/or recoveries from ‘serious’ or ‘catastrophic’ emergencies.57 Though COBR was convened in response to Ebola in July 2014, a SAGE was only convened three months later, in October 2014.58 Public Health England noted that, by this stage, “the outbreak in West Africa was out of control”.59

37.In evidence given to our predecessor Committee in January 2015, the Government Office for Science stated that one of the lessons that the SAGE secretariat learnt following the winter flooding crisis in 2013/14 was “providing more challenge to the Government process on when and how to provide scientific advice during an incident”.60 Evidence from several witnesses to our current inquiry, however, raised questions about whether this lesson had been implemented in time for the Ebola outbreak. Professor Melissa Leach from the Institute of Development Studies and a member of the Ebola SAGE, spoke in positive terms about what the SAGE achieved, yet commented that:

because of the lateness of the response [the formation of the SAGE], this science-policy interface had to operate in emergency mode in a context of extreme uncertainty. [...] An earlier response would have enabled more measured use of evidence, and more timely planning and response.61

38.In a similar vein, the Wellcome Trust told us that “in the event of a future emergency, the mechanisms for triggering the establishment of expert groups and determining who is responsible for these should be activated more quickly”.62 Sir Mark Walport, the Government Chief Scientific Adviser, conceded that one of “our learnings from this is that we probably would have established [SAGE] a bit earlier”.63 The Chief Medical Officer, Dame Sally Davies, however, was very defensive when questioned on this point, stating that she did “not think we needed to do it [establish SAGE] earlier, because the science advice was coming in and being acted on. [...] That is what matters”.64 She also questioned how setting up SAGE “a little earlier” could have been achieved in practice.65

39.We agree with Sir Mark Walport that the Ebola Scientific Advisory Group for Emergencies (SAGE) should have been established earlier. Convening a SAGE, however, currently requires a request from COBR in the Cabinet Office. It is not clear how, and when, COBR makes an assessment of whether there is a need for a SAGE to assist its response. We recommend that the trigger for the formation of a SAGE should be a formal recommendation from the Government Chief Scientific Adviser. This would ensure a more robust, evidential basis for convening a SAGE.

Membership and co-ordination of SAGE

40.For unforeseen emergencies, the Enhanced SAGE Guidance is clear that the “SAGE secretariat will need to define SAGE membership”.66 Many of our witnesses emphasised that establishing the ‘Ebola Anthropology and Social Science sub-Group of SAGE’, and ensuring that the membership of SAGE included social scientists, were “extremely important in controlling [the] outbreak”.67 Professor Chris Whitty described social science as “important in almost every aspect of what we did” in West Africa.68 This included understanding the “history of inequalities and economic policies that left people distrustful of foreigners and the state in many areas” as well as the “social routes”, such as burial practices, through which Ebola was transmitted.69

41.The importance of multidisciplinary research feeding into emergency responses was emphasised in Sir Paul Nurse’s review of the UK Research Councils, Ensuring a successful UK research endeavour. To support research proposals aimed at addressing “cross-cutting societal needs, including grand challenges, and responses to emergency situations”, Sir Paul recommended the establishment of a “common research fund” which, he proposed, would be administered by a new organisation called “Research UK”: a partnership of the seven Research Councils.70

42.While Professor Melissa Leach was “impressed by the breadth of expertise” included in the SAGE membership,71 others pointed to a lack of front-line clinicians represented on SAGE, particularly from “aid organisations providing emergency medical assistance in-country, such as MSF [Médicins sans Frontières]”.72 In the absence of such representation, Dr Oliver Johnson from the King’s Sierra Leone Partnership found that the transmission of scientific advice between the UK and Sierra Leone was problematic:

My impression is that there was some very thoughtful good science and scientific discussion taking place within the British Government. The challenge was that a lot more of it was happening here in London than out in the field, and sometimes the partners in the field were not aware of the discussions that were going on. 73

43.Referring to the anthropology research work, Dr Johnson highlighted that there were “colleagues on the ground, some who were involved in [...] decision making, [who] did not know it existed”.74 Professor Paul Cosford of Public Health England suggested that there was a “mismatch between what [Dr Johnson] was observing […] and what the international community was doing in response”.75 Dr Johnson suggested that “planning should be more local”, adding that he believed treatment facilities in Sierra Leone “could have been up and running more quickly […] if more of the planning had been done in Freetown rather than in the UK”.76

44.Compounding these problems was a lack of clarity about how those with valuable expertise, but without a seat on SAGE, could communicate evidence to the Government. Professor Tom Solomon, the Director of the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections,77 complained that while his Unit had conducted research on Ebola, there was “no formal process for Government to request of us the research felt to be needed, and no formal mechanism for us to feed in the results of relevant research we had done”.78 The Microbiology Society reported that its members had similar experiences, noting that they “had limited knowledge of the Government processes for collating and processing expert advice” and that it was “unclear how they could proactively submit ideas or information for consideration”.79

45.The Chief Medical Officer told us that she was surprised by claims that experts did not know how to feed in to the scientific response. She stressed that she was “very clear publicly, in many places, that we wanted to hear all views and that they could come directly to me, my office or through [Sir] Mark [Walport]”.80 The Government told us that it was examining how, through SAGE, it could “further rationalise processes” to ensure it gets “access to a range of opinion and advice in a health emergency”.81

46.The Government should review its Enhanced SAGE Guidance to establish a clear mechanism for experts on the ground, in affected countries, to participate in a two-way exchange of information during a disease emergency originating overseas.

47.If the Government sets up the new ‘Research UK’ body advocated by Sir Paul Nurse in his review of the research councils, it should include in its remit a responsibility to act as an evidence conduit between academia, industry and Government when a SAGE is established. This should provide a single point of entry for expert advice and evidence, beyond the SAGE membership, to feed into the Government’s emergency response.

Scientific Advisory Groups

48.Well-established networks and relationships, developed over the course of many years, can be crucial to delivering an effective emergency response, as Dr Jeremy Farrar from the Wellcome Trust highlighted from his personal experiences.82 Reflecting on the importance of existing networks in responding to the Ebola outbreak, he advocated the establishment of a standing advisory body on emerging infectious diseases. This, he suggested, could meet regularly, “even in the absence of an epidemic”, to ensure that the UK is ready to respond to the next disease outbreak.83 When asked about the merits of this suggestion, the Chief Medical Officer told us that it was important “to be aware of what we already have”.84 She pointed to the current structure of “standing advisory committees which meet regularly, to make sure that the advice is updated and they scan what is out there”.85

49.Both the Chief Medical Officer and the Minister highlighted the work of the standing Advisory Committee on Dangerous Pathogens (ACDP), an arms-length body.86 During the Ebola outbreak, however, this particular scientific advisory committee did not appear to have been fully integrated into the SAGE process. The Code of Practice for Scientific Advisory Committees states that “SACs should consider having procedures for providing advice in a national emergency”, while the Enhanced SAGE Guidance states that existing advisory groups should be utilised, though “SAGE should not seek to replace or duplicate” them.87 But when we asked how the Ebola SAGE interacted with the ACDP, and avoided duplicating its work, the ACDP’s chair during the outbreak—Professor George Griffin—revealed that “there was no formal interaction between SAGE and the ACDP”.88

50.The CMO stated that there had since been discussions about how scientific advisory committees “fed in”89 to the Ebola response. Public Health England was more explicit, stating that:

How the various advisory committees and other sources of scientific expertise link with SAGE, and also what their remits are in response mode, needs further consideration.90

51.One of the strengths of the UK science advisory system is its depth and breadth, with over 70 standing scientific advisory committees and councils, tasked with helping Government departments interpret, understand and make judgements about scientific information. Exactly how these committees operate during an emergency situation, however, is currently covered by a single paragraph in the Code of Practice for Scientific Advisory Committees. Furthermore, despite the Enhanced SAGE Guidance encouraging such advisory committees to be utilised by a SAGE, there was no formal interaction between the Advisory Committee on Dangerous Pathogens and the SAGE during the Ebola outbreak. We are concerned that this may be indicative of a broader failure by the Government to access, and use, the range of high-quality scientific advice available to it.

52.To take full advantage of the work and knowledge of a scientific advisory committee during an emergency, we recommend that its chair is invited to sit on the SAGE as a full member. The Code of Practice for Scientific Advisory Committees should be expanded to provide guidance on the procedures that these bodies should put in place, so that they are in a position to provide advice rapidly in an emergency.

Research during an outbreak

53.During emergencies, it may be necessary to conduct further research to ensure an optimal response and learn lessons for the next time. The Wellcome Trust identified undertaking research “in the field”, in “real-time” during an outbreak, as a critical means of trialling vaccines, treatments and diagnostics.91 Professor Trudie Lang of the University of Oxford agreed, noting that in the case of Ebola, where we “know little about how to manage patients […] and have no proven therapies,” it was vital that research “is embedded fully and from the outset into the response”.92

54.We heard, however, that the UK, and the international community more generally, had not been ‘research ready’ when the outbreak occurred. As Professor Lang explained, this lack of preparedness made a difficult situation even more challenging. Testing treatments on the ground, during an outbreak, was highlighted as particularly problematic because researchers:

did not know how long [the outbreak] was going to last, or how many patients would be available for the studies [...] This is why there have never been trials in an outbreak before, because you have a very narrow window within which to answer your question.93

Reflecting on her experience, Professor Lang concluded that the “challenges […] faced in the design, implementing and reporting of the Ebola drug trials were not scientific, but political and administrative”.94 Limited research coordination and data sharing on the ground, as well as longer-term problems with drug and vaccine licensing, were particularly singled out by witnesses.

Research coordination

55.By the end of 2014, five research groups (including Professor Lang’s) were ready to start trials for possible Ebola treatments. Speaking with the “huge benefit of hindsight”, Professor Lang suggested that having “five different groups testing five different things” was “not an overly sensible approach”95 since it resulted in an “absurd situation” whereby a disorganised and “unorchestrated throng of researchers” were each “negotiating for access to patients” on the ground.96 She stressed that “better co-ordination” was needed in the future, combined with a more obvious prioritisation of research studies.97

56.Other witnesses emphasised that in the absence of any clear prioritisation of research, important gaps in the knowledge base were not addressed. Professor Whitty stated that this included answering very basic research questions such as “how much fluid should you give people, and should you give them antibiotics?”98 Dr Johnson noted that while there was “a lot of focus on […] novel therapeutic drugs”,99 what health workers on the ground “really wanted to know was which was more effective: oral fluids versus intravenous fluids? These were the sorts of things that day to day we needed a simple study on to reach a conclusion”.100

57.Professor Whitty acknowledged that loading an additional study onto UK and Sierra Leonean health workers was “probably not realistic” during the first few months of the outbreak. He reflected, however, that “once the outbreak had peaked [in December 2014] we could easily have done that and got big enough numbers to get a serious answer, and we did not”.101 Dr Johnson stressed the importance of better cross-country co-ordination, and communication, of the scientific response. He noted that “there was a challenge in translating some of the science going on internally to things in the field”, adding that he was unsure, even afterwards, “who the co-ordinator of the scientific element of the response was”.102 To improve research prioritisation, co-ordination and communication in the future, the Wellcome Trust suggested that:

a mechanism needs to be identified which will enable the best people to undertake the appropriate research in an emergency situation, with appropriate coordination to ensure a joined up approach between research, public health and clinical expertise.103

Data sharing

58.Co-ordination difficulties extended to data gathering and sharing. The Wellcome Trust had funded transmission modelling work, which was presented to the SAGE, but its robustness suffered from a “lack of real time data” and from a “lack of data sharing amongst groups”.104 Similarly, the Academy of Medical Sciences pointed to “several studies of the epidemic (including some making use of virus genome sequences) that could potentially have informed the public health response,” but which “took too long to complete due to delays in obtaining specimens and data sharing”.105

59.The Wellcome Trust emphasised that data disclosure should not be delayed by journal publication timelines, adding that research groups needed to recognise that “sharing to address an immediate humanitarian emergency should be paramount to maintaining data for academic outputs”. Clarity regarding “who is responsible for directing and coordinating such research in an emergency” was also needed.106 The Academy of Medical Sciences recommended that the Government “work with partners to develop an appropriate system to collect and share real-time data to enable effective outbreak research modelling and clinical studies”.107

Clinical trials

60.Professor Piot, co-discoverer of the Ebola virus in 1976, stressed that the Ebola outbreak was the first time that trials for vaccines and treatments had taken place “in the midst of an epidemic”.108 Witnesses attributed this to the exceptional nature of the situation and the unprecedented efforts made by a wide range of people to expedite trial approval processes. Under ‘normal’ circumstances, the Medical Research Council stated that it “can take as long as a year” to establish “an early trial of a vaccine candidate” and “get in place peer reviewed funding, ethics approval and volunteer recruitment”.109 According to Dr Farrar, delays arise from “the bureaucratic challenge of securing multiple ethical approvals for trials, and putting contracts between institutions in place”.110 Testing the safety of a candidate Ebola vaccine, however, was completed in record time during the outbreak. Professor Hill from the Jenner Institute told the Committee that:

An application was made to the regulator in London, the Medicines and Healthcare Products Regulatory Agency, who turned this around in four business days [...] four days is absolutely exceptional. The ethical committee met specially to review the application, and I think it made a decision that day. There was lots of work on formulating the vaccine, transporting it, relabelling it and so on, all of which happened in a few weeks, and we were able to start about a month after that telephone call, which is quite exceptional.111

61.Trial approval processes were also expedited for candidate Ebola treatments. Professor Lang noted that while it “usually takes 18 months to set up a clinical trial”, her team “managed to do it [for a potential Ebola treatment] within six weeks […] but that was everybody pulling out all the stops and making it incredibly agile and streamlined”.112 Professor Hill told the Committee that he “would like every trial that we do to take that short period of time” adding that there “may be a case for further investment so that trials happen faster”.113

62.Some countries already have processes in place to facilitate faster regulatory reviews. Canada’s Health Products and Food Branch, for example, has a “Priority Review Process” that allows for a faster review to make available “promising drug products for life-threatening or severely debilitating conditions […] for which there are few effective therapies already on the market”.114 We are encouraged that the Government’s Accelerated Access Review is considering many of these issues and look forward to receiving its final report later this year.

Regulation and licencing

63.The Ebola outbreak showed a readiness on the part of pharmaceutical companies to divert resources quickly towards developing treatments and vaccines. Dr Ripley Ballou of GSK stated, however, that the “small market” for such products was not the only, or the main, factor that had previously resulted in limited development, instead pointing to the “fact that there is not a clear path to licensure”.115 He explained that absence of a “clear path” mattered because “if you cannot license a vaccine, you cannot commercialise it”.116

64.The problem, as Dr Ballou saw it, was a mismatch between the type of clinical trial design that could be initiated and conducted during an outbreak, and the kind of evidence that regulators required to register vaccines or drugs as safe and effective. Recalling meetings with regulators during the outbreak, Dr Ballou reported how “the regulators pleaded that [randomised control] trials were the only way to know if these vaccines were going to work”.117 He described a “tremendous resistance” to randomised control trials from stakeholders, with “very impassioned arguments coming from parts of the community who felt that any study that involved the use of a placebo or a control vaccine or drug was inherently unethical”.118 Professor Lang explained that, in other circumstances, researchers “would randomise and say ‘you get the drug, but you will get something else’,” but in the case of the Ebola outbreak:

you had very sick, frightened people, and there was no other treatment to give […] Médicins sans Frontières and local ethics committees said, ‘We cannot let you sit there and say that the mother gets the drug and the daughter doesn’t’. 119

65.We heard how, during the outbreak, discussions between scientists and regulators about ‘optimal’ trial designs took place under very difficult circumstances. Dr Ballou recalled that:

The message was essentially: ‘If it goes the way we are seeing, we are talking about the depopulation of West Africa by 2015’. It was incredibly sobering. […] This scenario contributed to a sense of desperation which I believe impeded normal scientific debate, especially around study designs.120

Professor Lang added that “we need to be able to have that debate in a rational scientific way, which was not always the case” for Ebola.121 There is, however, no clear process for approving a novel trial format (such as one without random control trials) or for providing indemnity against legal liability for producers and distributors of the vaccine or treatment.122

66.The Chief Medical Officer noted that an additional SAGE ‘Clinical trials subgroup’ was established during the height of the outbreak “bringing in the MRC clinical trials group and industry partners, and [the US Centers for Disease Control] dialled in from the States, to look at trial methodologies”.123 Longer-term, the Wellcome Trust recommended developing “standardised clinical trial protocols covering clinical trial design, data sharing protocols and ethical review for infectious disease outbreaks” in the inter-epidemic period.124 Such pre-agreed protocols would then be ready “for roll out in outbreaks”, enabling research to be “initiated within days” during a future public health emergency.125 The UK Vaccine Research and Development Network is examining the scope for advance protocols for a range of diseases, though any protocols that might emerge from such work would require the agreement of international as well as UK regulatory authorities.126

67.We recognise the enormous efforts made by governments, universities, regulatory bodies, humanitarian agencies, pharmaceutical companies and others to ensure that clinical trials for Ebola vaccines, treatments and diagnostics were launched in record time. But such efforts do not obscure the fact that the UK and other countries were not ‘research ready’ when the outbreak began, prompting a less than optimal and uncoordinated research response. The failure to conduct therapeutic trials earlier in the outbreak was a serious missed opportunity that will not only have cost lives in this epidemic but will impact our ability to respond to similar events in the future.

68.Research during an outbreak must be initiated rapidly, while still being designed and conducted to the highest possible standards. While we recognise the difficulties that arose in this outbreak, they are inherent to all epidemics; therefore, if we want to improve our response, we must address the weaknesses in our research readiness that this epidemic exposed. We recommend that the Chief Medical Officer urgently takes forward the work of the UK Vaccine Research and Development Network to negotiate new processes for embedding research into the emergency response. This should establish protocols for facilitating research that positively contributes to the emergency response, and should address the following questions:

a)Where do the key gaps in our knowledge of emerging infectious diseases lie and what research questions or projects need to be prioritised before the next epidemic?

b)What types of trial design can be readily used during an outbreak, and will be accepted by regulators as producing data that reliably demonstrates the efficacy of vaccines, treatments and diagnostics, thereby providing a pathway to licensing?

c)What ethical and cultural issues need to be considered before going into the field? Discussions should include patient consent, the use of placebos, and equitable access to the outcomes of the research, such as new drugs or diagnostics. These matters will need to be revisited and adjusted at the start of an outbreak to take specific local circumstances into account.

d)Who is best placed to coordinate the research effort, prioritise studies, and ensure that researchers are adhering to the agreed research plan during the outbreak?

e)How can a mechanism be established that enables open data sharing in real-time during a disease emergency?

69.Through the Chief Medical Officer’s membership of the World Health Organization Global Advisory Committee on Health Research, this work package should feed in to, and learn from, discussions taking place at the international level about research governance during an outbreak.

Communication

Giving advice to the public

70.Clear and balanced communication with the public is vital during an emergency. Public Health England described the Government’s communications during the Ebola outbreak as having learned particularly from missteps in the US, where “excessive previous reassurance led to significant loss of public confidence in the national agencies when [Ebola] transmissions did occur”.127 PHE thought that the UK message—delivered primarily by the Chief Medical Officer—that “a ‘handful’ of cases should be expected in the UK” was important in “setting realistic public expectations”.128

71.Witnesses were broadly in agreement with PHE’s assessment and were mostly positive about the Government’s public communications on the level of risk posed to the UK by the Ebola outbreak. The Academy of Medical Sciences was “pleased with the guidance and information provided by the Government”, adding that risks were “communicated well” which, in turn, helped to avoid “creating unnecessary panic”.129 The Microbiology Society thought the Government’s public communications were “measured and appropriate, given the level of threat posed to the UK”.130 The Wellcome Trust pointed to the “good” quality health information provided by the Government through NHS Choices, noting that it was “easy to understand” and that it appropriately rated “the risk of infection to the UK as low”.131

72.The UK media’s reporting of the situation unfolding in West Africa was similarly judged by witnesses to have been balanced. According to the Science Media Centre, the overall “UK media coverage of the Ebola outbreak was accurate and evidence-based” which, they suggested, was assisted by Government departments playing “a key role in fielding media enquiries from journalists and informing them of developments”.132 Professor Whitty told us that the UK media “did a very good job on this occasion”, particularly in comparison to other countries where, he suggested, “the media got seriously in the way of events by making hysterical claims about the risk to well-developed public health systems like the UK”.133

Screening at ports of entry

73.Concern was repeatedly expressed, however, about the rationale behind, and the communication of, the introduction of Ebola screening at UK ports of entry. The UK’s stance on implementing screening at airports changed over the course of three days during the height of the Ebola outbreak. On 7 October 2014, Public Health England issued a statement on the UK’s position. It explained that while the World Health Organization (WHO) recommended that affected countries should conduct exit screening for individuals with “unexplained illness consistent with potential Ebola infection, […] entry screening in the UK is not recommended by WHO”. PHE added that:

There are no plans to introduce entry screening for Ebola in the UK. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people.134

74.Two days later, the Prime Minister’s Office issued a statement. It acknowledged that screening at airports in Liberia, Sierra Leone and Guinea had been in place for “some weeks to ensure all passengers leaving affected countries are checked”. However, it explained that advice had been received from “the Chief Medical Officer today […] that enhanced screening arrangements at the UK’s main ports of entry for people travelling from the affected regions—Liberia, Sierra Leone and Guinea—will offer an additional level of protection to the UK”.135 These measures were initially rolled out at Gatwick and Heathrow airports, and at Eurostar terminals.

75.Many of our witnesses believed that the scientific evidence and rationale for introducing screening was missing. Professor George Griffin, former Chair of the Advisory Committee on Dangerous Pathogens, told us that “there was little clinical evidence that the screening involved, in terms of body temperature, would be either sensitive or helpful”, describing it medically as “an incredibly blunt and insensitive tool”.136 This was echoed by Dr Jeremy Farrar from the Wellcome Trust who stated he did not think screening “was epidemiologically and scientifically justified”.137

76.Witnesses recognised, nevertheless, that the Government was subject to other pressures when making decisions about screening. Professor Griffin continued that “in terms of something that raised and kept up public awareness, [screening] was reasonable”.138 Taking into the account “the politics of the situation”, Dr Johnson also thought screening “was proportionate”, noting that the “organisation on the ground was polite, rapid and effective”.139

77.PHE told us that the label ‘screening’ was partly responsible for the scientific debate around the effectiveness of the intervention. The label, it stated:

provided public reassurance but stimulated a scientific debate about the expectation that screening would prevent infected asymptomatic individuals entering the UK–which we knew it was unlikely to do. There are lessons to learn about communication to the scientific community alongside communication to the public so that all are clear on the purpose of such an intervention and its scientific basis.140

78.Communication with the public is one of the most important aspects of any emergency or crisis situation. The Government provided good quality, accessible and accurate health information on Ebola, and provided balanced communications of the risk of the outbreak to the UK. It is disappointing, however, that it failed to explain clearly its rationale for going against guidance from both the World Health Organization and Public Health England by introducing entry screening for Ebola at UK ports.

79.When interventions are made during a future disease emergency that are intended to protect the UK, such as entry screening, we recommend that the evidential basis for—and purpose of—the intervention is made explicit. This information should be clearly communicated, especially if it goes against established guidance from trusted advisory bodies.

56 Scientific Advisory Group for Emergencies (SAGE), gov.uk. accessed 14 December 2015

58 Department of Health (EME008) para 16

59 Public Health England (EME012)

60 Supplementary written evidence submitted by the Government Office for Science (LEG0019) [Science and Technology Committee, Ninth Report of Session 2014–15, Legacy—Parliament 2010–15, HC 758]

61 Institute of Development Studies (EME017) para 3

62 Wellcome Trust (EME015) para 12

63 Q169

64 Q170

65 Q178

67 Q174 [Sir Mark Walport]. See also Q80, Qq132-133

68 Q80 [Professor Whitty]

69 Q22

71 Q22

72 Welcome Trust (EME015), para 12; see also The Academy of Medical Sciences and The Royal Society (EME011)

73 Q134

74 Q134

75 Q126

76 Oliver Johnson, “A view from the frontline”, Journal of the Foundation for Science and Technology, Vol 21 (2015) pp 10-12

77 One of 13 such Research Units established in 2014 with £47.5m of funding from the Department of Health.

78 National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (EME007), para 5

79 Microbiology Society and the Society for Applied Microbiology (EME013), paras 16-17

80 Q173

81 Department of Health (EME008) para 42

82 Q85 [Dr Farrar]

83 Q85 [Dr Farrar]

84 Q176 [Dame Sally Davies]

85 Q176 [Dame Sally Davies]; a list of standing advisory committees can be found at: http://foiwiki.com/foiwiki/index.php/Scientific_advisory_committees

86 Q176 [Dame Sally Davies]; Q198

88 Q27

89 Q176 [Dame Sally Davies]

90 Public Health England (EME012)

91 Wellcome Trust (EME015) para 26

92 Professor Trudie Lang (EME010)

93 Qq60-61

94 Professor Trudie Lang (EME010)

95 Q60

96 Professor Trudie Lang (EME010), para 5

97 Q60

98 Q89

99 Black’s Medical Dictionary defines therapeutics as “the general name applied to different methods of treatment and healing”.

100 Q134

101 Q89

102 Q134-Q135

103 Wellcome Trust (EME015) para 9

104 Wellcome Trust (EME015) para 13

105 The Academy of Medical Sciences and The Royal Society (EME011) para 29

106 Wellcome Trust (EME015) para 13

107 The Academy of Medical Sciences and The Royal Society (EME011)

108 Ebola response: The Lancet Audio 22 November 2015 (Peter Piot discusses new recommendations for health agencies and public health systems in response to the 2014-15 Ebola outbreak)

109 Medical Research Council (EME014)

111 Q63

112 Q51

113 Q64

114 Health Canada, How Drugs are Reviewed in Canada, February 2015, accessed January 2016

115 Q52

116 Q52

117 Ripley Ballou, “Learning the lessons of the Ebola outbreak”, Journal of the Foundation for Science and Technology, Vol 21 (2015) pp 8-9

118 Ibid; Q70

119 Q71

120 Ripley Ballou, “Learning the lessons of the Ebola outbreak”, Journal of the Foundation for Science and Technology, Vol 21 (2015) pp 8-9; Q70

121 Q71

122 Ripley Ballou, “Learning the lessons of the Ebola outbreak”, Journal of the Foundation for Science and Technology, Vol 21 (2015) pp 8-9

123 Q176 [Dame Sally Davies]

124 The Wellcome Trust (EME015) para 28

125 The Wellcome Trust (EME015) para 27; The Academy of Medical Sciences and The Royal Society (EME011) para 28

126 Supplementary written evidence submitted by Jane Ellison MP, Parliamentary Under Secretary of State for Public Health (EME021)

127 Public Health England (EME012)

128 Public Health England (EME012)

129 The Academy of Medical Sciences and The Royal Society (EME011) para 20

130 Microbiology Society and the Society for Applied Microbiology (EME013) para 44

131 Wellcome Trust (EME015) para 15

132 Science Media Centre (EME009)

133 Q82

134Ebola surveillance and contingency planning ongoing in UK”, Public Health England press release, 7 October 2014

135Ebola update: Chief Medical Officer advice on UK screening, Prime Minister’s Office press release, 9 October 2014

136 Q43

137 Q103

138 Q43

139 Q156 [Dr Johnson]

140 Public Health England (EME012)




© Parliamentary copyright 2015

Prepared 21 January 2016