Select Committee on Science and Technology Written Evidence

Further Memorandum by the Academy of Medical Sciences[1]



  The Academy convened a meeting in London on 9 June to consider the recent SARS outbreak. Working group members were invited to take stock of current activity in the UK and worldwide and to identify ongoing concerns or issues for further work. The group was chaired by Professor Tony Minson, FMedSci, Professor of Virology in the University of Cambridge. A full list of members is given below.

International position/data collection

  Infection rates are slowing and can be concluded to be under control, although there is still uncertainty about China because of the limited information available. The most affected countries initiated very large public health interventions that would not be sustainable in the longer term. In lesser-affected countries, there is a problem of "high noise to signal" ratio in data collection and comparisons are complicated by different national policies in declaring suspect cases. The predictive value of clinical diagnosis is likely to be high in those countries with high infection rates but less in countries such as the UK because of the higher "noise" level.

  One continuing issue is the lack of consistency in case confirmation by laboratory testing (seroconversion, PCR) and it remains important to standardise quality control across all regional laboratories globally.

Crisis management

  The WHO performed well and there was generally good international collaboration. There is an issue relating to problems of linkage between datasets (different professional groups): there was successful laboratory collaboration between virologists and (to a lesser extent) between epidemiologists but there are concerns about database integration between laboratory sampling and clinical case finding and between virology and epidemiology. The weakness in linkage is a problem for crisis management—the real-time evaluation and interpretation of data in order to manage risk—and is attributable not just to lack of coordination but also to inadequate IT infrastructure. In the absence of real-time information, there is the temptation to extrapolate from previous epidemics (eg FMD) that may actually be dissimilar (eg in terms of viral persistence). This weakness may be compounded by the historical preference of public health systems to rely on epidemiology forecasts rather than engage with the implications of scientific uncertainty.

  There is a need for the UK to build more infrastructure to support research across a broad area (because of the uncertain nature of future threats). While the UK might not be able to match the intensity of activity in Hong Kong (influenza epicentre) or the US CDC (response to bio terrorism), it is important that the UK has sufficient infrastructure to capitalise on the expertise currently available—and to prepare the next generation expertise.

  Concern was expressed that the Health Protection Agency (HPA) may not recognise the importance of the R&D agenda—assuming that Standard Operating Procedures will suffice to underpin responsiveness—and that too much attention has been devoted to bacterial pathogens (because of food microbiology as a political priority), at the expense of respiratory viruses. There is also a continuing need to build research capacity in the regional public health laboratories, so that they do not become dominated by the imperative of service provision. The importance of building research capacity regionally (as well as centrally) reinforces the recommendations in the Academy Report on Academic Medical Bacteriology.

  In short, it was concluded, that the UK was lucky—in the low incidence of SARS—but if there had been a crisis, the UK may have struggled to respond in consequence of the weakening of surveillance structures.

Academic support/capacity

  It was also concluded that the UK is lucky because of the available corona virus expertise—but equivalent expertise may not be available "next time", for a different virus, for example a flavivirus (eg West Nile and related viruses). There is a need to review expertise in the UK and to ensure coordination of activities such that resources are not wasted on excessive duplication and a fast response can be mounted against new threats. There appears to be no mechanisms for providing funding in an emergency—Corona virus expertise in Bristol was mobilised efficiently to support the HPA, but only through the use of University funds. Such ad hoc arrangements do not offer much confidence that the UK will respond effectively to future emergencies. More funding is required to build academic research capacity in pathogen discovery and host specificity—prioritising according to perceived risk but also ensuring cover and response capability. The UK is losing competitiveness in this field and the weakness is exacerbated by unnecessary divisions between human and animal health research (divorced at both funding and policy levels). Insufficient notice has been taken of the interface between human and animal infectious diseases in allocating priorities for funding; there is a need for more connectivity between the funding bodies in order to encourage and support joint programmes in veterinary and human medicine.

Regulatory issues

  There are critical matters relating to both animal research and safety (containment) regulations. For animal research, it could have been difficult to initiate a SARS-primate study rapidly in the UK, if that had been deemed necessary. It is important that the UK raises preparedness by having a generic Home Office project licence in place to enable such research to proceed in the event of a public health imperative.

  With regard to the provision of containment facilities, the difference was noted between UK practice (primary protection of researcher) and EU practice (physical containment of risk)—international inconsistencies in containment practice should be resolved. In the UK, there is probable need to upgrade facilities (from category 3 to 3+, particularly at the regional level), to identify whether more category 4 facilities are required, to improve funding for running costs and to maintain a cadre of appropriately trained staff. While it seems appropriate for the early research groups (with HSE) to decide on containment status in a novel episode, there is room for clarification of the ACDP role in deciding national status in a timely manner once the organism is characterised.

Horizon scanning

  In addition to the issues already described (responsiveness, facilities, research culture), there is also the issue of whether SARS can be perceived as a paradigm for bio terrorism. Does SARS serve as a wake-up call to the EU and the UK to evaluate preparedness? Would increasing preparedness in bio defence help the responsiveness to other new, infectious diseases? If bio defence plans were in place, the UK would not have to rely on luck next time.

Clinical concerns

  Clinical expertise is needed to identify and manage patients with SARS (and the successors to SARS) and to develop a research agenda to explore pathogenesis, prohylaxis and treatment. Clinical investigators will wish to explore issues such as cross-infection policies, treatment strategies, and capacity in relation to clinical expertise.

Role of industry

  Much of the healthcare industry would be dependent on academic research leads in new infectious diseases, and there are issues for facilitating the interface between the sectors. It is unlikely that there are major HPA-spin off company opportunities; it would be easier to commercialise new areas with pre-existing companies, particularly if there is pre-existing hardware to serve as the template. But, for industry to be interested (in developing diagnostic kits, vaccines, therapeutics) there must be sufficient market incentive and, hence, political will to create the incentive.


    —  Many of the academia/Public Health Laboratory issues raised echo the weaknesses identified in the Academy (2001) Report "Academic Medical Bacteriology in the 21st Century" (that had alluded to significant problems in clinical virology). The report may be downloaded from the Academy web site:

    —  Related issues (surveillance, responsiveness, industry role) have also been raised in the Academy's input to the House of Commons, Science and Technology Committee Inquiry on "The Scientific Response to Terrorism" and the publication of the findings from that Inquiry may help to clarify roles for the Academy.

    —  The issues raised are also highly relevant to current discussions on the programme of the Academy Forum (eg role of industry/partnership in response to new and emerging infections/bio terrorism) and specific proposals will be reviewed shortly.

    —  The initial output from this SARS Working Group will be used to open discussions with key policy-makers. Without wanting to pre-empt these further discussions, key areas are likely to include: public health surveillance and crisis management; research funding flexibility and capability; coherent strategy for animal-human research interfaces; filling the impending knowledge gap by succession planning/training.

  Working group members: Professor Tony Minson (Chairman), Dr Maria Zambon, Sir John Skehel, Professor Peter Openshaw, Professor Stuart Siddell, Dr Mike Crumpton, Dr Phil Minor, Ms Mary Manning and Dr Robin Fears (Secretary).

June 2003

1   See oral evidence p 33. Back

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