Select Committee on Science and Technology Written Evidence

Seminar at the Academy of Medical Sciences, Tuesday 16 July

  1.  The Academy of Medical Sciences hosted a seminar for the Committee which explored some of the current issues facing the infectious disease community.

  2.  Members of the Committee present were Lord Haskel, Lord McColl of Dulwich, Lord Oxburgh, Lord Patel, Lord Quirk, Lord Rea, Lord Soulsby of Swaffham Prior (Chairman), Lord Turnberg, Baroness Walmsley, Baroness Warwick of Undercliffe. They were supported by Rebecca Neal, Clerk of the Sub-Committee, Adam Heathfield, Specialist Assistant to the Science and Technology Select Committee and Melanie Moore, Secretary to the Sub-Committee.

  3.  The participants in the seminar were:

Mr Jonathan Cowie, Institute of Biology; Professor Uri Desselberger, Addenbrooke's Hospital; Professor Brian Duerden, PHLS; Dr Robin Fears, Academy of Medical Sciences; Professor Roger Gilmour, CAMR; Professor George Griffin, St George's Hospital; Dr Simon Hay, University of Oxford; Professor Adrian Hill, Oxford University; Professor Sir Peter Lachmann, President, Academy of Medical Sciences; Mr Tony Leaney, Academy of Medical Sciences; Dr Jane Leese, Department of Health; Mrs Mary Manning, Executive Director, Academy of Medical Sciences; Dr Philip Mortimer, PHLS; Professor David Onions, Q-One Biotech; Professor Hugh Pennington, Aberdeen University; Dr David Salisbury, Department of Health; Dr Geoffrey Schild; Professor Julius Weinberg, City University; Professor Richard Wise, Birmingham City Hospital; Professor Douglas Young, Imperial College; Dr Marie Zambon, PHLS.


  4.  Professor Weinberg explained that the role of surveillance was to ensure that events were known and predictable, rather than unknown and unpredictable. To further this end improvements in basic science were needed, as were increases in the number of data gathered.

  5.  Professor Weinberg stated that new types of surveillance should be considered, such as analysing numbers and types of phone call to NHS Direct and perhaps by gathering data from pharmacy store cards.

  6.  Professor Weinberg pointed out that when designing or improving a surveillance system it was important to identify problems with the current surveillance system and to ask questions about what infections need to be surveyed and why, and how the collected data would be used.

  7.  Using surveillance systems that provide early warnings of an increase in infection could bring benefits but also could increase the numbers of false warnings, placing a burden on resources. Therefore, Professor Weinberg suggested that better analytical tools needed to be developed.

  8.  Surveillance systems should be sensitive and timely. Professor Weinberg provided an example from Eastern Europe where if there were a surge in reported infections relevant scientists were alerted by text messages, in order to ensure that the increase should not go unnoticed.

  9.  Professor Weinberg argued that clinicians in the UK were not very good at reporting suspected or actual infection. This owed partly to cultural reasons but also because of the small amount of infectious disease and epidemiological training that most clinicans received.


  10.  The following points were made in discussion:

    —  The current number of notifiable diseases was probably correct. Making a disease notifiable would not necessarily ensure that reporting occurs, with some non-statutory diseases having very high levels of reporting. However, the descriptions of notifiable diseases could be overhauled in order to make them more useful to clinicians.

    —  The Department of Health attempted to respond to public opinion, by conducting four surveys a year on attitudes towards infectious disease and vaccines; this data was collated and used to inform communication strategies.

    —  Some Department of Health communication strategies were confusing; one winter advert encouraged people not to attend GPs surgeries with flu-like symptoms, yet another campaign warned that flu-like symptoms could indicate meningitis and should therefore be taken seriously.

    —  Little attention was paid to the ethics of surveillance. Also there was poor understanding of public acceptance of use of personal data. Some participants suggested that the public accepted significant intrusion into personal files, so long as there was confidence in the system's independence and that the collated data would be used for valuable ends.


  11.  Professor Hill pointed out that vaccines were the most cost-effective medical intervention that had ever been used.

  12.  However, because of an increase in medical and scientific knowledge the number of known potential side effects had also increased. This added to the difficulties experienced by the public when deciding whether to have themselves or their children vaccinated.

  13.  Professor Hill suggested that people should be educated to be able to balance the often very small risks against the huge benefits of vaccines.

  14.  Professor Hill queried whether or not the media should be able to publish what it liked, even when it could lead to a significant decline in take-up of vaccines and a potential public health crisis.

  15.  Vaccine production companies had become fewer in number but bigger in size perhaps reducing the likelihood of new vaccines being developed. Professor Hill pointed out that vaccine development was high risk, in that it did not always lead to an effective vaccine. Even when an effective vaccine was found there was often little or no financial reward (this was particularly pertinent in the case of malaria).

  16.  Professor Hill pointed out that it took between seven to 10 years to develop vaccines with significant planning needed to examine emerging diseases at national, continental and global level. He asked the question: who will and who should identify priorities for development?

  17.  Professor Hill argued that there should be more targeted government funding for development of important vaccines. Also bureaucracy should be cut for development of vaccines: this was currently subject to between three and five levels of ethical review.


    —  Development costs of vaccines were not linked to potential future profits but were instead dependent on the current profits of pharmaceutical companies. Only three vaccines have recently been profitable.

    —  A large proportion of resources have recently been placed in developing combination vaccines, which was quite risky, particularly if combination vaccines were rejected by the public.

    —  Flu vaccines could be produced quickly each year for the annual immunisation programme because of effective global surveillance.

    —  A body should be established to provide an overview of all vaccine development, to direct the industry and to provide some financial assistance with development costs.

    —  The media often presents both "sides" of the vaccine safety debate as being equal, even when one "side" is much weaker than the other is.


  18.  Antibiotics and anti-virals had played a fundamental role in the treating of infectious disease throughout the twentieth century. However, there were increasing concerns about the levels of resistance to such drugs.

  19.  Professor Griffin explained that over the past 30 years only one new clan of antibiotics had been developed yet it was now known that resistance had developed to that.

  20.  Resistance was also common to anti-virals, particularly those drugs used to treat HIV and herpes.

  21.  Professor Griffin pointed out that pathogens were prospering, particularly in hospitals where it was often difficult to isolate patients properly, particularly given the levels of resources available to hospital managers and clinicians. Hospital acquired infections cost around £1 billion per year and gave rise to 5,000 deaths per year.

  22.  The incidence of drug resistance in people newly infected with HIV was now 30 per cent.


    —  Hand washing by hospital workers before treating a new patient was fundamental to cutting down the spread of antibiotic resistance, yet it was mooted that this was not carried out enough and remained a significant source of the problem. Some of the problem was behavioural and more needed to be understood about why clinicians and nurses do not always wash their hands between each patient.

    —  It was suggested that an effective way of separating patients and therefore preventing the spread of resistance would be to place a glass wall between each bed.

    —  The diminishing numbers of pharmaceutical companies was cited as a reason that more antibiotics were not being developed. Similar to vaccines antibiotics take, on average, seven to 10 years to develop.

    —  More effective surveillance of anti-viral and antibiotic resistance was needed.

    —  The Department of Health had now established an overarching Specialist Advisory Committee which would tackle some of these concerns. The Department had also developed a research strategy on antimicrobial resistance which should address some of these issues. Proposals were currently being reviewed.


  23.  Professor Pennington argued that statutory notification of food poisoning was a waste of time and money because it does not help to prevent future outbreaks.

  24.  The attempts to control Salmonella had been effective. Cases had decreased, mostly because chickens were now vaccinated against Salmonella but also because of good quality information provided through the media to the public about cooking chicken and eggs correctly.

  25.  Effective surveillance required people to be looking at the correct source of infection. For example, Professor Pennington pointed out that Camplobacter was on the increase but it was not known where the main source of infection was. The link between surveillance, public health and molecular biology should be carefully considered and improved.

  26.   E.coli 0157 was rare but when there was an outbreak it was often very severe. There was no effective treatment and it could lead to brain damage and renal failure. Professor Pennington suggested that there should be improved links between DEFRA and the Department of Health as E.coli 0157 was carried asymptomatically by animals.

  27.  Professor Pennington pointed out that public anxiety in the case of food-borne pathogens was related to mortality rate; so new variant CJD was a source of greater concern than was Camplobacter.

  28.  The Food Standards Agency was implementing some successful strategies. 30 per cent of food businesses now have a hazard analysis system, which Professor Pennington suggested would be at least as important as developing vaccines to combat food poisoning.


    —  As many food-borne infections were zoonoses perhaps proactive veterinary surveillance should be introduced.

    —  If chickens are immunised then the yolks also become immunised, therefore passing on immunity to people who eat the eggs. It has recently been claimed that people would not eat meat from cows that had been vaccinated yet people eat chicken that has been. This was perhaps because it was not widely appreciated that chickens are vaccinated.

    —  The food industry was cost-driven rather than driven by safety concerns. So were consumers.

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