Select Committee on Science and Technology Minutes of Evidence

Memorandum by the Public Health Medicine Environmental Group

We welcome the opportunity to contribute to the evidence to be considered by the Science and Technology Sub-Committee I.

The Public Health Medicine Environmental Group is a professional organisation concerned with the public health aspects of communicable disease and non-communicable environmental hazards. Currently there are over 200 members most of whom are consultants in communicable disease control or consultant epidemiologists.

Q 1.a Surveillance of infectious disease

The main problems are:

1.1 The piecemeal nature of our current surveillance programmes which have been developed in an ad hoc manner over many years. We need a properly resourced national surveillance strategy where the cost of the individual programmes balances the benefit they bring.

1.2 Many surveillance programmes are inadequately resourced. They are often dependent on the good will of clinical staff whose primary role is care of individual patients. Provision of surveillance data must be integrated into clinical care so that it is neither a burden nor an optional extra.

1.3 Many surveillance programmes are not based on modern technology, but are reliant on paper based data flows and multiple data entry.

1.4 There is a growing tension between the individual's right to privacy and the need to collect and analyse individual surveillance data for the purpose of protecting the public health.

1.5 We do not make adequate use of case definitions for clinical case reporting and notification. This undermines the validity of our data sets for disease such as measles.

1.6 As well as disease specific surveillance, we need to develop syndromic surveillance to pick up new and emerging infectious diseases.

1.7 We need to make better use of our surveillance data particularly to model future trends to inform national, regional and local strategies.

1.8 Consultants in communicable disease control and their teams need to be resourced to ensure that there is adequate surveillance of all infections at local level, including HIV and other sexually transmitted infections.

Q 1.b Treatment of Infectious Disease  

1.9 The growing problem of antibiotic resistance is an important issue although not the focus of the current enquiry.

1.10 The incidence and prevalence of infections such as hepatitis C and tuberculosis in marginalised and hard to reach groups present special challenges.

1.11 GUM department do not currently have sufficient capacity to diagnose and manage sexually transmitted infections.

Q 1.c Prevention of Infectious Diseases

1.12 We need to strengthen our research capacity to develop more effective population prevention programmes, especially for sexual transmitted infections (STIs).

1.13 There is a need for dialogue with the public to help maintain confidence in universal immunisation programmes.

1.14 It can be difficult at local level of secure adequate resources to fight infection in the face of competing priorities such as cancer or coronary heart disease.

The disease burden from individual infections such as syphilis or TB may be relatively small, so it is important that there is a strong focus locally to provide leadership and expertise for all the aspects of prevention, investigation, treatment and control of all infections irrespective of their causative organism or of which branch of the health service has responsibility for treatment and care.

Q 2. Will these problems be adequately addressed by the Government's recent infectious disease strategy, Getting Ahead of the Curve?

2.1 The 12 action points in GAC have the potential to tackle the major challenges associated with fighting infection in the UK.

However, we are concerned that progress in some areas may be very slow and that the potential in others will not be achieved unless control of infectious diseases achieves a higher priority and increased investment both within local government and the NHS.

2.2 The Health Protection Agency is potentially an important means of raising the profile of communicable disease control and of bringing together those with specialist expertise in this field.

There is, however, a risk that this may weaken the local function and, that the NHS may see the HPA as doing" all health protection. Finally, the increased emphasise on control of non-communicable environmental hazards must not be at the expense of control of communicable disease. Both elements need adequate resources.

Q 3. Is the UK benefiting from advances in surveillance and diagnostic technologies?

3.1 Molecular typing is an important development in this field. Within the field of meningococcal disease there is no doubt that the UK has a world class service. However, in other areas it is lagging behind. An obvious example is that of tuberculosis. A national strategy is however being developed. It is unlikely that this strategy will involve the typing of every isolate. In Holland, for example, every isolate is characterised using molecular techniques. The main limitations are the perception that such technology has limited value in the public health management of tuberculosis (not true) and the inherent complexities in the interpretation of the typing data, together with uncertainties as to the best methodologies. The main obstacles to this are:

— lack of consensus as to the methodologies;

— lack of consensus as to the usefulness;

— lack of resources to carry out the tests; and

— lack of training for microbiologists, clinicians and public health doctors in these techniques and therefore a lack of confidence in their interpretation.

3.2 Another major problem is the lack of investment in information technology to facilitate the collection and transmission of surveillance data.

3.3 A third challenge will be to ensure that public health needs are taken into consideration when new technologies such as near patient testing are introduced into clinical practice.

Q 4. Should the United Kingdom make greater use of vaccines to combat infection and what problems exist for developing new, more effective or safer vaccines?

4.1 Safe, effective and acceptable vaccines are the cornerstone of prevention of communicable disease. As the perceived risks of an infection decrease, the public will require robust evidence of the benefits of new vaccines. Before these are introduced, careful thought should be given to the acceptability of any proposed new universal vaccine programme and to the likely effect on current programmes.

Q 5. Which infectious disease pose the biggest threats in the foreseeable future?

— Those caused by microrganisms which develop resistance to antimicrobials.

— Tuberculosis, particularly MDRTB.

— Pandemic influenza.

— Sexually transmitted infections particularly HIV and Hepatitis B.

— Travel associated and imported infections.

— Infections resulting from bio-terrorist attacks.

Q 6. What policy interventions would have the greatest impact on preventing outbreaks of and damage caused by infectious disease in the United Kingdom?

6.1 One of the main policy interventions that would support the management of change is modernisation of the public health legislation. This is long overdue and the current lack of clarity causes difficulties in ensuring proper resourcing and accountability for the control of communicable disease.

6.2 Consideration should be given to policy initiatives that will enable infection to be on the agenda of health service managers and to performance targets that are related to infection control and provision of health care services for people with infectious diseases. Locally, this could be facilitated by the development of stakeholder groups similar to those in the management of cancer.

6.3 One of the key determinants of successful outbreak management is joined up working of all relevant agencies. An important policy initiative is to examine ways of promoting joined up working between the Health Protection Agency, the Food Standards Agency, DEFRA and the Veterinary Investigation Agency as well as NHS and local government.

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