Examination of Witnesses(Questions 320-325)|
TUESDAY 17 DECEMBER 2002
Professor Brian Duerden and Professor Angus Nicoll
320. Because we are going to collect together a substantial
body of institutions that in the past have been criticised politically,
for one reason or another, probably quite unfairly, but now it
is going to focus in on a single entity?
(Professor Duerden) But certainly two of the
bodies, the National Radiological Protection Board and the PHLS,
are both currently executive non-departmental public bodies, they
are arm's length bodies, they have a responsibility to act in
that independent way to give professional input.
Chairman: I am glad to hear it.
Baroness Warwick of Undercliffe
321. My Lord Chairman, might I just follow up that
very point. Did you not say you hoped it would be an NDPB?
(Professor Duerden) That is what is proposed.
It will be a special health authority for the first year, and
the intention is that there will be primary legislation during
the present session to create it as an NDPB.
Baroness Warwick of Undercliffe: It only occurred
to me, My Lord Chairman, that it was something that this Committee
would need to look at, that if that is a way in which one can
ensure that there is some clear blue water between political judgements
and the scientific judgements then this is something that we should
be alert to.
Chairman: Can we move on to the last question, and
you may wish to expand on this in writing, but it is to do with
expanding the role beyond the borders of England and Wales and
to other countries with limited resources.
322. The question is about co-operation with other
countries. Do you think there is a benefit to England and Wales
in co-operating with other countries in terms of public health
response to communicable diseases, and particularly countries
with limited resources? We note that you said in your evidence
that the WHO is very keen to continue to be able to draw on the
expertise of PHLS, and you explained that members of staff currently
carry out projects, sometimes in their own time or grant-funded.
So how would this best be organised in the future?
(Professor Duerden) I believe it is extremely
important that we do maintain what we have at the moment and that
it should be increased. It might sound trite but, of course, the
microbes do not know anything about international boundaries,
and with travel as easy as it is now infections have a major international
perspective. And we have learned a great deal in recent years
through links, we have had staff who went out from CDSC to the
haemorrhagic fever, the Ebola outbreak 18 months ago; we have
had a big involvement in helping to control the epidemic of diphtheria
in Eastern Europe that followed from the break-up of the USSR.
And not only are we providing our expertise but we are learning,
this is how our staff in the UK get experience of these diseases
and develop their own expertise. So it really is a two-way stream,
we benefit as well. So I believe that we have to, and should,
collaborate with WHO increasingly in this, and not just in providing
services, we have several designated WHO collaborating centres
within the PHLS, which is fine, we provide that expertise here,
but we need to have the interaction with people in the field where
the diseases are happening. Again, it comes back to funding and
the arrangements there. The money that is allocated to the PHLS
at the moment is for UK health services, UK health protection,
UK public health, whichever label we want to put on it, and that
has been under pressure in recent years, and it is difficult to
justify diverting money from that stream of Government funding,
which is for our own population, to outside the UK. We can do
some, when, as I say, we learn from it and our staff get experience
and we get the benefit back, but that is something we have to
be aware of. The funding for external things is through DFID,
and they fund outside the UK rather than funding us to do things
elsewhere. And really perhaps a closer look at that sort of arrangement,
to see how we can use the expertise that is available here, with
funding that has an international heading on it, because if you
have got experts you either need to be in-filling behind them
to enable them to do some time overseas, or you train people up
specifically for the overseas function. Whichever way, you need
the extra capacity to be able to do that. Now I am fully committed,
I would love us to do more than we can at the moment, but it is
a matter of how we link the internal and the external resource.
323. Just to follow that up, it is true, is it not,
that the PHLS made strenuous efforts to get funding from both
the Department of Health and DFID, unsuccessfully, by and large?
What gives you any confidence that the HPA will be any better
at getting that funding?
(Professor Duerden) Under present arrangements,
I have no confidence that they will be any better. What I have
said, I hope I chose my words reasonably carefully, is that this
is what I believe should be done, but it is not that I believe
it will be done, unless there is a recognition of the need for
(Professor Nicoll) I am slightly more optimistic,
from having had a meeting when WHO did a mission over recently,
and they met up with Sir William Stewart and with Dr Troop and
others, and there was a feeling that there ought to be a fresh
start and a fresh look at this. I think part of the problem is
an administrative structure that DFID has got stuck with, because
they do give money to the UK for people to go and to be working
in developing countries, but it is all done through what I call
body shops" and it is places that are given a contract to
find people to fill consultancies. And we are always encouraged,
Well, why don't you send somebody; why don't you either be part
of a consortium for doing these consultancies, or just put people
in for those consultancies?" But, as Professor Duerden says,
because we are service-related, we cannot simply say, eg; Well,
John Watson" (who is our TB expert) go off to Eastern Europe
for a month," because we will then look a bit silly if there
is a TB problem that blows up in this country and we need him
back here. So that is one point. I think, the fundamental question
that you ask there, the answer has to be yes, yes and yes. Our
laboratories need the experience with these exotic organism when
they are giving somebody else problems before they cause us problems,
that is making it rather blunt, but I know that David Brown, who
deals with esoteric viruses, feels a lot happier when he has been
doing some work on real things. There is also some caution in
that we have a lot of idealistic people who would like to go out
to do this work, it is a dangerous world out there now and that
is why we work particularly with the part of WHO we feel most
comfortable with, David Heymann's set-up, because we know that
they are taking the security issues very, very seriously. Certainly
I have been reluctant and stopped people going to resource-poor
countries when I have not felt that they had the experience, or,
the place they were going to, their hosts were not sufficiently
able to deliver their safety. So I think there has to be some
caution there, because it would take only a few casualties and
everyone would be feeling absolutely ghastly. You must also look
at this now in two ways. There is Europe now and the larger Europe,
and the big agenda for the next three, four years, in Europe,
is going to be establishing the European Communicable Disease
Centre function, or whatever it is called. Now we have very clear
views, which maybe we ought to give to you in writing, as to what
that ought to do and ought not to do, but it is one of those areas
where I think there is potentially huge European added value,
and we have seen some examples of that, that we mentioned in the
evidence. But also there are large risks and threats coming up,
especially with the accession countries. It has been only recently
with this egg problem that we have realised how easy it is for
food goods to move around Europe and nobody can stop them. If
these eggs were coming from outside of Europe then no problem,
but as they are coming inside of Europe that is difficult. And
then thinking there are a lot more food products like that, that
may be coming from Eastern Europe, and how are we going to deal
with that? So I would be including Europe in that question, as
well as looking more broadly. The final way I would answer it
is that, again, through the bioterrorism and deliberate release
activities, we have found that that agenda has become far more
important, and we are working as closely with the Americans as
they will let us in trying to make sure that there is a sort of
global security network growing up. And if you make a trip to
Geneva, I would encourage you to be looking at the global outbreak
and response network that they are setting up, which I feel is
the way to go, which is something which is not just looking at
a few privileged countries but is genuinely worldwide in developing
networks that can respond to bioterrorism and also to natural
324. On those words, I think we must bring this session
to a close. If there is any point that you wish to elaborate on,
especially on this last one, with a European dimension, perhaps
you could put that in writing to us?
(Professor Nicoll) Yes.
325. But it just remains for me to thank you very
much indeed for coming along for this fairly long and rather expansive
session. You have stood up to it very well.
(Professor Nicoll) Thank you very much for
making it so enjoyable and for the opportunity.
(Professor Duerden) Thank you very much.
Chairman: Thank you, indeed.