Select Committee on Science and Technology Written Evidence

Memorandum by Aventis Pasteur MSD


  0.1  Aventis Pasteur MSD is the leading pharmaceutical company in Europe specialising exclusively in vaccines. We supply vaccines to protect against a wide range of diseases such as tetanus, meningitis, pneumococcal disease and hepatitis B.

  0.2  This submission concentrates on hepatitis B and responds to the questions that the sub-committee is seeking to answer.

  0.3  Hepatitis B is a common and frequently undiagnosed sexually transmitted infection, which is spread primarily through contact with infected blood and other body fluids. Common modes of transmission include sexual contact, mother-to-child transmission at birth, sharing toothbrushes or razors, using unsterilised needles for injecting drug use, body or ear piercing, tattooing and acupuncture.[13]

  0.4  This submission demonstrates that the present policy of attempting to selectively vaccinate high risk individuals, eg the recently published national strategy for sexual health and HIV, is beneficial but does not go far enough to significantly reduce the incidence of disease in the UK. The most effective way to prevent hepatitis B is to implement a universal vaccination policy, as already adopted by 31 other countries in Europe and to protect people before they are exposed to significant risk.[14]

1.   What are the main problems facing the surveillance, treatment and prevention of human infectious disease in the United Kingdom?

  1.1  Current surveillance data rely on the successful laboratory diagnosis of hepatitis B, statutory notifications of infectious disease and the assimilation of these data by the PHLS and DoH. As two-thirds of hepatitis B cases are asymptomatic, many patients will be unaware that they have contracted the disease yet remain infectious to others. 13 Even cases that have been diagnosed are not always reported. Unless covered by a routine screening programme, such as the NHS antenatal screening programme, cases will continue to go undiagnosed. Even amongst at risk groups it is difficult to collect reliable results due to the erratic behaviour of some individuals, eg sex workers and i.v. drug users, who can easily be invisible to standard healthcare providers.

  1.2  There is currently no effective treatment for chronic hepatitis B.

  1.3  Behavioural change consistent with avoiding any risk of contracting hepatitis B is unachievable in practical terms. Therefore, the best method of prevention is through vaccination. The current DoH vaccination policy relies on confining the spread of disease within high-risk groups by selective, targeted, vaccination of such persons.[15]

  However, this is impossible to achieve as long as undiagnosed individuals continue to spread the disease, particularly as the virus is 100 times more infectious than HIV.[16] Further more, healthcare venues designed for high risk patients, like GUM clinics, are already oversubscribed and under-resourced and are forced to concentrate vaccination on current attendees, who have already commenced a "risk" prone behaviour. This is "shutting the stable door after the horse has bolted".

  1.4  "GUM clinics have been under-resourced for a while, but things are getting worse. Most clinics in London have had to close their walk-in service because of demand. There is often a 4 hour wait for our walk-in service and we've seen more people this year than the A&E department." Lead Nurse, London GUM clinic.

  1.5  "The government has given us extra vaccine to reach at risk groups (here she lists gay and bisexual men, sex workers and people living with a hepatitis B infected partner). What we have to do is ensure we are targeting these groups with health awareness campaigns, without reaching everyone else who might be interested in vaccination. We have to turn away these people as it is." Health Advisor, Manchester GUM clinic.

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

  2.1  Getting Ahead of the Curve outlines some welcome improvements, such as the establishment of a National Infection Control and Health Protection Agency in an effort to modernise methods of data capture.[17]

  2.2  However, due to the problems we have outlined in previous sections of this submission the problem of hepatitis B will not be properly addressed by targeting only high-risk groups, due to the nature of the disease and the problems and costs of implementing a high-risk vaccination policy.

3.   Is the United Kingdom benefiting from advances in surveillance and diagnostic technologies; if not, what are the obstacles to its doing so?

  3.1  Getting Ahead of the Curve states that it intends to improve surveillance. However, improving surveillance will help to capture only unreported, diagnosed cases. To establish the true burden of disease in the UK would require improvements in blood screening but it would be impractical and very costly to implement.

  3.2  There is an oral fluid test now available in the UK that is able to detect specific hepatitis B antibodies but its use is not widespread.

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  The UK should make greater use of the currently available vaccines. In 1992 the World Health Assembly endorsed the recommendation that "Hepatitis B vaccine should be integrated into the national immunisation programmes in all countries by 1997. Countries with low prevalence may consider immunisation of all adolescents as an addition or alternative to infant immunisation." [18]Additionally 99-100 per cent of children 0-15 years are protected following a full course of the currently available hepatitis B vaccines.[19]

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

  5.1  Hepatitis B poses a significant threat to public health, a disease second only to smoking as the main known cause of human cancer worldwide. This trend will continue as immigration, particularly from Eastern Europe, south-east Asia and the Far East, where endemicity is already high, is rising year on year. Equally the rates of diagnosed sexually transmitted infections and HIV have increased to their highest levels in recent years.[20]

    —  Hepatitis B is 100 times more infectious than HIV, however unlike HIV it is preventable.

    —  Twenty to twenty-five per cent of hepatitis B carriers develop progressive liver disease. Nigel Hughes, Chief Executive of the British Liver Trust, said, "between 1996-2000, 152 liver transplants were carried out, as a direct result of liver cirrhosis due to hepatitis B, costing the NHS £7.7 million. This figure only covers the costs of admission to hospital for transplant and does not include aftercare or other types of liver disease caused by hepatitis B."

    —  In Europe, the WHO estimates that there are 1 million new cases of hepatitis B each year and one in five gay men in London are now infected.[21] [22]

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  The UK should implement the WHO recommendation for a universal adolescent vaccination programme through the auspices of the Joint Committee for Vaccination and Immunisation (JCVI). Most infections occur in the UK between the ages of 16-30 (PHLS data) due to adolescents indulging in "adult" and potentially risky behaviour. Alternatively JCVI should, as a minimum, make provision in their recommendations for local areas and/or regions eg PCTs/SHAs to adopt a policy of universal vaccination in children 11-13 years, where a local need already exists. Examples would include inner city areas with an established problem of drug use in teenagers.

October 2002

13   Communicable Disease Control Handbook. Hawker J et alBack

14   Grosheide P, Van Damme P. Prevention and Control of Hepatitis B in the Community. Back

15   Department of Health, Immunisation against Infectious Disease, TSO, London, 1996. Back

16   Hilleman MR, Vaccine, 2001;19:1837-1848. Back

17 Getting ahead of the curve. Back

18   Grosheide P, Van Damme P. Prevention and Control of Hepatitis B in the Community. Back

19   Hilleman M R, Vaccine, 2001;19: 1837-1848. Back

20   West D J. Am J Infect cont 1989; 17(3): 172-180. Back

21   The National Strategy for Sexual Health and HIV Back

22   AIDS 1993 June; 7(6): 863-9 Hart G J et alBack

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2003