Select Committee on Science and Technology Written Evidence

Memorandum by GlaxoSmithKline

  GlaxoSmithKline (GSK) is committed to supporting the NHS in improving the health of the nation. An essential element of this commitment is our research and development of innovative treatments that provide patients with life improving medicines for diseases such as asthma, diabetes, cancer and HIV/AIDS. As the UK's leading supplier of vaccines, GSK also plays an important role in disease prevention (see Appendix for information about GSK Biologicals).

  GSK believes that significant improvements in public health can be achieved through sustainable partnerships with government, the NHS and most importantly the general public that requires a commitment to health promotion, improvements in socio-economic inequalities, availability of effective treatments and disease prevention.


    —  GSK believes that the NHS should give greater prominence to life saving vaccinations that are currently available but not being used as effectively as they could be to prevent the progression of potentially fatal diseases. The UK Government currently spends £68.9 billion on healthcare and only an estimated 0.03 per cent of that total is spent on the vaccination programme.

    —  Vaccination is one of the safest and most effective healthcare interventions available today. Developing new vaccines is a fundamental part of GSK's commitment to public health.

    —  Vaccination is also one of the most cost effective measures a society can take to prevent the spread of disease, which the treatment of can often be an expensive burden on an already stretched healthcare system.

    —  Yvette Cooper, Parliamentary Under-Secretary of State for Health stated in an adjournment debate earlier this year, "We should not underestimate the impact on public health of immunisation programmes such as the NHS programme. Immense improvements have been made not through treatment but through vaccination—a fact that is of worldwide significance. It is because of the immunisation programme that the incidence of childhood disease in this country has fallen to its lowest ever levels, greatly reducing morbidity and mortality from such diseases."

    —  One vaccine that we believe is currently under-utilised in the UK is for the prevention of hepatitis B. The following case study on the disease outlines some of the evidence for a more universal approach to the prevention of hepatitis B.

    —  GSK commends the Government for its ability to implement extremely successful mass vaccination programmes in the UK. In 1992, the Hib vaccine was introduced into mass vaccination and in 1994 the measles and rubella campaign vaccinated five to 16 year old children in the UK. The measles mass vaccination programme successfully averted an imminent measles epidemic. More recently in 1999 the meningitis C vaccination campaign was launched due to a number of outbreaks in teenagers. Children up to 18 years of age were vaccinated resulting in a decrease in the number of cases.

    —  There are several vaccines that are currently licensed in the UK but are under-utilised by the Government; hepatitis A and B, strep pnemococcal and varicella. The following case study on hepatitis B outlines some of the evidence for a more universal approach to the prevention of the disease.


Disease burden:

    —  100 times more infectious than HIV.

    —  One in 10 infected people will develop chronic carriage of HBV.

    —  Patients chronically infected with hepatitis B are at high risk of death from cirrhosis of the liver and liver cancer.[63]


    —  About two thirds of hepatitis B infections are asymptomatic and therefore may not be diagnosed.[64]

    —  In England and Wales, the proportion of reported cases of acute hepatitis B infection in 2001 with no identified risk was 53 per cent.[65]

    —  The number of acute cases of hepatitis B reported to the PHLS and SCIEH (Scottish Centre for Infection and Environmental Health) do not account for underreporting.[66]

    —  It is currently thought that there is about 20 per cent of underreporting of acute hepatitis B cases from laboratories.[67]

    —  The US Centers for Disease Control (CDC) study estimated that only 8.7 per cent of hepatitis B infections are actually reported.[68]

    —  Our concern is that underreporting is potentially indicative of a lack of government recognition of the importance of hepatitis B. This lack of surveillance may also apply to other infectious diseases.

Cost-effectiveness of universal hepatitis B:

    —  In the UK, studies show universal mass vaccination for hepatitis B to be more cost effective in the longer term than selective vaccination even in a low prevalence country.[69], [70]

    —  A recent review of the evidence: "epidemiological data and economic evaluation show that universal hepatitis B vaccination is cost effective in countries with low endemicity and that it will control hepatitis B, reinforcing the necessity for action."[71]


    —  In 1992, the World Health Assembly endorsed a recommendation of the Global Advisory Group of the Expanded Programme on Immunization which was held in Turkey in October 1991. The recommendation asked all Member States with an hepatitis B carrier rate of 8 per cent or greater to expedite the integration of hepatitis B vaccine immunization into their routine infant immunization programmes by 1995 and all other countries to introduce such immunization by 1997.[72]

    —  The UK is one of the few countries in Europe that has still not followed the WHO recommendation.

    —  Although it is a significant start, current Department of Health policy targets a defined set of "at-risk" groups such as intravenous drug users, gay and bisexual men, but these groups are very hard to reach. 63

    —  Vaccination uptake in many of the high risk population groups that are recommended for hepatitis B immunisation is poor and transmission of hepatitis B remains a problem. 65

    —  In many instances, the present immunisation strategy for the prevention of hepatitis B functions poorly and there are clear inequalities. 65

    —  Many people at extremely low risk of hepatitis B are being vaccinated, while those at highest risk are often unlikely to be offered the vaccine. 65

    —  We do not believe the current policy goes far enough because the "at risk" behaviours for hepatitis B includes piercing, tattooing, engaging in high risk activities while travelling to endemic areas and having multiple sex partners.

    —  The most frequent mode of transmission of hepatitis B is through sexual activity, either heterosexual or homosexual, between an infected and a susceptible person.[73]

    —  There is no way of knowing now which children and adolescents will be susceptible to hepatitis B due to their future lifestyle choices as the vast majority of new hepatitis B infections acquired in the UK occur in adults.[74]

    —  Vaccination against hepatitis B will protect the public now and ensure a healthier future.


    —  GSK strongly endorses the continued role of the Joint Committee on Vaccination and Immunisation (JCVI) as the main decision making body for vaccination and immunisation.

    —  However, whilst supportive of the JCVI's recent moves to reform, GSK believes that to restore public confidence and avoid criticisms of political bias following sustained negative media coverage of the vaccine decision making process, exemplified by MMR policy and the Government's handling of the small pox vaccine tendering process, further changes still need to be made to the JCVI.

    —  GSK believes that to achieve the best public health strategies for the UK population, and to ensure informed decision making there needs to be greater scope for consultation and the inclusion of all relevant stakeholders in the JCVI decision making process.

    —  GSK would suggest that the JCVI include representatives from the following key stakeholder groups:

    —  Vaccination and immunisation experts.

    —  Government.

    —  Patient groups (we understand there are proposals already in place).

    —  Suppliers (industry involvement in a neutral capacity).

    —  GSK also recommends that all interested parties should have an opportunity to address the JCVI in relation to a proposed policy change. This would allow the views of all stakeholders to be heard and considered, resulting in decisions based on informed debate. The US Advisory Committee on Immunisation Practices (ACIP) takes a similar approach and could be a model to consider.

    —  To avoid accusations of political bias we would also recommend that the role of the Secretariat is not undertaken by the membership of JCVI but by a neutral body.

    —  In addition, the agendum would be available in advance and the minutes of the meeting published. Decisions that are taken by JCVI would be announced to the public and open for appeal.

    —  The current and future public health of our nation is dependent on the decisions that are made on the best interventions to protect against infectious diseases. We believe that it is crucial that these decisions are taken with full stakeholder involvement to ensure that patients receive faster and more equitable access to vaccinations.


    —  It has been well documented, in recent times, that communication of scientific information to the public can be alarmist and undermine public confidence. However, patients need to understand the risk and benefits of any medicines.

    —  It is all of our responsibility, especially scientists, to communicate effectively through the media to the general public. It is also the media's responsibility to distil very complicated information in a responsible way.

    —  For example the debate on MMR is misleading about the benefits of single vaccinations over combination vaccinations. The facts about combined vaccines:

    —  Combined vaccines go through rigorous testing to ensure their safety and efficacy. Combined vaccines are as safe as each component of separate vaccines and after licensing are continuously monitored for any adverse events.

    —  Both parents and healthcare professionals hesitate to give a child more than two injections per visit. Fewer injections in the form of a combined vaccine means less discomfort for the child and allow protection against more diseases.

    —  Scientific evidence proves that multiple vaccines do not overwhelm or weaken the immune system of a child. In fact, vaccines protect children against the diseases that do weaken the immune system.

    —  Combined vaccines result in fewer visits to the GP with a less likelihood that a child will be exposed to the risk of infection unnecessarily between vaccinations.

    —  We believe that JCVI has a clear responsibility to educate and support the public. The media is an obvious tool to use and if JCVI were more independent from government they would be in a stronger position to do this.


    —  GSK believes that only through partnership with all stakeholders can we ensure that there are adequate plans in place to identify areas for research and to share best practice on new vaccines so that we can control the emerging threats to our population.

    —  GSK supports "Getting Ahead of the Curve" which is crucial to combating infectious disease in the UK. However, GSK believes that vaccination policy making must be improved to ensure that current vaccines which are now available such as Hepatitis B are better utilised and that future vaccines when they become available are used as quickly as possible.



    —  GlaxoSmithKline is one of the largest vaccine manufacturers in the world.

    —  In 2000, the company delivered over 1.1 billion vaccine doses to people in 177 countries.

    —  Every second 35 doses of GSK vaccines are distributed worldwide.

    —  GSK Biologicals is located in Rixensart, Belgium, and is the centre of all GSK's activities in the field of vaccine research, development and production.

    —  The headquarters of the company in Rixensart, Belgium, employs over 3,000 people of which over 900 are research scientists devoted to discovering new vaccines and developing more cost-effective and convenient combination products to prevent infections which cause serious medical problems worldwide.

    —  In order to ensure its leadership in vaccinology, GSK continues to invest important funds in research and development, in facilities and in leading edge technology equipment.

    —  GSK owns an influenza vaccine production plant located in Germany and has initiated ambitious projects in China, India, Russia, Egypt and Brazil.

    —  Over the last 10 years, GSK has lead innovation and launched 15 new vaccines which were a world first innovation, including Havrix the first vaccine against hepatitis A, and many new combinations.

    —  GSK has a rich pipeline of 18 vaccines including vaccines to protect against Malaria, Rotavirus, HIV, HPV, Herpes and Meningitis B.

October 2002

63   WHO factsheet, WHO/204 October 2000. Back

64   DoH, Immunisation against Infectious Disease, HMSO 1996. Back

65   PHLS. Back

66   Goldberg D, McMenamin J. The United Kingdom's hepatitis B immunisation strategy-where now? Communicable disease and public health 1998, Vol 1 (2): 79-83. Back

67   Mangtani P, Heptonstall J, Hall A J. Enhanced surveillance of acute symptomatic hepatitis B in England and Wales. Communicable Disease & Public Health 1998, vol 1 (2): 114-120. Back

68   US CDC Hepatitis B Surveillance Report 51, 1987a and US CDC Update on Hepatitis B prevention, 1987b. Back

69   Mangtani P, Hall A J, Normand C E M. Hepatitis B vaccination: the cost effectiveness of alternative strategies in England and Wales.J Epidemiol Community Health 1995, 49: 238-244. Back

70   Williams J R et al, Targeted Hep B Vaccination-a cost effective immunisation strategy for the UK? J Epidemiol and Community Health 1996, 50 (6667-73). Back

71   Van Damme, P, Kane M, Meheus A, et al, Integration of hepatitis B vaccination into national immunisation programmes. BMJ 1997:314: 1033-6. Back

72   WHO website Back

73   Health Information for International Travel; 2001-02.National Centre for Infectious diseases, 2002. Back

74   Ramsay M, Gay N, Balogun K, et al. Control of hepatitis B in the United Kingdom Vaccine 1998, 16: S52-S55. Back

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