Select Committee on Science and Technology Written Evidence

Memorandum by Wyeth Pharmaceutical

  Wyeth is pleased to respond to the call for evidence from the House of Lords Science and Technology Committee on fighting infection. Wyeth has a long history of pioneering developments in pharmaceuticals and biotechnology, with leading products in the areas of women's healthcare, neuroscience, musculoskeletal disorders, cardiovascular therapy, vaccination and infectious disease, haemophilia, immunology and oncology. Wyeth's vaccines and infectious disease franchises share a common mission to reduce the number of serious illnesses and deaths from bacterial and viral infections and to address the growing problem of bacterial resistance to existing treatments.

  In recent years, Wyeth Vaccines has developed some of the most innovative vaccines in the health care arena. Our Research and Development focuses on the needs of communities around the world. The national immunisation campaign began ahead of schedule in autumn 1999, following the availability of Wyeth's meningococcal group C vaccine a year earlier than planned allowing children and young people in Britain to become the first in the world to benefit. This was made possible through the collaboration between the Department of Health, regulatory agencies and other official bodies. This is an excellent example of what can be achieved by open communication to achieve a common goal.

  We are proud of the impact Wyeth has had on both childrens and adults lives and we are dedicated to continually developing vaccines so that they can have a healthier future.

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

  As a vaccine manufacturer we have identified several key problem areas:

    —  Surveillance

    —  Inconsistencies in implementation of policy

    —  Relationship between industry and reviewing bodies

    —  Media and education.

  Variations in compliance and commitment within different regional surveillance systems are a major cause of under-reporting of notifiable infections and the consequent under-estimation of the disease burden. This affects many important preventable conditions. An integrated surveillance system for the whole of the UK, ie a national framework, would more accurately quantify disease impact. Moreover, compliance with such a system would provide a powerful tool to assist policy makers.

  Implementation of vaccine policy outside the childhood immunisation programme is variable. The factors that contribute to this situation include:

    —  The system of financial incentives for meeting targets, eg fees for flu vaccination in "at risk" patients under 65 years of age are offered to GPs in Wales and Northern Ireland but not in England and Scotland.

    —  Inadequate national tracking systems mean that implementation of national guidance and recommendations is a primary care responsibility, eg immunisation of "at risk" populations with pneumococcal vaccines.

  The Joint Committee on Vaccination and Immunisation (JCVI), an independent statutory committee, has been advising the UK Health Minister on immunisation policy since 1963. Until recently the committee's constitution and meeting minutes were not made public. We welcome the introduction of the new JCVI website as we believe this will contribute towards better informing all stakeholders and helping to restore public confidence in vaccines. We hope that this heralds a new era of communication in which meeting agendas will be made public and vaccine manufacturers will be invited to contribute where appropriate. Guidelines for decision-making would enable prioritisation of manufacturers' research activities in order to facilitate the earliest possible availability of new disease management strategies.

  Furthermore, greater communication would allow the identification of common goals for educational programmes aimed at both healthcare professionals and the general public. Wyeth already develops and implements such educational initiatives to support customers in preventing antibiotic resistance and implementing vaccination policy.

  Whilst acknowledging the need to ensure the Department of Health's independence, we would welcome greater partnership in the development and implementation of educational initiatives.

  Ability to implement NICE guidance is consistently flagged as an area of great concern. Although NICE does not preside over vaccination policy, pharmaceutical utilisation in disease management programmes such as that for haemophilia raises the question of post code prescribing and therapy concordance. Wyeth's portfolio includes recombinant factor VIII which has been the subject of such deliberation.

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

  We welcome the strategy document as it provides a vision to work towards. However we appreciate that the next steps need to be put in place to demonstrate how this will be implemented. Specifically we look forward to understanding the priorities for vaccine development. We hope all the countries in the UK adopt the strategy document so that cohesive implementation is achieved. To this end, the process and communication needs require definition.

  Wyeth looks forward to contributing towards this process in conjunction with other industry partners which will enable us to match our R & D pipeline to strategically important targets.

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

  Wyeth is happy to participate in a working party to collaborate on technological projects related to effective development, production and distribution of our portfolio to meet the needs of all stakeholders.

  Where advances in surveillance and diagnostic technologies impact upon these factors we feel that the greatest obstacle would be lack of open and timely communication.

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?

  As a vaccine manufacturer, we believe that the impact of vaccination on the prevention of disease has been clear and significant in public health terms. Regulatory conditions sometimes result in the delay in the implementation of new vaccination strategies. This is especially applicable in the era of European licensure.

  National review policy also has significant potential to cause a delay in pursuing new vaccine opportunities due to the requirement to re-assess the safety and efficacy of any new vaccine in the context of incorporating it into the existing national immunisation schedule. Delay in the introduction of a routine immunisation programme for infants and children against invasive pneumococcal diseases such as meningitis is an example of this.

  Transparency of decision-making by bodies such as JCVI is vital to ensure public confidence.

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

  Getting Ahead of the Curve identifies developments for existing vaccines and the development of new vaccines. Priorities need to be set so that Wyeth's R&D investment is focussed on the right areas.

  We agree with Getting Ahead of the Curve with regard to antimicrobial resistance but are unsure as to how new threats are identified. We look forward to clarification on this matter. Antimicrobial resistance in primary care was flagged as a priority issue through the SMAC report. There are numerous reports of emerging antibiotic resistance to common hospital pathogens, eg MRSA, VRE, Colstridium difficile and ESBL's. Whilst factors such as irrational prescribing of antibiotics, poor infection control and use of antibiotics in animal fees contribute to this issue, Wyeth actively supports research to reduce the rapid emergence of these new resistant bacteria.

  Wyeth's treatments in areas such as H pylori eradication, infection control and immunisation are all vulnerable to cuts in health service expenditure when targets are set for other areas, such as dealing with patient waiting lists. This impacts upon our ability to invest in new areas which face emerging issues and as such might limit the future armoury available to healthcare professionals.

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

  Wyeth would welcome a more active engagement of the pharmaceutical industry with all stakeholders. Collaboration between ourselves, the Department of Health and health professions has led to the effective introduction and promotion of the Meningitis C programme. We look forward to greater transparency and cooperation in the future in order to protect the public.

October 2002

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