Examination of Witnesses (Questions 280
TUESDAY 1 NOVEMBER 2005
Ms Rosie Winterton MP, Dr David Harper and Dr David
Q280 Earl of Selborne: Will that
get through to local authorities?
Ms Winterton: Yes, the local authorities are
certainly consulted as part of those groups. They are a very,
very important part of the contingency planning in that area and
will increasingly be so. It is important obviously that they are
in close liaison with Primary Care Trusts as well. Again that
relationship, at local level, is very, very important because
that is where the real work, if you like, is going to take place.
So we can build on structures which have already been developed.
I think I am right in saying, and I will come back if this is
not correct, by November 2005 there is through the Civil Contingencies
Act a duty - is there not - to produce plans?
Dr Harper: Yes.
Q281 Lord Sutherland of Houndwood: A
very quick follow-up to that. If, or as some say when, a pandemic
comes, what is the Government process for looking at civil contingencies,
implementing measures relating to that? For example, banning large
meetings or indeed looking at the question of travel. Hanging
on to the issue of schools, will that be a local decision or will
that be a national decision, whether schools close and the consequent
impact on the workforce?
Ms Winterton: I do not know whether you have
had time to go through this document?
Q282 Lord Sutherland of Houndwood: I
have not had time to read it because I have been listening to
Ms Winterton: This is actually the plan which
was issued by the Chief Medical Officer and it sets out how within
that there will be liaison at national level across the departments.
This will obviously again, I have to stress, relate to the assessment
of who is being affected, how it is being passed, if you like,
and all the implications of whether closing schools or shutting
down businesses or banning public meetings will actually have
the desired effect. Again, it is very important to say that we
would be, through the ministerial and top level officials group,
looking at those issues as the situation develops, and, of course,
working with international partners as well as to actions which
were being taken in other countries. But it would then be for
guidance obviously to be issued at local level.
Q283 Lord Sutherland of Houndwood: Would
it be a matter at the discretion of a head teacher or a school
board whether a school closes, or could they do that before guidance
comes down the line?
Ms Winterton: There might be different decisions
in different areas but obviously there would be very clear guidance
from national level because, quite frankly, there would have to
be an exchange of expertise and information. So it would be very
much a local and national working-together but it may well be,
and again my advisers will be able to give you further information,
in the particular UK situation possible to contain things and
have one thing happening in one area and another thing happening
in another. That would depend on how any virus was developing.
Dr Harper: Infectious disease experts and our
modellers and our public health epidemiologists are currently
working on exactly those issues in the sense of school closures,
cancelling large public gatherings and so on. The models are being
revised as we speak, and they will continue to be revised in the
light of new information, new scientific considerations. So it
will be when the virus and the characteristics of the virus are
clearer as to the attack rate, the susceptibility of the population
and so on, that those will be fed directly into the models which
will be there for real time use, where we can base the policy
decisions and ministers can base the policy decisions on the best
available information at the time that the virus emerges.
Q284 Lord Sutherland of Houndwood: It
sounds a fairly frenetic process as the gap begins to narrow.
Dr Harper: That is why a lot of the preparatory
work and the models are being done now, and the scientific press
will be looking at that over the next few months. There will continue
to be publications around, for example, international travel,
school closures and some of these big issues, where we can use
peer review work, which is very important, internationally and
nationally, but we have those modellers who are helping us in
our policy development right now.
Chairman: I think we want to move on
now to the question of the funding of research.
Q285 Lord Paul: According to the
evidence we received from the Medical Research Council, the annual
budget for research was about £1.6 million which was spent
and this covers key areas such as assessment of the risk posed
by avian viruses, analysis of the development of the H5NI virus
and of its effects upon humans, and research into innovative methods
of vaccine development. Is this really enough?
Ms Winterton: We can assure the Committee that
we are very committed to improving research in this area and to
work closely with the Medical Research Council, Defra and others,
to ensure we have got a good research strategy here in the UK
but also to make sure we are aligning what we are doing at EU
and also at international level. That is a very key point, particularly
in terms of what came out of the Ottawa meeting. That was certainly
defined and there was a real sense at that meeting that there
was research taking place in different parts of the world and
that there was a very key co-ordinating role which needs to be
filled. So I would say the issue is not only about direct research
which we can undertake but also research one can feed into and
help to co-ordinate in other parts of the world. We do want to
look at what else can be done in terms of specific research on
pandemic flu vaccines. Already we have £750,000 committed
to flu vaccine research, and as you have said the MRC's current
investment is something like £1.6 million. I think it might
also be worth Dr Salisbury saying something about the work which
is going on by vaccine manufacturers as well, because I do think
that is quite an important part of the equation for us to consider.
It is obviously being in a sense stimulated by the fact that we
are making it quite clear this is an area we are interested in.
Q286 Lord Paul: My question was that
you have done a tremendous amount of preparation about what can
happen but £1.6 million looks so small.
Dr Harper: The £1.6 million is MRC funding.
If we take into account as well all of the work we have been alluding
to this afternoon which has been done, for example on diagnostic
development, near-patient testing both for national use and possibly
for developing country use, and there is work going on in academia
but also our Arm's Length Body, the Health Protection Agency,
has done a great deal of work through what we might describe as
core funding. The HPA have also successfully competed for European
Union funding from the Framework Programmes. So in a broader sense,
and if we look at the running of exercises and scenario development,
the Health Protection Agency has won contracts for two very large
exercises on a European scale which are being funded by the European
Commission. We also have a lot of work going on in the National
Institute for Biological Standards and Control on elements such
as reverse genetics and developing those technologies so they
can be applied to vaccine development and the development of standards.
So we have to be slightly careful when figures are taken and earmarked
as if they are the totality of research and development funding
because, apart from those specific figures, there is an enormous
amount of activity which is going on through these agencies and
academia and other channels.
Q287 Lord Winston: Is it not a fact
that in Britain generally we have run-down academic micro-biology
and that this is a problem for research in this area, and the
fact we have not filled chairs in this area, and we are now very
Dr Harper: I think there is a real issue there
in clinical microbiology and other specialisms as well - clinical
toxicology is another very good example. There are some gaps in
academia, but my point is that there is still a substantial amount
of work which is going on throughout academia but also through
the Arm's Length Bodies we sponsor.
Q288 Lord Patel: Currently, as we
know, there is a high level visit from MRC to China and Vietnam
to understand the spread, organisation and epidemiology and, hopefully,
that will identify areas where research could be targeted; basic
science research particularly the kind you have mentioned the
NIBSC is doing. If they come back and suggest there are areas
where targeting research would be profitable, would we be able
to find more money?
Ms Winterton: We obviously look at any proposals
in this area. As I have said, one of the very important results
of the Ottawa meeting and other meetings which are going on is
we need to look jointly with international partners at research
proposals and particularly in the area you have spoken about there.
Q289 Baroness Finlay of Llandaff: Could
I follow up on research proposals? One of the problems for anyone
putting together a research proposal is the lag period from when
they get the research proposal together and then getting ethics
approval, whether it is ELREC or MREC or however, and of course
time is not going to be on people's side in this. The other difficulty
though is going to relate to consent over data and information.
Clinical research in this area is going to be absolutely key and
will be a one-off opportunity and we will need to know whether
we dramatically alter survival by for example giving antivirals
within 24 hours versus 48 hours, whether when people become pulmonary
compromised they should have steroids first-line or bronchodilators
first-line, but they will probably be too ill to give consent.
They will also probably be too ill, and the people working in
the frontline will be so busy they will not have time anyway,
to go through the complex consent procedures over access to specimens
and access to data, and using that data. If we are taking sputum
samples, they will have cells in them and bits of DNA in them
inevitably because they will have bronchial cells in them, but
if we do not have a system in place to collect those samples and
systematically to deal with them and analyse the data at a national
level, we will miss a golden opportunity which may result, if
we get it right, in being able to alter the course of the disease
by saving many people's lives. So we are not just talking about
it being interesting and a small number, it is possible that if
we can get the data in very fast in week one and begin to analyse
it, we will begin to alter what we do in week three or week four,
and certainly by the time we get into the tail of the pandemic.
I wonder if you have given any consideration to special measures
that would allow people to by-pass some of the bits of regulation
which are currently in place which effectively mean they would
not be able to collect those sorts of samples or undertake that
type of research with the current framework around research?
Ms Winterton: As I said earlier, the Chief Medical
Officer and others are looking at a lot of the points to do with
not only the issues that we talked about earlier in terms of safety
regulation and so on but a lot of the points you have made which
are extremely relevant to the discussions which should be going
on. I cannot give you a definitive answer now to say this is what
would happen in this or other situation with regard to consent,
and this is always a very sensitive issue as I know through the
Human Tissue Bill and Act and we have had discussions at other
Q290 Baroness Finlay of Llandaff: Absolutely.
Ms Winterton: What I can say is, if there is
any progress which has been made so far which I think it would
be helpful for the Committee to have, I would be happy to take
away those points and write to you if you think that would be
helpful, because they are all areas which are extremely important,
particularly in terms of management of and identification of virus
Chairman: Thank you.
Q291 Baroness Finlay of Llandaff: I
think our concern as a Committee is if such issues are not addressed
and opportunities are missed, then we will all feel to blame.
We have time at the beginning to begin to work them through and
get some of the protocols in place and think through some of the
issues in the cold light of day. Once people start to be ill,
no one will have any intellectual energy to look at that because
they will be far too busy coping with the pandemic.
Ms Winterton: That is absolutely right and these
are all issues which are being looked at very closely at the moment.
Both Dr Harper and Dr Salisbury touched on that earlier but what
I am saying is if there are any specifics which have been addressed
in terms of the points you have raised already, I can write and
let you know.
Q292 Baroness Perry of Southwark: Dr
Harper, you mentioned near-patient testing and diagnosis, which
obviously in the very early stages of a pandemic, particularly
reaching here, would be vitally important, so that we do not have
to wait for samples to be sent away to some distant laboratory
and wait days for the results to come back. I know there is some
work going on in Cambridge in Dr Helen Lee's unit on this. Is
the Government putting money into that, because it does seem to
me to be one of the key links in the speeding up of controlling
Dr Harper: Dr Lee is working at least in part
very closely with the Health Protection Agency, which is the agency
we sponsor, so they are looking at the molecular virology with
one of the leading scientists at the Health Protection Agency,
who is working directly and closely with Helen Lee at Cambridge.
Q293 Baroness Perry of Southwark: And
that is Government money?
Dr Harper: The Health Protection Agency is funded
by the Department of Health.
Q294 Baroness Perry of Southwark: Is
the Health Protection Agency funding her? I thought it was Wellcome
money which was funding her.
Dr Harper: Maybe there is some confusion here.
I am not talking about the funding for Helen Lee, I am talking
about the Health Protection Agency side of the collaboration at
the moment. That is Government funding.
Lord Winston: A very brief observation.
The committee where I work has taken seven months with a very
low grade research proposal and still it has not been agreed to
give us ethical approval, for something which does not affect
patients in any way adversely. I think you have to recognise that
the ethical approval system is creaking at the seams already and
it is going to get worse.
Q295 Chairman: Minister?
Ms Winterton: I am sorry, I thought you said
that was an observation.
Q296 Lord Winston: I was backing
up what Lady Finlay was observing and I think it is going to become
an increasing issue.
Ms Winterton: Okay.
Q297 Chairman: Minister, we have
gone on for quite a long time and we have run out of time now.
Let me thank you very much, and Dr Harper and Dr Salisbury also
for being very helpful and answering our questions. If we may
ask you to keep to what you have just offered to do, to let us
know anything else you think would be useful to us, and perhaps
we can come back to you if we have further questions. But I would
like to thank you very much for being so helpful.
Ms Winterton: Thank you and I hope these various
documents are helpful.
Q298 Chairman: Thank you for those.
Ms Winterton: We can circulate the Ottawa communiqué
if it would be helpful.
Chairman: Thank you.