Select Committee on Science and Technology Fourth Report


CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS

Prevention is better than cure

8.1.  The first line of defence against a potential human influenza pandemic is effective surveillance and control of avian influenza, in particular in south east Asia. We are encouraged that there seems to be a growing consensus on this point, and in particular that the World Bank has committed $500 million to supporting the work of UN agencies and regional programs.

8.2.  Nevertheless the FAO, which is uniquely well placed to tackle avian influenza at source, remains under-funded. We recommend therefore that the Government review its support, financial and institutional, for the FAO; we further urge the Government, in partnership with the European Commission and other European Union countries, to respond positively to the World Bank's establishment of a multi-donor trust fund to support investment in the region.

8.3.  The Government should also make every effort to ensure that the efforts of United Kingdom departments and agencies in both animal and human health are fully co-ordinated. We therefore recommend that the Government review the current rules governing funding of HPA activities overseas.

8.4.  We welcome the appointment of Dr David Nabarro as UN Senior System Co-ordinator for Avian and Human Influenza. The performance of UN agencies, and the co-ordination between different agencies, has not always been optimal. We look to Dr Nabarro to ensure that the UN is well placed to co-ordinate international efforts to prevent the current epidemic of avian influenza turning into a full human pandemic.

Nip a pandemic in the bud

8.5.  Recent modelling by United Kingdom researchers suggests that by rapid diagnosis and targeted response it may be possible to nip a pandemic in the bud. While this research has profound implications, further refinement of the modelling is urgently required, and we look to the Medical Research Council to make this a high priority within its influenza research programme.

8.6.  While it may be theoretically possible to nip a pandemic in the bud, the practical difficulties remain formidable. We welcome the donation by Roche Products Ltd of three million courses of oseltamivir to the WHO, and we also welcome the efforts of the UN and its agencies to improve surveillance and implement a co-ordinated rapid response strategy. We urge the Government to give their full backing to these efforts.

8.7.  We further believe that substantial investment by the international community in improving healthcare in south east Asia represents the best long-term strategy to prevent future influenza pandemics. We recommend that the Government, in collaboration with international partners and the World Bank, make such investment a high priority.

Mitigation

8.8.  Once an influenza pandemic is established, in south east Asia or elsewhere, there is no realistic prospect of preventing its spread to the United Kingdom. Travel restrictions, quarantine or screening at airports, while they would be highly visible, would only delay the spread of the virus.

8.9.  The early and targeted use of antiviral drugs, not only to treat the first cases in this country, but to provide prophylactic protection to close contacts such as family members or health workers, could both delay and lower the peak of a United Kingdom pandemic. This would reduce the strain on health services, and give more time for the production of a vaccine.

8.10.  We are therefore extremely concerned at the lack of clarity in the Government's policy on prophylactic use of antiviral drugs, and at the possibility that the Government's order of only 14.6 million courses of oseltamivir may have tied them into a treatment-only policy on using the stockpile.

8.11.  We recommend that the Government work together with the HPA and the research community to establish the optimal strategy for the use of antiviral drugs, and that further orders, if required, should as a matter of urgency be placed to allow this strategy to be implemented. We further recommend that this strategy should incorporate a rigorous cost-benefit analysis.

8.12.  We recommend that the Government develop back-up plans in case resistance to oseltamivir emerges. These should encompass possible combination therapies or the acquisition of reserve stocks of zanamivir.

Damage Limitation

8.13.  The Government's Contingency Plan is an excellent top-level account of the United Kingdom health service response to a pandemic, but an enormous amount of work remains to be done at lower levels. We therefore recommend:

8.14.  We commend the work of the emergency services in developing contingency plans. However, despite the duties imposed on local authorities by the Civil Contingencies Act 2004 to develop contingency plans and participate in Regional Resilience Forums, we are not convinced that local government is yet fully aware of the implications of an influenza pandemic. We urge the Government to provide clear and unambiguous direction and guidance in this area.

8.15.  We are alarmed at the risk of serious disruption to food supplies, and at the lack of contact between the Government and the major food retailers. The Government urgently needs to address the resilience of food distribution networks.

8.16.  All departments of Government need to work together in preparing for a possible pandemic, but we do not believe the Department of Health can provide strong enough leadership to achieve this. We therefore support the view of Dr David Nabarro that the importance of pandemic influenza contingency planning should be underlined at the highest level within Government. The development and implementation of contingency plans should be the responsibility of a Cabinet-level Minister for contingency and disaster planning, located within the Cabinet Office.

8.17.  In the event of a pandemic a clear message and direction from all branches of Government will be critical, and we recommend that the Government develop and publicise a strategy for proactive dissemination of key information and advice, using all forms of national and local media.

A long-term strategy

8.18.  In the event of a pandemic the speed with which a vaccine can be prepared, manufactured and distributed will be crucial. We therefore make the following recommendations:

8.19.  We recommend that the Government fund further research on alternative treatments for pandemic influenza. This should include a full assessment of the risks and benefits of fractionation. If such risk analysis is left until a pandemic outbreak it will be too late.

8.20.  We agree with Professor Menon that a pandemic would present a unique opportunity for detailed research into the effectiveness of treatments, immune responses, the causes of mortality, and related issues, which could offer enormous long-term health benefits. The Government have a duty to facilitate such research, which will not be possible without advance ethical clearance, rapid access to funding, and the suspension of various legal and regulatory requirements.

8.21.  We therefore recommend that the Government initiate a public dialogue on the regulatory barriers to research in the event of a pandemic. We believe the public would support this research if its benefits were properly explained.


 
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