Memorandum by the Royal Society
The Royal Society is pleased to respond to the Committee's
call for evidence for the inquiry into UK's preparations
for a potential outbreak of pandemic influenza". The Society
would like to recommend that the Committee consider the following
points when conducting its inquiry:
1. The majority of cases of pandemic influenza
among human reported to date have emerged in south east Asia where
avian flu is endemic. However it should be noted that pandemic
influenza could emerge elsewhere in the world. For example, the
USA, South Africa and Canada all reported cases of avian flu in
2004 and the Netherlands recently reported human deaths from avian
flu. Furthermore, the UK is in the flight path of migratory wild
fowl from Siberia and central Asia, areas in which avian flu has
been reported. It is therefore essential that any assessment of
risk should be considered more broadly than solely emergence from
south east Asia. It is of further concern that many surveillance
organisations such as the Centre for Disease Control and Prevention
in the US are reporting the spread of a strain of avian flu in
south east Asia with an increased pathogenicity in a wide range
of bird and mammal species.
2. The Society believes the UK is strongly
placed to develop modelling-based scenarios on the possible routes
of human transmission and propose possible containment strategies
based on these scenarios. Development of these scenarios can be
used to anticipate which combinations of interventions are best
applied, given the current and future availability of drugs and
vaccines. Furthermore these scenarios will benefit from the addition
of epidemiological and clinical data which will further inform
interventions that may need to be made.
3. If an outbreak is due to a strain for
which an existing vaccine is available it will be possible to
offer protection as long as adequate production facilities exist.
It is important to note that there is not currently a vaccine
against the H5N1 strain of avian influenza that is licensed for
human use in the UK. Vaccines should be developed against strains
of avian influenza virus, but these may not be effective if a
virus mutates into a form that is easily transmissible to and
between humans. Therefore vaccines should be modified and updated
to keep pace with the evolution of the viruses. To ensure that
the development, manufacture and distribution of vaccines will
be effective the Government needs to put mechanisms in place to
ensure that the quality and supply of vaccines in the UK are maintained,
rather than being bought from the private sector on the open market.
It is likely that vaccine companies will not make large profits
from vaccines as the costs of updating their technology compared
with the potential usage could make it unviable. If necessary,
the Government should consider underwriting the cost and liability
of developing this new production technology.
4. In the event of a pandemic influenza
outbreak it would be preferable to have a rapid and inexpensive
diagnostic test available at the GP clinic and for bedside"
use. Current diagnosis is laboratory based and takes much longer
for results to be available to the prescriber than the narrow
window of opportunity (approximately 48 hours) that exists for
effective utilisation of antivirals after exposure to influenza.
Any dip stick" style test will require an appropriate
level of sensitivity and accuracy that allows a clear diagnosis
and typing of the virus strain. The Government should consider
allocating research funds for the development of such a test.
In the mean time, further research should also be conducted to
increase the accuracy and decrease the time taken for laboratory
based diagnosis. The widespread availability of a rapid diagnostic
test may also have implications for prescribing of treatments
outside of the GP surgery in an outbreak scenario.
5. Antiviral drugs can be used in the early
treatment of influenza as well as prophylatically in those at
risk. Government needs to initiate research on the use of antivirals
on a prophylactic basis, the development of possible resistance
to an antiviral treatment and the subsequent transmission of resistant
6. The Society is concerned by the loose
definition in the Department of Health pandemic influenza contingency
plan of an essential worker" (someone who would receive
antiviral treatment) and at what time they would receive the antiviral.
This definition should include not only workers in the healthcare
sector but other personnel involved in the maintenance of critical
national infrastructure such as power, finance, water and government.
A strategic decision on the priority of treatment given to essential
workers also needs to be made. It is essential that the number
of doses of antivirals and vaccines, if appropriate, available
in the UK is at least sufficient to cover all essential workers
identified in the contingency plans.
7. The globalisation of the economy means
that infections now have the potential to spread rapidly around
the world. A previously local epidemic now has the potential to
become a pandemic. It is essential the UK Government does not
focus entirely on stopping a pandemic at source through the use
of antivirals but instead considers a broad range of interventions
such as modelling based scenarios and developing new vaccine production