Select Committee on Science and Technology Written Evidence


Memorandum by Dr R L Salmon, Director, Communicable Disease Surveillance Centre, National Public Health Service for Wales

PREAMBLE

  1.  The submission is substantially confined to the Sub-Committee's particular questions. The views expressed are my own and based on 15 years as a regional epidemiologist in Wales, including some published research on the impact of the 1989 epidemic in Wales.

THE RISK

How is the risk of pandemic influenza emerging in south east Asia, and reaching the UK, being assessed; and how can this assessment be improved?

  2.  It seems inconceivable that there will not be another influenza pandemic, given that they have occurred throughout recorded history. How soon it will occur and whether H5N1 Avian influenza strains, circulating currently in the far east, will constitute the next human pandemic strain is very uncertain and could be said to represent a (well) educated guess. Nevertheless, sufficient authoritiative scientific authorities on influenza regard this to be of concern, that it would be unwise not to bring forward measures for influenza pandemic planning that are themselves necessary anyway.

  3.  Assessment might potentially be improved by harnessing a combination of molecular biological and information technology techniques. The ability of an influenza virus to infect a host (although not its subsequent virulence) is determined by the extent to which its haemagluttinin is adapted to bind with that host's cell's sialic acid receptors. Much is known both about the differences in haemagluttinin structure between avian adapted and human adapted strains and about the influenza genome and how these differences are coded for. This could permit an assessment of which nucleotides are critical coding regions for changes that would result in greater infectivity of humans. This would allow the a priori determination of what observed changes, in the genome and/or haemagluttinin molecule of currently circulating H5N1 viruses, should suggest emerging human adaption and should trigger a wider pandemic response, notably the large scale production and administration of an H5N1 influenza vaccine. I understand that certain British research groups, notably that of Queen Mary College, London, are involved in similar work to this. It would be worth seeking information as to progress and inquiring whether, in practice, it could be adapted in the sort of ways that are proposed.

How great are the risks, and what confidence can be placed in these figures?

  4.  The careful documentation of the impact of the three pandemics of the last century (1918-20, 1957-58, 1968-69), not to mention of the two years where previously encountered strains reappeared after an absence of some years (1976, 1989) allow intelligent estimates of the likely scale of the potential problem.

CONTINGENCY PLANNING IN THE UK

What is the current assessment of the likely impact of pandemic influenza on the UK (both in terms of health and on wider society, including the economy)?

  5.  The central planning assumptions, based on historical experience, anticipate a cumulative clinical attack rate of 25 per cent as a culmination of one or two approximately annual waves of pandemic activity, each of eight to 15 weeks' duration. This is very reasonable.

  6.  More speculative would appear to be some of the prognostications of wider societal breakdown. Previous pandemics in the 20th century did not result in this and it is difficult to advance the argument that society today is somehow more fragile than it was in those years. Nevertheless an influenza pandemic would be disruptive, although the historic experience suggests that this disruption is, with difficulty, manageable.

Are the measures described in the revised UK Influenza Pandemic Contingency Plan adequate to minimise the effects of a pandemic? What more could be done?

  7.  Work to introduce the necessary operational detail into the UK Influenza Pandemic Contingency Plan appears to be getting under way. It is necessary to recognise the critical role of the National Health Service, particularly Primary Care. The latter, which will have a key role in distributing antiviral treatments (below), is the key resource and engagement with general practitioners, community pharmacists and their representatives is vital and needs to be commenced urgently.

How well prepared and co-ordinated are health, emergency and other essential services for responding to a pandemic?

  8.  The development of emergency planning arrangements and local resilience fora, based on police force areas has been a helpful development, in a wider sense, for providing a focus for collaboration across the public sector more widely. However these arrangements were primarily designed to address major incidents unfolding over a few days or hours. They are less adaptable to the circumstance of pandemic flu where the problem lasts for several weeks and the key resources are in the health and related care sectors.

  9.  The health sector continues to digest various reorganisations and changes in contractual arrangements that are primarily aimed at reforming the delivery of personal health services rather than at public health. These affect the collaboration and co-ordination of infectious disease services, a problem that the Committee acknowledged in Fighting Infection. Thus, for example, organising the delivery of antiviral treatments and if appropriate, vaccinations, may prove to be more complicated in Wales than it might have been previously. This is, in part, a result of the abolition of the five health authorities and their replacement by 22 local health boards and of changes to the out of hours GP services brought about by the new GP contract.

What is being done to ensure that the general public are aware of the risks and likely effects of a pandemic, and of how they should react?

  10.  Welsh Assembly Government is, we understand, participating in the wider public communications package being organised by the Department of Health.

Is the UK's stockpile of antiviral treatments adequate, and how will it be distributed? What steps are being taken to ensure that the UK has access to sufficient antiviral treatment and vaccine in the event of a flu pandemic?

  11.  Once the UK's stockpile of 14.6 million doses is in place in April 2007, it should be adequate to treat the number of clinical cases that are likely to arise. Details of their distribution need to be worked out urgently and any potential contractual or legal obstacles ironed out.

What will be the role of vaccine development, manufacture and distribution in responding to a pandemic?

  12.  Traditionally, vaccines have only been available subsequent to the initial pandemic waves of a new influenza strain. They would then be incorporated into seasonal vaccination programmes.

  13.  A decision has to be made as to whether there is sufficient justification for vaccinating certain groups with the H5N1 vaccines being developed, at present. If not at present, then criteria for initiating such vaccination would be helpful. They could conceivably be based on molecular biological and information technology techniques (para 3 above).

23 September 2005



 
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