APPENDIX 2: CALL FOR EVIDENCE
The Committee has decided to undertake an inquiry
into the effectiveness of action carried out through intergovernmental
organisations of which the UK is a member to control the global
spread of communicable diseases. You are hereby invited to submit
written evidence to the inquiry. The deadline for submissions
is Monday 21 January 2008.
About the Committee
This is a new Select Committee of the House of Lords,
the Upper Chamber of the British Parliament. It was established
in November 2007 with the following remit:
"To consider how contemporary issues of international
policy are addressed through United Kingdom membership of intergovernmental
organisations (excluding the European Union), including their
impact and value for money".
The Committee's approach to its work is a thematic
one—that is to say, it focuses on specific policy objectives
and examines how these are being addressed via action through
intergovernmental organisations. The EU exclusion reflects the
fact that the House of Lords already has a European Union Committee.
However, while scrutiny of EU activity per se lies outside
the new Committee's remit, it may examine the interface between
activity by the EU and by non-EU intergovernmental bodies. The
Committee's remit is also limited to intergovernmental
organisations and thereby excludes non-government bodies. However,
the Committee is interested to hear non-government as well as
government and intergovernmental perspectives and both types of
organisation are therefore invited to submit written evidence.
The Members of the Committee are:
Lord Avebury, Lord Bowness, Lord Desai, Baroness
Falkner of Margravine, Baroness Flather, Lord Geddes, Lord Hannay
of Chiswick, Lord Howarth of Newport, Lord Jay of Ewelme, Lord
Soley (Chairman), Lord Steinberg and Baroness Whitaker.
About the Inquiry
Infectious disease knows no national boundaries.
The rapid spread of HIV/AIDS during the last 20 years, the more
recent outbreak of SARS (Severe Acute Respiratory Syndrome) and
now H5N1 Avian Influenza have underlined the importance of international
action to control the spread of such diseases before they become
pandemics. At the same time other infectious diseases, such as
Tuberculosis and Malaria, have become greater threats with the
emergence of widespread drug-resistance. Drug-resistant TB has
claimed many lives both in the UK and elsewhere, and the death
rate from Malaria in infancy and childhood is high in many parts
of the world—over 3,000 people die every day from the disease.
In addition, with climate change, areas of the world which have
hitherto been Malaria-free are becoming threatened by the disease,
as the anopheles mosquito shows signs of spreading more widely.
This is not the first time that the House of Lords
has addressed the subject of communicable diseases. In 2003 the
Science and Technology Committee reported on the impact of infectious
diseases in the UK and its report underlined also the importance
of international collaboration. In 2005 the same committee conducted
an inquiry into Pandemic Influenza. Its report was focused primarily
on the measures which the UK Government was taking to deal with
an outbreak of the disease if one should occur, but it noted also
that prevention is better than cure and that there is a need for
increased collaborative action with source countries in order
to arrest the disease before it begins to spread globally. The
present inquiry is focused on an in-depth examination of action
through intergovernmental organisations to control the global
spread infectious diseases generally and of Avian Influenza, HIV/AIDS,
Malaria and Tuberculosis in particular. The Committee wishes to
assess the overall effectiveness of intergovernmental action in
these fields and to explore the synergy with which the various
bodies involved are operating.
The Issues
This Call for Evidence is addressed to a wide range
of organisations. Some of them are national and others international
bodies; some of them fall within government while others are non-government
organisations; and some are focused on the control of specific
diseases while others are concerned with the field more generally.
In responding, therefore, you will need to be selective and to
answer those questions in which you consider you have an interest.
The principal issues on which the Committee would
welcome your views are:
1. A recent report on Communicable Diseases by the
UK Department of Health stated that "post-war optimism that
their conquest was near has proved dramatically unfounded".
What is your assessment of the overall position? More specifically,
is it simply that not enough progress is being made in reducing
the spread of such diseases? Or is the global situation actually
deteriorating? Would it be an exaggeration to talk of a crisis?
2. What reliable data exist regarding the numbers
of people infected globally with the four diseases[34]
on which the Committee is focusing particular attention? What
trends are discernible in both the numbers infected and the patterns
of infection? And what are the main underlying causes of infection
and of any changes in its incidence and pattern?
3. What intergovernmental surveillance systems exist
to give early warning of outbreaks of infectious diseases? Are
these systems adequate? And what improvements might be made?
4. Given the continuance of current or planned intergovernmental
programmes to prevent or control the four diseases, what predictions
can be made of their likely spread and pattern over the next 10
years?
5. What do you consider to be the principal blockages
to achieving progress in the prevention or control of the four
diseases? And how might these blockages be removed by more, or
better-targeted or better-coordinated intergovernmental action?
6. What role does your organisation play in combating
the four diseases? Do you believe that it is correctly configured
and adequately resourced to do the job? With which other organisations
do you collaborate? How would you assess the degree of synergy?
7. What are the main non-health causes (e.g. global
warming, poverty, changes in land use, international travel, lifestyle,
population) of the spread of the four diseases? To what extent
can intergovernmental action in non-health fields contribute to
alleviation of their spread? What action is taking place or planned
in these areas? And what more needs to be done? Do you consider
that there is sufficient 'joined-up' thinking in approaching the
problem?
8. Cases of Tuberculosis fell progressively in the
UK until the mid-1980s but started to rise again in the early
1990s. Around 6,500 cases are now reported each year, an increase
of about a quarter since the early 1990s. What are the main factors
of the revival of Tuberculosis infections in Britain? And how
could intergovernmental action help to reverse the trend?
9. Tuberculosis is potentially curable by long-term
antimicrobial therapies. Yet the numbers of reported cases worldwide
seem to be rising. Are the necessary medicines not getting through
to patients? What are the barriers to effective long-term therapy?
Are we now seeing infections which stem from other conditions—e.g.
HIV/AIDS? Or are there other reasons why a treatable disease should
be spreading? How might intergovernmental action help to deal
with this situation?
10. To what extent do you believe that the 2004 Stockholm
Convention limiting the use of DDT against Malaria-carrying mosquitoes
has been a factor of increases in the spread of the disease? Has
any risk analysis been carried out comparing the relative dangers
to human health posed by DDT and Malaria?
11. What intergovernmental action is planned or in
hand for early detection of the transmission of Avian Flu from
birds to humans and of human-to-human transmission in potential
source countries? Is this proving sufficiently effective to prevent
an Influenza pandemic? What more could be done?
12. To what extent do you consider that the rise
in infections in the four diseases is attributable to increased
microbial resistance to antibiotics? What intergovernmental action
is taking place in this area?
13. In a number of countries, including the UK, there
is a problem with hospital-acquired infections. What intergovernmental
sharing of knowledge is taking place to help bring this problem
under control?
14. Are there any difficulties with regard to patents
or intellectual property which are impeding the flow of medicines
or other control methods to those infected? Is intergovernmental
action needed to improve the situation?
15. What interchange exists between States in regard
to knowledge of and training in the diagnosis and treatment of
the four diseases or regarding preparations for dealing with outbreaks?
What improvements might be made through intergovernmental action?
16. The International Health Regulations 2005 are
intended to provide a global framework for the rapid identification
and containment of public health emergencies. How effective do
you consider this response system to be? Do improvements need
to be made?
17. What intergovernmental planning has been undertaken
to cope with the impact of an outbreak of infectious disease caused
by deliberate release of micro-organisms into the environment?
Is there adequate liaison between the various agencies involved,
including intelligence, law enforcement and health care professionals?
How could action by intergovernmental bodies help further?
18. Though our remit is focused specifically on known
infectious diseases, we would be interested to know how you view
the global threat from new or previously unrecognised ones and
from the transmission of infections from animals to humans.
19. What resources (subscriptions, staff, training,
medicines etc) does the UK Government commit to intergovernmental
bodies to help in the fight against the four diseases listed?
20. Do you wish to provide any other relevant information
in addition to what you have said in answer to the above?
34 HIV/AIDS, Tuberculosis, Malaria and Avian Influenza Back
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