Examination of Witnesses (Questions 120
- 136)
MONDAY 18 FEBRUARY 2008
Professor Gill Walt, Dr Richard Coker and Professor
Janet Hemingway
Q120 Chairman:
You cannot fully separate them out in that sense, can you?
Dr Coker: You cannot, no.
Chairman: Can we move onto the important
issue of human flu versus avian flu.
Q121 Lord Jay of Ewelme:
Could you help, first of all, with an analytical point because
I have never been entirely clear about this. Am I right in thinking
that there are actually two quite separate things here. There
is avian flu in the sense that there is a risk that there may
be a jump across the species barrier and we may all start communicating
among ourselves what is now avian flu? Separately, quite independent
of that, is there the risk of a flu pandemic of the kind that
we have had every 30 years over the last 200 years or so and ought
to be expecting another one? Are those separate? Is what you are
saying that we are focusing too much on the former and not enough
on the latter? I wonder if you could say a little bit about that
and what you think international organisations ought to be doing
to ensure we are properly prepared for the outbreak of either.
Professor Hemingway: You are largely correct
in your analysis and I think there is a large potential risk on
both sides, and it is how much you put onto both sides. What more
should we be doing and how should we be geared up is a difficult
one.
Q122 Lord Jay of Ewelme:
By saying that there has been too much emphasis, at least in some
countries, on avian flu and not enough on pandemic flu suggests
that somebody ought to be doing a bit more at least on the risk
of pandemic flu?
Dr Coker: We wrote that partly on the back of
an analysis of national strategic plans in Africa, where substantial
efforts from the international community focused on animal surveillance,
poultry surveillance, in culling and protection of the poultry
economy and so forth. What those national plans do, however, is
that they address avian flu and they disregard almost completely
pandemic human influenza. I suspect the reason for that is that
much of Africa would be incapable of responding to a pandemic
of human influenza. That means that the focus needs to be on stamping
out avian influenza before it becomes pandemic human influenza.
If we have a global pandemic, then Africa, as everywhere else,
will be affected. It also means that we have no strategic plans
in readiness for a pandemic of human influenza in large parts
of the world.
Q123 Lord Jay of Ewelme:
Is there any particular reason why pandemic influenza should break
out in parts of the world where there is avian flu?
Dr Coker: The epicentre of the next pandemic
of human influenza is likely to come from areas where there is
substantial avian influenza, because the change in the virus will
occur there. In all likelihood it will occur there because that
is where the greatest density of poultry is, where the greatest
number of strains of the virus are. In my view it is likely to
come from South East Asia or China because of the density of poultry.
Q124 Chairman:
This is the issue which we touched on earlier about the lack of
surveillance between the agricultural and the human.
Dr Coker: Exactly.
Q125 Chairman:
That is the key thing, and if there were more surveillance of
that switchover between the agricultural and the human we would
have a better chance of spotting when a human pandemic was beginning.
When the mutation takes place, presumably you would get the first
few cases of human pandemic flu; but, if you do not spot it at
that stage, it becomes a pandemic a short period down the line.
Have I understood that correctly?
Dr Coker: Yes, and if you go back to medical
school you will ask the question "What is surveillance for?"
Surveillance is information for action and, if you cannot act
in response to your surveillance, then that poses the question
why you are bothering with surveillance.
Q126 Lord Jay of Ewelme:
Even if there was not avian flu at the moment, am I not right
in thinking that we ought to be worried about a flu pandemic simply
because historically these come around every generation and we
have not had one for a while?
Dr Coker: There are always different strains
of avian influenza circulating.
Chairman: I want to move on finally to
trade versus health, which we maybe need to clarify.
Q127 Lord Howarth of Newport:
If global prosperity is to increase and the benefits are to be
felt throughout the world, then we need mobility. There is, of
course, an enormous increase in human mobility across the globe
and trade is an aspect of that. Migration of people on a very
large scale is another. Unless we can produce the wealth, we will
not get better healthcare systems and we will not see the other
benign effects of the alleviation of poverty. On the other hand,
the more people are free to move about, the more transmission
of infectious diseases is likely to occur. Clearly we cannot stop
world trade, but is there at least some discussion between the
organisations that have leading roles in these respective fields,
the WTO and WHO, for example? Do they reflect upon this dilemma
together?
Dr Coker: I am sure they do. I think the question
about trade is absolutely critical because, if we look at the
emerging zoonoses—the emerging diseases—over the last
20 years, most of them have come from animals. They have come
from animals either because of the movement of animals or because
of the differences in how we look after our animals. With BSE,
with SARS, with pandemic influenza, the driving force is the economy,
that is what drives our changes in practice and the movement of
goods. That is what threatens public health. I think there is
an emerging debate about this, not just in the spheres that we
are familiar with, but you just need to look at Jamie Oliver and
so forth and think about how we look after food and how we deal
with our relationship with food to recognise that the relationship
between trade and health is inextricable. We pay £1.50 for
our chickens because they come from Thailand or wherever and the
way they are looked after in some countries encourages the emergence
of infectious diseases.
Q128 Lord Howarth of Newport:
We can narro the problem down to some more specific issues such
as that. Can you see scope for effective international intervention
via the intergovernmental organisations? The difficulty in world
trade negotiations is that we are all the time dealing with the
excuses that are put forward for continuing protectionism, and
this would be another wonderful excuse for protectionism—to
stop imports from countries where there were large question marks
about the health and safety of food products. Can you envisage
that there could be some useful disciplines or some useful routines
applied in the way that world trade is regulated and developed
to reduce the risk of transmission of infectious diseases while
not seizing up trade?
Professor Hemingway: To take the example you
have with chickens coming from Thailand, the way that the chickens
are looked after in Thailand for that trade is now dramatically
different to the way it was a few years ago because there is now
a much lower tolerance, for example, of aflatoxin contamination
within those broiler chickens because they are for the international
market, and so the home market within Thailand has had to change
the way it works. There are only two distributors of chicken feed
within Thailand and both of those chicken feed manufacturers have
to work within more restricted norms. In some ways, because you
have opened up the international market, you have actually improved
the animal husbandry that is going on over what it would normally
be.
Q129 Lord Howarth of Newport:
Somebody has suggested health impact assessments; is that meaningful?
I am not quite sure where the idea came from.
Dr Coker: Sorry?
Q130 Chairman:
There is a suggestion that, if you made a health impact assessment
of certain types of food which might be at risk, for example you
could say that in Thailand there is a risk factor and that might
put pressure on the government to do something more about it.
Dr Coker: I can imagine that is possible.
Q131 Lord Desai:
To take an example, there is a chicken flu epidemic in West Bengal
and they had to slaughter very many more chickens than people
would like, but I want to ask you would BSE happen here? There
are certain bans on British beef exports everywhere, very instantaneous.
Obviously in some forms of animal products there is a very tight
form of prevention of trade if there is a health risk. Is it the
problem again that poor countries do not have such safeguards
or we cannot safeguard against imports from poor countries? Certainly
whenever there is the slightest evidence of BSE or foot and mouth
or anything, all countries stop importing British beef.
Dr Coker: That assumes that international trade
is the driver. But, if you look, for example, at poultry density
in southern China over the last 30 years, it is something like
a 3000 or 4000 fold increase in poultry density. That is not just
in serving the international market, it is serving a domestic
market as well. The potential consequences of generating new zoonoses,
they would impact on international trade but whether domestic
trade responds in the same way I am not sure. One only needs to
look, for example, at Thailand's neighbour, Vietnam, where most
of the poultry is backyard to see the contrast.
Q132 Lord Desai:
I presume one can only control poultry which is factory farming
but back yard farming cannot be controlled?
Dr Coker: It is difficult, but Vietnam was very
successful actually in dealing with backyard problems.
Q133 Baroness Whitaker:
Does WHO make representations to national governments about animal
husbandry with respect to infection? Or is there another international
organisation which deals with this?
Dr Coker: FAO.
Q134 Baroness Whitaker:
Do they have the same regional networks and so on? Are they active
in this way?
Dr Coker: They are, yes; they are very active.
Also there is a coordinating body.
Q135 Baroness Whitaker:
Do they link up with WHO?
Dr Coker: Yes.
Q136 Lord Howarth of Newport:
Looking at the kaleidoscopic system of international governmental
organisations interested in health it is hard to see what capacity
there is in the system overall to prioritise. I just wondered,
coming to your own institutions, how you have experienced that.
Both your institutions are very important international resources
for research. How free are you to determine your own priorities
for research? To what extent do you have to scramble around to
secure funding from one funder or another who have their own favourite
priorities and are willing to pay you to work in one field but
not in another? How possible is it for you to be selective, to
be strategic, to pursue your own preferred programme of research?
Professor Walt: It is a mixture, but we can
be strategic. It depends on our relationships with the various
funders, because we can go to them and we often have policy dialogue
about issues that are emerging and so on and, therefore, can suggest
areas to look at. At the same time, obviously, we are extremely
dependent on those particular funders; if they are not interested,
then we may not be able to pursue something. That would be my
view; I am in a different disciplinary field from my colleagues.
Professor Hemingway: I think it is actually
easier now than it was five years ago. I think it is easier because
there is more money in this area. We certainly decide strategically
from Liverpool's perspective what we are going to do and, more
importantly, what we are not going to do; which areas we are not
going to get involved in and where we are going to put forward
a very strong market and say that these are the areas that we
are good at, that we are internationally competitive at and where
we should be pushing. We have been fairly restrictive then in
terms of making sure that those are the areas we are going for.
I think we have also tried to make sure that we are well enough
connected in the system that we understand that that money is
not going to dry up in the next few years and that we are covering
a broad enough area so that we are balanced, and that there are
enough funders in those areas to be able to go for that. I do
think it is easier now than it was a few years ago.
Chairman: That is encouraging. Thank
you very much for that. If you get any more thoughts on any of
the questions that have been asked or indeed anything that we
did not ask that you think maybe we should have done in relation
to intergovernmental organisations, please contact the Clerk.
You will get the transcript of evidence, as I have said, and you
can correct any factual errors or make anything clearer if you
wish to do so. Thank you very much indeed for coming today and
giving us your time.
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