Examination of Witnesses (Questions 160
- 179)
MONDAY 25 FEBRUARY 2008
Professor Peter Borriello, Professor Mike Catchpole,
Professor Francis Drobniewski and Professor Peter Chiodini
Q160 Lord Desai:
If the only point of ECDC is that the Euro section of the WHO
does not have enough resources, would it not be better to give
resources to the WHO and not have ECDC? That would save duplication.
Professor Borriello: ECDC was established by
the European Union to which all nation states have an input and
a vote and they agreed to its establishment. The debate as to
whether or not those functions could have been discharged by an
existing body—I would be surprised if that was not debated—I
think is above my level to respond to. They do discharge slightly
different functions.
Q161 Lord Desai:
Do they interfere? Do they make it more difficult to coordinate
response?
Professor Borriello: The issue that we have
already alluded to is that there needs to be some clarity in certain
areas between the WHO Europe and ECDC. They are in those discussions
but the debate on the extent to which another body that already
existed could have undertaken those functions must have taken
place elsewhere. It was not one that we were engaged in.
Baroness Falkner of Margravine: I slightly
disagree with the premise of your question. In addition to the
political or institutional factors which you pointed to in terms
of how it was set up and why, would it not also have a logic in
its existence, ECDC, in the future direction of travel, which
is to have a more integrated Europe-wide healthcare approach?
As our systems are becoming more integrated, as people are travelling
across the boundaries, there is a more Europe-wide national health
market being created and that would seem to me to be the logical
direction.
Q162 Chairman:
I understand your point but we are in danger of drifting into
the European Community here. Do you have a quick response to that?
I am not saying it is irrelevant but there is a distinct dividing
line between what the House's European Union Committee does and
what we are doing.
Professor Borriello: At the intergovernmental
level, as healthcare provision becomes more plural within Europe,
there does need to be a body that looks at healthcare acquired
infections for example, and their associated risks at European
level. ECDC as a body could and probably should do that.
Q163 Baroness Eccles of Moulton:
The core of my question is the integration of animal and human
disease surveillance as a result of the increasing emergence of
new infections which are transmitted from animal to human. But,
before we get on to the core of the question, I think it would
be interesting and useful to know why it is that this particular
form of transmission from animal to human is becoming of increasing
importance and is an emerging source of infection and, very quickly,
what the reasons are. We probably do know them but I think it
would be helpful if we could just have that clarified.
Professor Borriello: Zoonose, transmissions
from animals to humans, are not new. TB was probably one of the
first that we can have some accurate records on. In essence, we
need to view ourselves as part of the mammal population of the
planet and transmission is not one-way; we also infect animals.
In essence, we are part of a big, major, common reservoir but
for centuries our concentration on identifying the pathogens and/or
combating them has concentrated on ourselves as a species and
ignored the rest of the mammal population and others. New diseases
emerging? The classic example has to be HIV and probably that
is an example of things that have happened many times in the past
with other infections. The converse is also true. The reason it
happens probably more commonly now is just that we now recognise
them more but of course there is increased exposure to wild animals
by what you might consider naïve populations. Earlier in
our existence there was not a lot of contact. For centuries then
there was none other than with domesticated animals. Now there
is increased contact either in zoos or with exotic pets or by
foreign travel, going to these sorts of places to see wild animals.
Then there is pressure in Africa and other parts of the world,
the use of bush meat and encroachment. It is increasing the risk.
It is considered or thought that SARS probably arose that way
by association with bush meat.
Q164 Baroness Eccles of Moulton:
It comes much more from animals in the wild than from domestic
animals?
Professor Borriello: CJD would be a classic
example where that was not true but, by and large, that is probably
the case because we have been with domestic animals and husbandry
for so long that what is there we have already been exposed to
and what is new would be picked up very quickly if it affected
animals because of the economic impact on livestock.
Q165 Baroness Eccles of Moulton:
If we come to the surveillance point, it says that the two bodies
that are mainly responsible for animal and human surveillance
are not very integrated. They tend to operate separately. Would
you support that?
Professor Borriello: No. I will qualify the
no. The animal side and the human side for known zoonose work
very closely together. Of course they could work closer still
but within this country at least they work very, very closely
together. I can give you many examples in writing later if you
wish. The one area where that interaction is not sufficiently
strong is on what you would call fully integrated surveillance
where we can match patterns of human disease and newly emerging
syndromes in humans to newly emerging syndromes or diseases in
animals and to have the two bits of intelligence in some way brought
together, analysed and undertaken at that level. Analysis does
take place but it is at the sharing of intelligence around a table
level, not at the IT supportive level and that is the next step
where we would like to see some improvement. Of course the problem
with zoonose in general is that it always falls between two areas
of responsibility and it always begs the question who is meant
to fund which bit. It is not quite so easy. If it is health, whatever
answer we get, we know where to go. If it is animals, whatever
answer they get, they know where to go. If it is zoonose, it is
so easy to end up being batted backwards and forwards.
Q166 Baroness Eccles of Moulton:
Even without that, surely the fact that the emerging infections
on the animal side of the equation are in the wild must make it
incredibly difficult to track down and get hold of?
Professor Borriello: Absolutely, which is again
a totally different thing. By and large, on the veterinary side,
it is for the analysis of current livestock.
Q167 Baroness Eccles of Moulton:
Very little of it is generated on the domestic scene. It comes
out of the wild?
Professor Borriello: Absolutely.
Professor Chiodini: Certainly from my point
of view, I deal almost exclusively with parasites and here I am
talking about parasites other than malaria, which is not a zoonosis.
In many cases the synergy between the veterinary specialist and
the medics is crucial to control. For example, hydatid disease
requires good animal husbandry, de-worming of farm dogs etc. Trichinosis
is another good example. Parasites over millennia have taken advantage
of the proximity of humans and their domestic animals to infect
us. As parasitologists, we rely greatly on liaising with our veterinary
colleagues in order to work out control programmes and so on.
Q168 Baroness Eccles of Moulton:
It is fascinating, and obviously we could go on talking about
sources and all that. But perhaps we should get back to what we
are here about, which is what you can see as a way forward in
getting closer integration between the animal side and the human
side.
Professor Borriello: A number of committees
are already now in existence which have full representation of
the animal, the human and the food side. The National Expert Panel
for Newly Emerging Infections has that plus the Devolved Administrations,
so it is fully intergovernmental within the UK. Across the board,
though, it is not quite so true in a number of countries abroad
where the health, the vets and the food have no linkage whatsoever.
Q169 Chairman:
That is a major part of the problem, is it not, in some developing
countries?
Professor Borriello: It is, and in some developed
countries they have evolved separately. To be blunt, if you went
back 20 years in the UK outside parasitology—Salmonella
etc.—there was not that much interaction. The Memorandum
of Understanding between what was then the PHLS and the VLA, the
Veterinary Laboratories Agency, is only about 12 years old. Even
for us it was a recent awareness, and structures were put in place
to improve that. In many other European countries it does not
exist at all.
Q170 Chairman:
There is a lot of work to be done there?
Professor Borriello: There is.
Q171 Lord Geddes:
What vehicle could be used to achieve that objective?
Professor Borriello: The OIE.
Professor Catchpole: It is the animal equivalent
of the WHO.
Professor Borriello: Possibly it is to look
at the existing international, intergovernmental bodies and to
get them to agree to the creation of fora. In the UK the Chief
Veterinary Officer and the Chief Medical Officer meet. I cannot
say that was a consequence of BSE.
Q172 Chairman:
This might be the question about a new structure for the international
surveillance issue. That is what I was asking you to look at and
come back to us on, if you could.
Professor Borriello: Yes. Within that we may
need to bring in plants as part of that whole environment of disease,
infection and transmission.
Q173 Chairman:
We want to ask you about bio-terrorism. Can I ask if any of you
are constrained on this issue by the Official Secrets Act?
Professor Borriello: I do have clearance but
there are no obvious constraints. I will not know if there are
any constraints until I hear the question.
Q174 Chairman:
If you indicate to me, there is a number of ways I can deal with
it. The Clerk is pointing out to me, quite rightly, that you must
know at the moment that we are in public session. If that causes
you a problem, perhaps you could indicate to me.
Professor Borriello: I will do so.
Q175 Baroness Whitaker:
I was interested in not only bio-terrorism but also the International
Health Regulations. My neighbour, who was anxious to ask the question
originally, says that there was a lot of fear in regard to the
Iraqi war in Kuwait that there would be biological attacks made.
I am aware that there is quite a powerful convention for chemical
weapons. Of course, it does not completely eradicate capacity
and the suspicion is that there are chemical weapons around. But
at least there is an international norm about chemical warfare.
As far as I know, there is no international norm to deter biological
warfare. Do you think it would be useful to have one? And would
you recommend we take any further steps than those we may be taking
to combat the threat of potential biological warfare?
Professor Borriello: My answer to the first
part of the question is quite simple, in that I was unaware that
there are not any existing criteria on limitations or restrictions
on biological weapons for warfare, but that would be my ignorance,
not anybody else's. I certainly know that there are committees
in existence, international and intergovernmental, that discuss
these issues as well as agree on removal of stockpiles and agree
on no use of certain agents.
Q176 Baroness Whitaker:
International agreements?
Professor Borriello: That is my understanding.
Certainly there is an expert in the HPA, among the other experts
you have access to, who could clarify that directly, if you wish
to put that question, directly in writing.
Q177 Baroness Whitaker:
That would be helpful.
Professor Borriello: The second part of the
question was?
Q178 Baroness Whitaker:
Was there anything else that we ought to be doing in the absence
of a convention?
Professor Borriello: The use of infective agents
as weapons, we know, is not new and has happened throughout warfare
to varying degrees. The real question is the extent to which natural
agents could be used, particularly if there were a fear, of course,
of smallpox because the population is now naïve: could somebody
release smallpox? The same could be true in the future, say, of
polio. As the world eradicates certain pathogens, the population
becomes naïve, there are no vaccinations, therefore the release
of such an organism, if it is retained, could have quite devastating
effects. There is then the issue of the extent to which people
could engineer pathogens, could create an animal pathogen to become
a human one. Increasingly, our knowledge and the science take
us to the position where that can be achieved. That is a slightly
different set of control regulations and considerations, the creation
of something damaging, to make it more dangerous, more virulent,
putting in lots of antimicrobial resistance, putting in masking
agents and all sorts of things, but that is quite a degree of
sophistication. The fact that that degree of sophistication existed
within countries and was developed at State level shows it is
possible to do. Could any of that still exist and be made available
to terrorists? Or could terrorists ever commission somebody to
make such organisms? I think it is on those grounds that there
is a fairly concerted global intergovernmental response, saying
"How can we control this problem and how can we be better
alerted to spot it if it starts to happen?"
Q179 Chairman:
There are some agreements on biological weapons actually, but
the key bit in a sense, as Baroness Whitaker was highlighting,
is that some could be produced on a relatively small scale, almost
by individuals; some could be produced in a way that would constrain
their development geographically, i.e. they could only spread
so far; others could be spread on a much wider basis. I suppose
the key question here is how much are the Intergovernmental Organisations
looking at that, in your understanding?
Professor Borriello: They are looking very carefully,
and one of the surprising things that comes out of most of the
analysis is how difficult it is to deliver an agent to cause a
massive problem quickly. It is the delivery end which is where
most of the sophistication is needed. To be blunt, growing anthrax,
even with the restriction of transfer of anthrax organisms between
countries—and there are great restrictions—any microbiologist
could go and dig up some soil in country Z and stick it in some
broth and grow the thing. It is not that they do not exist; they
are all over the place. Growing it to a sufficient level and then
weaponising it is where the limitations are. It is certainly true
that the risk is high, the desire to pursue such developments
is high, and the consequences could be high.
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