Examination of Witnesses (Questions 340
- 359)
MONDAY 10 MARCH 2008
Dr Christopher Conlon, Dr Maureen Baker, Dr Helen
Williams and Dr Imelda Bates
Q340 Chairman:
So it is essentially identifying it and stopping it at source?
Dr Conlon: Yes. A good example, although it
is a much less contagious disease in terms of zoonoses, is the
ebola virus that has been happening in Uganda recently. It is
contagious locally with poor infection control but by getting
in there, finding the disease and controlling it locally—which
is what has happened—it is less likely to spread beyond
that, but you cannot do that without having the infrastructure
locally.
Q341 Baroness Falkner of Margravine:
I would just like to pick up the point you made about having travel
restrictions against citizens. As I understand it, the United
States does. The Disease Control Center at Atlanta can, in fact,
issue a travel ban against individuals?
Dr Conlon: Yes, and it was clearly circumvented
by a lawyer with TB without any clear repercussions last year.
Q342 Baroness Falkner of Margravine:
Yes, that is the case I am thinking of. The State does have the
power.
Dr Conlon: Yes, but that is for one individual
with a known, declared disease. When you start to talk about large
populations who are incubating a disease, it is very hard to stop
people travelling because you think they might have something.
Q343 Baroness Falkner of Margravine:
Would you recommend, in the case of people who are beyond the
incubation period, that there should be rules to prevent them
from travelling?
Dr Conlon: I think that, if somebody is actively
ill with a contagious disease which is a public threat, then yes,
I do. You can do that but I think it is very hard to implement
because of the incubation period. In a pandemic flu setting, if
somebody has a high fever, is coughing and looks terrible, you
can stop them getting the airplane, but the guy behind him who
has the same infection but is not symptomatic, how do you stop
him? That is where I think the intergovernmental organisations
would have a hard time stopping a pandemic.
Q344 Baroness Whitaker:
There might be an area where an intergovernmental organisation
could come in. I have been reading an article in The Economist
about something called the Global Viral Forecasting Initiative,
which is a chap in America who wants to spot the virus which is
going to jump from the animal to the human species. I am not competent
to know whether this is feasible, but he has a great programme
for that. Is that the kind of thing, do you think, that WHO could
reasonably commission research in? Is that the sort of thing they
should be looking at because it is not just human, it is looking
at the actual virus; it is virus hunting rather like butterfly
hunting, as it were?
Dr Conlon: I think the concept of WHO initiating
research is just wrong; they do not do it to any degree that is
helpful. If research has been done, more commonly initiated by
Research Council money or Wellcome Trust money or something like
that, then that research can be made more useable and made more
applicable to the local scene.
Q345 Baroness Whitaker:
They could facilitate the transmission of knowledge about such
a programme; they could not initiate such a programme?
Dr Conlon: They could but they do not; that
is not how they are designed to work.
Q346 Lord Hannay of Chiswick:
Is the question not more where the powers lie to impose restrictions
on travelling, whether they rely exclusively with 192 independent
governments or whether they lie partly with intergovernmental
organisations like the WHO and behind it other UN organisations
like the Security Council? These are not totally impossible concepts
but they are very difficult concepts. Surely what we are talking
about is not so much organising research about how to do this—although
that would be necessary but not done by these intergovernmental
organisations—but whether or not there should be powers
to do this and, if so, how should they be exercised in relation
to the powers that governments do have to quarantine situations.
Do we need world quarantine guidelines, arrangements or what have
you?
Dr Conlon: There are guidelines for travelling
with TB, but the WHO has no powers to implement them, so they
can only advise either governments or regions how to do that.
I am not an expert on international law, so I would not know how
it is actually effected, but the WHO would have no power to do
anything; they can only recommend things.
Q347 Lord Hannay of Chiswick:
Unless they were given it?
Dr Conlon: Yes, but I cannot see that happening;
maybe I am wrong.
Q348 Lord Geddes:
Both Dr Conlon and Dr Bates have advertised very strongly that
it is not up to WHO to instigate research, is that right?
Dr Bates: I think they can identify the question
but they should not do it; they should then commission academic
institutions to do the research.
Q349 Lord Geddes:
I think your two views are slightly at odds because I thought
I heard that they should not instigate research, but actually
what you are saying is that they should instigate the research
and get somebody else to do it.
Dr Bates: What they need to do is to say, "We
have a policy for malaria but we do not have any evidence around
this bit of treatment, so we need evidence"; and they can
then commission some research to fill that gap. They would not
know the exact research questions to ask.
Q350 Lord Geddes:
Would you go along with that?
Dr Conlon: I think they are not actually sufficiently
academic to even commission research in the way I think you are
interpreting Imelda's comments. I think what they should say is,
"There is a problem and we would like research done in this
area; it would be nice if somebody did that", but the WHO
very rarely is going to commission basic science or basic clinical
research. They might look at operational research as to how it
is employed in the field; that is how I would see it.
Q351 Baroness Eccles of Moulton:
This, then, comes to the question of funding. You can only commission
if you can pay. I thought commissioning meant you could actually
say, "Do this and what's it going to cost?" and get
people to tender. Can they actually do that?
Dr Bates: The WHO do not have any money but
what they can do is lever money from other organisations.
Q352 Baroness Eccles of Moulton:
So they turn the idea out and hope somebody picks it up?
Dr Bates: Yes.
Q353 Chairman:
Do they approach organisations or countries or whatever?
Dr Bates: Sometimes but mostly not, in my experience.
Q354 Chairman:
They just put the idea out there most of the time and hope somebody
responds. Is that your experience is it?
Dr Bates: Yes.
Q355 Lord Desai:
I would have thought that other people are also picking up and
throwing out ideas; WHO is not the only one. It must be a very
collective effort.
Dr Bates: In practice the way it works is that
WHO themselves do not know where the evidence gaps are because
they may not be academic enough to see the holes in the policy.
What tends to happen is that other organisations proactively go
to WHO and say, "Look, your policy does not add up; you need
some more evidence around this area". Sometimes it is picked
up and sometimes it is not, and sometimes they will pick it up
but there is no funding.
Q356 Lord Desai:
If you want money to do research that you have identifoed, does
it help to say, "WHO supports us"?
Dr Bates: Absolutely. If you can go with WHO
to a funding agency you stand a much better chance of getting
money.
Q357 Chairman:
Moving onto bioterrorism, I think the Royal College of Physicians
were rather dubious about the problem of spreading pathogens by
artificial means. Can you say a little more about why that is?
I would also like to know whether, when you talk about pathogens,
you are talking about the human variety or indeed the variety
that applies to crops.
Dr Conlon: The argument is based on human pathogens,
and I think most of us would think that biological warfare in
that sense is pretty inefficient and, therefore, is unlikely to
be a major player in a terrorism event. If you were going to cause
terror, it is much better to have dirty radiation rather than
smallpox or something that is not that easily transmissible. I
think the argument we put forward is that quite a lot of effort
went into this a few years ago, a lot of us got vaccinated, there
is a lot of money going into education about smallpox and seminars
on bioterrorism, whereas in fact MRSA and CDiff and things like
that were getting less attention at the time and are much more
of a problem.
Q358 Chairman:
What about wheat germ, foot and mouth, and things of that nature?
Do you take a similar view?
Dr Conlon: I take a pretty similar view. They
are all pretty inefficient ways of terrorising countries.
Q359 Chairman:
That is, presumably, because of the problem of weaponising these
things and transporting them, as opposed to chemicals or radiation,
which is so much easier to transport?
Dr Conlon: Yes, and disseminate.
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