Examination of Witnesses (Questions 360
- 366)
MONDAY 10 MARCH 2008
Dr Christopher Conlon, Dr Maureen Baker, Dr Helen
Williams and Dr Imelda Bates
Q360 Chairman:
Am I also right in saying that, presumably, the mechanisms you
have in place to identify and then deal with an outbreak of a
normally occurring pathogen would not in any event be different
from what you would have from one that was spread by unnatural
causes, if you like, by a state or a non-state player. Is that
right?
Dr Conlon: Yes.
Q361 Chairman:
Would the rest of you agree with that?
Dr Baker: I think at this stage I would like
to say that the work that has gone on in the UK on pandemic planning
is a very good model for dealing with a major outbreak of communicable
disease regardless of how it arises. It makes much more sense
probably to model on something that is reasonably likely to happen
at some point but to be able to draw upon that work in the event
that the next major outbreak is not pandemic flu but something
unknown. That would seem to be a good use of the resource and
the energy that has gone into pandemic planning. It is a good
thing to do from the point of view of that level of preparedness,
but it should also serve as a model for dealing with very many
other possibilities that could arise.
Dr Williams: Could I just add to that and say
that the detection of any disease, whether it is bioterrorism
or a naturally occurring one, depends entirely on having a good
infrastructure, which is about having alert clinicians when patients
present, it is about having good diagnostics available, people
thinking outside of the normal things when something is abnormal
and having good surveillance systems and good communication systems
in place to actually deal with it. In this country we do have
quite a reasonable surveillance and alert system.
Chairman: I have heard a number of quite
good things said about the system here.
Q362 Lord Hannay of Chiswick:
I want to follow this up a little bit further, because this is
not the first time that witnesses have said that there is not
a real distinction between a bioterrorism event and the outbreak
of a communicable disease of an unknown nature which comes suddenly
upon the world and threatens to spread very rapidly. Do you think,
therefore, that it would be helpful if governments stopped dealing
with these two things in two separate kinds of categories and
admitted that they were phenomena of a very similar kind which
would need very similar responses and, therefore, got away from
an argument about whether or not bioterrorism was terribly likely
to happen? That seems to me slightly dodgy territory because,
although you are probably right that at the moment it is a very
inefficient way to take terrorist action, I doubt any of us could
put our hand on our heart and say that it would still be as inefficient
in 30 years' time. If it is true that there is not a real distinction
between these two things, would it not be much better if they
were addressed internationally as a kind of single group rather
than as two different groups?
Dr Conlon: I think that is the point that Dr
Bates was making. I have sat through smallpox scenario planning
meetings and I have sat through a lot of pandemic flu planning
meetings; they are exactly the same. One is much more likely than
the other but the planning is the same, the infrastructure you
need is the same; you have to make sure that you have the infrastructure
in place that works and you can recognise that. That involves
clinicians and laboratory scientists being aware of the possibilities.
There is no difference particularly other than saying that, if
it is a new virus and you do not have a vaccine for it, it is
slightly trickier than a virus you do have a vaccine for, which
is the only argument for vaccinating against smallpox possibly.
Q363 Lord Hannay of Chiswick:
Presumably, the countries which are most vulnerable to this sort
of thing are developing countries because they have very little
capacity either to spot the thing in the first place or to take
action thereafter. They might respond more readily if it was not
said that what they were doing was guarding themselves against
bioterrorism—which they probably think is a completely zero
threat to them—but that they were guarding against an unknown
infectious disease, which they probably realise could be a very
real threat to them. If their responses and defences are the same,
it seems to me to be unhelpful basically to put two different
labels on it.
Dr Conlon: The SARS outbreak a few years ago
and the current avian flu situation have focused people much better
on what the problems are and have actually made people get away
from bioterrorism. These are new diseases, what new infrastructures
do we need for these, how are we going to deal with this internationally?
I think things have got better from that point of view.
Q364 Lord Desai:
Just to add a comment, if you call it bioterrorism you get more
money assigned to it. Your evidence from the Royal College of
Physicians draws attention to the fact that migration is possibly
one of the major factors in spreading infectious diseases. Can
the WHO do something constructive about that, perhaps instruct
governments to screen immigrants or whatever?
Dr Conlon: Again I do not think the WHO can
do that. I think there can be guidance as to what may be useful
as screening tests for certain diseases but there are not many
that there easy screenings for. Tuberculosis is the one that is
characteristically talked about, but I commonly see people with
TB who have been screened at Heathrow or somewhere else, who were
genuinely negative on the screening but are still carrying the
disease a couple of years later. I think there are ways to screen
people, and it may depend on how acute the problem is, but it
is hard.
Q365 Lord Desai:
Does it make a difference whether you screen on boarding the plane
or upon landing?
Dr Conlon: It depends on the disease.
Q366 Chairman:
Are there any particular things you would like to draw our attention
to which could help on this because clearly world travel is one
of the factors in spreading disease. Are there any ways of dealing
with that that you can think of that are not before us?
Dr Conlon: Going back to what we have been talking
about all afternoon to some extent, if you increase infrastructure,
diagnostic treatment and abilities in other countries, it reduces
disease burden and therefore reduces the amount of disease travelling.
Chairman: Unless you have anything else
to add, that completes our session today. Thank you very much;
you have been very helpful. If you do have any other ideas or
thoughts about this session when you have read the evidence, or
before then if you like, please send them in. Thank you very much
for your attendance today.
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