Examination of Witnesses (Questions 920
- 939)
TUESDAY 6 MAY 2008
Professor Harvey Rubin
Q920 Lord Avebury:
You said a few minutes ago, Professor Rubin, that you wanted a
mechanism for enforcing linkages; I wonder how you do that, particularly
with the military organisations that are mentioned in your evidence
such as ESSENCE (US Military Electronic Surveillance System),
the US Department of Defense Global Emerging Infections Surveillance
and Response System. These are military operations and they are
not going to take kindly to being told that they must adopt the
linkages which are suggested by some supra-national organisation;
and neither, I suppose, would the commercial companies, people
like Merck and Pfizer, who have got to come into the picture.
How are you going to tell commercial organisations that they must
conform to these supra-national structures and exchange data with
people who have an interest other than a commercial one in using
the information which is their intellectual property?
Professor Rubin: Lord Avebury, you read very
closely! ESSENCE is definitely in that list of surveillance organisations,
and I put that in there for completeness. It is clear that the
military may not be part of this; on the other hand, I was just
appointed to the Biological Cooperative Threat Reduction Programme,
which is funded by the United States Congress to the Department
of Defense to go out and indentify infrastructure resources to
ensure biosecurity in various countries around the world—the
most prominent in the last programme was the former Soviet Union.
There are areas in which the military will co-operate, there are
areas where they certainly will not. In terms of the private sector
there is a whole new movement out there—I am sure you will
know about this—the notion of public/private partnerships.
Q921 Lord Avebury:
But they are voluntary, are they not?
Professor Rubin: They are voluntary, that is
exactly right. But it is in their best business interest, so in
some sense, although it is voluntary, in terms of developing drugs
for the developing world many of them have already signed on.
The Commonwealth of Pennsylvania has just made antibiotic development
a State research priority and we have already had conversations
with major pharmaceuticals, where they will be part of a public-private
partnership. They have what are called non-progressing assets
in their freezers; non-progressing assets are compounds that have
gone through various stages of development as antibiotics and
have literally just been frozen away following a corporate decision.
It is not as business-wise as making other kinds of drugs, but
they are very willing, as it turns out, to share that information
and share those compounds. You are right, however, that there
is only a certain amount that we can start doing. But the notion,
just like the cluster bomb issue, is that once this thing starts
moving it will be seen, I believe, in the best business interests
and, perhaps, even by our respective militaries as providing force
protection. But that remains to be seen.
Q922 Chairman:
Lord Avebury's point you have answered to some extent, but this
question of these enforced linkages is a bit of a difficult one
to envisage when it is hard to see what force would be applied.
You are implying, I think, that eventually there would be an acceptance
that might stand legal challenge. Am I right?
Professor Rubin: You are exactly right. It starts
off in a sense voluntarily and then, as you get closer and closer
to a Treaty notion, it becomes more legislative and more enforceable.
I do not know that we will ever have to get there though, to be
very honest if we do—then we do; if we do not, I still think
that based on things like the Landmine Convention and other "soft
law" issues—the apartheid issue for example—many
of them started with "soft law" that may never require
legal intervention.
Q923 Baroness Whitaker:
Before I get down to the detail, could I just ask you very briefly
to paint a picture of what the world would be like if your Compact
was up and running? What would be the major changes?
Professor Rubin: If you allow me to be relatively
grandiose, because I want to paint the best picture, if we had
a fully developed compact, we may not have had SARS.
Q924 Baroness Whitaker:
Do you mean that people would not have got the infection? Or that
the animal infection would have been contained?
Professor Rubin: It would have stopped at a
small local outbreak in China, it would not have been the worldwide
outbreak.
Q925 Baroness Whitaker:
So the polecats, or whatever it was, would still have transmitted
the infection?
Professor Rubin: Right. In that case, with the
full-blown Compact, we would have been tracking even the zoonotic
infections, which is what Kate Jones's article suggests. Kate
Jones in Nature said we had to have what she calls "smart
surveillance", which actually includes the zoonotic infections.
This notion of smart surveillance can be based on embedded systems;
embedded systems include tiny sensors distributed everywhere.
The European Union had a study of embedded systems and there will
be 2.7 billion Euros devoted to so-called embedded systems, distributed
sensors with very fancy mathematical algorithms to encompass that.
Q926 Baroness Whitaker:
You predict that?
Professor Rubin: We will even get to the zoonotic
infections, but short of that, zoonoses going into humans would
have been picked up much earlier. One could even imagine—this
would have been remarkable—that we could have intercepted
HIV/AIDS at a much, much earlier stage. Imagine a world without
HIV/AIDS. We would certainly have better control over extremely
drug-resistant tuberculosis than we do today, because there would
be infrastructure built, there would be understanding of rapid
diagnosis that would come under the basic science research programmes
that we are suggesting; and then, if you add in the whole notion
of the profound economic impact of these diseases—and you
would know this better than I—the economic impact would
be much less an issue. Yes, sure, there are still going to be
infections, nature will also provide infectious doctors like me
with a livelihood. However, there would be much less potential
for pandemics, epidemics and overwhelming infectious disease on
a global scale.
Q927 Baroness Whitaker:
Would it be fair to say that what would happen would be much,
much better contained?
Professor Rubin: Absolutely!
Q928 Baroness Whitaker:
But that would not necessarily affect the diseases which are very
prevalent and not at all new, like Malaria, which require a developed
infrastructure to get the bed nets to the people, to get to the
rural areas, to have somebody trained enough to explain what is
needed, and that would be done by a different organisation?
Professor Rubin: No, I think it would still
be part of this. Why? Because being part of the surveillance programme
means that you have to start building the infrastructure, so the
big question is where is the money going to come from? There are
strategies out there: for example, a 0.005 per cent tax on international
currency exchanges would generate billions of dollars, so there
are strategies out there that could fund this.
Q929 Baroness Whitaker:
As I read your evidence, the original timetable which you have
for the drafting and signatures has now been revised, so you are
putting in further groundwork. Can you tell us if there are any
NGOs or IGOs joining in this process and how it is going?
Professor Rubin: That is a good question, and
I have thought about that because I was sure you might want to
know who else believes in this crazy idea. There are a number
of NGOs and IGOs that have at least heard about the story; it
has not become their main mission of course, but it has become
part of their mission. In no particular order—we have a
local connection here in London with King's College the University
of Pennsylvania, King's College, London, the Interdisciplinary
Centre in Israel and the Jordanian Institute of Diplomacy, have
a four-way formal arrangement that we have with MOU signed, agreed
to by our universities. This group is investigating political
violence and biosecurity is part of that programme. There is another
programme funded by the Bill and Melinda Gates Foundation called
the Centre for Global Development out of Washington DC, and they
have asked me to be on their Working Group on antibiotic resistance.
That is a very vigorous organisation and I emailed Rachel Nugent
just before I came and asked could I mention their work and she
said "Please, tell them about us." The Bill and Melinda
Gates Foundation, therefore, is looking specifically at the drug
resistance area, that is another NGO. The Global Alliance for
TB Drug Development, also funded in part by the Bill and Melinda
Gates Foundation, which actually funds part of the basic research
in my own lab on tuberculosis resistance, is very engaged in this
whole area. We are in varying follow-on discussions with the newly
merged college at Oxford: Templeton College merged with Green
College to become Green Templeton College. We have been talking
to Colin Bundy, who is the new Principal of that new college,
and Michael Earl, and we would like to address these issues as
part of a collaborative effort between my organisation and Oxford.
I mentioned earlier the OECD, with whom we were engaged in drafting
the Noordwijk Medicines Agenda. The Partnership for Global Security
and the Landau Network-Centro Volta run by Maurizio Martellini
in Italy is another group of NGOs interested in this area. We
presented the idea for the Global Compact at their meeting in
Lake Como, and it became part of the statement they made to the
Biological Weapons Convention recently. Then I mentioned the Commonwealth
of Pennsylvania as devoting themselves to the antibiotic resistance
issue. , So there are the biosecurity people, there are the antibiotic
resistance people, and policy people my point is that we need
to integrate these efforts. They need to do their work because
they need to focus but there has to be an integrator. There are
a number of these organisations that are picking up one or other
parts of the Compact.
Q930 Baroness Whitaker:
How do you rate the chances of getting there?
Professor Rubin: Each individual organisation,
I think, will get there but in the end it will still take somebody
with representatives from all these groups sitting round a table
much like this, saying are we getting it done? That is why we
need a new organisation to hold people to that issue.
Q931 Chairman:
Do these organisations say to you they like the concept?
Professor Rubin: Yes, absolutely. Please ask
Ian Gillespie for example. While many love the concept, they have
very similar questions—this is not the first time I have
heard these questions, but you have to think large to answer a
large problem.
Q932 Lord Avebury:
What I cannot get my head around is your suggestion that a group
of people sitting around a table would say "Are we getting
this done?" and they would then have the power, as I understand
it, to direct all these various organisations to do something
different to what they are already doing, that this group of university
professors will say to the Bill and Melinda Gates Foundation,
say, you have been doing the wrong things, you must adjust your
programme according to our diktat almost.
Professor Rubin: No, that is exactly not the
intention, the intention is to have them say to the Bill and Melinda
Gates Foundation "You are doing a spectacular job and here
is how it fits—at no cost to you—into the really big
picture." They know that they do one thing or two things
or three things extraordinarily well—and I have to tell
you, almost as an aside, that without the Bill and Melinda Gates
Foundation the developing world and this whole endeavour would
fall apart, they are doing a spectacular job. But it is not the
whole job, so the goal would be for everybody to go back to their
organisation and say we are doing such a great job that it is
part of this big picture, that is the goal.
Q933 Baroness Hooper:
I am just interested to know, if you have all these people around
the table, who is actually funding the organisation? Obviously
the Bill and Melinda Gates Foundation might be in the picture.
But, if you are inviting people to join and people volunteer to
join and to be involved, do they have to stump up something? How
does the mechanism work?
Professor Rubin: That is exactly what my Dean
asked me and that is a good question. Right now my organisation
is funded by the University of Pennsylvania, by the Provost at
the University; each project is funded on its own and for this
particular project, because it is really at the conceptual stage,
we have been talking to various donors but we do not have the
big, big slug of money yet to really make this happen. That is
why we have been going for these individual components and it
looks a bit fragmented, because you have got to convince the individual
components. You are absolutely right; right now it is being funded
by the Provost.
Q934 Baroness Eccles of Moulton:
Professor Rubin, in 2005 the IHR established a global surveillance
system for public health events of international concern and,
at first sight, there does appear to be a certain overlap between
the Compact and IHR. Could you, please, explain to us what value
the Compact will add and also, slightly differently, what you
consider the main weaknesses of the current IHR to be?
Professor Rubin: That question comes up again
quite frequently. As you know, the IHRs originally were for the
three diseases after the eradication of smallpox—cholera,
plague and yellow fever—and then it became very clear to
many people that that really was not sufficient, and now this
new definition of communicable diseases of international consequence
has been proposed. As of May 2007, it was finally put into effect
in the United States. The IHRs have their own sets of really wonderful
surveillance and infrastructure-building components to them, and
this is not my own work but people have written extensively about
the shortcomings of the IHRs, in particular a colleague David
Fidler, a Law Professor. David has written extensively about some
of the issues and, again, enforcement even of the IHRs is a major
problem. Kumanan Wilson and Fidler had an article in the March
issue of the Bulletin of the World Health Organization—I
have a copy here if you would like to see it—addressing
these enforcement issues and they break it down as legislative,
a memorandum of understanding between governments, guidelines
and so on. So the recognition of enforcement even of the IHRs
is certainly a major issue. The second major issue with the IHRs
is, again, their technical limitations in recognising new and
as yet unreported diseases. There are also political issues with
IHRs; it is a great start but there are still a number of shortcomings
that need to be addressed. The World Health Organization did issue
advisories when SARS was found to be spreading around the world
much to the surprise of many people in sovereign States, who thought
that the World Health Organization may not really have that mission.
Yet they did it anyway, much to the consternation of Canada. There
is not yet, therefore, a governance structure for IHRs and, quite
frankly, there is still very little incentive other than to be
a good guy, not to be named and blamed. That is exactly why we
need to integrate this with enforceable linkages. The answer is
that there certainly will be overlap with some surveillance but
they are not interested in extending that mission, for example
to cataloguing and having a queryable database on chemical structures
or chemical libraries. When I give this talk at basic science
conferences, the first thing people say to me is "Hey, will
there be a catalogue of all the libraries of chemical compounds
out there that we might be able to access because I am interested
in this disease?" The IHRs database is small compared to
the universe of data that we need.
Q935 Chairman:
You used that word "enforceable" again, and I am still
not quite sure why this is any more enforceable than the International
Health Regulations.
Professor Rubin: Linkages, that is my answer.
Without being linked to the benefits of the Compact the hard part,
ie the surveillance and the harmonisation, will have a much tougher
row to hoe. If you report your data, you will be high in the queue
to get the vaccine; if you do this harmonisation, your scientists
will be part of the governing board of the research centres. When
I travel around the world and I talk to foreign governments and
foreign scientists—and it may be just because of the environment
and the venue—it is very important around the world for
scientists to feel that they are part of the community working
on this project. The developing world, the developed world, the
former Soviet Union, the Russian Federation, you name it, it is
important to be part of the scientific community addressing these
problems, where you can get on the phone or go to a conference
or get on an email and say "What is up?" is almost like
ping-pong diplomacy; it is the players that are playing together
that will really drive the governance.
Q936 Baroness Eccles of Moulton:
If the Compact succeeds in its aims, would there no longer be
any need for the IHR?
Professor Rubin: No, the IHR would be an integral
part of the Compact, absolutely: it would be that part of the
data set and we would help build that data set. The scientists
and the engineers and the algorithm builders will help build that
data set.
Q937 Baroness Eccles of Moulton:
But it could still be a separate entity?
Professor Rubin: Absolutely, sure.
Q938 Baroness Eccles of Moulton:
But it would be part of the Compact?
Professor Rubin: It is like a federation.
Q939 Lord Jay of Ewelme:
If I could just pursue for a moment this question of influence,
leverage and enforceability, in your paper you draw the analogy
between the Compact and the Landmine Action Group, and we were
talking about that earlier on. My understanding is that that really
succeeded through a combination of powerful and effective advocacy
and great moral authority in the end, convincing first of all
the NGO and academic community and then successive governments
that it was right. Is that the kind of process which you see here?
Is that how you see the linkage between the two or why you use
that as an example?
Professor Rubin: The answer to that first question
that you asked is that this is absolutely a moral imperative and
it should carry the same weight as landmines. We do not have those
graphic images, although if you come to my hospital or go across
the River to St. Thomas' Hospital you will easily see people intubated
with blue fingers and blue hands because they are dying of a bacterial
infection, one could generate those kinds of very intense visual
images. Again, as I said before, this is not an "over there"
problem, this is an "over here" problem as well as an
"over there" problem. So I think—it could be that
I am believing my own public relations—that the moral imperative
here is as great if not greater than landmines and cluster bombs.
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