Select Committee on Defence Minutes of Evidence

Further memorandum from Department of Health Re: Getting Ahead of the Curve and further action against bioterrorism (7 May 2002)


  National surveillance has been strengthened. On-going mechanisms are being developed by the Communicable Disease Surveillance Centre (CDSC) to alert relevant clinicians to achieve the earliest possible detection of the first cases of illness due to deliberate release of biological agents. Guidelines on the approach to the care of patients with rare diseases, developed with multi-agency groups, have been published on the PHLS web-site. CDSC is also piloting a new system that captures early patient reports of symptoms that could be associated with the release of certain organisms. NHS Direct is a national nurse help line which aims to provide the public with rapid access to professional health advice and information about health, illness and the NHS. The data that NHS Direct provides can be collated for use as an early warning system and complements the existing national schemes run by CDSC, of clinician, routine and specialist laboratory reporting systems that capture illness at a slightly later stage. However, this system is likely to be at its most effective once an attack is suspected of confirmed as it would provide an early assessment of the potential extent of an attack. The response element to an outbreak or a change in pattern of a particular disease is outlined below in the section on identifying newly emergent pathogens. In addition, there is increasing alignment of surveillance of organisms in animal, food and humans that will assist in identification and monitoring of control measures of infectious disease incidents.

  Training has been undertaken and is being developed further. Clinical awareness is the foundation stone for the early detection of a covert attack, as clinicians inform public health response teams and organisations at local, regional and national levels. This integrated approach ensures that the relevant diagnostic tests and public health investigations are carried out to determine the precise cause of the infection as well as ensure the appropriate treatment and control measures. Information on key diseases is readily accessible on the Public Health Laboratory Service (PHLS) web-site. Infectious Disease Physicians, Medical Microbiologists and Public Health Physicians have worked to produce training materials that are available for use and the topic has been discussed at professional training events. DH has hosted scenario-planning exercises for anthrax and smallpox with stakeholders. At present, additional training is being developed, under the auspices of DH that will be tailored to the needs of different professional groups with the aim of ensuring continuing awareness as well as rapid response and appropriate response that is continually up-to-date. This additional training is scheduled to begin in the Autumn.

  A mult-country smallpox scenario exercise is being planned for 2003 and follows the G7 ministerial conference in March 2002. As part of this activity, DH is liasing with the World Health Organisation and the Centres for Disease Control and Prevention (CDC) in the US on training initiatives.


  DH is taking this work forward with the aim of having tests that are rapid, accurate, sensitive, valid and as easy as possible to undertake. DH is supporting programmes at the PHLS Central Public Health Laboratory (CPHL) and at the Centre for Applied Microbiology and Research (CAMR). Staff at each of these Centres are developing rapid tests based on modern technologies that include DNA microchips and laser based detection systems. The application of these methods in the detection of potential terrorist attacks is being co-ordinated by a project team comprising CAMR, CPHL and the National Institute for Biological Standards and Control (NIBSC). In addition, CAMR has a close working relationship with its neighbour, the Defence Science and Technology Laboratory.


  Surveillance will be a cornerstone in the recognition and identification of emergent pathogens. This will build on the raised clinical, microbiological and public health awareness, as outlined above, with the ability to identify organisms and have the appropriate clinical and public health response.

  DH is sponsoring a programme of work at CAMR to establish a detection capability for the newly discovered viruses, Hendra and Nipah. In doing this, CAMR is collaborating with CDC.

  Assessing antibiotic resistance in potential bio-terrorist agents is an integral component of the functions of the Reference Laboratories.

  National plans for outbreak response are being updated by DH and CDSC. These will deal with outbreaks that:

    —  occur naturally and frequently eg E.coli;

    —  occur naturally and infrequently eg international flu epidemics;

    —  are "expected" eg West Nile Fever;

    —  are due to bio-terrorist activity that may be due to any of the above and/or due to unusual organisms;

    —  DH is preparing a specific plan for smallpox with input from across the NHS, PHLS including CDSC, and CAMR;

    —  Advice from DH expert advisory committees will be fed into these plans. These include the Joint Committee on Immunisation and Vaccination, the Advisory Committee on Dangerous Pathogens and the Specialist Advisory Committee on Antimicrobial Resistance.


  Appropriate diagnosis and management relies on good procedures and standards.

  Standard laboratory and surveillance operating procedures have been updated and complement the existing work of the PHLS laboratory and surveillance/response activity of CDSC on protocols for infectious diseases.

  As part of the new strategy for infectious diseases, all NHS microbiology laboratories will undertake the four basic public health functions of reporting to public health departments and CDSC, sending appropriate specimens to specialist/reference laboratories, supporting outbreak investigations and development of local policy. All clinical laboratories will be required to operate to common reference standards and standard operating procedures.

  The new Health Protection Agency will provide the specialist microbiology and surveillance/response expertise to local teams. This will build on the current PHLS, CAMR and NIBSC systems that support local NHS teams and contributes to European and international infectious disease surveillance and response activities.

  A new Inspector of Microbiology post will be established to ensure a rigorous approach to laboratory standards and safeguards.

  DH strengthened supporting arrangements in August 2001 through the establishment of an Emergency Response Capability at CAMR which includes the provision of the diagnosis of anthrax, plague and other bio-terrorist agents. An increased capacity is now in place and was in operation in 2001.

  In addition, CDSC is a member of the EU wide surveillance network. It is a leading centre for a number of disease surveillance networks that use common protocols and contribute to the investigation of multi-country outbreaks. The reference laboratories in CAMR and the PHLS have joined the USA Laboratory Response Network that facilitates international co-operation in information, methods and re-agents.


  Plans are being developed for a new National Panel for Emerging Infectious Diseases which will regularly review any new of emerging infectious diseases reported in this country or from elsewhere in the world. This is one of the recommendations in the new strategy for infectious diseases. The Panel will advise on the potential threat to the population and of any protection or control measures that should be initiated to reduce the potential threat to the population's health. The Panel will subsume the work of the National Zoonoses Committee which has cross working with other government departments especially DEFRA. Risk assessment, scenario planning and the need for appropriate research will be an integral follow through component to this system.


  The development of new anti-viral drugs is an activity of high cost and risk. Industry figures indicate that R&D costs of £800 million for each successful new drug. This is not an area that the UK will pursue alone, but will be the subject of wider international co-operation.

  The Ministry Of Defence, through its corporate research programme, is supporting research at DSTL into new vaccines for anthrax, plague, tularaemia and smallpox. DH is working with MOD to ensure that the products of this research will be applicable to public health. As part of this, DH has commissioned CAMR to consider the design and costing of an emergency vaccine manufacturing capacity facility.


  Innovations in countermeasures will come from obtaining advice from independent experts as well as working within and between relevant departments and countries.

  At present DH is working with other government departments and countries in certain areas in countermeasures. DH wishes to capitalise on this joint working and with the establishment of the new HPA, wishes to promote a more systematic approach to:

    —  prioritise areas of work across departments;

    —  develop multi-disciplinary/agency teams for key areas of work;

    —  build on particular areas of expertise;

    —  tap into networks already in existence or planned;

    —  joint audit performance manage the outputs/outcomes.

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Prepared 24 July 2002