By the Select Committee appointed to consider Science
PREFACE AND SUMMARY OF RECOMMENDATIONS
1.1 The Science and Technology Select Committee established
a Sub-Committee in May 2002 to carry out an inquiry into diagnosis,
treatment, prevention and control of infectious disease. The membership
of the Sub-Committee together with declarations of interest is
given in Appendix 1.
1.2 The Sub-Committee issued a call for evidence
in July 2002, which is given in Appendix 2. This attracted 117
written submissions from individuals and organisations. Forty-nine
individuals from thirty-eight organisations were invited to give
evidence in person .
In July 2002 the Sub-Committee organised a seminar, hosted by
the Academy of Medical Sciences, to gain an overview of some of
the main issues of infectious disease control [II]. Over the duration
of this inquiry the Sub-Committee visited health care institutions,
research and surveillance centres and public health departments
in England, Switzerland and the United States of America [see
evidence vol II].
1.3 The organisation of some of the services involved
in infectious disease control has changed over the duration of
this inquiry following the establishment of the Health Protection
Agency (HPA) in April of this year. The broad concept behind the
HPA was widely welcomed by our witnesses, although they raised
a number of concerns about the detail. The HPA is in an early
stage of its development and, throughout this report, we draw
attention to some of the areas that we believe it must address
as a matter of urgency.
1.4 There is a large number of infectious diseases
and many methods and particular services are needed to tackle
them. In this report we discuss the processes of diagnosis, treatment,
control and prevention; we focus on infection in general as it
affects humans. However, we discuss the importance of animal-borne
infection and we also draw on specific infections as examples.
We point readers to some recent and pending inquiries which investigate
in more detail particular groups of infection. The House of Commons
Health Committee has published a report on sexual health
and the National Audit Office will, in winter 2003-04, publish
a follow-up to its earlier study of Hospital Acquired Infection.
The House of Commons Science and Technology Select Committee will
discuss deliberate release of infection in its report on Bioterrorism,
expected to be published in July 2003. We reported on antibiotic
resistance in 1998 with a follow-up report in 2001.
1.5 This report focuses on infectious disease as
it affects England (devolved administrations have separate arrangements)
but we recognise the importance of international dimensions to
infectious disease control and discuss this accordingly (see chapter
1.6 We received much help from a large number of
organisations and individuals throughout this inquiry. We thank
all of our witnesses. Without people giving up significant time
to submit evidence in writing or attend formal evidence sessions
our inquiry and report would not have been possible.
1.7 We are most grateful to the following which hosted
visits or seminars:
of Medical Sciences
Public Health Laboratory - Public Health Laboratory Service (CPHL,
for Applied Microbial Resistance (CAMR)
of Food Research
University, Atlanta, USA
Hospital, Atlanta, USA
for Disease Control, Atlanta, USA
of Public Health, Washington DC, USA
Institute of Allergy and Infectious Disease, Washington DC, USA
of Medicine, Washington DC, USA
York City Department of Mental Hygiene and Public Health, USA
TB Centre at Harlem Hospital
Health Organization Headquarters, Geneva, Switzerland
of Migration, Geneva, Switzerland
1.8 Throughout this inquiry we have been fortunate
to have the aid of two committed Specialist AdvisersProfessor
Julius Weinberg of City University and Professor George Griffin
of St George's Hospital Medical School. We thank them for their
careful advice and hard work..
Summary of recommendations
1.9 This report outlines a number of problems facing
an effective response to the threat of infection in England. We
acknowledge that infection cannot be conquered, but we believe
that the Government could significantly improve services in order
to counter the effects of infection.
1. We recommend that the Government
recognises and addresses the fact that, although England has not
experienced major epidemics of infection in recent years, this
owes as much to good fortune as to good management. Without improvements
we fear that this country will suffer from major epidemics and
will continue to see infectious disease take its toll in economic
terms, in suffering and in lives [9.16].
1.10 In view of this, we have made recommendations
on the following themes:
2. We recommend that the Department
of Health encourages and facilitates the development of infection
centres which integrate scientists (virologists, microbiologists),
clinicians and epidemiologists. These should be associated with
academic and tertiary referral centres and the regional HPA laboratories.
Each Strategic Health Authority should have access to services
of one of these [9.24].
3. We recommend that the Minister for
Public Health should publish as a matter of urgency a document
outlining roles and responsibilities of all organisations involved
in infectious disease services and should disseminate this to
those concerned in order to facilitate effective communication
and collaboration [9.7].
4. We recommend that the Minister for
Public Health should publish an annual account of all progress
in cross-departmental working in relation to infectious disease
5. We recommend that the HPA be provided
with resources to take on specific and primary responsibility
for integrating surveillance related to human, animal and food-borne
infection at national, regional and local levels in order to bridge
the gaps that currently exist between these areas of speciality
6. We recommend that the HPA publishes
by April 2004 a proposal for developing collaborative relationships
with organisations concerned with tackling infection, including
the devolved administrations, environmental health departments
and the Food Standards Agency [9.12].
7. We recommend that the Government
enable the HPA to second health professionals to international
bodies such as WHO and provide the resources to make this possible
Providing well-trained staff
8. We recommend that the Government,
in conjunction with relevant Royal Colleges and the Joint Committee
on Infection and Tropical Medicine, address the shortage of expertise
in clinical infectious disease, clinical microbiology and communicable
disease epidemiology by increasing numbers of fully funded consultant
posts and ensuring that there are available training posts [7.5].
9. We recommend that the General Medical
Council, the Nursing and Midwifery Council, the General Dental
Council and the Health Professions Council ensure that universities
strengthen existing content relating to clinical and public health
aspects of infection undergraduate education [7.15].
10. We recommend that, with respect
to postgraduate education, the medical Royal Colleges and the
Nursing and Midwifery Council should ensure that infection prevention
and control is a key component [7.16].
11. We recommend that the Government
investigate the decline in numbers of trained Environmental Health
Officers in local authorities and take steps to reverse this trend
Improving information exchange
12. We recommend that the Department
of Health should ensure that procedures for collecting and reporting
information electronically are integrated where possible into
everyday working practices and are less burdensome than at present
13. We recommend that the Government
should develop a fully compatible electronic system of infectious
disease surveillance information across all relevant departments
and agencies [6.15].
14. We recommend that the HPA should
standardise information entry across all surveillance systems.
This should be undertaken in consultation with representatives
of all those involved in the collation and transfer of information
for infectious disease control [6.11].
15. We recommend that the HPA takes
the lead in further developing electronic methods for providing
feedback about surveillance and for targeting delivery of information
about infectious disease to healthcare professionals [6.19].
Maintaining public health laboratories
16. We recommend that the Department
of Health should ensure that Primary Care Trusts provide NHS laboratories
with at least the same level of extra resources for public
health work (including food, water and environmental activity)
that was previously received through the Public Health Laboratory
17. We recommend that the Department
of Health ensures that microbiology laboratories managed by the
HPA and NHS Trusts act in a coordinated manner to deliver effective
surveillance and to provide surge capacity [5.15].
18. We believe that vaccine development
should be facilitated and recommend that the Government should
develop and maintain clear evidence based guidelines about vaccine
requirements and should create financial incentives to enable
early research, development and commercialisation of vaccines
19. We recommend that, given that there
is little vaccine production capability in the United Kingdom,
the Government should, by April 2004, develop and publish a strategy
to ensure that there is secure access to supplies of vaccines
in the face of national outbreaks of infectious disease [P 4.13].
20. We recommend that the Government
should fund enhanced surveillance of the impact of vaccine programmes
on the incidence of disease particularly when new vaccines are
Initiating research and development
21. We recommend that the Department
of Health, in conjunction with the HPA, establishes and publishes
by end of 2003 clear evidence-based priorities for the development
of vaccines and diagnostics [8.10].
22. We recommend that the Department
of Health ensures that funding is made available to increase research
into organisation and delivery of infectious disease services
and, in particular, into how human behaviour impacts on outcomes
of diagnostic procedures, treatments and prevention programmes
Communicating with the public
23. We recommend that the HPA, like
the Food Standards Agency, should act, and should be seen to be
acting independently of Government [7.24].
24. We recommend that the HPA creates
a post for a well-resourced infectious disease specialist to act
as spokesperson and to lead on all aspects of communicating with
the public including developing innovative methods of increasing
awareness of infectious disease [7.30].
1 Evidence is found in :
House of Lords Select Committee on Science
and Technology Fighting Infection: Written evidence volume
I (evidence received up to 18th February 2003), , Session
2002-3; HL 23, ISBN 010 400218 2
House of Lords Select Committee on Science
and Technology Fighting Infection: Evidence volume II (oral
evidence and written evidence received after 18th February 2003),
Session 2002-3; HL 138-I
In addition this is available on the
CDRom provided in the back of this report volume or on the website:
House of Commons Health Select Committee Sexual Health,
Fourth Report Session 2002-03, HC 69. Back
The Management and Control of Hospital Acquired Infection in
Acute NHS Trusts in England Session 1999-2000, HC 306 Back
House of Lords Select Committee on Science and Technology Resistance
to Antibiotics, Third Report Session 2000-01, HL 56, ISBN
0 10 405601 0 Back
Northern Ireland, Scotland and Wales organise services differently.
The HPA has some presence in Wales and a Service Level Agreement
with Northern Ireland. Back