Select Committee on Science and Technology Fourth Report


Chapter summary

An effective infectious disease service should be underpinned by research and development in order to further understanding of how organisms survive, spread and interact with their hosts. This in turn should inform action: how best to react to and prevent further outbreaks.

We were particularly concerned about reported difficulties in obtaining support for developing new products such as tests to diagnose infectious disease and vaccines and funding for research on delivery of services.

Development of vaccines and diagnostics

8.1 The development of both vaccines and diagnostics is a lengthy process with uncertain outcomes and profits. This makes it a relatively risky venture for industry [Roche Diag, I p141]. In particular, this means that there are still many unexploited opportunities for developing and using vaccines [BioIndustry Assoc, I p25, UK Vaccine Ind Grp, II p234-8].

8.2 We were particularly impressed, when we visited the National Institutes of Allergy and Infectious Disease in the US, to hear about their Small Business Initiatives. Small companies willing to take financial risks inherent in developing a vaccine could apply for up to $100,000 to cover initial development costs. If the company then patented the vaccine they were obliged to make every effort to bring it to market [Chatfield, II p248; USA, II p388].

8.3 Pharmaceutical companies invest ten or twenty times less money in vaccine R&D than in therapeutics. They regard the public expectation that vaccines should not have any side-effects as a particular burden. Such public anxiety requires vaccines to be more thoroughly tested than other pharmaceutical products in order to reveal any potential side-effect. This informs companies' risk-analysis of products to decide whether or not to further develop or to market [Kingston, Q530]. Pharmaceutical companies desire clearer guidance from Government about levels of demand [Kingston, Q531]. For example, the Government promised to include a vaccine for meningitis C in the childhood schedule (vaccines given to children as routine) and this facilitated its development [Salisbury, Q42].

8.4 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.

8.5 We heard that academic medical researchers often do not consider commercial applicability of their research [Borriello, Logan, Reeders Q476]. However, this is changing somewhat with an increase in numbers of university technology transfer offices, which encourage and facilitate moves from research to development [Logan, Q503]. The MRC also expects to encourage more product development of research through a Health Implementation Research Centre which would enable people to "design their projects so that they can be better implemented and translated into practice" [Q752]. We applaud this move and hope to hear of its progress over the next few years.

Box 13

Primary Research and Development funders

Department of Health—specifically the NHS R&D fund and the Policy Research Programme, which has historically funded much public health work [Pattison Q617];

DEFRA —funds research into animal infection. It has recently announced a joint fund with Higher Education Funding Councils of £23 million in veterinary science.

Government agencies—fund and carry out R&D work. Before the Health Protection Agency was created on April 1st 2003 the Centre for Applied Microbiology and Research had research funding, which has transferred to the HPA. The Public Health Laboratory Service carried out significant work in development of new diagnostics, vaccines and other lab-based technologies [Miller, Q523]. The HPA expects to raise further funds from outside bodies [HPA Qs 735-46; PHLS Q303].

Medical Research Council—any area of infectious disease work is funded apart from that which is "needs-driven research" [MRC Q743]. Infectious disease research applications have an average success rate and antibiotic resistance is now a priority area. Health services research grant applications are considered so long as their outcome is generalisable [Q752]. The MRC hopes to hear to secure a funding stream for health protection research in conjunction with other funders next year.

The Wellcome Trust—funds across the board of different types of research with approximately a thirty percent success rate for applications for research in infectious disease [Q736-41]. It is currently reviewing its ten-year Medical Microbiology Fellowship Initiative [Q743].

The Department of Trade and Industry—funds development work through its Link Programmes specifically in health technology devices, applied genomics and genetic and environmental interactions in health [II, p364]. It is unclear how much spend in infection disease developmental work these programmes have led to.

Pharmaceutical and biotechnology industry—large pharmaceutical companies such as GlaxoSmithKline and PowderJect Pharmaceuticals invested £200 and £33 million respectively in vaccine R&D in 2001-02 in addition to their spend on therapeutics [PowderJect, I 122; Assoc Brit Pharma Ind, I 3-14; GSK, I 70; UK Vaccine Ind Grp, Q526-44; II, x]. Smaller venture-capital funded biotechnology companies, whilst not involved in manufacturing therapeutics or vaccines, carry out research and development [Dr Chatfield, Q523; Dr Reeders, Q476].

The European Union and WHO—fund a variety of infectious disease related research through different streams.

8.6 One of the concerns regarding development work, particularly related to public health, was that staff in the PHLS pursued this on a day-to-day basis alongside their other work, and it is, as of yet, unclear whether this will be able to continue under the HPA [Duerden, Q303].

8.7 The big funders of medical research such as the MRC and the Wellcome Trust do not fund research into use and development of diagnostic technologies [Q757-759]. Apart from the HPA it is unclear which organisations would prioritise development of diagnostics. The development of diagnostics is a general concern and we heard in the United States that no one is taking responsibility for developing and improving standards of diagnostics [USA, II p384].

8.8 We were pleased to hear from the Government that they have established a Bioscience Innovation and Growth Team (BIGT) to examine how policy and investment can encourage innovation and growth in the UK bioscience industry. One of its particular aims is to examine how to develop relationships between the NHS and industry in order to exploit new technologies [Q850]. BIGT expects to report in July 2003. We look forward to its recommending a strategy to develop priority areas for investment [DTI, II p364].

8.9 Highlighting priority areas and linking funding to those priorities could facilitate development of appropriate technologies [Borriello, II p218; Miller, Q548]. In order to ascertain that development is properly linked with health care need it may also be necessary to carry out evidence-based research to assess efficacy and cost-effectiveness of vaccines and diagnostics. All of this would require a certain amount of coordination between relevant funding bodies. Sir William Stewart, Chairman of the HPA, expressed caution about over-coordination [Q788]. We agree that it is important not to stifle innovation but we note that in a stretched health care service with limited R&D funding it is necessary to prioritise.

8.10 We recommend that the Department of Health, in conjunction with the HPA, establishes and publishes by the end of 2003 clear evidence-based priorities for the development of vaccines and diagnostics.

Research into Delivery

8.11 We heard that in order to improve infectious disease services there needs to be more research into how services are organised and decisions are taken. Better understanding of human behaviour has a significant part to play in understanding how organisations are run and s can reveal how organisations could be improved.[17] Understanding organisational issues and behaviour can help to inform guidelines about treatment, prevention and control measures and may improve outcomes [CAMR, I p42; Crowcroft, I p45-9]. For example, research can examine how laboratory testing can be used to inform GPs' decisions about when and how to treat [PHLS Prim Care, I p132-3].

8.12 Further research is required into questions such as the best design of hospital wards for managing infection and reasons for patients failing to complete courses of treatment. We heard that there is a disproportionate burden of infection in certain social groups but the reasons for this, or indeed why people choose not to take up interventions such as vaccines, are not fully understood [Calman, Ghosh, Q364-5]. We found that work is needed to ensure that infection services reach socially disadvantaged groups if health inequalities are not to be perpetuated [Assoc Brit Pharma Ind, I p10; Hawker, II p117].
Box 14

Behaviour and handwashing

Handwashing is a key intervention to reduce spread of infection and yet it is known that many health care workers do not wash their hands when moving between patients. Research could inform those who organise services how best to design wards and run services so as to minimise the barriers to handwashing.

8.13 We are concerned that there is not enough delivery related research, either that which evaluates methods of diagnosis (such as near patients tests) or surveillance, or seeks out new sources of information [see chapter 5]. This type of research would provide evidence to improve services.

8.14 It is clear that it is, at present, difficult to fund research that examines social factors, evaluates new techniques and considers the delivery of services. The PHLS used to carry out research in this area [AcMedSci, II p36; PHLS, II p139]. The MRC considers funding applications of this nature, with the caveat that results should be generalisable across the health service. However, such research applications are subject to severe scrutiny and we heard that it is often more difficult to convince MRC research committees of the quality of service delivery research than of basic science research [Q754].

8.15 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.

17   We discussed this in our report on Antimicrobial Resistance, 7th report 1997-98 HL81-I Back

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2003