Seminar at the Academy of Medical Sciences,
Tuesday 16 July
1. The Academy of Medical Sciences hosted
a seminar for the Committee which explored some of the current
issues facing the infectious disease community.
2. Members of the Committee present were
Lord Haskel, Lord McColl of Dulwich, Lord Oxburgh, Lord Patel,
Lord Quirk, Lord Rea, Lord Soulsby of Swaffham Prior (Chairman),
Lord Turnberg, Baroness Walmsley, Baroness Warwick of Undercliffe.
They were supported by Rebecca Neal, Clerk of the Sub-Committee,
Adam Heathfield, Specialist Assistant to the Science and Technology
Select Committee and Melanie Moore, Secretary to the Sub-Committee.
3. The participants in the seminar were:
Mr Jonathan Cowie, Institute of Biology; Professor
Uri Desselberger, Addenbrooke's Hospital; Professor Brian Duerden,
PHLS; Dr Robin Fears, Academy of Medical Sciences; Professor Roger
Gilmour, CAMR; Professor George Griffin, St George's Hospital;
Dr Simon Hay, University of Oxford; Professor Adrian Hill, Oxford
University; Professor Sir Peter Lachmann, President, Academy of
Medical Sciences; Mr Tony Leaney, Academy of Medical Sciences;
Dr Jane Leese, Department of Health; Mrs Mary Manning, Executive
Director, Academy of Medical Sciences; Dr Philip Mortimer, PHLS;
Professor David Onions, Q-One Biotech; Professor Hugh Pennington,
Aberdeen University; Dr David Salisbury, Department of Health;
Dr Geoffrey Schild; Professor Julius Weinberg, City University;
Professor Richard Wise, Birmingham City Hospital; Professor Douglas
Young, Imperial College; Dr Marie Zambon, PHLS.
4. Professor Weinberg explained that the
role of surveillance was to ensure that events were known and
predictable, rather than unknown and unpredictable. To further
this end improvements in basic science were needed, as were increases
in the number of data gathered.
5. Professor Weinberg stated that new types
of surveillance should be considered, such as analysing numbers
and types of phone call to NHS Direct and perhaps by gathering
data from pharmacy store cards.
6. Professor Weinberg pointed out that when
designing or improving a surveillance system it was important
to identify problems with the current surveillance system and
to ask questions about what infections need to be surveyed and
why, and how the collected data would be used.
7. Using surveillance systems that provide
early warnings of an increase in infection could bring benefits
but also could increase the numbers of false warnings, placing
a burden on resources. Therefore, Professor Weinberg suggested
that better analytical tools needed to be developed.
8. Surveillance systems should be sensitive
and timely. Professor Weinberg provided an example from Eastern
Europe where if there were a surge in reported infections relevant
scientists were alerted by text messages, in order to ensure that
the increase should not go unnoticed.
9. Professor Weinberg argued that clinicians
in the UK were not very good at reporting suspected or actual
infection. This owed partly to cultural reasons but also because
of the small amount of infectious disease and epidemiological
training that most clinicans received.
10. The following points were made in discussion:
The current number of notifiable
diseases was probably correct. Making a disease notifiable would
not necessarily ensure that reporting occurs, with some non-statutory
diseases having very high levels of reporting. However, the descriptions
of notifiable diseases could be overhauled in order to make them
more useful to clinicians.
The Department of Health attempted
to respond to public opinion, by conducting four surveys a year
on attitudes towards infectious disease and vaccines; this data
was collated and used to inform communication strategies.
Some Department of Health communication
strategies were confusing; one winter advert encouraged people
not to attend GPs surgeries with flu-like symptoms, yet another
campaign warned that flu-like symptoms could indicate meningitis
and should therefore be taken seriously.
Little attention was paid to the
ethics of surveillance. Also there was poor understanding of public
acceptance of use of personal data. Some participants suggested
that the public accepted significant intrusion into personal files,
so long as there was confidence in the system's independence and
that the collated data would be used for valuable ends.
11. Professor Hill pointed out that vaccines
were the most cost-effective medical intervention that had ever
12. However, because of an increase in medical
and scientific knowledge the number of known potential side effects
had also increased. This added to the difficulties experienced
by the public when deciding whether to have themselves or their
13. Professor Hill suggested that people
should be educated to be able to balance the often very small
risks against the huge benefits of vaccines.
14. Professor Hill queried whether or not
the media should be able to publish what it liked, even when it
could lead to a significant decline in take-up of vaccines and
a potential public health crisis.
15. Vaccine production companies had become
fewer in number but bigger in size perhaps reducing the likelihood
of new vaccines being developed. Professor Hill pointed out that
vaccine development was high risk, in that it did not always lead
to an effective vaccine. Even when an effective vaccine was found
there was often little or no financial reward (this was particularly
pertinent in the case of malaria).
16. Professor Hill pointed out that it took
between seven to 10 years to develop vaccines with significant
planning needed to examine emerging diseases at national, continental
and global level. He asked the question: who will and who should
identify priorities for development?
17. Professor Hill argued that there should
be more targeted government funding for development of important
vaccines. Also bureaucracy should be cut for development of vaccines:
this was currently subject to between three and five levels of
Development costs of vaccines were
not linked to potential future profits but were instead dependent
on the current profits of pharmaceutical companies. Only three
vaccines have recently been profitable.
A large proportion of resources have
recently been placed in developing combination vaccines, which
was quite risky, particularly if combination vaccines were rejected
by the public.
Flu vaccines could be produced quickly
each year for the annual immunisation programme because of effective
A body should be established to provide
an overview of all vaccine development, to direct the industry
and to provide some financial assistance with development costs.
The media often presents both "sides"
of the vaccine safety debate as being equal, even when one "side"
is much weaker than the other is.
18. Antibiotics and anti-virals had played
a fundamental role in the treating of infectious disease throughout
the twentieth century. However, there were increasing concerns
about the levels of resistance to such drugs.
19. Professor Griffin explained that over
the past 30 years only one new clan of antibiotics had been developed
yet it was now known that resistance had developed to that.
20. Resistance was also common to anti-virals,
particularly those drugs used to treat HIV and herpes.
21. Professor Griffin pointed out that pathogens
were prospering, particularly in hospitals where it was often
difficult to isolate patients properly, particularly given the
levels of resources available to hospital managers and clinicians.
Hospital acquired infections cost around £1 billion per year
and gave rise to 5,000 deaths per year.
22. The incidence of drug resistance in
people newly infected with HIV was now 30 per cent.
Hand washing by hospital workers
before treating a new patient was fundamental to cutting down
the spread of antibiotic resistance, yet it was mooted that this
was not carried out enough and remained a significant source of
the problem. Some of the problem was behavioural and more needed
to be understood about why clinicians and nurses do not always
wash their hands between each patient.
It was suggested that an effective
way of separating patients and therefore preventing the spread
of resistance would be to place a glass wall between each bed.
The diminishing numbers of pharmaceutical
companies was cited as a reason that more antibiotics were not
being developed. Similar to vaccines antibiotics take, on average,
seven to 10 years to develop.
More effective surveillance of anti-viral
and antibiotic resistance was needed.
The Department of Health had now
established an overarching Specialist Advisory Committee which
would tackle some of these concerns. The Department had also developed
a research strategy on antimicrobial resistance which should address
some of these issues. Proposals were currently being reviewed.
23. Professor Pennington argued that statutory
notification of food poisoning was a waste of time and money because
it does not help to prevent future outbreaks.
24. The attempts to control Salmonella
had been effective. Cases had decreased, mostly because chickens
were now vaccinated against Salmonella but also because
of good quality information provided through the media to the
public about cooking chicken and eggs correctly.
25. Effective surveillance required people
to be looking at the correct source of infection. For example,
Professor Pennington pointed out that Camplobacter was
on the increase but it was not known where the main source of
infection was. The link between surveillance, public health and
molecular biology should be carefully considered and improved.
26. E.coli 0157 was rare but when
there was an outbreak it was often very severe. There was no effective
treatment and it could lead to brain damage and renal failure.
Professor Pennington suggested that there should be improved links
between DEFRA and the Department of Health as E.coli 0157 was
carried asymptomatically by animals.
27. Professor Pennington pointed out that
public anxiety in the case of food-borne pathogens was related
to mortality rate; so new variant CJD was a source of greater
concern than was Camplobacter.
28. The Food Standards Agency was implementing
some successful strategies. 30 per cent of food businesses now
have a hazard analysis system, which Professor Pennington suggested
would be at least as important as developing vaccines to combat
As many food-borne infections were
zoonoses perhaps proactive veterinary surveillance should be introduced.
If chickens are immunised then the
yolks also become immunised, therefore passing on immunity to
people who eat the eggs. It has recently been claimed that people
would not eat meat from cows that had been vaccinated yet people
eat chicken that has been. This was perhaps because it was not
widely appreciated that chickens are vaccinated.
The food industry was cost-driven
rather than driven by safety concerns. So were consumers.