Select Committee on Science and Technology Written Evidence

Visit to Geneva, 31 January, Principal Points Arising

  1.  Baroness Finlay of Llandaff, Lord Rea and Lord Soulsby of Swaffham Prior represented the Committee on this visit. They were supported by Julius Weinberg, Specialist Adviser and Rebecca Neal, Clerk of the Committee.


  2.  The Committee met Dr Gro Harlem Brundtland, Director-General, Dr David Heymann, Executive Director, Communicable Diseases, Dr G Rodier, Director, Communicable Disease Surveillance and Response, Dr J Schlundt, Director, Food Safety Programme, Dr G Moy, Food Safety Programme, Dr R Williams, Coordinator, Communicable Disease Surveillance and Response, Dr C Dye, Coordinator, Tuberculosis Monitoring and Evaluation, Dr T Boerma, Coordinator, HIV Surveillance, Research and Monitoring and Evaluation, Dr K Stohr, Mapping and Drug Resistance, Communicable Disease Surveillance and Response, Dr P Braam, Strategy Development and Monitoring of Zoonoses, Foodborne Diseases and Kinetoplastidae, and Mrs S Block Tyrrell, Coordinator, Communicable Disease Communications, Media and External Relations.

United Kingdom support

  3.  The Committee heard that the UK provides valuable technical aid to WHO, supporting 22 WHO Collaborating Centres in specific communicable disease areas and five national influenza centres.


  4.  In April 2000, largely thanks to support from the Department for International Development, WHO had developed an international network of technical associates in order to collaborate in alerting others to possible outbreaks and to respond to those outbreaks: Global Outbreak and Response Network (GOARN). ( The Communicable Disease Surveillance Centre of the PHLS is a member of GOARN.

  5.  GOARN established detailed standard operating procedures and guidelines for how to verify and respond to an outbreak and procedures for alerting others. It had been used to control Ebola haemorrhagic fever in Gulu, Uganda (2000) and Crimean-Congo haemorrhagic fever in Kosovo (2000); to investigate febrile deaths of unknown cause in young adults in Bangladesh (2001); and to prevent epidemics of yellow fever in Côte d'Ivoire (2001).

  6.  This network placed as fundamental to its success central coordination, engaging national and international partners, an effective communication strategy and quick response time.

  7.  This network needed to recruit and retain full time, highly motivated, and skilled experts. It also was imperative that it could access short term aid from partners, such as through laboratory support and experts on secondment.

  8.  A number of countries had made available funds for this purpose, Centres for Disease Control in the US for example had a budget dedicated to international work.

  9.  The UK did not have a formal means of supporting GOARN's work in terms of financing short-term international assignments. It was to be hoped that the Health Protection Agency could encourage the Government to support and co-ordinate these activities, perhaps through a single interface by which such contributions could be facilitated. The Committee heard that the Department for International Development had been supportive of World Health Organisation capacity building in several areas.

  10.  If the UK were able to establish a fund/mechanism for short-term international assignments, it would be able to benefit even more from sharing resources with WHO through contributing to international communicable disease control and therefore reducing likelihood of outbreaks in the UK, providing experience and training for staff and for developing networks and enhancing global communication in this area.

International Health Regulations

  11.  There had been a long term failure in the arena of public health to recognise the importance of the World Trade Organisation and those international trade rules which have an impact on health (for eg Codex Alimentarius).

  12.  WHO-CSR was coordinating the major revision of the International Health Regulations (IHR), which currently could only take into consideration plague, smallpox, cholera and yellow fever, to make them more responsive to public health needs. IHRs should make clear the duties of nation states to share information when they identify infections which could have an impact on another country.

  13.  There was a need to coordinate across different arenas: for example people involved in food quality control should communicate with food retail sector and insurance businesses. The food trade increasingly had a global outlook and therefore ensuring food safety should also be considered as a global concern.

  14.  WHO hoped that the Health Protection Agency would promote the importance of public health in relation to trade and agriculture.


  15.  WHO organised twice yearly meetings to decide upon the constituents of the vaccine needed to combat likely influenza outbreaks in the near future.

  16.  Historically the UK, and NIMR and the PHLS in particular, contributed significantly to influenza surveillance and prevention. However this role was diminishing with, at present, only two people working in the UK's global influenza lab. There were much better resources now in CDC, Melbourne and Tokyo.

  17.  It was important to develop surveillance of animals in order to predict potential problems in humans.

  18.  Surveillance and protection activities should be linked rather than isolated activities.

Information Technology

  19.  WHO was increasingly using information technology to identify possible communicable disease events.

  20.  There were a number of electronic discussion groups, some of which had free and unrestricted subscription, which were based on emerging infection problems or disease areas. These sites either had an international scope (such as ProMed, TravelMed), regional (such as PACNET in the Pacific region) or a national scope (such as Sentiweb in France).

  21.  The Committee heard that the Global Public Health Information Network (GPHIN) was an electronic surveillance system which Health Canada developed and maintained in collaboration with WHO. It had powerful search engines that actively trawled the World Wide Web looking for reports of communicable diseases and communicable disease syndromes in electronic discussion groups, on news wires and elsewhere on the Web. GPHIN had begun to search in English and French and would eventually expand to all official languages of the World Health Organization. On a number of occasions reports to this site had then been investigated and verified by the local unit responsible for surveillance.

Epidemiology Training

  22.  There was a global dearth of people trained in epidemiology.

  23.  The World Health Organization, Centres for Disease Control and Rockefeller had developed field epidemiology training programmes which ran in a number of countries.

  24.  There was a European wide programme in intervention epidemiology training being developed in Europe which was part funded by the EU.

  25.  The World Health Organization had funded and organised an initiative based in Lyons, which trained fifty to fifty five people over two years in microbiology methods and epidemiology.

  26.  The London School of Hygiene and Tropical Medicine was developing distance learning programmes in field epidemiology.

Key Threats

  27.  Key threats included effects of globalisation and deliberate release.

  28.  It was important to:

    (a)  develop and sustain national health policies to underpin international initiatives; and to

    (b)  strengthen public health, in particular through surge capacity, and to increase collaborations between defence and health.


  29.  The Committee met Mr Brunson McKinley, Director General, Ms Irena Omelaniuk, Director of Migration Management Services, Ms Mary Haour-Knipe, Senior Adviser on HIV/AIDS, Ms Jill Helke, Special Assistant to the Director General.

  30.  The Committee heard that the International Organization for Migration (IOM) had been established in 1951 to assure orderly migration of those in need of assistance. It was an intergovernmental organization with over 150 offices worldwide and 98 member states.

  31.  In its work on health and population mobility, IOM provided pre-departure health assessment of migrants through immunization, health promotion, counselling and treatment where necessary.

  32.  TB needed to be tackled because a third of the world's population was suffering from it. Migration Health Services stated that, according to the Centre for Disease Control and Prevention (CSC), 48 per cent of people with TB in the United States were foreign born.

  33.  It was important that public health programmes recognised the importance of migrants in communicable disease control and considered them when developing systems and carrying out forward planning: inclusion not exclusion.

  34.  In addition, IOM provides migration health assistance and advice, including physical and mental health and research and assistance to governments in formulating policies on migration-related health issues. IOM believed that well-managed national and community migration health could be a tool to facilitate integration of migrants (immigrants and refugees) in host communities: migrants in a state of physical and mental well-being will be more receptive to education and employment.


  35.  The Committee heard that UNAIDS was a joint project between various UN agencies, the International Labour Organisation (ILO), the World Health Organization (WHO) and the World Bank. It aimed to prevent transmission of HIV and to care and support those with HIV/AIDS.

  36.  AIDS surveillance was not well integrated into surveillance systems. It was difficult to ascertain what information was relevant to collect.

  37.  UK was relatively good at surveillance and treating HIV/AIDS. However the patient group was changing which would demand different approaches. There were now more cases in foreign born individuals rather than in the gay community and in IV drug users.

  38.  It was possible to carry out surveillance on an anonymous basis but this raised the ethical consideration whereby people could be found to be HIV+ but it would not be possible to trace them and offer them treatment.

  39.  In some areas of the world it was common that the existence of HIV/AIDS was denied. This had prevented opportunities for developing effective surveillance, prevention and treatment activity and therefore increased suffering and the epidemic.

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