Select Committee on Science and Technology Written Evidence

Memorandum by the Institute of Biology in conjunction with the Association for Clinical Microbiology and Society for Applied Microbiology

  1.  The Institute of Biology is the independent and charitable body charged by Royal Charter to further the study and application of the UK's biology and allied biosciences. Its 15,000 members (January 2002) and over 60 specialist, learned Affiliated Societies make the Institute ideally placed to respond to the above consultation. The Institute of Biology is aware that a number of the specialist biological learned societies within the Affiliation are concerned with this issue and these include the Association for Clinical Microbiology and Society for Applied Microbiology who support this response.

  2.  This response's principal points include:—

    (i)  Their Lordships in their consultation are addressing an issue for which there is a growing likelihood of great biological, human and economic impact.

    (ii)  We understand that the 2001 foot and mouth outbreak prompted the question to be asked "what if a similar scale of infection affected the human population"? However, outbreaks of non-human infections can also result in suffering and mortality among the human population (eg Irish potato famine).

    (iii)  Resistance to anti-infective agents continues to be a problem requiring holistic and novel approaches. This Institute and a number of its specialist Affiliated Societies recently (2002) appraised the way forward for anti-infectives.

    (iv)  If the UK were a PLC it would be obliged to conduct a risk assessment.

    (v)  We are not convinced that the full investment required by the new Health Protection Agency recommended in Getting Ahead of the Curve are being made available.

    (vi)  With regards to the supply of scientists, microbiology as a profession is perceived among bioscientists (and we believe many clinicians) not to have the status that is appropriate. Worse, the state of UK agricultural research (part of which relates to infectious agents) is now almost beyond a critical state.

    (vii)  Governmental investment in science R&D has not kept pace with the economy it innovates and protects for the past one and a half decades. A number of Select reports have noted that UK agricultural and systematics research has been severely eroded—research on fighting plant and animal infection directly relates to human infections. Furthermore, investment in surveillance-science managed by Departments and their agencies has not kept pace with economic growth though there is more need for it today than before.


This consultation focuses on human disease but the topic is far broader than that

  3.  This consultation has a focus on human disease but the topic is in reality far broader than that. First, some human infectious diseases are shared with those of other animals. Secondly, some plant infectious diseases have an adverse impact on human well-being. Here frequent examples can be found among crop pathogens where epidemics can have economic and direct nutritional effects such as the role of mycotoxins in poisoning (the Salem, US, incident) and delayed development of cancers (alfatoxins) and famines (hence health) consequences (such as the Irish potato famine). (Indeed, we understand that the 2001 UK outbreak of foot and mouth disease was in part a factor behind their Lordships choosing the topic of this consultation inquiry.) Third, there are opportunistic microbial populations that are shared between non-humans and humans that develop resistance to anti-microbials. The question can then be seen to become one of our species' ability to tackle global pandemics of infectious agents of humans as well as of species of economic (hence frequently human well-being) importance. A good current example is that pandemic strains of the influenza virus originate in birds. The Institute of Biology is currently considering whether it can usefully explore this topic separately.

The risks of epidemics are growing

  4.  The topic of fighting infection is of increasing importance. Your Lordships through this consultation are addressing an issue for which there is both growing likelihood, as well as probability, of great biological, human and economic impact from epidemics of infectious agents. This is primarily because:

    (i)  The human population increased dramatically over the last century (see Appendix 1) and for a time was growing, not at an exponential but, at a super exponential rate. It is currently just over 6 billion and by 2025 is expected to be around the 8.5 billion mark.

    (ii)  Human population densities are increasing. Here the UK and Western Europe has an above average population density compared with the rest of the developed world (OECD nations).

    (iii)  Human mobility is increasing. Globally international arrivals in 2000 were around 664 million and the World Tourist Organization has predicted an 80 per cent increase in travel to long-haul destinations between 1995 and 2010 (BMJ 325:260-264).

    (iv)  The problem of resistance to anti-infectives is increasing, as well as (where applicable) disease vectors are becoming increasingly resistant to chemical controls.

All of these factors individually work to increase the potential size of an epidemic. Together their effects are synergistic.

Populations, and population densities, of species of economic importance are increasing

  5.  Secondly, as the human population has increased, this has largely (but not strictly) been mirrored by the growth in populations of species of economic importance (for example the UK chicken flock is far bigger at the beginning of this century than it was in the last). The mobility of individuals within these population has also increased. One only has to go down the supermarket aisle to see just how far many of the raw food products have travelled. Indeed, the mobility of UK cattle was cited as one example as to why the 2001 foot and mouth epidemic was so great. This means that epidemics affecting species with large populations and highly mobility (irrespective of whether they also affect humans) are likely to be potentially greater than previously with smaller populations. Also, in addition to the spread of disease, the spread of undesirable infectious agents is more likely. An example of this last is the number of instances of the spread of antimicrobial resistant strains among some domesticated animal populations.

The risk literally has never been as great as today

  6.  Taken together—human demographics and those of species of economic importance—the risk (be it in terms of human health, economics and/or health of other species) from pandemics of infectious agents has literally never been as great as it has today. These factors have a synergistic effect. They are not simply additive but combine to be more than the sum of their parts.

The hazard from infectious agents is complex and some aspects are getting worse

  7.  The hazard from infectious agents is more complicated. Treatments in the form of anti-infective agents are available. Yet again the effectiveness of some of these is being undermined. For example, the rise in resistance to anti-infectives is a major problem. Bacterial strains are becoming resistant to the present antibiotics and fungal crop pathogens to existing fungicides. Finally disease vectors are also showing increased resistance to the chemicals used to control them. With regards to human health it is worth remembering that globally, in terms of the proportion of total causes of death, only AIDS and tobacco-related cancer are growing. Of these, AIDS results from the infection with the Human Immunodeficiency Virus, an infectious agent.

The UK bioscience community recently produced a policy alert on resistance to anti-infectives (see appendix 2)

  8.  Concern among the UK bioscience community as to how to address the question of resistance to anti-infectives manifested itself earlier this year (2002) in the form of a two-day symposium—Anti-infectives: The Way Forward—which was run by this Institute with other learned and professional scientific bodies, the support of industry and the endorsement of a Government Department and one of its Agencies. This symposium in turn resulted in a policy alert called Pharmageddon Now which was launched to Parliamentarians in the House of Lords in October by the Institute of Biology and the Royal Pharmaceutical Society of Great Britain. Pharmageddon Now included some suggestions as to how we might begin to address the question of the rise in resistance to anti-infectives. The Pharmageddon Now policy alert is reproduced in Appendix 2: we draw your attention to this as there is little value in duplicating its suggestions here in the main body of this response.

Historically there have been major epidemics the question is not "if" but "when"

  9.  The UK population has in the past suffered epidemics and pandemics of infections. Historically there is the well-known Black Death. In more recent times there was the 1918-9 influenza pandemic which claimed 25 million lives Worldwide and around 228,000 in Great Britain. We concur with the DH's Chief Medical Officer's report Getting Ahead of the Curve (2002) that the question is not one of whether there will be another severe influenza pandemic but when? We need to decide now what measures and investment are required to combat such a pandemic.

There are plenty of examples to illustrate the need to ensure we invest in infection control and get the best out of such investment

  10.  Currently there are a range of infectious agents of concern. For example, Escherichia coli O157, Salmonella enteritidis, and Legionella pneumoniae causing Legionnaires' disease. Then there are the emerging infectious diseases such as new variant CJD, as well as those with the potential to emerge in the UK such as West Nile Virus. Taking this last as an example of an infectious agent expected to be of low risk for spread to the UK, the principal vector is the Culex species of mosquito which is present in this country.West Nile is found in southern Europe but may migrate north towards the UK with global warming. Its spread to the US and Canada was thought to be either by the importing of an infected bird, an infected migratory bird or human traveller; this again illustrates the increasing risk due to greater population mobility cited above. Such current and potential threats from infectious agents demonstrate that we need to ensure that we are getting the best out of our investment in surveillance and treatment and if needs be appraise as to whether the investment being made is appropriate.

If the UK were a PLC it would be obliged to conduct a risk assessment. Government Departments are encouraged to undertake risk assessments

  11.  Policy-makers sometimes view the UK in terms of a hypothetical UKPLC: no doubt because they have to balance the costs and benefits of policy against the nation's economic requirements. It is interesting to note that if the UK were a PLC it would be obliged to conduct a risk assessment under the UK Financial Services Act. This Act determines that PLCs must follow the "Combined Code" which itself adopts Turnbull Guidance that recommends companies undertake risk assessment exercises. Indeed Lord Sharman's report, The Review of Audit and Accountability for Central Government (2001), that all Government Departments and central government bodies, should undertake risk assessment as defined by Turnbull Guidance.

DEFRA and the Department of Health might benefit of assessing the risk from major epidemics

  12.  Typically risk assessments undertaken by companies identify threats. They usually include both an identification of the threats (hazards) and estimation of the likelihood of each threat becoming manifest as well as of impact. History and biology can combine to indicate both a likelihood of an event and severity of its outcome, it suggests that such a risk assessment would point to the requirement for UK PLC management action. We are suggesting it is possible to argue that the appropriate governmental body undertake a risk assessment of a severe epidemic in the UK. With the human population in mind this might be a severe influenza pandemic as per 1918-19 but could more appropriately be any infectious disease with the potential to spread rapidly through the population. Though there have been risk assessments by Government Departments (such as recently by DEFRA in to foot and mouth disease), we are not aware of a general risk assessment being made in economic terms. It should be noted here that risk assessments are made in advance of anticipated events. Given the potential impact of, for example, an epidemic a major crop pathogen on DEFRA's area of remit, or of an aggressive strain of influenza on the Department of Health's area of remit, it would appear that such risk assessments would be valuable.

Risk assessments would help ensure that key questions regarding the value of prevention strategies would be answered

  13.  Such an assessment should help ascertain the magnitude of investment required for surveillance, control and treatment. For example, would it be worth regularly vaccinating the working population on an annual basis against less virulent strains of influenza? This would have a direct economic benefit of reduced lost days at work. It would also have the benefit of ensuring that the mechanisms were in place and practised for the vaccination of a large and economically important proportion of the economy if a suitable vaccine strain were available in time. The other important consideration is the use of antivirals, which have been available for the last thirty years to treat or act as prophylactics against influenza. These are but some of the strategic questions that might be addressed by such an exercise.


Are all the costs for the new Health Protection Agency being met?

  14.  In "fighting infection" much will depend on the success of the new Health Protection Agency (and its eventual counterparts in devolved parts of the UK). We are not convinced that the full investment required by the new Health Protection Agency recommended in Getting Ahead of the Curve are being made available. In the recent Department of Health consultation document on the new Agency (to which this Institute responded), there was constant reference to the proposals being cost neutral. While we believe this to be true within the scheme of things for the nation as a whole (there are economic benefits from having a healthier work force and improved health among the population generally), this will not be true of the Agency's immediate financial costs. There are increased costs associated with co-ordination at a strategic level and further downstream costs associated with working to standard specifications determined at the strategic level. The fact that the nation benefits over all in terms of improved human-wellbeing and over all economically, will not prevent the Agency from costing more to establish as well as run.

There are concerns for the Public Health Laboratory Service (PHLS)

  15.  There are also fears that the Public Health Laboratory Service (PHLS) may lose resources when the network is broken up and transferred to local NHS Trusts. Then eight specialist laboratories will become part of the new Health Protection Agency. Possible problems include the current interdependency of PHLS labs as well as the element of national level work that a number undertake. This would mean that they will not function well within local NHS Trusts unless firm and clear arrangements are made at local and national levels.

Investment in the PHLS has been declining

  16.  Then there is also the major problem of the real-term decline in Government investment in the PHLS.

  Government R&D investment has declined as a proportion of GDP since the mid-1980s. DEFRA research has been hit particularly hard and a proportion of this, including topics such as systematics, has a bearing on infection control

  17.  This is part of a longer-term problem in real-term decline in Government Department investment in R&D over the past one and a half decades. This funding problem has been recognised by the House of Commons Select Committee for Science & Technology in their reports Government Expenditure on Research and Development (2000) and Are we Realising Our Potential? (2001). MAFF/DEFRA R&D has been hit particularly hard. We suspect that this is because of pressure from the Treasury and that the Treasury does not value the agricultural sector that only contributes 1 per cent of GDP. However it also needs to be appreciated that the food and drink sector (which takes forward the products from the agricultural sector) adds another two per cent, and then there is tourism and other rural economies that benefit for operating in a managed landscape. Altogether this adds up to a not insignificant proportion of GDP. However DEFRA R&D does include research into animal and plant infections and these have both a direct and in-direct bearings on human well-being. Even a topic seemingly as remote from infection control as systematics is in fact relevant as a population's genetic biodiversity is inversely related to its susceptibility to epidemics.

Investing in cost avoidance avoids costs

  18.  Then again, the Treasury needs to be aware of the need for investing in cost avoidance. The recent foot and mouth outbreak demonstrated that MAFF expertise had been allowed to erode and so when the Government's Chief Scientific Advisor stepped in he brought with him researchers from the Science Base. This clearly showed that the cost of failing to have a sound surveillance programme, and failing to horizon-scan, is significant. But these relate to a third failing in that having the scientific and technical staff to horizon scan and undertake surveillance, means that there are the expert personnel in place to fire-fight emergencies when they arise. Investing in cost avoidance avoids downstream costs. (Such investment needs to be long-term and as such has been of concern to the Affiliated Societies who view the balance of research investment and policy as being short-term.)

Departmental research beyond the DH can make an essential contribution to fighting infections

  19.  The above is neither theoretical nor unrelated to fighting human infection. Departmental research beyond the Department of Health can contribute to fighting human infections. For example, as this Institute is learning during our current examination of the future for anti-infective agents, DEFRA R&D can support research into antibiotic resistance populations among farm animals and these have the potential to affect human microbial populations. Returning to the previous example of West Nile Virus, if we are to properly ascertain the threat we need to have sound entomological knowledge of likely vectors and how the distribution of these vectors will alter with possible climate change. Again, such applied and policy-driven research requires Departmental funding first and foremost, and secondly linkage with the Science Base. (Though it needs to be perfectly understood that the Science Base Research Councils are responsible for fundamental and blue skies research, and not policy-driven and applied research which is the remit of Departmental research programmes. Consequently the Research Councils should not be imposed on to bear the brunt of the research costs but can be relied upon to provide expertise on a contract basis.)

DEFRA R&D is now critical

  20.  Despite the Commons Select Committee concerns (see paragraph 17 above) the state of DEFRA (former MAFF) R&D is now so low that to describe it as critical is literally an understatement.

Science can contribute to the fight against infection but will continue to find it increasingly difficult in an environment of dwindling governmental investment as a proportion of GDP

  21.  With regards to Governmental level of investment in science, the position is perplexing. Successive Governments of the past one and half decades have enthused about the UK becoming a knowledge-based economy. Yet until recently Governmental investment in R&D has declined in real-terms: in fact it has only recently (1998-99) been stabilised with some marginal growth but is still behind where the UK had been in the mid-1980s. In terms of research as a proportion of GDP, UK investment in science has steadily declined and so it is almost inevitable that addressing problems such as fighting infection will become increasingly difficult. The signal sent to industry is that perhaps it is not worth their while investing in near-market research (which is the only research industry and commerce will for the most part fund (though there are a few exceptions)). Indeed we understand that some companies have taken their research into anti-infectives out of the UK. While it is most laudable for their Lordships' committee to look at "fighting infection" and "the science underpinning conservation"—to take two recent worthy examples—there can be little progress until the UK has devised a long-term strategy for investing in its science, engineering and technology. Genomics and cutting-edge bioscience offers potential wonders in the fight against infection, but will be impotent if there are not the skilled personnel on the ground engaged in strategic surveillance in a co-ordinated way as well as undertaking remedial action.

Microbiology's status is being eroded

  22.  Moreover, this Institute has been aware of a growing trend that is undermining microbiology as a profession. We are aware of microbiology being marginalised in some university curricula. Furthermore, microbiology is perceived among bioscientists (and we believe many clinicians) not to have the status that is appropriate. The Department of Health needs to consider its supply of scientists for professions allied to medicine and, we would claim, especially microbiologists if the improved implementation of infection control is to be a strategic goal. One fairly straightforward measure would be for those within the Department of Health responsible for professions allied to medicine to ensure that there is both dialogue with, as well as financial support for, appropriate learned and professional societies. (This would also chime with recommendations in the House of Commons Select reports The Scientific Advisory System (2001) and Government Funding of Learned and Scientific Societies (2002).) At the moment this is not happening as it perhaps might.


Given adverse population demographic trends effectiveness of existing surveillance systems must be declining

  23.  As described in paragraphs four and five, because of demographic and mobility changes the risks and threats from infectious agents are increasing. Ipso facto current effectiveness of existing surveillance systems are being increasingly challenged.

Declining funding undermines surveillance and the development of new treatments

  24.  Declining Departmental R&D and declining PHLS funding mentioned in paragraphs 14-21 only serve to undermine surveillance and the development of new treatments.


Good long-term surveillance is vital

  25.  Our recent investigation of resistance to anti-infectives (see Appendix 2) revealed that long-term surveillance was fundamental to identifying resistant strains locally, hence control and treatment. This linkage between surveillance and treatment is fundamental to the management of infectious disease. However there needs to be a continual programme of research to ensure that only the best and cost-effective surveillance is adopted. For example, to take a non-UK case used before in this response, in Canada the spread of West Nile Virus is monitored through the surveillance of birds (especially those found dead, and not the virus' mosquito vectors.


Rapid diagnosis is vital to the successful containment of an epidemic

  26.  Rapid diagnosis (early detection) is critical when dealing with an outbreak. It is far harder (and more costly) to contain an epidemic once it has had the chance to spread.

Good surveillance has proven itself in the past, as has poor surveillance that has let us down

  27.  That surveillance enabled the detection of a virulent strain of influenza in chickens in Hong Kong in 1997 provides an excellent example of how surveillance can effectively prevent an epidemic. The failure of surveillance in the early stages of the 2001 foot and mouth epidemic demonstrate how the lack of surveillance and lack of expert personnel can lead to a major epidemic and high societal costs.


Research is too expensive for any one country to carry the cost

  28.  Relatively new infectious diseases such as AIDS demonstrate that the cost of treatment is high, as a result of the cost of research and clinical trials. Consequently these costs are too great to be borne by any one nation. International co-operation is required. As cited in Appendix 2, the cost of developing new antibiotics is high and requires a new paradigm in research funding.

Infectious agents do not respect borders so international surveillance is required

  29.  Because infectious agents do not respect political boundaries, international co-operation is required for surveillance.

International co-operation as to the way anti-infective agents are used is required

  30.  Aside from research co-ordination there need to be greater international agreement as to the way infections are treated and anti-infective agents are used. It has been demonstrated that the rise of resistance to anti-infective agents in one country can spread to another. The Foreign Office (as well as its Science and Technology Unit) need to be fully aware of the need for there to be a full role for foreign policy and diplomatic programmes to help fight infection globally so that the same can be done at home with maximum effect.


Those representing industrial and commercial management and the work force have a role to play

  31.  Industry and commerce have a role to play in ensuring the health of the work force. Representative bodies for industry and commerce, as well as representative bodies for the work force, need to be aware of the value of vaccination and other measures to combat infection. There are other important stakeholders within the public that need to play a part.

Media problems persist and an effective science and society programme remains a priority

  32.  Media coverage tends to be sensationalist and is likely to continue to be in countries that have a free press. This question is too complex to address here and neither policy makers nor the social science nor scientific community have developed an effective science and society programme. Little has changed since the House of Lords report Science and Society (2000) although there is now good evidence to suggest that the public is more appreciative of science and technology than that report hypothesised.


  Taking the benefits of improved health for granted we have become complacent

  33.  Investment in public health and science and technology have been allowed to slide. There are many reasons for this. Partly this is because public health as well as science and technology have been victims of their own success. People now live over 20 years longer than at the beginning of the 20th century and this has brought about with it a change in the nature of health care and the growth in demand for health care for the elderly. Science and technology have also revolutionised communication, travel and entertainment and people want investment in access to and the development of these goods rather than in health care or the further development of science and technology for strategic reasons. Because health care and science and technology largely work very well, complacency has set in. Public health care and the ability to combat infections (both old and new) requires on-going investment. This simply has not taken place. We have become complacent. The problem has not been that the UK requires to spend a growing proportion of its economy on science and technology, the problem is that such investment from Government as a proportion of GDP over successive Governments has been allowed to slip. Irrespective of the science there is no escaping this underlying conclusion.


  34.  The Institute of Biology, in line with Government Policy on openness and the Lords Science and Society recommendation for transparency, is pleased for this consultation to be made publicly available. Should their Lordships have further questions related to this response then they should feel free in the first instance to contact. Jonathan Cowie, Science Policy and Books, Institute of Biology, 20-22 Queensberry Place, London, SW7 2DZ.


  Human population growth for the past 2,500 years. Re-produced from Climate and Human Change with permission of the author.


  Pharmageddon Now Policy Alert

Pharmageddon Now


At the moment:

    —  There are 5,000 deaths per annum in the UK from infectious diseases contracted in hospitals.

    —  There has been no completely new class of antibiotic developed in the last 30 years.

    —  Virtually all major pharmaceutical antibiotic research has moved out of the UK.

    —  New antibiotics take in excess of 12 years to bring to market at an approximate cost of £250 million.

    —  Any new antibiotics would be promoted for use by companies seeking to recover development costs which is counter to the desire to limit their use to treat resistant organisms.

    —  In many countries, antibiotic availability and use is so indiscriminate that resistance is a serious burden worldwide.

Importantly in 2002 we are aware of these facts:

    —  Parliamentarians understand how important these issues are, and in 1998 the House of Lords published a report on antibiotic resistance.

    —  Antibiotic use as prophylactics in agriculture is declining, with application as growth promoters negligible in the UK.

    —  We have the necessary scientific and medical expertise to prevent the future scenario envisaged.

The bad news is that:

    —  In 1969 the Swann Committee recommended that Government address resistance, but the Expert Advisory Committee on Antimicrobial Resistance recommended by Swann was only set up in 2001.

    —  Little progress has been made implementing recommendations of the House of Lords Report issued in 1998.

    —  Continuation of the national surveillance system currently provided by the PHLS is in doubt.

Future—fact of fiction?


    —  There will be more strains of bacteria resistant to all antibiotics in our communities and within many hospitals in the UK.

    —  There will be strains of bacteria resistant to some antibiotics in all hospitals in the UK.

    —  Reliable surveillance data on the various antibiotic-resistant strains of bacteria in either our hospitals or local communities will not be available.

    —  Numbers of intensive care patients will rise (costing £1,000-£1,800 per patient per day) resulting in a commensurate increase in NHS costs.

    —  A marked increase in the number of deaths per annum from infectious diseases will occur in the UK.

    —  It is unlikely that effective new antibiotics will be available to tackle the problem.

    —  There will be few medical microbiology specialists being trained at degree level, and new doctors will have only a rudimentary grasp of infectious disease.

    —  The UK will have returned to the pre-antibiotic era and average life span will significantly decrease.

Action required


The UK must:

    —  Ensure that the recently published UK Antimicrobial Resistance Strategy and Action Plan is actively adopted by all stakeholder departments and agencies. The Interdepartmental Steering Group, and recently established Expert Advisory Committee on Antimicrobial Resistance, must continue to press for widespread acceptance of the strategy.

    —  Develop a cross-departmental co-ordinated funding programme, involving charities and industry as appropriate, to stimulate efforts in antibiotic research, to facilitate effective long-term surveillance of antibiotic resistance, and tackle the growth of hospital-acquired infections.

    —  Increase funding for academic research focused on development of new therapeutics.

    —  Provide a more favourable climate for pharmaceutical companies to develop new antibiotics by extending market exclusivity for these beyond the current 20 years from patent registration, through changes to patent legislation, to provide patent rights running 20 years from marketing.

    —  Ensure that foreign policy champions best practice for antibiotic use overseas, particularly in Europe, with new products being given EU-wide licences.

    —  Literature and advice required at school level to encourage pupils to pursue careers in pharmaceutical science and medical microbiology and related professions. Government Departments should liaise with learned societies to this end.

    —  Revise medical and veterinary curricula to reflect the significance of infectious disease and the appropriate use of antibiotics.

  The science behind this policy alert was reviewed and discussed at a symposium principally organised by the Institute of Biology and the Royal Pharmaceutical Society of Great Britain but with assistance of a number of learned societies within the Affiliated Societies together with the Department of Health and Medical Research Council. The symposium received some welcome support from Bayer and AstraZeneca.

October 2002

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