Select Committee on Science and Technology Written Evidence

Memorandum by Joint Committee on Vaccination and Immunisation (JCVI)

  I write on behalf of the Joint Committee on Vaccination and Immunisation (JCVI), an independent advisory committee of the Department of Health, with terms of reference "To advise the Secretaries of State for Health, Scotland, Wales and Northern Ireland on matters relating to communicable diseases, preventable and potentially preventable through immunisation".

  Practice in the field, in which the UK is a leader, is dependent upon the means of ascertaining the degree and nature of infectious disease risk in the population, and the availability of safe and effective vaccines. These have to be matched practically by population acceptance of benefit from immunisation, and robust service immunisation arrangements.


  Reliable data, as have been obtained by standard surveillance methods and through the Public Health Laboratory Service (PHLS), are essential in determining who is at risk, and the extent to which that risk is reduced by immunisation. The formation of the Health Protection Agency should provide the opportunity for further supporting and enhancing the work of the PHLS. Disease surveillance depends upon sustained and coherent national, regional and local action in support. Current proposals to devolve a significant quantum of the PHLS functions to NHS laboratories can bring significant strengthening provided that standard clinical work does not take precedence over the less immediate, but nevertheless real benefits from disease monitoring. It is therefore important that devolved surveillance functions are properly supported, with control by staff with specialist interests. At the same time, there will remain a need for a network of laboratories with specialist epidemiological and clinical pathological support, which is likely to form the mainstay in developing new technical methods, and in exploring changes in disease behaviour or frequency. These laboratories need to be under the direct control of the agency, with some form of central funding. At the same time, adequate support for the research and development function has to be ensured. The acquisition of reliable sets of data which can be confidently used to extrapolate back to the general population require that information collection is not limited by over-narrow interpretation of the Data Protection Act, although with appropriate safeguards to individual anonymity.


  The expanding range of vaccines makes it essential that adequate effort is devoted to examining the extent to which individual vaccines can be combined particularly in childhood. Outside the range of conventional vaccines there is a need, amongst others, for effective vaccines against respiratory syncytial virus, hepatitis C, Helicobacter pylori and the papilloma virus [see Department of Health "Getting Ahead of the Curve", a strategy document which presents overall a logical and sensible way forward in enhancing protection against infectious disease].


  The UK has an excellent record in instituting new immunisation practices, as evidenced by the introduction of immunisation against meningitis C.

  Effort needs devoting to examining the extent to which different vaccines will give protection of long duration, and to ways in which that protection can be enhanced.

  Tuberculosis. The resurgence of tuberculosis, and the raised risk in the immuno-compromised emphasise the need for more effective versions of BCG (as does the significantly raised incidence of the disease in immigrant populations, which appear less well protected than native populations by BCG).

  Pneumococcal disease. The overall efficacy, or comparative efficacy in terms of practical population benefit of differing varieties of pneumococcal vaccines is currently unclear. Thus, it is likely that such vaccines have significant value in the elderly, but the degree of benefit, and its duration are unclear.

  Hepatitis B. Although hepatitis B is relatively uncommon in the UK it is an important cause of morbidity and mortality through cirrhosis and hepatocellular carcinoma, and the risk is enhanced in those exposed to sexually transmitted disease. Possible extension of immunisation policies outside at-risk populations needs assessment.


  Public interest in immunisation, particularly its safety, is very high. Such interest probably stems from a declining knowledge at first hand of the often severe or fatal consequences of diseases such as measles, compounded by the need to immunise a child when healthy against a disease then seen by the parent as a non-immediate risk. Combating fears about the safety of immunisation depend upon the availability of sound information about the benefits and risks (or lack of risks) from immunisation, underlining the need for robust surveillance systems. That information must then be made available as openly as possible, with the decision-making process also being as open as possible. It is for such reasons that JCVI now has lay membership, and produces open minutes of its meetings, and that the Department of Health has recently opened a web-site currently devoted to issues related to MMR.


  It is important that, at a time of managerial reorganisation of the Health Service, accompanied by a range of targets for improving health, the needs of effective immunisation based on high general coverage of the at-risk population are not forgotten. "Getting Ahead of the Curve" rightly stresses the importance of an integrated approach to health protection.


  The requirement of access to high quality consistently available data needs stressing. Transfer of data [appropriately handled to safeguard individuals] between one part of the NHS and another must be facilitated, and the need to report infections for public health purposes must be practically supported. Molecular biological techniques need general application in the tracing of the patterns of outbreaks of infectious disease, and the population responses to immunisation need a means of consistent identification of what batch of vaccine was used where and when (such as bar-coding). Linkage to existing databases such as the General Practitioner Research Database would then provide a powerful means of scrutinising practical outcomes.


  UK immunisation practice is currently amongst the best. That position needs safeguarding by the provision of adequate resources for maintaining and extending activities, and by ensuring that the importance of immunisation is accepted in practical terms within the reorganised NHS.

Michael Langman

October 2002

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