Memorandum by Roche Products Ltd
1. Infectious diseases should be afforded
a higher priority by the Government and the NHS.
2. Influenza is a prevalent, serious and
highly contagious virus which can lead to lower respiratory tract
complications and increased hospitalisation.
3. Although vaccines have a role to play
in preventing influenza, many eligible individuals do not present
for vaccination. Despite vaccinations some individuals may go
on to develop influenza due to poor vaccine match against circulating
strains. New antivirals, neuraminidase inhibitors, that can treat
and prevent influenza may be used as an option for those individuals
who are not vaccinated, or who get influenza despite having been
4. Hepatitis C is estimated to affect 10
times more people than have HIV. The virus is the leading cause
of liver transplants worldwide and the cost of treating the disease
will be enormous. Effective treatments are available that can
cure the disease in over 60 per cent of patients.
5. The Government is not prepared for the
scale of the problem ahead. More needs to be done to raise awareness
of Hepatitis C among the public and health care professionals,
to improve detection and make treatments available at the earliest
Roche is a leading healthcare company with an
expertise in infections through our influenza, Hepatitis C and
Through its core businesses in pharmaceuticals
and diagnostics, Roche takes an integrated approach to healthcare,
with the aim of offering superior solutions that are tailored
to the individual. In the UK, Roche employs nearly 2,500 people.
We are committed to working in partnership with the Government,
the NHS and other agencies to help enhance the health and quality
of life of people in the UK.
We welcome the Committee's enquiry into Fighting
Infection and believe we have a valid contribution to make to
the debate in this important area of healthcare.
We are concerned that infectious diseases are
not afforded a high enough priority by the Government, particularly
due to the large number of other Government health priorities
and targets, These concerns are especially relevant when considering
the prevalence of Hepatitis C and the threat of the next influenza
Roche has recently launched a new treatment
for Hepatitis C in the UK, a pegylated interferon known as Pegasys,
and we are about to launch an innovative prophylaxis and treatment
for influenza, a neuraminidase inhibitor (NAI) known as Tamiflu(tm).
Additionally, we are a leader in the field of HIV/AIDS and have
developed and manufactured a number of innovative treatments.
We are planning to launch an innovative new treatment, a fusion
inhibitor for treatment resistant HIV in 2003. As the Health Select
Committee is currently undertaking an enquiry into sexual health,
the focus of this submission is predominantly concerned with influenza
and Hepatitis C.
What are the main problems facing the surveillance,
treatment and prevention of human infectious disease in the UK?
More needs to be done to determine the epidemiology
of Hepatitis C in the UK. Estimates for prevalence vary and the
rates in sub-populations need to be established. The majority
of the population infected with Hepatitis C are not aware they
have the infection. Detection in at risk patients before the onset
of advanced liver disease allows access to potentially curative
Effective surveillance and communication of
influenza activity is critical for proper awareness of, and preparation
for, influenza outbreaks and accurate patient diagnosis. GPs would
benefit from more timely local information on influenza. Accuracy
of influenza diagnosis can be increased to 60 per cent when physicians
know that influenza is circulating in the community and when they
use a defined set of influenza symptoms as a diagnostic criteria.
Will these problems be adequately addressed by
the Government's recent infectious disease strategy Getting Ahead
of the Curve?
Our view is that Getting Ahead of the Curve
suggests what needs to be done, but does not give sufficient details
or timelines. The key points are addressed in the strategy but
not the mechanisms or targets for increasing awareness of HCV.
Is the UK benefiting from advances in surveillance
and diagnostic technologies? If not, what are the obstacles to
its doing so?
The level of specificity, sensitivity and accuracy
of current influenza point of care diagnostic tests may offer
little incremental benefits over a clinical diagnosis of influenza
when influenza is circulating in the community. Further development
would be required to improve these parameters.
Should the UK make greater use of vaccines to
combat infection and what problems exist for developing new, more
effective or safer vaccines?
Research is on-going to discover a target within
the virus in order to develop a suitable vaccine. However, because
of the genetic diversity of the virus no vaccine has yet been
Clearly vaccines have an important role to play
in preventing influenza but their efficacy is limited according
to their match to the circulating virus. Due to the constantly
changing composition of the virus, the vaccine must be modified
each year to match the current strain. The efficacy of the vaccine
is reduced if it does not contain the strain in circulation. Additionally,
many people are still not vaccinated.
While vaccination will remain the first line
of defence against influenza, there is a need for new, effective
therapies to prevent and treat influenza. New antiviral medicines
represent a breakthrough in the management and treatment of influenza.
They target the root cause of the illness by inhibiting the neuraminidase
enzyme thereby preventing the virus from multiplying and spreading
to new cells in the body. NAIs are effective against all influenza
strains including potential pandemic strains. They reduce the
duration of the illness, provide rapid relief from and reduce
the severity and duration of symptoms.
Tamiflutm also has a role to play in the treatment
of influenza by reducing the incidence of lower respiratory tract
complications and hospitalisation compared to standard therapy.
Tamiflu can be used for prevention of influenza in certain situations,
including the family setting, in closed communities and in nursing
home residents. Tamiflutm provides immediate protection against
influenza whereas vaccination may take up to two weeks to have
It is established opinion among leading virologists
that antivirals as well as vaccines will have a crucial role to
play in managing the next pandemic.
Which infectious diseases pose the biggest threats
in the foreseeable future?
It has been estimated that there are approximately
250,000 people carrying the Hepatitis C virus in England and Wales
(NICE), most of whom are unaware of their infection. This is over
10 times the number of people living with HIV.
It is transmitted in a number of ways including
shared needles by drug addicts (the main cause of transmission),
tattoos, piercing and shared toothbrushes. Transmission through
infected blood products occurred prior to screening in 1992, particularly
Symptoms may take up to 20 years to manifest.
There is no effective investigation into the scale of the UK epidemic
and the Government and NHS are not prepared for the scale of the
problem ahead. About 85 per cent of people initially infected
with Hepatitis C become chronically infectedie the infection
is not cleared by the body within six months. Many of these people
do not have symptoms and will lead relatively normal lives for
many years before realising the extent of the problem. The disease
progresses over a period of 10-40 years, with some individuals
sustaining liver damage that will lead to cirrhosis and potentially
liver failure requiring liver transplant (at some considerable
cost to the NHS). Cirrhosis may also progress to liver cancer
which is one of the most common primary malignancies. If treatable,
this would require surgery or transplantation. The virus is the
leading cause of liver transplants worldwide.
Influenza is a prevalent, serious and highly
contagious virus with potentially life-threatening complications
including bronchitis and pneumonia. Often confused with the common
cold, it is more severe and has different symptoms.
Every year 10 per cent of adults and one in
three children are affected by influenza. For most people, it
is an unpleasant but by self-limiting illness. For the young,
elderly, and those with heart disease, chronic respiratory problems,
diabetes, kidney disease or the immunocompromised, infection with
the virus can lead to a high risk of complications, hospitalisation
and sometimes death.
The consequences of influenza are underestimated.
It has high medical and resource costs. During an epidemic, primary
care consultations increase by 150 to 450 per cent and the rate
of hospital admissions may increase by 70 per cent. 60 to 70 per
cent of all influenza consultations are associated with a prescription
and about 45 per cent of these are for an antibiotic which has
no effect on the virus. Influenza accounts for 10 per cent of
all sickness absences from work, is estimated to cost British
business up to £6.75 billion per year in lost productivity
and to lead to 3-4,000 deaths each year.
A report published last November, Influenza:
A race against time, examined the worldwide impact of influenza
and its burden on society. It highlighted the importance of pandemic
preparedness to counteract the disaster that the next influenza
pandemic could bring.
Three major influenza pandemics have crippled
the world in the twentieth century and experts agree that the
next one is imminent. The WHO has been urging national governments
to plan for its arrival.
What policy interventions would have the greatest
impact on preventing outbreaks of and damage caused by infectious
disease in the UK?
Hepatitis C has received too little attention
from policy makers to date despite the disease's prevalence. At
last the Government has published a strategy for consultation
to which Roche will be making a response. There is an urgent need
to raise public and professional awareness and improve the general
understanding of the prevalence of Hepatitis C and its treatment
options through health promotion campaigns.
Due to the silent nature of Hepatitis C, more
needs to be done to improve detection and promote testing of the
disease, particularly for those at risk now and in the past so
that treatment can be made available at the earliest opportunity.
The time delay between infection with Hepatitis
C and onset of symptoms means that the disease is likely to slip
down the list of treatment priorities among budget holders who
are focused on the "now". A large number of patients
will have been infected in the 60's and 70's and the numbers of
these patients with end stage liver disease will be increasing.
The longer-term implications of this include the costs of treating
liver cancer and/or liver transplants along with the considerable
suffering of the growing number of patients exposed to this disease.
We believe that early diagnosis and treatment should be a priority
and the Government should undertake a cost/benefit analysis of
the long-term cost implications of not targeting the disease in
its early stages. Roche has developed a cost effectiveness model
for Hepatitis C which we would be happy to share with any interested
Early access to, and widespread availability
of, new innovative treatments is also required, including pegylated
interferon in combination with ribavirin to treat patients with
There are currently very few services in place
for Hepatitis C and resources should be set aside, or targeted
towards setting up relevant infrastructure including specialist
treatment centres. This is an important lesson from HIV and should
be applied to Hepatitis C.
We are also concerned that PCTs are not able
to recruit the appropriate expertise to satisfactorily resource
their Hepatitis C commissioning. It is important that the PCTs
fully understand the long-term implications of the disease and
put in place appropriate measures.
NICE is due to appraise pegylated interferons
as part of its seventh wave in 2003. Enormous geographic variations
currently exist in access to, and availability of, treatment for
Hepatitis C. Widespread implementation of NICE guidance with adequate
resources will be important in the effective management of the
The Infectious Diseases Strategy recognises
the threat of the next severe pandemic and an influenza pandemic
plan exists in the UK. It is important that the Government acknowledges
the seriousness of influenza and is adequately prepared to manage
not just a future pandemic but annual epidemics as well.
There should be widespread access to vaccines,
neuraminidase inhibitors and other antivirals which all have an
important role to play in the management of influenza.
An European Commission event on pandemic threats
held last year recognised the need for better Europe-wide co-ordination
to meet pandemic challenges and the inclusion of vaccines and
antivirals in pandemic planning. The role of antivirals should
be recognised in the Government's infectious diseases strategy.