Memorandum by The Royal Society of Edinburgh
1. The Royal Society of Edinburgh (RSE)
is pleased to respond to the House of Lords Science and Technology
Committee Inquiry into Fighting Infection. The RSE is Scotland's
premier Learned Society, comprising Fellows elected on the basis
of their distinction, from the full range of academic disciplines,
and from industry, commerce and the professions. This response
has been compiled by the General Secretary with the assistance
of Research Officer, Dr Marc Rands, and a number of Fellows with
substantial experience in medicine and health.
2. The specific issues identified in the
call for evidence are addressed below.
What are the main problems facing the surveillance,
treatment and prevention of human infectious disease in the United
3. In order to have a satisfactory national
surveillance system it is important to have comprehensive, timely
and reliable data. Not all infections need to be reported and
not all of those that do will receive the same degree of urgency.
Among the Notifiable Diseases there is often a lack of uniformity
in reporting and it is likely that there is a considerable under-reporting
of patients with conditions such as food poisoning. This, of course,
is often due to the fact that, unless the patient is badly affected,
there will not be any involvement with the medical community and
even then notification to the public health authorities will not
necessarily always follow.
4. Among other problems with the present
surveillance system are:
(a) Although good surveillance of the communicable
diseases is generally considered to be the most powerful and effective
control technique it is still often under-rated despite its value
being well demonstrated in the eradication of smallpox from the
world in the 1960s.
(b) Because of the new advances in medicine
there are increasing numbers of subjects being taught in medical
schools and there is often not enough time for medical students
to be given information about the value of surveillance. Thus,
after qualification there is usually not the required priority
given to carrying out the necessary procedures.
(c) There are now fewer medically qualified
persons in public health departments and microbiological laboratoriesespecially
those with infectious disease experiencethan in former
years. Therefore there is perhaps less awareness in this area
of work of the importance and urgency of their findings.
(d) Because the infection process involves
not only the virulence of the microbe but also the susceptibility
of the host and the state of the environment in which the host
lives, successful surveillance entails the interaction of several
disciplines whether in the health centre, the hospital, the laboratory
or within environmental agencies. Also, several infections can
be transmitted from animals so that the involvement with the veterinary
authorities cannot be ignored. This extended chain of communication
can have the potential for creating problems.
(e) Problems can also arise if there is not
the closest possible interaction between those treating infection
and those preventing it.
Will these problems be adequately addressed by
the Government's recent infectious disease strategy, Getting Ahead
of the Curve?
5. Getting Ahead of the Curve certainly
addresses many of the problems associated with the control of
infection. There are, however, areas that still need to be dealt
with. For example, the responsibility of medical faculties of
universities to ensure that students are made more aware of the
value and methodology of surveillance techniques and the enhancement
of arrangements (eg the formation of "spotter" general
practitioners) to give an early warning of hazards.
6. It is also important to recognise that
the strategy Getting Ahead of the Curve refers to the situation
in England. In Scotland there are differences in the surveillance
system in several respects. For example, another area where perhaps
more emphasis could have been given is in the multidisciplinary
working of those involved with infection and environmental problems.
This already happens in the Scottish Centre for Infection and
Environmental Health where there are medical, veterinary, nursing
and environmental personnel working in the same building and under
the same administrative structure.
Is the United Kingdom benefiting from advances
in surveillance and diagnostic technologies; if not, what are
the obstacles to its doing so?
7. The surveillance agencies, diagnostic
laboratories and departments of infectious diseases in the United
Kingdom are still admired elsewhere in the world but there seems
to be an increasing tendency for blunting, to some extent, the
expertise of those working in this area by their responsibilities
becoming more general. For example, unlike the USA where infectious
disease physicians usually concentrate solely on infectious problems,
in the UK many of these doctors are general physicians with an
interest in infection and therefore do not have the same opportunity
to go into the subject as deeply as their American counterparts.
Should the United Kingdom make greater use of
vaccines to combat infection and what problems exist for developing
new, more effective or safer vaccines?
8. Undoubtedly immunisation, despite some
concerns, has been an extremely effective weapon to combat infection.
Because of the success of polio and measles vaccines it is likely
that these diseases will be as successfully dealt with as has
happened to smallpox. There are of course several other diseases
of high morbidity which could lend themselves to effective immunisationespecially,
in this country, certain respiratory infections of childhood,
eg Respiratory Syncytial Virus infection. Although there appears
to be many difficulties associated with the development of a vaccine
against the Acquired Immune Deficiency Syndrome (AIDS) such is
the impact of this disease that every effort should be made to
bring immunisation to a successful conclusion.
What infectious diseases pose the biggest threats
in the foreseeable future?
9. CreutzfeldtJakob disease of the
brain obtained by eating meat from cattle infected with Bovine
Spongiform Encephalopathy and the tragic rise in the number cases
of AIDS have been timely reminders that alarming and fatal hazards
can appear in the population quite unexpectedly. For the moment
these probably pose the biggest threat but history has shown that
new problems can come along with surprising rapidity and are frequently
difficult to predict.
What policy interventions would have the greatest
impact on preventing outbreaks of, and damage caused by, infectious
disease in the United Kingdom?
10. (a) Greater emphasis on the education
of professionals (medical, nursing, environmental and veterinary)
at both undergraduate and postgraduate level in the treatment
and control of infection.
(b) The adoption of an even greater integrated
approach between those involved in the clinical, epidemiological
and laboratory aspects of infection.
(c) Surveillance operations should be re-assessed
to ensure that they are not encumbered with obsolete, over-elaborate
and redundant procedures and that they can incorporate new methods
as rapidly as possible.
(d) Further enhancement of health education
efforts to ensure that all sections of society accept that they
have the knowledge and a responsibility to try and deal with infection
as effectively as possible.
23. In responding to this inquiry the Society
would like to draw attention to the following Royal Society of
Edinburgh responses which are of relevance to this subject: Healthcare
in 2020 (September 2000); and the RSE Inquiry into Foot and
Mouth Disease in Scotland (July 2002). Copies of this response
and of the above publications are available from the Research
Officer, Dr Marc Rands (email: [email protected]).