Select Committee on Science and Technology Written Evidence


Memorandum by the Society for General Microbiology (SGM)

1.  CURRENT EFFECTIVENESS OF THE SURVEILLANCE SYSTEMS IN THE UNITED KINGDOM AND POTENTIAL PROBLEMS FOR THE FUTURE

  Infectious disease surveillance in the UK looks at a wide range of infectious agents from a variety of viewpoints. It is aimed, in part, at achieving improved protection of public health by an increased understanding of the epidemiology of infectious agents and the early recognition of significant trends and new events of public health significance. It also monitors progress and effectiveness in control and prevention strategies. Ideally surveillance should be targeted at high priority public health issues and should provide information of direct relevance to policy development. It should be sufficiently flexible to move on rapidly in the face of new challenges; those involved in surveillance need to be acutely aware of the necessity to remain alert for the novel and unexpected.

  Influenza is an example of surveillance in a field of continuing and major public health importance, in which the UK has had an internationally leading role. We have an outstandingly good national surveillance programme, centred on the PHLS, but also make important contributions to the global surveillance of influenza through our international reference centres at the National Institute for Medical Research (MRC), PHLS and National Institute for Biological Standards and Control (NIBSC). Collaborating closely with WHO, these centres have a key role in the early identification of new influenza virus variants of epidemic and pandemic potential and in ensuring that up-to-date influenza vaccines effective against these variants will be available. It is worthy of mention that the WHO influenza surveillance network, one of the most effective and practical aspects of WHO activities, was established in 1948 on the advice of a British virologist, Sir Christopher Andrewes, and has enjoyed substantial input from UK scientists for the last 54 years.

  Surveillance of poliovirus and poliomyelitis in relation to the global programme on polio eradication has received major attention in the UK as has measles, rubella and mumps surveillance in relation to our public health immunisation programme. A further good example of UK surveillance is in the field of meningitis including studies relevant to the effectiveness of vaccination. The introduction of Hib and more recently meningococcal C vaccine in the UK were examples of public health intervention where surveillance played, and still plays, a critical role in the design and effectiveness monitoring of the vaccination programme. The above examples of surveillance have all depended for their success on strong academic science inputs, and rely on advanced technologies and innovation.

  There are many other examples, including the important field of food microbiology, for example the surveillance of Salmonella strains in relation to food safety and food-related outbreaks of disease.

  Surveillance in the UK will increasingly need to focus on the arrival of exotic agents such as West Nile virus, dengue, ebola and others, and will need to include alertness for agents introduced through bioterrorism.

  It is important that surveillance is not restricted to humans and human agents. Surveillance of wild and domestic animals is critically important. Many of the new infectious agents of man were of animal origin, eg the influenza/chicken/Hong Kong/97 virus, vCJD, HIV. We neglect the study of animal sources of new infections at our peril.

  The UK needs to be well prepared for the unexpected. The capacity and flexibility to introduce rapidly and effectively new areas of surveillance in relation to new diseases remains critically important to UK public health, as for example in the case of BSE and vCJD. New diseases will require scientific imagination and innovation for their study.

  In the view of SGM, surveillance should not involve merely "stamp collecting", but should be well targeted at issues of major public health concern and include the analysis of outcome measurements. Innovation, including the implementation into surveillance activities of new tools such as PCR-based methods for microbial detection, genetic profiling and molecular biological methods, which all have an increasingly important role, will be essential to state-of-the-art surveillance. Surveillance needs to be underpinned by a strong R & D effort, which is integrated and cohesive rather than "add-on".

  Effective surveillance depends upon close collaboration between laboratory microbiologists, scientists, medical and clinical professionals and public health experts. It will require increasing amounts of investment in IT and biometrics facilities and must maintain good and effective communication with government.

  We believe that there are clear advantages in having a strong central steer (eg the Health Protection Agency) rather than completely devolved responsibility. At present in the UK surveillance is undertaken in England, Scotland, Wales and Northern Ireland without the existence of an overarching UK strategy. We believe that a unified UK surveillance system would serve us better. It is also important that the UK surveillance activities should strengthen their links with international and major national bodies such as WHO, the European Commission and CDC.

  The proposed organisational changes in relation to setting up the Health Protection Agency offer opportunities for new thinking on integrated UK-wide surveillance. However, it could also involve risks to the future of existing, high quality, surveillance activities such as those conducted by PHLS. If changes are made too rapidly and without sufficient consultation, systems that have been developed over many years and are of proven success and value may be at risk.

  For the future, the excellence of infectious disease surveillance in the UK will depend heavily on the continued availability of well-trained and experienced microbiologists in stable career positions. Currently there is a serious shortage of microbiologists in some areas of medical and clinical science. Also there is a drift away from science subjects at school level. Remedial actions are required to encourage the recruitment, retention and training of microbiologists.

  The SGM, recognising the importance of microbiological education, has developed a successful education programme aimed at fostering and advising on microbiology teaching in schools and colleges. The programme provides resources for lessons and experimental work as part of the National Curriculum, and training support for teachers, technicians and students. It operates at both primary and secondary levels.

2.  LINKS BETWEEN SURVEILLANCE OF INFECTION AND INTERVENTIONS

  The introduction of effective interventions, such as vaccines, anti-microbials and antiviral therapies, needs to be informed by effective surveillance, which, in turn, monitors their effectiveness. The interventions of the future may well be driven by an improved knowledge of the genetic and molecular as well as pathological features of the infectious agents. Drugs could potentially, in the future, be tailored to the genetic and other characteristics of individual patients and the incident infection.

  Surveillance often needs to take account of behavioural modification, as in the case of sexually transmitted diseases, or dietary habits and customs in relation to food safety issues.

3.  DEVELOPMENT OF VACCINES AND IMMUNISATION

  Prevention of infection and disease by the use of safe and effective vaccines has been one of the great successes of medicine. The UK has made major contributions to this field over many years and has a national vaccination programme of very high quality, much admired by other countries. However, there are no grounds for complacency; there is an important need for new vaccines against diseases for which there are none available at present, and for vaccines of improved effectiveness, safety and cost-benefit. Research and development work is a major and continuing need in this field. It needs to involve academic scientists, public health and clinical experts and vaccine manufacturers. Characteristically, scientific concepts for new vaccine design arose from basic biomedical research in academia, and further development work is undertaken in biotechnology companies and by the large, multinational vaccine manufacturers. There are some eight of these in the world, which together produce a high proportion of the vaccines needed by many countries.

  The Society for General Microbiology believes that continued funding of academic microbiological research will be important in relation to vaccination. There is a need for a clearer mechanism for prioritisation of targets for vaccine development and related R&D activities. The public sector will continue to have a key role in independent clinical evaluation of new vaccines to establish safety and efficacy and will need to establish close collaboration with industry. High quality surveillance programmes will be needed, in association with development of new vaccines and assessment of their effects.

  There are many infectious diseases for which new or improved vaccines are urgently needed. These clearly include the big three agents, HIV/AIDS, malaria and TB. But there are many other vaccine targets which receive less recognition. They include vaccines against meningococcus type B, respiratory syncytial virus, rotavirus, herpes viruses (including CMV), papilloma virus and Helicobacter, as well as against potential "bioterrorism" agents for which no vaccines are currently available.

  SGM believes that the programme of accelerated vaccine development and greater use of existing vaccines, as indicated in the Getting Beyond the Curve strategy, should be given a very high priority by the new Health Protection Agency. Again, progress will depend upon increased funding of research and development, and a strong government commitment to the task.

  The HPA will have a critically important role in providing a platform for the effective interaction of the several agencies in the UK involved in vaccine science, the delivery of vaccination programmes, and the prioritisation of projects. It will also need to be a powerful and articulate advocate of increased funding for this vitally important aspect of fighting infection.

4.  PUBLIC CONCERNS AND RISK PERCEPTIONS

  Recent events in relation to MMR vaccine safety has clearly indicated the public's attitude and depth of distrust of government assurances on vaccine safety. There is a strong and vociferous anti-vaccine lobby. It is very important that as professionals we get better at communicating to the public the advantages and risks of vaccination. This is part of the bigger issue of the public's general lack of confidence in scientists and scientific advice. Progress in fighting infection will be greater if the public are on the same side as the scientific community. The new HPA will need to take this challenge on board among its priorities.

5.  SUMMARY AND CONCLUSIONS

  The establishment of the new Health Protection Agency provides an important and unique opportunity for the UK to strengthen its programmes and strategy on fighting infection, particularly in relation to effective surveillance and preventative measures including vaccination.

  Success in these objectives depends strongly upon a commitment to research and development. In addition, microbiology is clearly an essential tool and there is a need for increased levels of education and training in microbiology.

  A high priority for the HPA will be the effective management of change and reorganisation without risking damage to the systems which currently serve us well. In particular, the partial dissolution of the PHLS, as proposed, needs to be approached with great care and considerable consultation if the quality of surveillance of infectious disease is not to suffer.


 
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