Written evidence submitted by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (EME0007)

 

Executive Summary

● The evidence base and sources of scientific advice to Government on emergency mitigation, planning and response could be improved by closer working with the relevant National Institute for Health Research (NIHR) Health Protection Research Unit/s.

● The Health Protection Research Unit in Emerging and Zoonotic Infections was established to address infection such as Ebola. It is one of 13 Units established in 2014 with £47.5M funding from the Department of Health to conduct health protection research into different threats.

● The Emerging and Zoonotic Infections did (and continues to) conduct research on Ebola, and did feed into SAGE, and the Department of Health through informal channels; however there was no formal mechanism established by which questions raised by those groups would be fed to the Health Protection Research Unit.

● In future emergencies SAGE and other Government Committees, should consider including in their membership representation from the relevant Health Protection Research Unit/s.

 

Introduction

    1.                 This submission is made to the House of Commons Science and Technology Committee Science in emergencies: UK lessons from Ebola inquiry by Professor Tom Solomon on behalf of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections. Zoonotic infections are those which spread from animals to humans, such as Ebola
    2.                 I am Director of the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, a collaboration between the University of Liverpool, Liverpool School of Tropical Medicine, and Public Health England. I am also Director of the University’s Institute of Infection and Global Health. For the last 20 years I have conducted research on emerging zoonotic infections including, more recently, Ebola.
    3.                 The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections was established in 2014 with £4M of Department of Health Funding. Its purpose is to conduct research to support and strengthen Public Health England in its role of protecting England from emerging and zoonotic infections and threats.

 

Submission

    1.                 My submission relates to the question: Could the evidence base and sources of scientific advice to Government on emergency mitigation, planning and response be improved? If so, how?
    2.                 It became clear, during the Ebola outbreak, that there was no formal channel for communication between SAGE, COBRA, or other Department of Health or Government agencies, and our Health Protection Research Unit. i.e. there was no formal process for Government to request of us the research felt to be needed, and no formal mechanism for us to feed in the results of relevant research we had done.
    3.                 When they were established in 2014, Health Protection Research Units were asked by NIHR to retain a responsive capacity to emerging health protection research requirements, and to provide flexible staff capability in the event of a major health protection incident. With the emergence of the Ebola outbreak, we therefore addressed urgent research questions as we perceived them. And we fed the results of these into Government by any mechanism that we could, without wishing to swamp people who were already very busy. The issues we addressed included:-

-          Assessing the risk of Ebola Transmission to new countries by infected airline passengers (appendix A).1  We predicted the United States would be the first country outside Africa to be infected; we predicted the UK would have a case before the end of 2014. We were proved correct in both instances, well in advance of them occurring.

-          Examining the effectiveness of screening for Ebola virus at airports.2 This was a challenging and controversial issue where there was considerable pressure on policy-makers, and a whole range of contradictory opinions. We produced evidence on the impact of such screening, and could have provided it much earlier to policy-makers, had it been asked for.

-          Understanding UK healthcare workers attitudes to tackling Ebola in West Africa.3 At the start of the outbreak there was a desperate need for more volunteers to go out, but they were not forthcoming. Our research showed this was primarily because of a lack of information about how to volunteer, and what the role would be, rather than fear of catching Ebola virus. This could easily have been addressed establishing a well-publicised high quality portal of reliable information.

 

    1.                 Our Unit also contributed to controlling the outbreak through sending volunteers out to work in the diagnostic laboratories in Sierra Leone, and support clinical research studies; additionally members of the Unit conducted research examining the origins of the outbreak,4  and developing new diagnostics.5, 6
    2.                 It is likely that answers to important research questions to inform policy would have been achieved more speedily if SAGE and other Government Committees had included in their membership representation from the Health Protection Research Unit in Emerging and Zoonotic Infections. Given that the Health Protection Research Units had only been established relatively recently at the start of the outbreak, and given the unprecedented and overwhelming nature of the outbreak in West Africa, it is perhaps understandable that this did not happen.

 

    1.                 Our Unit is one of thirteen Health Protection Research Units established with £47.5M funding for health protection research. The others cover the following areas:

Recommendations

    1.             Many of the NIHR Health protection Research Units are doing research which is pertinent to risks identified in the National Risk Register. However, based on our experience, I worry that in another emergency SAGE and other Government Agencies would not take full advantage of them, despite the fact they were established to provide scientific advice and evidence to address such risks.
    2.             I think this could be addressed partially by greater awareness in general of the roles and functions of the Health Protection Research Units. In addition, in future emergencies, SAGE and other Department of Health and Government Committees, should consider including in their membership representation from the relevant Health Protection Research Unit/s.

 

References

 

1.              Jonathan M Read, T Déirdre Hollingsworth, Fiona McGill, et al. Ebola virus disease in West Africa: low risk of spread by international air travel, despite sustained local epidemic growth. Submitted to New England Journal of Medicine 19th August 2014. 2014.

2.              Read JM, Diggle PJ, Chirombo J, Solomon T, Baylis M. Effectiveness of screening for Ebola at airports. Lancet. 2015; 385: 23-4.

3.              Turtle L, McGill F, Bettridge J, et al. A Survey of UK Healthcare Workers' Attitudes on Volunteering to Help with the Ebola Outbreak in West Africa. PloS one. 2015; 10: e0120013.

4.              Carroll MW, Matthews DA, Hiscox JA, et al. Temporal and spatial analysis of the 2014-2015 Ebola virus outbreak in West Africa. Nature. 2015; 524: 97-101.

5.              Broadhurst MJ, Kelly JD, Miller A, et al. ReEBOV Antigen Rapid Test kit for point-of-care and laboratory-based testing for Ebola virus disease: a field validation study. Lancet. 2015; 386: 867-74.

6.              Hunt L, Gupta-Wright A, Simms V, et al. Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. The Lancet infectious diseases. 2015.

 

September 2015