The British Society for Immunology, the largest immunological society in Europe, represents over 4,200 immunologists working in academia, clinical medicine and industry. Our objective is to promote and support excellence in research, scholarship and clinical practice in immunology for the benefit of human and animal health.
We welcome this opportunity to inform the Joint Committee’s timely enquiry. The UK is ranked top in the G7 for the quality of our immunology research[i]. Immunologists, working in both human and veterinary fields, play a key role the research, surveillance and control of infectious diseases, which pose biosecurity threats to public health.
The UK should aim to be at the forefront of identifying and assessing risk of pandemics, and work with international partners to identify diseases with conceivable risk of pandemic effect. This coincides well with the UK Government’s determination to present an outward facing, ‘global Britain’ to the world. It also accords with the UK’s commitment to spend 0.7% GDP on aid and international development, which allows us to play a major role in halting the spread of disease in low- and middle-income countries (LMICs).
There is also, however, a major role for wider horizon scanning to play: a clear majority of diseases which evolved into pandemic status in the recent past can be traced back to a zoonotic leap between species, HIV originating in chimpanzees[ii] and Ebola originating in bats[iii] are just two. USAID’s PREDICT programme is a $200 million global project which carries out surveillance for new pandemic threats in so called ‘hot spot’ countries in Africa, Asia, and Latin America, focusing on wildlife, predominantly non-human primates, bats, and rodents[iv]. This type of proactive tactic is the outward facing approach that the UK should be investing in. It is not a new approach; a Rockefeller Foundation funded virus hunt discovered the Zika virus in 1947, sixty years before the first large scale outbreak in humans[v]. Studies have found that modern dynamics including climate change, ecological degradation, population pressures, and globalisation are all making it more likely for zoonosis to occur and for there to be rapid spread of the disease in humans afterwards. It has never been more important for the UK to contribute to such an important body of work by investing in a worldwide surveillance system of diseases spread by human to human transmission and those deemed likely to make the ‘zoonotic jump’ from animals. Co-operation with our foreign partners will be vital for this, as will using the existing extensive UKAID/DfID network.
The EcoHealth Alliance focuses on this convergence between conservation and health, with the identification and prevention of emerging infectious zoonotic diseases being at the core of its work. As human populations increase and encroach on the natural habitats of animals that act as vectors or reservoirs for disease, the likelihood that novel viruses will transmit across species into the human population increases. This is one reason why bats in particular are a cause for concern. Bats are believed to be able to survive as host to these viruses due to evolutionary adaptations borne out of them being the only mammal with the ability to fly, an activity during which they expend a great amount of energy and which, in turn, produces high levels of waste metabolic products. To ensure that these harmful waste products do not damage the bats’ own DNA, they have developed a sophisticated defence mechanism which dampens their immune responses. It is thought that dampening of the STING-interferon pathway due to a genetic modification prevents the immune system from an over-response that could trigger severe illness in other species such as humans[vi].
Disease surveillance must not exist unaccompanied however, and without information being passed onto those with the power to make decisions based upon the evidence, i.e. Ministers – then it has been compared by an expert to just ‘stamp collecting’[vii]. There must be clearly delineated lines of reporting surveillance data, which are well understood by those within the reporting organisations, so that resources and personnel may be mobilised effectively to tackle abrupt surges. Doing otherwise will result in disease outbreaks escalating, potentially to pandemic status, which will be unequivocally damaging and result in loss of life. The role played by advisory groups such as New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) is important in disease surveillance too.
The reporting of disease surveillance could in turn be used to direct infectious disease research and the development of vaccines that could be used both abroad and to protect the UK against diseases should the situation deteriorate into a pandemic. The British Society for Immunology has proposed a network model to co-ordinate the numerous internationally recognised centres of excellence spread across the UK that undertake vaccines research[viii], an idea that was taken forward through the current MRC/BBSRC Vaccines Networks. Continued long-term commitment to this research landscape, whilst still allowing individual centres to work according to their specific skills and areas of interest, would allow for closer co-operation, clearer funding models, and greater sharing of resources and expertise. This would require the Government to commit more funding to vaccine research, but the pay-off from better preparedness at home and a superior ability to halt a pandemic in its tracks abroad, would be well worth the investment. This fits in well with the Government’s plan to increase spending on R&D to 2.4% GDP by 2027.
The announcement of the UK’s first Vaccine Manufacturing Innovation Centre (VMIC) in December 2018 was a welcome step forward in being able to prepare for a UK epidemic or global pandemic[ix] and this has been highlighted by acceleration of these plans during the COVID-19 pandemic. It will allow for the development and manufacture of vaccines at moderate scale for emergency preparedness for epidemic threats to the UK population. This is a significant measure because previously, the UK has had little capacity to manufacture large quantities of vaccines at short notice to protect our own population. The Government must ensure that were that event to occur, that the UK has the capacity to produce enough vaccine to protect the whole population within a short timeframe. In this case, infrastructure is just as important as the development of a vaccine.
Emerging infectious diseases
There are a great number of contributing factors to making an ‘emerging infectious disease’. The United States Center for Disease Control and Prevention (CDC) publishes a journal, Emerging Infectious Diseases, that lists microbial adaptation of existing organisms, e.g. influenza; known infections spreading to new geographic areas or populations, e.g. SARS, Zika, Ebola; previously unrecognised infections appearing in areas undergoing ecologic transformation, e.g. West Nile disease spreading from the tropics as the climate warms; old infections remerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures, e.g. tuberculosis[x]. Baylor College of Medicine further clarifies that for ‘an emerging disease to become established at least two events have to occur – (1) the infectious agent has to be introduced into a vulnerable population and (2) the agent has to have the ability to spread readily from person-to-person and cause disease[xi].
There should be thorough and rigorous disease surveillance by the Government, so that we are aware of disease outbreaks before they become a problem on our own shores. We should learn the lessons of the gaps in reporting from the influenza pandemic that occurred in 2009–2010. Despite virological data being useful in monitoring the characteristics of the virus, epidemiological data was lacking, even in countries with longstanding influenza surveillance systems but which were intended for use on mild outpatient managed disease rather than the severe acute respiratory infection which manifested[xii]. The UK Government should ensure that it and its partners around the world have pre-established systems and standards in place for reporting virological, epidemiological, and clinical data for both existing and novel pathogens; indeed working together to this end with partners of DfID and UKAID is extremely important.
The Government should also continue its work via Official Development Assistance, Department of Health and Social Care, and the Department for International Development. The outreach and internal co-operation do not need to be groundbreaking, but instead simple measures such as promoting and delivering vaccinations where appropriate, education around infection control, and support for better public health infrastructure in LMICs. An important example of this work is UK Government involvement in the Democratic Republic of the Congo in the efforts to stop the spread of the Ebola virus, as well as being the leading donor for Ebola preparedness in neighbouring Uganda by providing medical equipment and training medical personnel.
Additionally, the UK should reaffirm its commitment made in the London Declaration on Neglected Tropical Diseases (NTDs) to ensure that vaccine research and development continues in earnest and raise this as a priority in international fora. Some diseases classed by the World Health Organization (WHO) as a NTD, e.g. Dengue fever, have seen outbreaks worldwide aided in part by increasing ease of international travel[xiii], and the UK’s biosecurity rests on controlling these diseases. The UK Government’s investment in the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private coalition that endeavours to prevent epidemics and their spread through speeding up the development of vaccines, is an enterprise to be lauded. It aims to fill the critical gaps in the vaccine R&D, including against previously unknown pathogens, whilst co-ordinating a joined up international response to infectious diseases that could erupt into an epidemic[xiv].
It is incredibly important that we learn lessons from the past. The current COVID-19 pandemic has highlighted the failure to learn from previous epidemics such as SARS-CoV-1 in 2002–2003 and MERS in 2012. Both of these were caused by coronaviruses and whilst SARS-CoV-2 is a novel virus, much of what we are working on in terms of, e.g. vaccine development, could have been sped up had we continued research following these previous outbreaks. Coronaviruses are a particular problem as they are able to replicate so efficiently on entry to the human population, so this illustrates the gap that exists between public health and basic science. Research needs to be acted on properly for it to have a tangible effect. There has also been a tendency for the level of urgency with which the government has acted on a disease outbreak to be historically dependent on the proximity of the outbreak – an approach which is not realistic in today’s globalised world.
22 June 2020
[i] All Party Parliamentary Group on Global Health, The UK as a global centre for health and health science, February 2020
[ii] Cold Springs Harbor Perspectives in Medicine, Origins of HIV and the AIDS Pandemic, September 2011
[iii] WHO, Origins of the 2014 Ebola epidemic, January 2015
[iv] USAID, Emerging Pandemic Threats
[v] Smithsonian Magazine, Can Virus Hunters Stop the Next Pandemic Before It Happens?, January 2018
[vi] Dampened STING-dependent Interferon Activation in Bats; Cell Host and Microbe; February 2018.
[vii] House of Commons Science and Technology Committee, Science in emergencies: UK lessons from Ebola, 2016
[viii] British Society for Immunology, A Proposal to Create a ‘UK Vaccine Network’, September 2015
[ix] Imperial College London, £66 million UK centre to help prepare for global epidemics, December 2018
[x] ECDC, EID Journal Background and Goals
[xi] Baylor College of Medicine, Emerging Infectious Diseases
[xii] WHO/Dr Sylvie Brand, Challenges of global surveillance during an influenza pandemic
[xiii] WHO, Dengue and severe dengue, April 2019
[xiv] CEPI, Our Approach