On 21 January, 2020 POST and the APPG for Future Generations hosted a closed briefing on future biosecurity risks: pandemics, infectious diseases and beyond, considering trends in globalisation and emerging technologies. These are the notes from the briefing. As this was a closed event for Parliamentarians and parliamentary staff, questions and comments during the different rounds of discussion have not been attributed.
- Dr Ngozi Erondu, Associate Fellow, Centre on Global Health Security, Chatham House
- Professor Christl Donnelly, School of Public Health, Imperial College
- Dr Catherine Rhodes, Executive Director, Centre for the Study of Existential Risk and Senior Researcher at Biosecurity Research Initiative at St Catharine’s (BioRISC)
- Professor Daniel Bausch, Director of the UK Public Health Rapid Support Team, Public Health England and the London School of Hygiene & Tropical Medicine
- Dr Piers Millett, Senior Research Fellow at the Future of Humanity Institute
- Lord Browne of Ladyton, Visiting Researcher at the Centre for the Study of Existential Risk
Lord Harris welcomed guests to this timely meeting, jointly convened by the APPG for Future Generation and POST. He outlined that we are facing a situation where things can arise in any part of the world, and that with the speed of international movement, disease can spread rapidly around the world. Many parts of the world have poor health infrastructure, and of course we have the situation in which it becomes easier for those with malign intent to create or produce new pathogens.On timeliness, the Joint Committee on National Security Strategy has an “oven-ready” inquiry on biosecurity ready to go if the new Committee wishes to pursue it.The purpose of today’s event is to give parliamentarians the opportunity to hear about challenges and coordination across government regarding biosecurity threats. This includes pandemics, vector-borne disease, as well as intentionally created infectious agents.Key themes are the frameworks designed to respond to such outbreaks,tools to collect and analyse data, and appropriate plans for preparedness and readiness. There are also the future risks posed by dual use technologies,such as synthetic biology.
Dr Ngozi Erondu
Associate Fellow, Centre on Global Health Security, Chatham House
Ngozi is a Senior Research Fellow at the Chatham House Centre for Global Health Security and a Senior Public Health Advisor at Public Health England. She has 10 years’ experience in epidemiology and programe valuation. Several of those years spent doing fieldwork on the surveillance of various epidemic prone or vaccine preventable diseases: she worked in Kenya on poliomyelitis, Saudi Arabia on H1N1, Chad on meningococcal meningitis, and Guinea on Ebola Virus Disease. She has also worked with the WHO on developing a costing tool for the International Health Regulations (2005) and with several countries to evaluate their disease surveillance systems.
There are multiple opportunities for the UK to continue to be a key player in biosecurity and global health diplomacy. For example, in providing countries with limited resources access to the global health systems. However, sustained investment is needed in public health to ensure sustainable disease control capacity, with Ministers having ownership of health preparedness.
Strengthened bilateral health partnerships are important, at home and abroad, especially in resource-constrained countries. When a major public health problem affects the country, responders are accountable to national governments, the wider public and international institutions, such as the International Association of National Public Health Institutes (IANPHI). Historically this accountability has been important for domestic public health, but now also for international research and preparedness for outbreak responses.
In the UK the most recent work by IANPHI and Public Health England (PHE) has been to help resource constrained countries to develop their own plans. The UK has a prominent role in global responses. An ODA funded PHE programme worked to collaborate to prioritise areas. An example of work is in the Strengthening National Accountability for Global Health Security (SNAP-GHS ) project. Implemented by Chatham House, this project was formed to recognise gaps in monitoring biological and non-biological health threats. This included work with national public health partners in Pakistan, Ethiopia and Nigeria. It involved collecting data for indicators on air passenger illness, vaccination rates in countries and so on. The project output was a at country and sub-national levels of preparedness, with indicators for preparedness such as vaccination rates heading in the right direction. In terms of the UK government, it can provide support for these programmes and enhance diplomatic channels to provide parallel networks for prioritising investment in national institutes. By investing in these programmes, we can be confident that we can put out fires elsewhere and be able to smell the smoke and put out problems emerging ever earlier.
Professor Daniel Bausch
Director of the UK Public Health Rapid Support Team, Public Health England and the London School of Hygiene & Tropical Medicine (LSHTM)
Daniel is a physician and virologist trained in internal medicine, infectious diseases, tropical medicine, and public health. He specialises in the research and control of emerging tropical viruses, with over 25 years’ experience in sub-Saharan Africa, Latin America, and Asia combating viruses such as Ebola, Marburg, Lassa, hantavirus, and SARS coronavirus. He is the Director of the United Kingdom Public Health Rapid Support Team (UK-PHRST), the primary arm of Her Majesty’s Government to provide and coordinate the UK’s public health response to outbreaks in low- and middle-income countries (LMICs). Created in 2016, the UK-PHRST is a unique collaboration between LSHTM and Public Health England, with academic partners at the University of Oxford and King’s College London. The UK-PHRST’s tripartite remit includes outbreak response, conducting research on outbreak-prone diseases, and building capacity for outbreak response in LMICs.
Professor Bausch invited attendees to reflect on a fictitious scenario describing an outbreak of Ebola and its consequences:
“On August 4, 2018, the Democratic Republic of the Congo (DRC) declared an outbreak of Ebola virus disease (EVD) in the city of Beni (pop. 1 million), North Kivu Province, on Congo’s extreme eastern border. North Kivu has a population of approximately 8 million people of mixed ethnicity and language, with the capital city being Goma (pop. 1.5 million). North Kivu and neighbouring provinces share borders with Rwanda, Uganda, South Sudan. The vestiges of the Congolese civil war (1998-2003), the genocide in Rwanda, and the stepping up of pursuit of armed groups in Uganda have result in tens of thousands of refugees and migrants in the area, and also over 150 distinct armed groups, some coalesced as large rebel groups and others as small private militias, protecting local business interests, called Mai Mai. The North Kivu population lives under chronic duress, with attacks occurring on a daily basis.
Although the source of the Ebola outbreak remains unknown, reports indicate that early cases may have resulted from a hunting party returning to Beni form the surrounding forest, where they hunted various animals, including non-human primates, and may have had contact bats, the putative reservoir for Ebola virus.
This is the 10th recorded Ebola outbreak in the DRC. The DRC Minister of Health quickly dispatched a team of experts familiar with Ebola from Kinshasa to Beni, arriving within 72 hours of the declaration of the outbreak. However, with North Kivu being a traditional area of government opposition, there is significant suspicious of federal government worker, especially coming from Kinshasa, over 1500 kilometres away and from different ethnic and linguistic groups.
The international community, including the World Health Organisation and other UN agencies, the US CDC, the UK Public Health Rapid Support Team, and multiple non-governmental organisations, such as Médecins Sans Frontières (MSF) are also swift to respond. However, there is significant disagreement regarding the command structure and approach to outbreak control, both between the international partners and between them and the DRC Government. Because of this inward focus and infighting, the outbreak responders are slow to engage the local community, such as village elders, religious and business leaders in the response.
By September 4th, one month into the outbreak, there are over 300 reported cases in five recognized foci around Beni. While response operations are getting more organized, only 60% of contacts are able to be traced daily, in part because many contacts disappear from view, distrustful of contact tracing teams, who are primarily led by foreign personnel, and often viewed as being “government collaborators”. Rumours abound, fuelled by ubiquitous social messaging networks, which include that Ebola does not exist, or that it has been introduced by the government or foreign sources to control or exterminate the local population or as a “business” to make money. Attacks from local militias on response workers have been reported. While use of a new Ebola vaccine is credited with keeping transmission in check, the civil unrest, as well as difficulty maintaining the necessary cold chain, has limited its widespread use.
On October 23rd one confirmed and four suspected cases are reported in Goma. Two days later, in opposition to WHO guidance and in violation of international health regulations, Rwanda closes its border with the DRC. This move has particular consequence for the adjacent cities of Goma and Gisenyi, between which 55,000 people normally cross daily (the second largest daily crossing in the world, after the Mexico USA border), the majority being women engaged in trade.
A week later, 15 cases in three foci in Goma have been confirmed, along with another 33 suspected cases. Fuelled by fear, many shops close and public events cancelled. Combined with diminished trade from Rwanda and the affected areas toward the north, food supplies in Goma begin to dwindle, although this has yet to be recognized internationally. On November 7th a small cluster of cases is confirmed in the village of Kasese, Uganda, near the border between Uganda and DRC. The cases stem from a sick Congolese man who, fearing recognition and isolation by contact tracing teams in Beni, fled with his family, many of whom were exposed and infected, to stay with family members in Kasese. Within two weeks 17 cases are reported in Kasese, with suspected cases in three surrounding villages. While Uganda does not close the border, which is also crossed by tens of thousands of people daily, tensions are high, with reports of Ugandans throwing rocks at and attacking those wishing to cross from DRC, accusing them of spreading Ebola to Uganda. These eventually result in almost daily small-scale riots, effectively closing the border and highly limiting trade. Protests and riots are also emerging frequently now in Goma, prompting Rwanda to send troops to reinforce the Goma-Gisenyi border.
By December 1st, daily case counts in Beni and surrounding provinces number over 100. Existent laboratories are having difficulty keeping up with the high daily flow of samples. Isolation units are full and forced to provide rudimentary care and shelter for suspected cases in “holding centres”, which usually consist of little more than a tent with mattresses on the ground and a jug of water. Although not yet confirmed, there are alerts of cases in the Ugandan capital Kampala, well as in South Sudan, and Tanzania. Local suspicion of the outbreak control efforts has now often turned to outright aggression, with attacks on Ebola Treatment Units, laboratories, and field workers. Over 20 response workers have been killed, forcing many response operations to cease. On December 5th the ADF rebels attack the primary depot of the Ebola vaccine supply, and force vaccinators at gunpoint to vaccinate their soldiers. Any supply not used is destroyed.
Food supplies across the region are now thin, with daily violent protests in Beni and Goma. The international community, including the World Food Programme, is engaged to help provide supplies, but having trouble getting access. The three international airlines which previously served Goma have now suspended service not only to Goma, but to nearly Kisangani. The small airstrips in Beni and the city of Butembo to the north are too small to accommodate large cargo planes. Furthermore, when food is supplied, either at the source of distribution or afterwards, it is often immediately commandeered by armed groups.
On December 17, having commandeered nearly all supplies available in Beni, a heavily armed force of an estimated 30,000 ADF rebels and associated Mai Mai enter Goma and declare themselves in charge. Virtually all food supplies are now under their control, but the supplies are few. Hungry locals continue to protest and are frequently fired upon and killed by the rebels. With little food to fight for in Goma, the rebels begin attacks on Rwandan troops at the border, with hopes to invade.”
Professor Bausch highlighted that while this scenario creates a sombre picture, it is not unrealistic. It could happen in the DRC. The intention is that we should recognise that the consequences for health security are often in broad terms.
Take home points
- Most emerging diseases are zoonoses (maintained in animals), and thus outbreak hotspots are:
- Areas where daily contact with animals is common.
- Public health infrastructure to detect and contain is limited—often areas of civil unrest. These are increasing in number.
- There are few “remote places” left in the world. Old “protections” are gone.
- All global health security is “local”. The linchpin of epidemic and pandemic preparedness lies at the local interface. The messenger is as important as the message to connect to the local population.
- The international response, including the UK Public Health Rapid Support Team (which I’m privileged to lead) is important, but must engage local actors and stakeholders immediately. International processes, in part due to limited capacities at the country level and unclear leadership and organisation of international actors, is routinely too slow.
- “Siloed” responses that address only one disease are unlikely to be successful, especially if that disease is not the community’s priority. Need to search for ways to combined technical approach to outbreaks with broader humanitarian response.
- Biomedical innovations, including new diagnostics, therapeutics, and vaccines, are important, but not a panacea.
- The UK and the World have a moral obligation to attend human suffering, such as outbreaks, but even if not compelled by a moral imperative, it is still the strategically the right thing to do. Isolationism not an option. Even if you don’t care about your neighbour, put out the fire down the block, to prevent it from spreading to your house.
- Continue funding of UK capacity for global engagement (e.g. UK-PHRST, Global Public Health, DfID).
- Continue funding for WHO and UN systems, but need further clarity of leadership and organisation during outbreaks.
- Heighten emphasis on local capacity building, which is the only sustainable long-term solution, and inevitably much less costly than perpetual attending to outbreaks and related insecurity.
Dr Erondu agreed with Professor Bausch’ comments. They have worked in very similar arenas, such as the response to Ebola in West Africa. The points about siloed responses and the non-health realities that impede the response are all concerns. Looking at the UK Government, resources can strengthen local capacity. On data to inform scenarios, one of the projects looked at non-traditional data sources. There are sets of tools that look at laboratory capacity and other health system components. One approach is to look for diseases in animals as indicators for potential or regional outbreaks as most have zoonotic roots. Data from smallholder farmers for example, can be useful. There is also a need to think creatively and at a more granular level as far as data is concerned.
Question: There is sometimes a delay of international responders going into a country – with disagreement about who is doing what and who is in charge. Is there an accepted international framework for such cooperation?
Answer: No, there is not. There is a tendency for bodies to say well that is a good idea, unless they are already first on the ground for an outbreak. International co-operation is a huge transition to make, not least as national stakeholders say no one is in charge except for us.
Question: Could you comment on the Ebola vaccine and how well it is working? And how long did it take?
Answer: It is working, and health workers are being vaccinated. There are two vaccines in use now. This is a great medical innovation, but it cannot completely overcome some social, cultural and economic barriers. A vaccine is a good tool but is not a panacea.
Dr Catherine Rhodes
Executive Director, Centre for the Study of Existential Risk and Senior Researcher at Biosecurity Research Initiative at St Catharine’s (BioRISC)
Catherine is Executive Director of the Centre for the Study of Existential Risk (CSER) and Senior Research Associate, Biosecurity Research Initiative at St Catharine’s College, Cambridge. Her work has broadly focused on the interactions between and respective roles of science and governance in addressing major global challenges. In the context of extreme technological risks, Catherine is particularly interested in understanding the intersection and combination of risk stemming from technologies and risk stemming from governance (or lack of it). She has particular expertise in international governance of biotechnology, including biosecurity and broader risk management issues.
The main challenge of biosecurity is that is that there are multiple layers of governance, it is not just about what is done at national level; it is rarely only a national issue. For example, with the coronavirus in China: China has a coordination issue in the locality of the outbreak, but also regionally, then nationally. Ultimately it is an international matter, overseen by the World Health Organisation (WHO). The WHO will advise on whether the virus poses a serious public health threat. This advice includes the likely spread and potential recommendations for action required, and WHO will co-ordinate the surveillance required and the nature of the response. It is necessary to take governance systems to the local level to coordinate between and across those levels – for example, between public and private sector research institutions, government agencies and emergency responders.
The challenge is the level of complexity and the actors involved. Multiple partners are responsible for different aspects and there can be a lack awareness as to how these interact, and these can be points at which coordination fails. The UK is doing well, particularly on flu pandemic preparedness with a framework in place. There are plans and public guidance documents. It is clear who holds which positions and what their responsibilities are; for example, the Chief Medical Officer, the Cabinet Office, Cobra and SAGE. This planning also applies at other levels, for example hospitals have plans in place. These plans have been tested in exercises and in real world situations, such as the 2009 swine influenza outbreak, and updated accordingly.
However, co-ordination is weaker is in terms of how biosecurity planning interacts with the bio-economy and industrial strategies. The UK’s Biological Security Strategy highlights how industry contributes to biosecurity, but this is not reflected in the Life Sciences Industry Strategy or the UK Bioeconomy Strategy. We need to understand the threats, where they come from and how they converge with other scientific areas, such as the cyber area. Much biotechnology is in a digital form, such as digital genetic sequences, but cybersecurity is not integrated into the Biological Security Strategy. Better understanding is needed of the institutions, departments and agencies operating all levels from local to national, which the Biological Security Strategy is the UK starting point, to ensure clear coordination for biosecurity. Sometimes continuity resides in institutional memory. Preparedness exercises are important, and lessons can also be learnt from exercises carried out in other countries. Exercises based on different threats are useful for identifying how to coordinate on biosecurity and how to identify capacity needs at the UK government level.
Dr Piers Millett
Senior Research Fellow at the Future of Humanity Institute
Piers is a Senior Research Fellow at the Future of Humanity Institute, where he focuses on pandemic and deliberate disease and the implications of biotechnology. He consults for the World Health Organization on research and development for public health emergencies. He spent more than a decade working for the Biological Weapons Convention, the international treaty that bans these weapons. He has collaborated with a wide range of international organizations dealing with human and animal health, humanitarian emergencies and International Humanitarian Law, law enforcement, international security.
There are significant benefits and risks from science and technology on emerging infectious disease. For example, the iGEM bioengineering competition involves 300 teams of students from 45 countries working to push the boundaries of synthetic biology by tackling everyday issues facing the world. One of the benefits is that it creates a talent pipeline for the biotech industry. The £0.5 billion invested worldwide annually in bioengineering start-ups shows how important the biotech sector is.
These important developments in science and technology have provided an unprecedented understanding of disease and we are becoming much better at combating it. On the other hand, it can also resurrect pathogens from extinction; for example, the influenza virus responsible for the 1918 pandemic. There are new laboratories all over world doing important public health work and many of them are working with dangerous pathogens. There is a long history of oversight of these labs and managing the risks, but accidental releases do happen. There were several accidental releases of the SARS pathogen (a forerunner of the current coronavirus outbreak). The US’s Biodefence programme has unintentionally released pathogens. There have also been accidents in the UK; for example, the world’s last case of smallpox in 1978, then more recently causing the 2007 foot and mouth outbreak. The take home message is that the more places we have that hold and use these pathogens, the more likely it is that there will be an accidental release.
The consequence of scientific progress is that we can make new things including pathogens that have never been seen before in nature. This is because we have new tools at our disposal such as those used in the synthetic biology field and now, gene editing. We are co-opting evolution and directing it to make things we want. We are now reaching the capability of making changes that would not be possible through biological evolution, a capability that is likely to increase with AI and machine learning. This offers potential benefits but also risks. While we have to get ahead of future outbreaks, it needs to be borne in mind that we could possibly be engineering something worse than anything that has previously appeared in nature. This could include potentially pandemic pathogens, which spread rapidly, are virulent, and against which we have no effective public health interventions. Accidental releases of such pathogens could have the same consequences of the pandemic event the research is trying to prevent.
There is also the possibility of deliberate use of pathogens by malign actors. Every major power over the last century had an offensive bioweapons programme. It is likely that there are terrorist groups actively pursuing these weapons today. There is a well-established history of new advances being weaponised and as we become more comfortable with biotechnology, we should not discount the resurgence of biological weapons.
There are two specific actions needed to make progress:
- A Select Committee inquiry could examine this area – the UK is uniquely placed to show global leadership both at the level of technological development and its governance. The UK is a leader in synthetic biology and bioengineering, largely as a result of our funded strategy (which needs to be refunded). The recently published US National Academy of Sciences report ‘Safeguarding the Bioeconomy’ highlights the importance of protecting technological leads. The UK has a long history of governance of new technologies, maximising benefits and minimising risks, especially through more participatory forms of oversight such as over stem cell research, and the citizen’s assembly on climate change.
- The UK has a Biological Security Strategy – this has been around for 18 months and there has been a lot of discussion in government, but it still has to be implemented and there has been minimal interaction with those outside of government. There is a need for an official link between the security and biotech communities. This may be as simple as a dedicated individual housed in the right department. There is also a need for a better institutional link, something like the Synthetic Biology Leadership Council would bring together researchers, the public and the private sector, and relevant government departments to update our thinking, identify opportunities for action, and to help revise and review the strategy as necessary.
Question: Every country some offensive capability – and Russia has been cited as an historical example with the programme cancelled. Is there any evidence about whether it is still going on?
Answer: There is suspicion in the public literature and amongst the UK and allies that is continues. There are a number of biological weapon laboratories in Russia to which no non-Russian has visited since the end of the Soviet Union, so what is happening in these locations is unknown.
Question: Could the UK’s strategy be improved – where is the UK in terms of ranking with international comparators?
Answer: We are fairly advanced in UK, for animal and plant health and the economic aspects – others are looking to the UK. In terms of what others are doing, such as the US National Biodefense Strategy, have a slightly narrower focus. It provides a good model of what it expects its approach to be and the US further ahead on the implementation side of it.
Question: To what extent are biotechnology companies seeking environments in which there are fewer regulatory requirements in which to work? Do they choose the laxest regulatory environments in order to make progress and what risks would arise from this?
Answer: It is better to look at this from a market perspective; if a company does want to enter a highly regulated market with a product then it is likely going to be required to have developed it there in first place. However, the bad news is that there is a disconnect, while in nearly all locations there will be rules around ethics and human experimentation, it is highly unlikely that the rules will ensure there is no deliberate or accidental releases.
Question: How are the activities of terrorist groups engaged in biotechnology monitored?
Answer: The culture around discussing them is different in the UK compared with the US. The US is open about who is looking at what and what their specific job is. In the UK it much more difficult to know this. There are parts of the Metropolitan Police and counter-terrorist forces looking at that and they are thinking about these issues. However, we have limited knowledge of what they are doing, and they are difficult to engage with. One of the reasons that there have been so few incidents of biological weapons being used is that those developed in the 1950s and 60s weren’t terribly effective and people have tended to assume that most countries got rid of them in the last century. It is no longer true that high capability bioweapons can’t be developed by modern state actors, but the ability to control outbreaks once they are released is another matter. The way that bans on bioweapons are constructed allows all countries to carry out defensive work. For example, states can make biowarfare agents in small quantities, in order to test counter-measures. Where states have links to terrorism there are opportunities for material to be provided to malign actors.
Professor Christl Donnelly
Department of Statistics, University of Oxford and School of Public Health, Imperial College London
Christl’s research programme aims to improve our understanding of (and ability to predict) the transmission dynamics of infectious diseases and the effects of disease control interventions. She uses rigorous parameter estimation and hypothesis testing to gain the robust insights from dynamical models of disease transmission, demography and interventions. She received a CBE in 2018 for services to epidemiology and the control of infectious diseases. She was elected Fellow of the Royal Society (FRS) in 2016 and Fellow of the Academy of Medical Sciences (FMedSci) in 2015.
Professor Donnelly explained her specialism in infectious disease and statistics. This year sees the bicentenary of Florence Nightingale, a pioneer of evidence-based medicine in the fields of nursing and public health. She collected and analysed data as well as presenting the results to policymakers.
We need good surveillance data, but these are not just about simple counts. There are rich and complex data that are valuable not only about individual cases but in how those cases are interlinked. For example, were all affected members of the family exposed to wildlife at the market or are there cases of human-to-human transmission? Understanding both the source of a novel infection and its spread is critical. The novel coronavirus situation is changing as we speak, with numbers increasing rapidly. There are important uncertainties, but human-to-human transmission has definitely occurred. There are 15 cases in healthcare workers, with an estimated 291 latest cases overall according to the latest reports (on Tuesday 21st January). There has been spread from Wuhan to other cities in China and cases have been identified in other countries: Japan (1); Thailand (3); South Korea (1); Taiwan (1); and the United States (1). It is very likely that additional cases will be identified. Scaling this number of exported cases up indicates an estimate of 2,900 cases in total at this time.
It is also important to take into consideration that some people infected but with mild symptoms may not seek care. Another challenge for a novel disease is to decide on a case definition. This is particularly challenging when no diagnostic test is available. There is now a test for the novel coronavirus as it has been isolated and sequenced. Once a test is available the question is then how best to apply it, particularly if there are limited diagnostic resources. The testing procedure followed can determine how many cases are identified and perceptions of the likely transmission routes. Data need to be collected, analysed and understood in a variety of contexts. Just because human-to-human transmission is possible does not mean it is sufficient to sustain an epidemic. Data are most limited at the start of an epidemic, but this is when people are most keen for data and insights. However, there needs to be careful consideration of the assumptions underlying analyses and limitations of available data. Community engagement is particularly important. In previous serious epidemics, there have been increases in other diseases. For example, during the Ebola outbreak in West Africa there were additional excess deaths attributed to malaria, measles and increased maternal and infant mortality. Rather than each of these arising in isolation, they are connected as there can be changes in health-seeking behaviours by communities both due to concerns about infection risks and due to limited healthcare capacity for non-epidemic needs. If vaccine programmes are affected, then it is likely that vaccine-preventable diseases will increase. In short, there are very wide-ranging consequences to public health beyond the emerging disease and these wider public health impacts are just as important to measure and understand. Even more broadly, there can be associated repercussions for food and political security that arise.
For updated analysis of the novel coronavirus in Wuhan, China, please refer to this article, co-authored by Professor Donnelly:
Lord Browne of Ladyton
Visiting Researcher at the Centre for the Study of Existential Risk
Based at St Catharine’s and at CSER, Lord Browne is working on a number of projects that engage the challenges science and technology pose for public policy. He has held a number of ministerial posts. In particular, he was Secretary of State for Defence (2006 – 2008). Currently a member of the House of Lords, Lord Browne is also the Vice-Chair of the Nuclear Threat Initiative and Co-founder and current Chair of the Executive Board of the European Leadership Network.
Lord Browne began by introducing the 2019 Global Health Security Index report. This was published by NTI in collaboration with Johns Hopkins, with funding from Open Philanthropy Project, the Bill and Melinda Gates Foundation and the Robertson Foundation. The report aims to give an overview of global preparedness. It comprises an index against which improvements can be encouraged and measured. Global biological threats are recognised in the UK’s Biological Security Strategy. No such strategy means that a government can meet these challenges alone. The strategy outlines who Government needs to work with in order to address the complexity and diversity that are inherent to the very nature of the threat. There is an obligation on Government to facilitate that co-operation and Parliament needs to hold Government accountable for building that network. That network will not be effective unless parliamentarians understand this. To understand this complicated threat, we need to spend time with researchers working closely on the topic and feasible options for what can be done.
There is also a need to prioritise the resources the UK are responsible for. The Index report makes some specific recommendations. In the report, there were no example of areas that states with more sophisticated capabilities, such as the US and UK, had a green traffic light for. Even with good resources, the UK can only make some of them amber level against some threats. The UK does well, but other highly developed countries of perform worse than expected. There is a need to reform the international institutions for health and security, that currently work in silos. For example, the World Health Organization works in bilateral relationships with affected countries and it is almost impossible for information to be shared. On some occasions, the UK has not been very good at sharing information and showing how things can be done better. There are good tools available and these must be sustained in order to drove improvement.
Question: There is clearly a need for a global approach and the panel in the Global Health Security Index Report is not diverse enough.
Answer: This is a legitimate criticism. But the panel comprises global expertise and is diverse and impressive.
Question: There are significant uncertainties at the beginning of an outbreak – how quickly can we start gathering critical issues such as incubation period and mortality rate?
Answer: There are very specific and contextual pieces of information that are needed in order to determine characteristics like incubation period (the time between being infected and showing symptoms). For example, knowing the timepoint at which exposure occurred is particularly helpful. It is often the case that we must wait some time for good estimates of case fatality rate. There are some assumptions in calculating this that introduce error, this was seen with estimates for SARS and some influenza outbreaks. For the current outbreak the estimate is ~15% but this is subject to uncertainty.
Question: What is it that we should be doing or change to best prepare for future? For the current outbreak have we been able to access samples to carry out testing such as sequencing? Or is all the knowledge generated by the Chinese?
Answer: The results of genotyping have been produced in China, but it is not clear whether any samples have been shared by the Chinese. With cases in other countries including Japan and South Korea it is likely that similar analysis will be carried out by other states. Access to samples is an example of how international governance can fall down. The protocols in the UN Convention on Biodiversity guarantee that sovereign states have rights over the genetic resources present in domestic wildlife, including pathogens. Discussions are ongoing as to whether this will be extended to digital sequence information obtained from a nation states’ biodiversity, raising concerns that states could see themselves complying with the Convention by refusing access to samples. This is an unintended consequence of a governance approach seeking to implement benefit sharing between developed and developing countries over genetic resources.
In terms of communicating risk, engaging with the public is important but it can take some time to accumulate evidence. Social media can be inaccurate, and it can be difficult to disprove false information and stop untrue stories spreading. The public need to have a clear idea about which channels they can trust.
Question: Thinking about the variables of infections, many of which are zoonotic in origin – do those pathogens change as they adapt to humans?
Answer: There is not enough evidence concerning the current coronavirus (which is believed to have gone from bats to snakes to humans), but it is notable that SARs did not evolve substantially during that outbreak. However, there is the possibility that strains evolve. It is unlikely that the changes would be significant, but this is not impossible.
Question: If the new coronavirus came to the UK would be prepared. Specifically, how well prepared are GPs, and given what we know about how difficult it can be to access timely appointments.
Answer: It is unclear what if any advice has been given to UK GPs. The challenge with respiratory viruses is that they present with non-specific symptoms. Most people presenting with such respiratory symptoms would have illnesses caused by other pathogens. An example of a simple screening method would be to ask about recent travel. However, once sustained transmission is present, then that simple screening question becomes irrelevant. Early recognition is possible by exit screening at airports for those travelling from epidemic areas.
Question: With Chinese New Year we can expect that significant movement of large numbers of Chinese people from Wuhan and other affected areas. What are we telling staff working at UK borders about how we should respond?
Answer: Exit screening in Wuhan is in place and arrival screening could be an approach used at UK airports, but it is also possible that people may develop the disease at a later point given the incubation period. Arrival screening has limited benefit, especially is sensitive exit screening is in place.
Lord Harries summarised the importance of integrating scientific input to parliamentary and government discussion on the topic. Themes that emerged from the discussion meriting further consideration were: strengthening international organisations and regulatory frameworks; developing ethical frameworks for research and development, especially for dual use technologies; and how best to communicate risk to the public. Parliament is already considering new work on this large topic area, notably the possibility of an inquiry by the Joint Committee on Security Strategy. There is a need for further consideration of this topic in both Houses.