APPG Future Generations - Global Pandemics: Is the UK Prepared?

The All-Party Parliamentary Group for Future Generations held an event: Global Pandemics: Is the UK Prepared?
Tuesday 27th of November, 6:30pm - 8:30pm
Thatcher Room, Portcullis House, House of Commons

Pandemics have always been a part of human life, but our interconnected world makes us more vulnerable than we have ever been before. This risk stems from both natural and man-made pandemics. What can be done in the UK and internationally to increase preparedness, how can we mitigate the risks of engineered pandemics, and what would future generations want Parliament to do?

Speakers:

Professor David Heymann CBE
Head of the Centre on Global Health Security at the Chatham House and professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine. He formed part of the team investigating the first Ebola outbreak in 1976 and later headed the global response to Sars through WHO in 2003. His recent work includes examining lessons to be learnt from the 2014-16 Ebola outbreak.

Dr Catherine Rhodes
Academic Project Manager at the Centre for the Study of Existential Risk at the University of Cambridge. Her work focuses on the international governance of biotechnologies and biological risks.

Dr Piers Millett
Senior Research Fellow at the Future of Humanity Institute at the University of Oxford, working on pandemics and the impact of biotechnology. He spent more than a decade working for the Biological Weapons Convention, the treaty that bans the use of such weapons.

Overview

The first speaker at the meeting was David Heymann, Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine and Head of the Centre on Global Health Security at Chatham House.

Professor Heymann began by highlighting the UK Global Health Strategy as a world leading, and precedent setting, approach to managing the impact of global health on a single country. The strategy, whose first instance ran from 2014 to 2019, is remarkable both for its engagement in the relationship between global efforts to achieve health security and public health in the UK and for taking a cross government approach, with every single government department contributing something to its development and implementation.

He noted, however, that the strategy came out of lessons learned from two recent global pandemics. The first of these was the global epidemic of Variant CJD caused by BSE in the British Beef cow population. This was seen to have been poorly managed by the government and had very significant impacts on the economy of the UK. The second was the SARS epidemic of 2003 which emerged in Guangdong and Hong Kong. The spread of this disease was traced back to a single doctor who fell ill in an international hotel in Hong Kong, infecting other guests who spread it around the world. At first the government of China was heavily criticised for not taking this outbreak seriously enough. However, following a change in policy and aggressive international efforts it was effectively contained.

Other recent epidemics, including MERS, Ebola and Human Monkeypox, highlight the important role that poor biosecurity and infection control, especially in hospitals, often plays in initiating a disease outbreak, and thus the significant opportunity that governments have to prevent such outbreaks by investing in global health. They also highlight how international cooperation is key to detecting and fighting outbreaks. Sometimes this has been achieved via intergovernmental cooperation (as with UK-Nigeria Health Service cooperation which enabled the early detection of two cases of Human Monkeypox in the UK. However, in other cases international cooperation has had to be achieved without government assistance, or even in the face of government opposition.

Professor Heymann concluded by arguing that the UK has played a leading role in improving global health, especially in the field of fighting antibiotic resistant pathogens. Partially this has been made possible by our involvement in International partnerships such as the Global Health Security Initiative. However, it has also been made possible by the fact that we continue to invest in International Development via our legal commitment to spend 0.7% of our GDP on Aid.

Our next speaker was Piers Millett, Senior Research Fellow at the Future of Humanity Institute. Dr Millett focused on the relationship between biotechnology and biosecurity.

He began by pointing out that biosecurity was an inherently intergenerational concern. Large scale global pandemics do not, thankfully, occur on a regular basis but can be expected every 50-100 years, with the last major event being the 1918 ‘Spanish Flu’. For another thing, immunity to diseases is not something that we inherit, so each generation has to build up its own defences. For instance, since smallpox immunization largely stopped half a century ago, most of the world’s population have no protection against the disease.

However, he continued, new technologies are giving us more powerful means to secure ourselves against dangerous pathogens. For instance, it is no longer necessary for everyone working at the front-line to wear full body suits anymore and much more of the work of studying emerging pathogens can now be undertaken in the field rather than in the lab. Recently, researchers at Novartis were able to use digital sequencing and synthetic biology to create a vaccine for a new strain of influenza in a week, far faster than traditional lab-based methods. Dr Millet thus argued that the UK should support a proactive strategy of supporting research and development in biosecurity, to make use of its expertise and leading role and the massive data that comes out of the NHS.

Yet, such research and development initiatives can only ‘pre-position’ medical interventions, in that they must still be taken through medical testing and regulatory approval. This means that there are a growing number of unlicensed vaccines and other experimental treatments that are now available. These create a challenge for policy makers who need to respond in these situations. In the USA there is a general legal indemnity for companies whose treatments are used in emergencies, however at present there is no equivalent provision in the EU. This may be one area in which the UK may be able to use its greater regulatory freedom post Brexit to improve biosecurity by providing similar indemnities to those offered in America.

These new technologies are also dual use, in that they can also be used to construct bioweapons and other biohazards more easily and efficiently. Arguably one of the reasons why the international ban on bioweapons has been, generally, more effective than that on other kinds of weapons of mass destruction is that it is generally acknowledged that bioweapons are either too ineffective or too dangerous to use. However, that consensus is now shifting and this may have a knock-on effect of making these weapons harder to control.

Another problem Dr Millet noted with these new technologies is that they can open up new vulnerabilities in the biosecurity system. Because biological data is now being digitized and transmitted over the internet for synthesis elsewhere it is becoming increasingly vulnerable to cyberattacks. Nor is it possible anymore to contain potentially dangerous pathogens merely by securely storing the biological material itself, since if one knows enough about these organisms it is now possible to synthesise it elsewhere. This is making international biosecurity increasingly difficult, especially as governments have different approaches to the regulation of information sharing.

At present the main people who are thinking about, and addressing, the risks of information sharing are those who are actively involved in producing potentially dangerous information. Dr Millett and other researchers at The Future of Humanity Institute have worked to produce a set of guidelines for managing information hazards, which can be accessed at here.

Whilst a growing number of organizations are aware of these risks, recent surveys suggest that only half have any idea where to obtain support in how to manage them, and the only institutions that appear widely known about are in the USA. Even when people are not doing anything illegal, they can still be acting dangerously and anyone whose suspicions are raised about this should be able to contact somebody who they can easily communicate their concerns to. The lack of any clear UK based person or agency who can address these concerns and bring together the security and engineering communities means that there is nobody building relationships of trust and best practice.

The final speaker was Catherine Rhodes, Co-director of the Centre for the Study of Existential Risk.

Dr Rhodes pointed out that whilst future generations would like us to take steps to prevent pandemics from occurring they would also like us more broadly to take steps to boost social resilience to pandemics, including those that would allow us to recover more quickly, since sooner or later our security will be breached. She then argued that a key theme in shaping how we can go about doing this is trust. 

At the global level many of the institutions and practices that have been put in place to boost pandemic preparedness rely on trust in order to operate. For instance, Indonesia stopped sharing samples with the international system for monitoring influenza because it felt that it was not receiving an equitable share in the benefits of this scheme. The WHO were able to take steps to rebuild this trust, such as centralizing the sharing of vaccines and other benefits. However, often individual states act in ways that significantly undermine these efforts.

At the time of the 2009 Swine Flu outbreak, 7 industrial states were found to have advanced contracts with vaccine manufacturers and came to dominate the international supply of vaccines - these were not the states that would be most affected by such a pandemic. This is not an easy thing to talk about as states desire to put their own citizens first. However, governments could still take real trust building actions such as issuing assurances that they would not act in the same way in the future.

Dr Rhodes also pointed out that Trust is important between states and the international biomedical research community. The community is worried that governments may limit the activities of researchers in ways that could threaten research efforts that rely upon international sharing of sequencing and other resources. Governments do not seem to be responding to these concerns.

Within states there are also issues about people receiving conflicting advice from different agencies, and this can undermine trust between citizens and their governments. We need to carefully think about how and why we will provide differential recommendations to different people should a pandemic occur as this can create a powerful sense of mistrust and inequity and thus hamper cooperation.

At the moment most people are not even aware that there is a pandemic preparedness strategy, let alone willing to engage with it. Some key concerns are that people are not aware of the burden that a pandemic event is likely to place on healthcare infrastructure, and how we can manage the ‘worried well,’ or at least people who are not sick enough to require hospital treatment. There is also not much awareness of the impact of an increased number of deaths over a relatively short period, such as using community facilities for expanding mortuary capacities. These things will greatly undermine trust if they are a surprise to people, and could be seen as a sign of a lack of preparedness, rather than of a well-developed strategy.

In the UK there are Local Resilience Forums, but people do not know about them and they are not aware of where we can go and who we can look to for advice and guidance in an emergency situation. Many people do not even know who their neighbours are and whether they will need additional support. On the other hand, she concluded, knowing in advance what you could contribute is something that could really help to build trust and resilience.