29 January 2016
This week the UK House of Commons Science and Technology Select Committee published a report from their inquiry on Science in Emergencies: UK Lessons from Ebola. They found that the UK response – like the international response- was undermined by systemic delay.
The Committee’s response suggests that the Ebola epidemic exposed a ‘lack of readiness’ for an infectious disease emergency which could impair the UK’s ability to respond to future emergencies at home and abroad. Tellingly, the committee Chair, Nicola Blackwood MP commented that "a combination of hard work and chance prevented Ebola spreading further than it did." Among the shortcomings exposed were:
Around the time this inquiry was initiated (July 2015), the PHG Foundation released its report on the impact of genomics for infectious disease management. Pathogen Genomics into Practice examines the actions that need to be taken across the health system in England in order to realise the full potential of genomics. The report includes an appraisal of the various applications of genomics, including the management and prevention of emerging infectious diseases, where we expect genomics to be increasingly of value.
Although the Select Committee inquiry is a retrospective review of the UK’s response to disease emergencies and our report a prospective assessment of the potential impact of a technology on infectious disease management, there were two key conclusions that chime strongly across both reports.
A ‘worrying’ lack of coordination in the response to Ebola was cited several times by the Select Committee inquiry. This included references to multiple ‘unorchestrated’ research activities, all aiming to address the same question. The different explanations advanced for the failure to deploy a rapid diagnostic antigen test exposed a lack of coordination across the Government departments and agencies at the forefront of delivering the UK’s response to Ebola.
Our own work uncovered a similarly fragmented approach to the implementation of pathogen genomic services in the UK. Despite their great potential to improve the management of disease threats such as TB and healthcare associated infections such as MRSA, they are languishing in ‘translational research limbo’ due to lack of resourcing and poor coordination of research and implementation activities. As the Ebola outbreak highlighted, the consequences of fragmentary and uncoordinated activity for patients can be grave.
Given that many emerging infectious diseases originate in animal populations, it’s imperative that activity is coordinated and knowledge shared across the wide range of organisations involved, including human, food, and animal health agencies. As the Ebola experience demonstrates, the timely and effective development and delivery of new technologies critical to protecting the health of our population cannot be left to the goodwill and altruism of some researchers and frontline health professionals. Implementation of critical new technologies and response systems to tackle the threat from epidemics requires national coordination, leadership and accountability - and the UK needs to act urgently to ensure these.
The Select Committee report rightly points out that 'surveillance data loses its value, if it fails to reach those who have the ability to act upon it'. This is true not only in the context of Ebola, but also infectious disease surveillance generally. Our own report emphasises that wide-ranging benefits of genomics for prospective and reactive infectious disease epidemiology will only be realised if action is taken now to develop a strategy for the timely sharing and integration of genomic and clinical / epidemiological data. Moreover having the systems and strategy in place for data management will not only enable health systems to respond more proactively to disease outbreaks, but can also accelerate the ability to undertake ‘reactive’ research under time-sensitive circumstances. Indeed the Select Committee report concluded that the UK and other countries were not ‘research ready’ when the outbreak began, prompting a less than optimal response.
Delays in data sharing, communication and action in response to real-time data in this most recent emergency situation cost thousands of lives. In large part these delays were due to a lack of systems and clear strategy for data exchange both within and between countries. In the UK, the Select Committee report reveals there were challenges in sharing data and more broadly in communicating knowledge across the different groups responsible for the response efforts, including the government and Public Health England. Furthermore, an independent panel report on the Global Response to Ebola, noted that although some academic researchers shared genomic sequencing data early in the outbreak through an open access database, other researchers later withheld such data from the public domain. In my opinion publicly funded researchers unwilling or reluctant to share data promptly in emergency situations should be penalised for their actions.
The extent of goodwill among volunteers and how, in the absence of established mechanisms, ad hoc approaches emerged to fill the gaps to eventually bring the Ebola outbreak under control, is both heartening and alarming to learn. Prevention is always better than cure. Whilst a strategy for augmenting Public Health England’s capacity during disease emergency situations (as recommended by the Select Committee) is reasonable, it is vital to not overlook the importance of ongoing public health activity once the ‘storm’ of the emergency is over. In the context of health protection this means building coordinated systems for surveillance to achieve earlier detection of emerging infectious diseases, and investing in coordinated programmes of research to enable the development of vaccines, diagnostic tests and other preventive measures.