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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, it is a pleasure to speak in this debate on Diseases Know No Frontiers, which results from the work of the committee so ably chaired by the noble Lord, Lord Soley, who has pretty well done my job for me. The committee could have chosen a great many topics for its first inquiry into intergovernmental organisations and how we are making use of our membership of them. However, examining how IGOs are tackling the global spread of infectious diseases turned out to be a complex and worthwhile exercise. We took evidence from many dedicated and experienced witnesses, who enabled us to build up a picture of how things are at present and what most urgently needs to be done to contain future threats. Following the old maxim that prevention is better than cure, we believe that preventing the spread of disease is an important factor to be pursued. I should like to say a few words on prevention of each of the four diseases that we selected for special attention, but I shall concentrate a little more on HIV and pandemic influenza than on the other two. With malaria, control is achieved through a combination of practical measures, such as the spraying of dwellings and the provision of insecticide-impregnated nets, which kill the carrier mosquito before she reaches her victim. Unsanitary, crowded living conditions and malnutrition create a breeding ground for tuberculosis, the second of our four diseases. Therefore, prevention is linked to improving poor socio-economic conditions. Preventing the spread of HIV is largely dependent on changing lifestyles, including, for example, sexual relations and the use of contaminated needles. However, the balance between prevention and treatment has reached a Catch-22. The evidence suggests that effective treatment through the use of antiretroviral drugs could actually increase the prevalence of the disease unless it is accompanied by effective and sustained prevention measures. The will to change behaviour may be undermined by a sense that, with the effective antiretroviral treatments available, the disease is no longer such a threat and horror. Nick Partridge, chief executive of the Terrence Higgins Trust, said that, "““good therapy … makes people healthier but it certainly does not reduce, it increases, the prevalence of HIV overall … It also creates an ongoing need for funding drug therapy which can squeeze out funding for good prevention campaigns. What is vitally important is that both go hand in hand””." In the case of pandemic influenza, prevention is largely dependent on surveillance so that the necessary steps can be taken to prevent the virus from spreading rapidly. In order to achieve comprehensive surveillance, rather than in richer countries only, an effective global alert and response system needs to be maintained to help to identify emerging infections and deal with them at source. We understand that the University of California is carrying out research into patterns of emerging infections with a view to developing risk-based forecasts of what the next pandemic might be and where it might appear. That research is still in its infancy. The London School of Hygiene and Tropical Medicine believes that global disease surveillance has improved markedly in the past decade. Dr Coker, reader in public health there, told us that, "““the SARS crisis forced a re-think globally on global surveillance and was really, in a sense, a dry run for pandemic flu””." The noble Lord, Lord Soley, drew our attention to GOARN; I am sure that noble Lords will remember what those initials stand for. However, it is worth emphasising the need to invest in basic health infrastructure to provide a firm foundation on which more specific disease control initiatives can be built. That is in our national interest as well as in the interest of other countries. The committee recommended that, "““the resources which are provided through organisations of which the UK is a member””," should bring, "““infectious disease surveillance and response systems up to an effective level””." In their response, the Government stated that they are currently preparing their international pandemic influenza strategy, which details the direction and objectives of the UK’s international efforts on pandemic preparedness over the next three to five years. I end by endorsing the plea made by the noble Lord, Lord Soley, for consideration of the importance of the topics still in the pipeline that could relate to our membership of IGOs. There will be many more that will be relevant. It is to be hoped that this committee or one like it will be re-established so that the good work can continue.