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Meeting of the United Kingdom National Influenza
Pandemic Committee (UKNIPC) held on 18 July 2005
- Download minutes
in Portable Document Format
Present Chair:
Sir Liam Donaldson Chief Medical Officer, Department of Health (DH)
Dr David Harper Head of Health Protection, International Health and
Scientific Development, DH
Gerard Hetherington Head of Health Protection, DH
Dr Penny Bevan Head of Emergency Preparedness, DH
Dr David Salisbury Principal Medical Officer: Immunisation, DH
Dr Liz Jones Head of Patient Environment, DH
Dr Jim Smith Chief Pharmaceutical Officer, DH
John Hibbs Head of News, DH
Philip Selwood Civil Emergencies Committee
Dr Joyshri Sarangi Gloucestershire and Wilts HPU
Professor Pat Troop Health Protection Agency
Dr John Coakley Homerton Foundation Trust
Professor Kent Woods MHRA
Dr Mike Simmons National Assembly for Wales
Dr Stephen Inglis NIBSC
Dr Maureen Baker Royal College of General Practioners
Professor Peter Donnelly Scottish Executive
Dr Rashmi Shukla West Midlands Public Health Group
Dr Debby Reynolds DEFRA
Dr John James Hounslow PCT
Tom Griffin Local Government Association
Secretariat
Ms Siobhan Jones Department of Health
Mrs Pamela Gardiner Department of Health
Ms Jacintha Moore Department of Health
Apologies
John Bacon Department of Health
Professor Christine Beasley Chief Nursing Officer, DH
Dr Henrietta Campbell DHSSPSNI
Dr Lorraine Doherty DHSSPSNI
Sir Brian Briscoe Local Government Association
Dr David Salter National Assembly for Wales
Sir John Skehel National Institute for Medical Research
Dr Harry Burns Scottish Executive
Dr Elizabeth Stewart Scottish Executive
Lorraine Lambert South Tyneside NHS Trust
Dr Diana Grice Surrey and Sussex PCT
Dr Angela Dawe Lambeth PCT
1. Introduction and Welcome
The chairman welcomed everyone to the meeting.
2. Terms of Reference
Members were asked for their comments on the draft terms of reference.
No comments were received and the terms of reference were agreed without
change.
3. Cross-Government preparedness (Paper 02/05)
David Harper provided a brief summary of cross Government work on preparing
for an influenza pandemic. As lead Government Department, the Department
of Health was working with the Civil Contingencies Secretariat to co-ordinate
the cross Government response.
Dr Harper also provided a summary of some of the different organisations
and groups involved in preparing for an influenza pandemic, including
the Scientific Advisory Group.
Questions and comments were invited on this item. Debby Reynolds suggested
that there may some value in incorporating data on animal health into
the wider collection of information for cross-Government decision making.
David Harper undertook to pass this on to the cross Government working
group. Dr Reynolds also mentioned that the Department for the Environment,
Food and Rural Affairs (Defra) would be undertaking a planning exercise
on avian influenza next year.
4. Revising the UK National Influenza Pandemic Contingency Plan
Members were reminded that the plan was published in March 2005 and is
currently being updated in response to comments received. The revised
plan will be published in early Autumn. Gerard Hetherington outlined the
key changes of the plan:
Updating the phases in line with the World Health Organization (WHO)
phases;
Revising modelling assumptions as appropriate;
Additional information on projected numbers affected;
Reviewing plan in light of developments since publication.
Any comments on the plan should be forwarded to the Secretariat.
5. Actions taken by the Department to improve preparedness - General
update [Paper 02/01]
Members were updated on actions taken by the Department to improve preparedness
for an influenza pandemic. Questions were invited on the Department's
work.
Vaccine development
Dr David Salisbury provided an update on current work undertaken by the
Department. He also explained some of the difficulties and limitations
inherent in developing a vaccine for a pandemic strain of influenza -
for example, limited manufacturing capacity means that vaccine could currently
only be produced for around 5-15% of the world's population.
Given that a vaccine specifically against pandemic influenza will not
start to become available until 4-6 months after the strain has been identified,
the Department of Health is considering what other measures could be taken
to improve preparedness and reduce this delay as far as possible.
David Salisbury reported that the Department had met with six of the
major influenza vaccine manufacturers to discuss their preparations for
the production of a pandemic influenza vaccine. The Department would continue
to work with manufacturers to ensure that the UK obtained access to vaccine
as early as possible.
Any vaccine strategy will pose significant challenges in implementation.
Even when a specific vaccine is available, supplies are likely to be limited
in the early stages. The Department will be considering how to promote
wider debate on some of the ethical issues posed.
H5N1 vaccine
H5N1 vaccines based on the strain of influenza currently circulating in
South East Asia may play a role in improving preparations for an influenza
pandemic. In discussion, the following points were made:
" Manufacturers have only a very small window (a couple of months)
to manufacture non-seasonal flu vaccines such as H5N1.
" The H5N1 vaccine would be most effective if an influenza pandemic
arose from this particular strain. The level of protection provided will
depend on several factors including the extent to which the virus has
evolved to be able to transmit from person to person.
" The Department had issued a tender to produce 'seed stock' vaccine
for H5N1 and other strains, which should help reduce the time taken to
produce a new vaccine. Pat Troop indicated that this work held some promise
for reducing the delay in obtaining vaccine.
" One option being considered was to include H5N1 as one of the strains
in the seasonal influenza vaccine developed annually. The strain could
be introduced as an additional strain, but the vaccine would require a
new license; or H5N1 could be used to replace an existing strain, but
this would reduce the protection against strains that we know to be circulating.
Options were still being considered, but vaccine for this winter is already
being produced. However, a decision will be taken on this issue in liaison
with the WHO in time for next year's vaccination campaign. Stephen Inglis
suggested that this was a promising option worth raising again with manufacturers.
" Another option of interest internationally was to co-administer
a H5N1 vaccine at the same time as the seasonal flu vaccine.
Research into novel vaccine techniques
Manufacture of a pandemic influenza vaccine is currently likely to use
similar techniques to the production of normal flu vaccine. There are
several limiting factors in this process, for example the reliance on
egg supply. The Department is working with the Medical Research Council
(MRC) and the National Institute of Biological Standards and Control (NIBSC)
to ensure that the necessary research is taken forward on vaccine development.
Other issues
Discussions also touched upon wider operational issues. These included:
" Identification of key health workers - it was agreed that early
vaccination of key healthcare workers would be important in maintaining
a capacity to provide healthcare.
" Identification of other key workers - it was noted that the identification
of key workers in other sectors was the responsibility of other Government
Departments. Cabinet Office were leading on this ongoing piece of work.
" Time for preparation - it was emphasised that the NHS needed as
much time as possible to prepare.
" Information on distribution - the NHS will need further information
on distributing antivirals and vaccine. It was noted that the Department
was currently working on this and would provide information in due course.
" Clear policy on use of antivirals and vaccines - it was noted that
the antiviral stockpile was for treatment only and that clear guidance
would be needed on how antivirals and vaccines should be used. It was
also noted that a separate policy might be needed before full stocks of
medications were available.
" Prioritising vaccination in children - it was suggested that having
children as a priority group to receive the vaccine may reduce transmission
of the disease as children are known to be an efficient route of transmission.
It was noted that the Joint Committee on Vaccination and Immunisation
(JCVI) were considering current recommendations in relation to seasonal
influenza.
" Natural immunity - it was suggested that plans should take into
account that people may develop natural immunity to the pandemic strain
after exposure to the virus.
" Testing for flu - the possible role of near patient diagnostic
tests was considered and the Scientific Advisory Group had asked for further
analysis to be undertaken by the Health Protection Agency. It was noted
that the accuracy of these tests was low when there are a limited number
of cases of influenza in the population.
" Advice for members of the public - research seen by the Health
Protection Agency emphasised the role of simple hygiene measures in reducing
the spread of SARS in the 2003 outbreak. It was noted that this was one
of the key messages incorporated in the Department's communication materials
intended for members of the public both before and during a pandemic.
(For example, the information leaflet available on the Department's website
www.dh.gov.uk/pandemicflu.)
" Importance of communications - Members were reminded of the importance
of effective communication, both with healthcare professionals and members
of the public. Further detail on the Department's communications strategy
was given in paper 02/07.
Members were asked to email the secretariat with:
" Any areas where they had observed significant gaps in planning;
" Any areas where actions are not in place or not robust enough;
" Any suggestions for issues to be discussed at future meetings.
Next meeting
CMO suggested that the Committee should meet again in Autumn. The Secretariat
would circulate dates shortly.
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