MEETING OF THE STATES PARTIES TO THE BWC/MSP/2009/MX/WP.

3
CONVENTION ON THE PROHIBITION OF 27 July 2009
THE DEVELOPMENT, PRODUCTION AND
STOCKPILING OF BACTERIOLOGICAL
(BIOLOGICAL) AND TOXIN WEAPONS AND
ON THEIR DESTRUCTION
ENGLISH ONLY

2009 Meeting
Geneva, 7-11 December 2009

Meeting of Experts
Geneva, 24-28 August 2009
Item 5 of the provisional agenda
Consideration of, with a view to enhancing international
cooperation, assistance and exchange in biological
sciences and technology for peaceful purposes, promoting
capacity building in the fields of disease surveillance,
detection, diagnosis, and containment of infectious diseases

UK VIEWS ON PRIORITY PROGRAMMES FOR PROMOTING

CAPACITY BUILDING FOR SURVEILLANCE, DETECTION,
DIAGNOSIS AND CONTAINMENT OF INFECTIOUS DISEASES
Submitted by the United Kingdom of Great Britain and Northern Ireland

I. Introduction

1. This working paper aims to highlight some lessons and suggestions for priority
programmes for international action in the relevant fora on capacity building for surveillance,
detection, diagnosis and containment of infectious diseases. The paper draws on some of the key
conclusions and recommendations in the following published UK government papers as they
apply to this year’s Intersessional Programme topics: the National Security Strategy; Health is
global: a UK Government strategy; World Health Organisation UK Institutional Strategy; and
the Foresight Project on Detection and Identification of Infectious Diseases (DIID). 1 This latter
report’s aim is particularly relevant here as it sought to produce a challenging and long-term
vision looking 10 to 25 years ahead for the detection and identification of infectious diseases in
plants, animals and humans. 2

1
http://interactive.cabinetoffice.gov.uk/documents/security/national_security_strategy.pdf;
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_095296
2
This project was run as part of the UK’s Foresight Programme, which is a part of the Government Office for
Science within the Department for Business, Innovation and Skills. The findings of the Foresight project on
Detection and Identification of Infectious Diseases (DIID) were published as the ‘Infectious Diseases: preparing for
the future’ report on 26 April 2006 and a review of progress was published in May 2007 see
http://www.foresight.gov.uk/Infectious%20Diseases/One-year_review_-_report_-_May_2007.pdf

GE.09-62782
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2. In HM Government’s statement on Health is Global, one of the five key areas

identified for action is the need to work for better global health security, which includes reducing
the threat from infectious disease. In this context the UK believes that promoting wider
adherence to the Biological and Toxin Weapons Convention and agreeing practical measures to
enhance its effectiveness are key objectives, and this includes capacity building in the fields of
disease surveillance, detection, diagnosis and containment of infectious diseases. 3 This paper
highlights key observations relevant in any discussion of these issues, addresses the linkages
between human, animal and plant health, including food security, and makes some observations
on the need for coordination and maximising the effects of assistance programmes and aid.

II. Surveillance, detection, diagnosis and containment

3. In the UK view, the following points and lessons from our national and international
experience are particularly important in striving to improve global capabilities in the areas under
discussion at this year’s MXP:

Surveillance

4. The international community needs to work out how best to contribute to improving both
animal and human surveillance systems in vulnerable countries for highly pathogenic avian
influenza. We must encourage the wider application of improvements made to those surveillance
and response systems for H5N1.The development of surveillance and diagnostic capabilities is
an important part of comprehensive health systems. 4

5. The WHO and the OIE international systems for human and animal health provide a
sound basis for surveillance. The collaborative links established through them in the field,
together with FAO, provide vital early warning of disease, often even before it is officially
confirmed. WHO, OIE and FAO communicate with each other and each has developed its own
early warning and response system. These are all brought together under the umbrella of the
Global Early Warning and Response System, which adds value to the international community.
We must therefore ensure that this system is made increasingly effective.

6. Not all countries have the veterinary and health infrastructures to produce robust disease
reporting data, and thus information remains incomplete for many countries. Therefore, we need
to strengthen capability and capacity in developing countries and to develop internationally
agreed protocols for the rapid sharing of information. UK international aid initiatives will
continue to support developing countries in strengthening health systems, including support to
national surveillance systems for both human and animal diseases. Similarly plant health
surveillance systems are less robust in developing countries, underlining the importance of broad
action in national capacity building in such countries.

3
HM Government Health is global: a UK Government strategy 2008-13, 30 September 2008 page 20
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088702
Summaries are available in Arabic, Chinese, French, Russian and Spanish.
4
Government Response to the House of Lords Select Committee on Intergovernmental Organisations Report –
Diseases Know no Frontiers: How Effective are Intergovernmental Organisations in Controlling their Spread? Cm
7475, October 2008
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089591
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7. The UK Foresight project on Detection and Identification of Infectious Diseases

highlighted key steps for further action in its report, published in April 2006. This included the
need to building a more sustained, pro-active and integrated approach to international
surveillance for infectious diseases of humans, animals and plants.

8. Exotic and zoonotic viral diseases of livestock, plants and fish pose a continual threat to
the agricultural economy, animal welfare and the natural environment. We have almost no
systematic information on diseases in wild animals and plants in many parts of the world, but
note those areas that are least under surveillance are often also centres of high biodiversity and
therefore of high risk of new diseases. The need for surveillance techniques to identify rapidly
new threats is thus a priority. 5 6 The UK has launched a new approach to wildlife diseases in
England. Its objective is to increase knowledge and understanding of wildlife disease generally –
both infectious and non-infectious disease – by working to continue to build our evidence base,
share intelligence and monitor wildlife populations. 7 We would encourage others to adopt
similar approaches towards a scientifically sound and consistent approach to identification,
assessment and intervention in wildlife diseases.

Detection and diagnosis

9. Accurate diagnosis and subsequent pathogen characterisation remains a cornerstone in

the control of disease. Surveillance systems are dependent upon the capacity and capability
within countries to diagnose diseases accurately; to report through a reliable reporting
infrastructure; to capture health data from the whole of the population; and upon states
demonstrating political willingness to share early suspicion of diseases that they cannot diagnose
themselves. This is why improvements to detection and diagnostic capabilities are important.

10. The strengthening of generic infrastructure for responding to infectious diseases is the
key approach. In building a resilient capability and capacity for early detection of dangerous
pathogens, the UK has built upon existing and successfully tested strategies for controlling major
infection outbreaks, while simultaneously recognising that certain diseases demand very specific
and unique medical countermeasures. As an example, the UK’s Health Protection Agency’s
Centre for Infections is participating in the WHO Laboratory Twinning Scheme, which is
intended to develop capacity along with laboratories in developing countries. 8 The UK also
contributes to the OIE Laboratory twinning scheme (OFFLU, for instance, the joint OIE-FAO
network of expertise on influenza) with significant involvement from the Veterinary
Laboratories Agency and the Institute for Animal Health.

5
http://randd.defra.gov.uk/Default.aspx?Menu=Menu&Module=More&Location=None&Completed=0&ProjectID=14570
6
In the UK the National Expert Panel on New and Emerging Infections has set up the Human and Animal Infections
Risk Surveillance Group to provide a forum for detailed analysis and scrutiny of animal and human health
surveillance data. The development of an agreed methodology for assessing zoonotic risk potential in a consistent
manner has strengthened the Group's ability to undertake rapid horizon scanning for infections with potential for
transfer between species. Perhaps a similar approach could be considered in other countries national strategies to
counter infectious disease.
See http://www.foresight.gov.uk/Infectious%20Diseases/One-year_review_-_report_-_May_2007.pdf page 21
7
England Wildlife Strategy Working together to reduce the impacts of wild life diseases June 2009
http://www.defra.gov.uk/animalh/diseases/vetsurveillance/species/wildlife/pdf/whs-090615.pdf
8
http://www.foresight.gov.uk/Infectious%20Diseases/One-year_review_-_report_-_May_2007.pdf page 22
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11. Developing effective and sustainable partnerships between richer and poorer countries
that help provide infrastructure, technologies and skills to support detection, identification and
monitoring activities are key objectives; as are encouraging the development and deployment of
new detection, identification and monitoring systems nationally and internationally (including
making new systems more flexible).

12. Continued innovation in disease diagnostics and detection tools and technologies is
required. 9

Containment of infectious diseases

13. The UK believes that the international community identified several key lessons from the
2003 SARS outbreak:

(i) countries must promptly report diseases with potential to spread internationally.
(ii) political leadership is important in combating disease.
(iii) WHO has a key role in sharing information and providing the best public health
advice (this was the first outbreak where new communications technology played a
major role).
(iv) Scientists, clinicians and public health experts must work together to tackle global
health challenges such as SARS.
(v) strong health systems are essential: weaknesses in one country means vulnerability
for all. We are only as strong as the weakest link.

14. The rapid containment of SARS was a success, but also a warning. It provided proof of
the power of international collaboration and highlighted the importance of investing globally in
public health – in terms of political commitment, effective international institutions, health
systems, research and development, and building networks and relationships. 10 The UK is
engaging with WHO and other global health bodies, the UN, the EU, the World Bank, and
individual countries, on the coordination of international surveillance requirements and on early
warning systems; on analysing and preparing viruses for vaccine and research purposes; on
increasing vaccine supplies; on planned responses, including coordinated travel restrictions; and
on support to vulnerable countries to help them develop their capabilities. 11

15. Another priority area is to increase the number of WHO member states that have
developed a national action plan to achieve core capacities for surveillance and response on
pandemic influenza, in line with their obligations under the 2005 International Health
Regulations. 12 We are committed to ensuring global pandemic preparedness and look to WHO to
continue to show leadership here. The International Health Regulations are fundamental to
global public health security; the UK is working with WHO on their implementation. 13

9
See for instance the UK Department for Environment Food and Rural Affairs funded Biochip project that resulted
from a recommendation in the aforementioned Foresight Project on infectious diseases and aims to develop a
microarray that is capable of identifying viruses of plants, animals and fish including zoonotics –
www.biochip.co.uk
10
HM Government, Health is global: a UK Government strategy 2008-13, 30 September 2008
11
National Security Strategy, March 2008
12
HM Government World Health Organisation UK Institutional Strategy 2008-13, February 2009
13
HM Government World Health Organisation UK Institutional Strategy 2008-13, February 2009 para 4.4.
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16. Effective training for personnel in diagnostic laboratories in the developing world, such
as those created by the OIE laboratory twinning scheme, is essential. Training - whether
provided or supported by national, regional or international sources - is an essential element in
developing sustainable capabilities and as such is key to all the aspects of disease control under
the headings surveillance, detection, diagnosis and containment.

III. Current international efforts: linkages between human and animal health

17. A recent study on emerging infectious diseases (EID) in humans identified that 60% were
caused by zoonotic pathogens, of which 72% had a wildlife origin. The number of EID events
caused by pathogens originating in wildlife has increased, constituting 52% of those in the last
decade. 14 These statistics exemplify the significant threat presented by zoonotic diseases and the
importance of wild animals as reservoirs. In this context the “One World, One Health” initiative
is particularly important as it envisages a strategic global framework for reducing risks of
zoonotic diseases. 15 A good deal of work is already well underway within WHO, OIE and FAO
to combat infectious diseases; key weapons in our armoury are capacity building in disease
surveillance, detection and diagnosis. Increasingly this is an interdisciplinary and collaborative
approach where we are seeing not just recognition of the linkages between animal and human
health, Avian Influenza for example, but practical steps to give effect to these linkages. This
argues strongly for sustainable and strategic linkages to be further developed between the two
communities. This is beginning to happen, but much more could usefully be done. 16

18. “One medicine” partnerships for the detection and identification of diseases that infect
both humans and animals are therefore an essential first step in any future control of emerging
infections. 17 For this reason we should be emphasising here the need for strong coordination
between human and animal health services, especially strengthened animal health services and
laboratories, better and cost-effective monitoring of wild animal populations, enhanced virus
detection and research, improved inspection and support on outbreak containment plans, and the
teaching of good farming practices. This point was made too in a recent Royal Society Report. 18

19. In a 2009 study that compared the frequency of new pest reporting between Africa and
Europe, the authors suggested that Africa had a declining capacity to identify and report new
diseases and pests and that this presented a threat to global food security. 19 Major pest outbreaks
in Africa affecting crops such as cassava and banana have demonstrated the vulnerability of
developing countries to plant diseases. The spectre of a global pandemic of a crop pest presents
real concern for food security; the recent food price spike demonstrated the vulnerability of
global food supplies. The international community therefore needs to take seriously the

14
Jones et al., 2008. Nature 451:990-994
15
http://un-influenza.org/node/2341/
16
Foresight. Infectious Diseases: preparing for the future.Executive Summary. Office of Science and Innovation,
London (2006). Page 28 See also paragraph 3 (a) of this paper.
17
“One medicine” is a concept linking disease diagnosis in human and veterinary patients.
18
In particular, the report noted that there was a need for greater synergy between human and animal health sectors
and policy is also demonstrated by increasing environmental pressure for the emergence of new diseases, for
instance due to climate change, particularly for zoonoses . Prevention and treatment of zoonotic diseases
successfully requires a combination of expertise from both medical and veterinary sectors. Royal Society RS Policy
Document 2/09. An integrated approach to infectious diseases in the UK see
http://royalsociety.org/displaypagedoc.asp?id=32574
19
Waage et al, 2008. Patterns of plant pest introduction in Europe and Africa. Agricultural Systems, 99[1], 1-5
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weaknesses of developing countries for disease surveillance. It is not by chance that successful
agricultural and human health systems are characterised by strong surveillance and response
capabilities; and vice versa, where there is vulnerability within such systems there is a
compromised surveillance and response capability.

IV. Coordination and integration of efforts

20. Global health initiatives and funds have increased in recent years and are now an
important part of the aid infrastructure. They are made up of more than 90 issue based technical
partnerships and funds, each of which targets specific health issues, many of which are hosted by
the WHO. The GAVI Alliance and the Global Fund to fight AIDS, Tuberculosis and Malaria
(GFATM) provide substantial resources. Many of the gains in global health have resulted from
targeted health initiatives like these, which are funded and implemented alongside the
institutional health system. 20

21. However, while these have had impressive gains – for example in high immunisation
coverage – they have often not been well integrated into country plans. Consequently budgets
and the gains made initially have subsequently proved unsustainable. Sometimes these initiatives
have undermined the ability of countries to set priorities within an overall health strategy and
budget. Consequently, opportunities for creating an integrated approach to health care have been
missed.

22. Global initiatives and funds need to increase the effectiveness of their aid, for example,
by providing support in ways that strengthen systems and dovetail with national planning
processes and timelines. Global initiatives should aim to work collaboratively with other
organisations and initiatives and with UN agencies, rationalising the number of initiatives, where
possible, to achieve effective and sustainable outcomes.

V. Conclusions

23. Work in the BTWC context cannot hope to match the efforts underway in the relevant
international organisations, nor should it seek to duplicate it. However, it can help reinforce,
publicise and promote best practice, highlight priorities and act as an additional catalyst.
Furthermore, efforts to improve capacity building to combat infectious disease, especially
surveillance and diagnosis, also helps strengthen the BTWC as the capabilities to identify
naturally occurring outbreaks of disease are largely the same as those required to identify
deliberate use of pathogens and toxins to cause disease in humans, animals and plants.

24. As the aforementioned UK Foresight project noted, we need to foster an inter-

disciplinary approach to infectious disease problems, incorporating traditional biomedical
science with economics, social sciences, demographics and agricultural science. 21 We need also
to build effective and sustainable partnerships between developed and developing countries that
help provide infrastructure, technologies and skills to support infectious disease control
activities, and we need to encourage the development and deployment of new tools and
technologies for surveillance, detection, diagnosis and containment of infectious diseases.
Meaningful progress is only possible if there is sustained commitment from governments, non-
20
http://www.dfid.gov.uk/Documents/publications/health-strategy07.pdf pages 31-32
21
http://www.foresight.gov.uk/Infectious%20Diseases/One-year_review_-_report_-_May_2007.pdf page 19
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governmental organisations, industry and the international community. Only by working

together can sustainable improvements in combating infectious diseases be achieved.

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