No time to go it alone

Abstract

Plans for a new National Infection Control and Health Protection agency in England were announced recently. It aims to combat the threat of new and emerging infections, to intensify control measures, and, implement timely responses to chemical and biological hazards or attacks. Liam Donaldson, the government's Chief Medical Officer for England launched a government strategy—an action plan of 10 key points—outlining his vision for the new organisation (http://www.doh.gov.uk/cmo/idstrategy/index.htm). The overall strategy emphasises a more integrated approach to infectious disease control with activities being co-ordinated locally, regionally, and nationally rather than by individual agencies. There is a lot of attention towards improving surveillance, thought to be the cornerstone activity in disease control. More efforts will be targeted at the more serious infectious diseases such as tuberculosis, healthcare-associated infection, antimicrobial resistance, and blood-borne and sexually transmitted diseases. The services provided by microbiology laboratories will be divided into those providing routine diagnostic work and those providing a public health or reference function. There will be clear and comprehensive contingency plans to reduce the impact of any future acts of biochemical terror. Educational initiatives for the public, and infectious diseases training for professionals will be improved and there will be more opportunities for research programmes into vaccines, treatment, and diagnosis. The agency is scheduled to open its doors in 2003. This is not long to restructure and merge the four existing agencies that will form the new “superagency”, namely the Public Health Laboratory Service (PHLS), the National Radiological Protection Board, the Centre for Applied Microbiology and Research (CAMR), and the National Focus for Chemical Incidents. But given that for many of the activities outlined in the strategy document there is common ground between the agencies that are being brought together for example, all the references services in the PHLS and CAMR and all those in the health services responsible for mounting a response against biological, chemical, or a radiological hazard or attack, the initiative seems a logical and positive step forward to tackling infection control more efficiently in England. What is slightly disconcerting, however, is that the 146-page document does not name any of the members of the working party that helped form the strategy. This might be accounted by the fact that the last strategy meeting with members was 3 years ago, and although their original ideas and expertise were probably used to derive the current document, there is a cause for concern that much of the fine detail of the proposed actions may not be acceptable 3 years on. What is also slightly puzzling is why this new face of infectious disease control, or NICHPA as it will soon be known, is focused only on England, and does not include Wales, Scotland, and Northern Ireland in its activities? We continually hear that infectious diseases knows no borders so would it not make more sense to have a UK-wide approach. If a single institution like the US Centers for Disease Control can oversee 50 states, surely the UK could co-ordinate one programme that would encompass all four nations? Although we are replacing four organisations with one superpower we will still have separate organisations for each country, and that could be a waste of resources. Of course the problem here is, that healthcare is a devolved responsibility with nations having their own infrastructure. But it will be important in the future to work more closely with ones neighbours, and ignore the political borders that have no place in infectious disease control. Even a national plan of action for the UK, ignores the fact that spread of infectious diseases is a far-reaching international problem. One point missing from the ten key action plan is to strengthen links with developing countries. Does it not make sense that if we were able to combat infectious diseases where they arise, we would have a better chance of protecting our home countries? Back in 1998 the idea of a European Centre for Infectious Diseases (ECID) raised much debate, with defenders and critics against such an organisation, reaching a stalemate. Now in the current climate is it time once more to look at how viable a centralised European institution would be? A major hurdle here would be obtaining the necessary political support because of the unwillingness of the European Union's 15 member states to relinquish control over public health policy to the European Commission, or have a centralised international agency scrutinise their national health-care systems. Perhaps what is needed is a European center that has an important co-ordinating role among nations (BMJ 2001; 323: 819–20). Overall, the National Infection Control and Health Protection agency is welcomed in these difficult times when the threat to public health is fierce as ever. What we await to see is, will it go far enough?