Science advice and global health discussion event

The Academy held a discussion event in December 2015 with Professor Dame Sally Davies DBE FRS FMedSci and Professor Christopher Whitty CB FMedSci.

Status: Completed

As Foreign Secretary, I was delighted to welcome Professor Dame Sally Davies DBE FRS FMedSci and Professor Christopher Whitty CB FMedSci to the Academy on 1 December 2015. Both are well-known in their roles which straddle the scientific community and policy-making in Whitehall, and the session was a wonderful chance to hear them reflect on their experiences.

We opened on a topic that has seen science advice very much at the forefront of public awareness – the Ebola outbreak in West Africa. As Sally listed the number of committees formed to guide the UK’s activities, I was struck again by the breadth of our response. At the time, I was chairing the UK Advisory Committee on Dangerous Pathogens and I agreed with Sally’s view that the UK recognised early that the threat was evolving from something local, to a threat of global significance. This provided time for the necessary policy machinery to form, allowing the rapid delivery of advice to Ministers and the Cabinet Office Briefing Room A (COBRA) committee. Sally noted her pride in the UK’s response, and rightly so – we saw the commitment of meaningful funds and human resources to tackle the issue, and the UK’s efforts made a genuine difference. However, there are lessons to be learned for the future, including ensuring that interventions are evidence-based and that there is political acknowledgement that a crucial way to protect the UK is to engage with global health challenges at source.  Medical science relies upon the full spectrum of disciplines – non-clinical, clinical, and onto social science research; Chris highlighted the important role played by the social sciences during the Ebola crisis, a feature he felt was largely an afterthought in previous global outbreaks, such as the 2009 Swine Flu pandemic.

Our discussion then turned to the challenges ahead for the community, including the impact of global development trends. It was clear that we have seen many positive outcomes for international health over the last 15 years, including the substantial drop in malaria mortality, the turning of the tide against HIV, and improvements in child and maternal health. Chris rightly stressed the UK’s leading role in driving these changes with science, and emphasised the value of science advice in the UK. However, I’m grateful that he also took the opportunity to stimulate discussion on a number of issues which are likely to stretch the community, and our existing approaches, in the coming years:

  • Economic growth in developing nations means that the purchasing power of aid money is in decline and has probably already passed its peak. If investment levels do not increase, then spending will need to be more targeted in the future.
  • Many mass interventions, such as the distribution of bed nets against malaria or large vaccination programmes, have already been put in place or are underway. This leaves a set of future challenges which are focussed on smaller, fragmented populations which are harder and more cost-intensive to reach.
  • The patterns of health challenges will change, both seasonally and geographically, with endemic issues such as malaria also appearing in epidemic form.
  • There is likely to be a broader trend in which ill health becomes increasingly concentrated in fragile states, necessitating far greater coordination between academics and non-governmental organisations to implement long-term solutions.

Driven by points from the audience, we discussed how the political and public perception of development spending might change as the burden of ill health shifts from infectious diseases, towards non-communicable diseases and the challenges of multiple morbidity. Some of the Academy Fellows in the audience felt this represented an opportunity to move from funding specific diseases to tackling health more broadly, through supporting local health systems and focussing on aspects such as prevention. Chris highlighted that the UK has a good track record of funding health system improvement, but that far greater evidence was needed on how to direct this investment most effectively. Taking multiple morbidities as an example (a topic on which the Academy is working) we could see a significant shift in public and political attitudes once the focus embraces non-communicable diseases. Such conditions continue to challenge the UK itself, and this might influence the perception of priority in tackling such issues abroad.

Conversation turned to global governance, and the future of the World Health Organisation (WHO). It was clear from the discussion that the recent Ebola outbreak has crystallised the pressing need for reform, but that the WHO potentially offers a vital function and was a major global asset when wielded effectively. Audience members asked where the drive for reform would come from, and whether it could be sustained beyond the tenure of the current Director General, Margaret Chan. Sally welcomed the ongoing internal efforts at the WHO, including the appointment of a Deputy Director General for Emergencies, and confirmed that the UK would continue to be a challenging, but supportive, voice. Chris felt that structural reform should be high on the agenda to address the disconnect between regional and central WHO functions. Funding remains a challenge, with greater support needed for the central functions of the organisation. We discussed how the UK community could contribute to overall leadership, and identified a need for stronger partnerships, particularly with and between nations in the southern hemisphere, to build local capacity and resources in a sustainable way. I was pleased to see this topic raised, as the Academy has previously addressed this issue in our report on ‘Building institutions through equitable partnerships in global health’.

The evening drew to a close on the topic of antimicrobial resistance, an area that Sally has successfully championed and is now actively debated in public forums. She reiterated the rate of growth of this problem, and the continued trend for greater antimicrobial use, often in place of basic hygiene standards. There is a clear need for massive behavioural change if the problem is to be tackled and, again, we must make use of the full spectrum of disciplines including the social sciences. In the context of global health, we discussed the impact of rising living standards, which are bringing antimicrobials within reach of an increasing number of people. Chris warned against seeing antimicrobial resistance as a single issue, noting that the many global contexts in which antimicrobials are used means that solutions would need to be tailored and structured to protect against unintended consequences.

It was a privilege to preside over such an interesting evening, which brought together two fascinating speakers and a highly engaged audience. The breadth of topics addressed, and the appetite for tackling future challenges, reflected the UK’s strengths in this area. The importance of using scientific evidence as the basis for decision making was a common theme throughout the meeting. I very much look forward to welcoming guests to similar events in the future, and thank everyone who attended, and particularly Sally and Chris for their insight.

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