The UK Clinical Virology Network was established last year to co-ordinate the activities of the nation's Virologists. Full details of our activities are available on the website, www.clinical-virology.org but, in summary, we have agreed to interact as a series of specialist laboratories aiming to provide best practice to all parts of the UK. We aim to do this by sharing laboratory protocols and epidemiological information and plan to use the Network to ensure that information on current epidemiology of virus infections is provided electronically to the Communicable Disease Surveillance Centre. Please note that our work is complementary to that of Medical Microbiologists (who deal with the laboratory aspects of bacterial/parasitic/fungal and some common virus infections) and Infectious Disease Physicians (who provide clinical care to patients with illnesses caused by all types of infectious agents). Virologists provide specialist laboratory diagnostic services for virus infections and are at the forefront of applying molecular biological techniques to achieve rapid and sensitive diagnosis. Our members include all of the specialist Virologists practising within the UK and our activities to date have been funded entirely from our own resources.

  This response deals with all viruses of medical importance. As requested, we will focus on natural infections rather than bioterrorism although better surveillance and control of the former will obviously facilitate prompt recognition of the latter.

  A—New viruses have been discovered (approximately one per annum over the last two decades), new antiviral drugs have been discovered (approximately two per annum over the past two decades) and better diagnostic methods have been developed through the application of molecular biological techniques. Yet,

—  there has been no official co-ordination of the activity of the nation's Virologists;

—  work is not conducted according to a common standard operating procedure;

—  there is no guarantee from local NHS Trusts/Universities/PHLS that the needs of accreditation will be funded;

—  we have a small number of trained medical Virologists, many working in single handed clinical practice;

—  there is an insufficient number of training posts to provide the next generation of medical Virologists;

—  surveillance of viral infections through the PHLS has never provided comprehensive cover of London.

Question 2—Will these problems be adequately addressed by the Government's recent infectious disease strategy, "Getting Ahead of the Curve?"

  A—No.

  As a professional group we support the recommendations for change in "Getting Ahead of the Curve" but have no confidence that the changes to bureaucracy will help achieve the defined objectives. We have taken the initiative to contact distinct branches of the Department of Health on several occasions but, apart from polite holding letters, our views have not been acknowledged. (See attached letters of 28 June 2002 to the Chief Medical Officer, 13 September 2002 to Dr Mary O'Mahony and 13 September 2002 to Sir William Stewart).

  Our response to the consultation exercise on a national specialised services definition set for pathology had a particularly disappointing outcome. It appears that those commissioned to produce the report did not realise that the diagnosis of virus infections relies upon specialist services. Our colleagues in Medical Microbiology identified this omission and I was asked as CEO of the Clinical Virology Network to provide information on Specialist Virology Services. This information answered the concerns of the people who responded to the national consultation process, 100 per cent of whom had stated that the original version was inappropriate for Virology. For some reason, the additional text I provided was subsequently edited out at the final stage. There was no response to either my initial email (shown below) or a follow up letter of 17 September 2002 (attached). We feel that a response addressing these issues of concern raised by experts in the field would have been appropriate for a body which should have a commitment both to quality and to the need to learn from its own mistakes.

  In summary, our experience to date leads us to question whether the final goal is the delivery of a better service rather than the creation of more bureaucracy.

Question 3—Is the United Kingdom benefiting from advances in surveillance and diagnostic technologies; if not, what are the obstacles to its doing so?

  A—No.

  The shortage of trained laboratory staff within the UK should be addressed by co-ordinating activities and rolling out best practice throughout the nation, for example, by developing networks of specialists as we have proposed for Virology.

Question 4—Should the UK make greater use of vaccines to combat infection and what problems exist for developing new, more effective or safer vaccines?

  A—Yes.

  The UK is one of a dwindling number of countries worldwide who have not yet introduced hepatitis B vaccine. Chronic hepatitis B infection causes chronic liver disease and hepatoma so that this is the first vaccine against human cancer.

  Likewise, other virus infections cause other chronic diseases and so vaccines should also be prepared for these.

  However, there is no real "market" for vaccines which are priced according to their cost not their value to individuals or to society. In particular, the policy of discounting future benefits is inappropriate for investments in health, yet is applied uncritically in health economic analyses.

Question 5—Which infectious diseases pose the biggest threats in the foreseeable future?

  1.  Those which are preventable by routine immunisation but where a substantial minority of the public have lost confidence in vaccine safety, so risking herd immunity for the whole country.

  2.   Human Immunodeficiency Virus—While great strides have been made in controlling the mortality attributable to AIDS, the incidence of HIV continues unchecked so that prevalence is rising at a great rate. Resistance to antiviral drugs is widespread, including patients who present with primary infection having acquired resistant strains from the donor of the virus.

  3.   Hepatitis C Virus cause chronic liver disease and has now become the major indication for liver transplantation in the UK.

  4.   Herpes Simplex Virus is important in its own right and also because it facilitates spread of HIV by causing genital ulcers and by driving the replication of HIV.

  5.   Cytomegalovirus—A recent report from the Institute of Medicine identifies CMV vaccine as a number one priority for the United States due to the damage caused to the unborn child, presenting as mental retardation and hearing loss after birth. The report estimates that a modest vaccine programme could yield savings of $50,000 for every quality adjusted life year that is saved.

  6.   Influenza causes an excess of deaths every winter. Yet vaccines and new treatments are still targeted at those at highest risk of disease, whereas they could be used to interrupt transmission in the community.

  7.   Viruses which cause diarrhoea and vomiting such as Norwalk, produce outbreaks in the community or in hospitals. Most are not formally diagnosed despite the potential of new molecular assays to do so.

  8.   Emerging viruses such as West Nile. Epidemiological data are needed to determine if this virus has reached the UK. Network members have responded enthusiastically to this challenge and testing of a substantial number of cerebrospinal fluid samples is underway.

Question 6—What policy interventions would have the greatest impact on preventing outbreaks of and damage caused by infectious disease in the United Kingdom?

  A—Restoration of public confidence in vaccines; aggressive deployment of new vaccines and antiviral treatments; Co-ordination of activity by specialists as described above so that best practice can be rolled-out across the country.

  Please let me know if you would like any further information on these or any other items. As requested, this letter is being sent by email but I will also send you by surface mail a copy of our booklet, "A National Strategy for Clinical Virology in the UK".

Professor Paul D Griffiths

Chief Executive Officer

Clinical Virology Network

10 October 2002