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Applying foresight

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A FORWARD-LOOKING report on infectious disease control would always have been relevant. Current concerns about avian influenza make it all the more so. ‘Infectious diseases: preparing for the future’ was published last week and aims to assess how the threats of disease might evolve over the next 10 to 25 years and how science can help in managing them.

The report has been produced under the Government’s ‘Foresight’ programme, which is run by the Office of Science and Innovation under the direction of the Chief Scientific Adviser, Sir David King, and aims to create ‘challenging visions of the future to ensure effective strategies now’. In discussing infectious disease, it takes an unusually broad approach, in that it looks across diseases in humans, animals and plants rather than considering them separately. The authors do not confine discussion to the situation in the UK but, conscious that disease does not respect boundaries, examine the situation in both developed and developing countries. Points made are that animal disease outbreaks can be devastating in human and economic terms as well as in their own right and that ‘the great majority of emerging and re-emerging human infectious diseases have originated from animal sources’.While multidisciplinary in nature, the report therefore places welcome emphasis on the need to control disease in animals.

More than 300 experts from nearly 30 countries contributed to the Foresight project, for which the lead scientists were Professor Joe Brownlie, professor of veterinary pathology at the Royal Veterinary College, London; Professor Catherine Peckham, a paediatric epidemiologist at University College, London; Professor JeffWaage, a specialist in plant protection at Imperial College, London; and Professor Mark Woolhouse, who holds the chair in infectious disease epidemiology at the University of Edinburgh.

The report (available at www.foresight.gov.uk) identifies the challenges posed by existing, emerging, and re-emerging diseases, some of which were highlighted in the Wooldridge Memorial Lecture at last year’s BVA Congress (VR, November 26, 2005, vol 157, pp 673-679). The days are long gone when anyone could claim that science can solve all the world’s problems. The report acknowledges this, but rightly points out that, while science might not hold all the answers in the fight against disease, it is ‘a powerful tool in the battle’. It emphasises the importance of early detection, rapid and accurate identification, and continual monitoring of disease and disease agents in preventing disease and, using the possibly less than inspiring acronym of ‘DIM systems’, explains how new systems and technologies can assist in this process. The systems themselves – which include new diagnostic devices and innovative data collection and handling methods – are actually quite clever, and the report includes a number of hypothetical examples of the human and financial benefits that could ensue if they were developed and adopted. Of just as much interest is discussion of the context in which the new technologies are applied, and the point is well made in the report that ‘DIM systems only provide information, and therefore will only yield benefit, when linked to timely and effective disease management measures and when properly embedded in disease management infrastructure.’

The report sets out key choices for policymakers, emphasising that the way technology is used is every bit as important as the technology itself. As a result, it says, the fundamental choices that need to be made are as much about broad strategies for managing disease as they are about individual systems. Although many existing diseases will continue to be important, diverse new diseases will continue to arise and, for this reason, the report advocates a flexible, multidisciplinary approach to managing them, suggesting a move from the traditional ‘vertical’ approach which focuses on specific diseases to a broader, ‘more coherent’ approach. It notes that more can be done to strengthen links between the human and veterinary medical fields; it also argues that new skill sets are needed to address the challenges presenting themselves. Some of the technologies being developed raise ethical questions about how information is gathered and used and, as the report points out, these need to be addressed.

Historically, the Foresight programme has grown from an initiative aimed at improving Britain’s technological competitiveness. However, some of the most challenging observations in the report concern the situation in developing countries and the need to develop a global infrastructure for disease surveillance and disease management. As it points out, ‘Many regions of the world do not have the laboratory infrastructure, the human resources or the financial resources to support effective disease surveillance programmes. Yet it is increasingly clear that infectious diseases are a global problem and that surveillance is an international responsibility. Investment by richer countries in surveillance capacity in poorer countries may be a sensible response to this problem.’

In terms of diseases of livestock, it remains worrying that, globally, investment is skewed, with most of the investment being in regions where people are less dependent on animals for survival. As things stand, developed countries rightly devote resources to keeping diseases out of their region but a fortress mentality is not enough and ultimately cannot be sustainable. Effort must continue to be devoted to preventing disease incursions but, at an international level, more needs to be done to tackle diseases at source.

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