Innovations for infectious disease: the need for speed

Dr Philippa BriceTuesday, 3 May 2016

Philippa leads our communications and knowledge management activities, including dissemination of the PHG Foundation’s activities and outputs.

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Earlier this month, Public Health England (PHE) released their four-year strategic plan. Entitled Better Outcomes by 2020, it notes that PHE was created in 2013 ‘to protect and improve the public’s health and wellbeing and reduce health inequalities’, broken down into four key areas:

Protecting the country from threats to health, including outbreaks of infectious diseases
Improving the public’s health and wellbeing
Improving population health through sustainable health and care services
Building capacity and capability of the public health system

This is said to be achieved ‘through world-class science, advocacy, partnerships, knowledge and intelligence, and the delivery of specialist public health services’.

Looking back: achievements so far

The report highlights a wide range of organisational achievements over the past year, ranging from the response to the Ebola outbreak in West Africa through to more mundane matters, such as having ‘delivered seminars to our 1,600 people managers to develop their skills’. One achievement of note is the creation of a new National Infection Servicefrom June 2015, to protect the public from infectious disease threats by bringing together PHE epidemiologists, biological and social scientists, microbiologists and support staff. There has also been a fall in cases of tuberculosis (TB).

Looking forward: aims and ambitions

Many of the priorities for PHE focus on the need to work with local authorities to improve the health of the public, but infectious diseases also feature; PHE says it will work more closely with the NHS to support the response to infectious and environmental hazards. As well as following through earlier plans to relocate PHE’s headquarters and the National Infection Service to a new ‘science hub’ in Harlow, PHE says it will develop this service ‘using whole genome sequencing and other innovations, to enable rapid detection, greater insight, and an improved service to those treating patients and managing infectious disease outbreaks’.

This sounds an excellent plan, a brilliant example of harnessing great British science and expertise to protect the health of individuals and populations. There is nothing to criticise with this aim, which (like many other or ganisational ambitions) fits perfectly with the NHS Five Year Forward Plan and other elements of government strategy in healthcare and innovation.

Unnecessary delay?

But will PHE deliver on this admirable aim, and if so, when - as late as 2020? The scope to use whole genome sequencing to improve infection and outbreak control and management of antimicrobial resistance is considerable, as amply demonstrated by the PHG Foundation’s own work in this area. Other innovations could add further value – for example, new capacity for portable, point of care DNA sequencing that is ideal for international outbreak responses, as well as other developments such as digital tools for health screening and reporting.

However, whilst PHE has a whole host of other responsibilities to concern them, progress in harnessing technology to improve infectious disease services to date has been disappointingly slow. Work by the PHG Foundation in 2014-2015 clearly delineated the current landscape of PHE infectious disease services, the barriers to effective and efficient use of existing expertise, knowledge and capacity, and the steps needed to address these. In theory, a A National Infection Service should be the perfect vehicle to achieve this – and the Pathogen Genomics into Practice report (June 2015) called for national coordination of service development and delivery, including requirements for genomic data sharing between different PHE centres. In practice, however, little appears to have changed beyond the ongoing emphasis on TB services.

Going beyond TB genomics: a bigger vision

PHE held a consultation on plans for a TB control strategy in 2014. The strategy – including the use of whole genome sequencing (WGS) - was announced in January 2015, and over a year later is already yielding results: good work. However, PHE experts have in fact been using WGS for TB for years already, and are also doing so for all sorts of other infectious disease agents of public health importance – but without a coherent, coordinated national approach. PHE’s aim to develop the National Infection Service ‘to enable an improved service to those treating patients and managing infectious disease outbreaks’ should fill this vacuum – but it will need to look beyond TB, and indeed beyond the confines of PHE to work with other agencies, as previously emphasised.

An urgent priority

The new PHE strategy says that it will deliver ongoing scientific advances ‘including PHE’s role in the next steps of the 100,000 Genome programme’. There has been some confusion over whether infectious disease genomics does, or does not, form part of the 100,000 Genomes Project (as it is correctly called) – it seems that it does, as originally envisioned, but in a wholly separate and autonomous project led by PHE, apparently thus far relating only to TB sequencing.

It is to be hoped that if infectious diseases will, as suggested in the PHE strategy, also form part of the next steps of the 100KGP – to move from massive sequencing effort to widespread clinical integration into the NHS – it will go way beyond TB to encompass other infectious disease threats, and do so sooner rather than later. If we as a nation genuinely want to lead the world in genomics and health, it has to. Unnecessary delays are wasting the undoubted expertise of UK specialists, and failing both individual patients and the wider population. We never know when the next infectious disease threat may emerge, as we have seen withZika virus and parechovirus. When our scientific expertise and capacity outstrips our ability to make the most of that knowledge for health, we are wasting valuable time.