A national agency is to be set up to counter the threat of chemical and biological weapons, radiation and the alarming spread of infectious diseases, the chief medical officer, Sir Liam Donaldson, announced yesterday.
The national infection control and health protection agency will provide scientific expertise to combat bioterrorism, such as the anthrax spores sent through the post in the United States. It will also coordinate the response to diseases such as malaria and tuberculosis, which are on the increase because more people are travelling to countries where they are endemic, and to new infections, such as new variant CJD and flu viruses. One in 15 people dies of an infectious disease, according to figures produced last month by the public health laboratory service.
The PHLS is one of four organisations which will be merged to produce the new agency. The others are the national radiological protection board, the centre for applied microbiology and research, and the national focus for chemical incidents.
The threat of biological and chemical attack is not the only reason for the move, said Sir Liam yesterday, at the launch of a strategy document for infectious diseases. "When we get outbreaks of disease, we often don't know what's caused them," he said. Techniques for investigating bacterial infection or environmental pollution were very similar.
There is growing concern about the worldwide spread of infectious diseases. About 30 new diseases have been identified since the 1970s. HIV/Aids was unknown until the early 1980s. Now 40m people have the virus.
"That is comparable with any of the infectious disease scourges of the middle ages," said Sir Liam. "They can emerge from nowhere. That's why we have to have our protective mechanisms and surveillance very well developed."
Many infectious diseases have been transmitted from animals or birds to man. HIV is thought to have crossed the species barrier from monkeys. Flu epidemics occur when the virus in pigs or birds crosses to humans.
In 1997, a strain leapt from chickens in a Hong Kong market into a three-year-old boy, who died. Two million birds were slaughtered. If the virus had come into contact with any strain of human flu, it could have mutated to infect large numbers of people, killing the vulnerable.
"It was a tinder box," said Sir Liam. "A lighted match did not fall into it, but on another occasion it could."
The BSE epidemic, in contrast, was triggered by changes in the feeding and rendering of cattle.
The first cow was diagnosed with BSE in 1986. By last October, 179,000 cows had developed the disease and 101 people had died of variant CJD.
The new agency will, together with a national panel and strengthened surveillance of animal and human infections throughout the country, help the government respond to a variety of environmental, terrorist and health threats, such as a major gastro-intestinal outbreak, a large fire in a plastics factory, a national vaccine safety scare or a serious imported infection affecting a number of hospitals.
In 1969, the US surgeon general, William H Stewart, enthused by success against typhoid, cholera and smallpox, told congress that it was time to "close the book on infectious diseases".
The quote was now infamous, Sir Liam said. "Experience has shown that complacency, slack control measures and lack of vigilance allows micro-organisms to regain the upper hand. We underestimate them at our peril."
Killers on the loose around the globe
West Nile fever
In summer 1999 an unusually high death rate was noticed among crows in New York. Then people started to fall ill. By October seven people had died and 31 confirmed and 25 probable human cases had been reported. The virus killed zoo birds as well as crows.
Examination found West Nile virus, which had caused epidemics in Israel, Europe and South Africa since the early 1950s, but had not before reached the US.
Tests confirmed the virus in humans and birds was the same. It is now spreading through North America and the eastern Caribbean. How it arrived is unknown.
Malaria
By 2050 climate change could bring indigenous malaria back to the UK. Higher temperatures could restore to low-lying salt marshes the mosquitoes which spread the parasite known as Plasmodium vivax.
However, conditions in the UK will remain unsuitable for the mosquitoes which carry the more dangerous malaria, caused by Plasmodium falciparum. But cases are already on the increase because of increased travel to malarial regions.
Tuberculosis
TB currently kills 3m people a year worldwide - more than at any other time in history. Deaths in England peaked in the mid-19th century, when victims were sent away to sanatoriums. Thanks to antibiotics, cases dropped to 5,087 in 1987. But they have since been rising again, to 6,500 cases in 2000.
People living rough or in poor housing are most likely to suffer from TB, but last year 67 children at a school in Leicester developed the disease and 246 had signs of infection. There are increasing fears that drug-resistant strains of TB might be brought into the country by travellers.
Ebola
A terrifying new disease emerged in 1976 in what is now the Democratic Republic of Congo and was named after the river Ebola, where it first struck. It is a haemorrhagic fever, causing extensive internal bleeding, and without medical treatment is frequently fatal.
Ebola has not spread widely, but has had a lethal impact wherever it has emerged. Between August 2000 and February 2001, 426 people in Gulu, northern Uganda, caught the disease and 224 died in spite of international aid. One contact reached London, but proved not to be infected.
. Getting Ahead of the Curve: a strategy for combating infectious diseases is available at www.doh.gov.uk/cmo/publications.htm
