 Dwi'n teimlo nesaf ar y 11 ffaith o'r CEO y byddai'n cyd-19 yn 2023. Mae agenda item 1 yn ymgyrcholion i ffwinesg, a mae'r ffaith yn cyrcholion i'n siwr yw newid mwy yn gyfrifoedd Iosid, ddych chi'n ei ffawr ac weithio i'r ffawr yw'r committee i gwybod i'r host i'r reumith. I crwydd diwrn yn cymdeithasni i ddamdd a blwyddyn yn y cyfrifoedd i'r hyn. Thank you very much. This morning we are going to take evidence from members of the Scottish Government's standing committee on pandemic preparedness. I would like to welcome to the meeting Professor Andrew Morris, who is the chair of the standing committee on pandemic preparedness. Professor Morris is also the director and CEO of Health Data Research UK. He is the vice principal of data science at the University of Edinburgh. Good morning Professor Morris. I would also like to welcome to the meeting Professor Tom Evans, who is a Professor of molecular microbiology and a consultant in infectious diseases at the University of Glasgow. We estimate that the session will run up to 10.30 am and each member will have approximately 10 minutes to speak to the panel and ask their questions. I am keen to ensure that everyone gets an opportunity to speak and I apologise in advance, therefore, if time runs on too much and I may have to interrupt members or witnesses in the interests of brevity. I will now turn to the questions that I have again. I would like to ask the first question, gentlemen. What meetings have been held with activity and what activity has the committee undertaken over the past six months? Good morning. On behalf of Tom and I, it is great to be here in person after our previous technology challenges. Over the past six months, the committee has met three times. We are meeting next week as well, but there are two comments that I would like to make. Firstly, we are in the detailed analysis phase, having set out the stall. We need granularity and detail, so we have set up three so-called short-life working groups that are interdisciplinary to look at three areas that we feel really need greater definition. The first of those are on data. We have called it the Scottish Data for Pandemic Preparedness Oversight Group, chaired by Professor Dame Anna Diminiciek. The second one is really important. We have recommended a centre for pandemic preparedness, so we have set up a subgroup on what that centre would do, how it would be led and how we might suggest that it is governed. Thirdly, we have a group on behavioural intervention and community engagement. As you know, the social contract in Scotland is so important and working with the public and communicating with the public. Those are the three groups. The other thing that I would like to highlight is that, as the independent chair of this group, it is really important that we are outward looking. Pandemics are global. The exam question is how does Scotland position itself in a global ecosystem of pandemic preparedness, working with the UK and internationally. We have set up an international steering group, which met on 10 November. It is Bijou, but we have three fantastic members. We have Sir David Nabarro, who is chair of Global Health at Imperials Institute of Global Health Innovation. He was also asked by the WHO director-general to be his special envoy in March 2020. We have Jeremy Farrah, who was formerly director of the Welcome Trust, is now chief scientist for the World Health Organisation. We have Camilla Stoltenberg, the director-general of the Norwegian Institute of Public Health. That group has met, and I am happy if Tom and I would be happy to provide feedback from any of those activities that are of interest to the committee. I think that that is a rough, fascinating session. Thank you. When do you expect the final report to be published? Well, we intend to be on time and on budget. The guidelines were set by the First Minister's commission. The request was the final report to be published within 18 months of the interim report, so that would be February 2024. However, we hope to publish the report in the fourth quarter of this year, so we have another seven to seven or eight months. I am going to ask one final small question. I hope that this is a small question before I go on to other members of the panel. The UK resilience framework, all risks and civil contingencies, can you expand on what that is? There are a number of other groups that are working across the UK, and, indeed, as Andrew said internationally, and I have been involved a bit with the emergency preparedness and clinical countermeasures group, which is organised as a four nations group, but is organised out of Department of Health and Social Care in London. They have directed towards a number of different issues to do with pandemic preparedness. Epidemiology modelling, what kind of diseases might become pandemic, disease X, what do we need to think about? To think about the infrastructure needed to deal with a pandemic in terms of diagnostics, testing, surveillance and so forth. An issue to do with provision of personal protective equipment and healthcare, what do we need to think about getting, and also in terms of medicines in particular, what agents might the United Kingdom think about stockpiling and where do we need to think about procurement and so forth. Clearly, some of these issues overlap with the work of our committee, and we certainly want to make sure that everything that we do is relevant to Scotland. That is really key, but absolutely we need to be integrated into the United Kingdom's response, and also, indeed, internationally. I should say that international reference group has been hugely helpful in terms of making sure that we align to best practice internationally and not to be precious about our own ideas and so forth, to make sure that we leverage all that help that we can get. There is potential overlap here, but, as much as we possibly can, we work collaboratively with all these different institutions in the UK health security agency as well. I was going to say that there may well be overlap, but it is better to have overlap if there is something missing. Absolutely. I want to move on to other members and more in the past to you. Thank you, convener. Good morning, Professor Morris and Professor Evans. Professor Morris, you will remember when we saw you back in September on that session that was plagued by internet problems, so it is good to see you in person. At that point, you published your interim report and we asked you if you had a response from the Scottish Government at that point. I think the answer at that point was that you hadn't had one, although you were hoping to get one. Has there been one yet that you can tell us about? Yes, there has. On 8 December, the former First Minister wrote to me as the independent chair, and I would also be happy, because the key to this is transparency. We are very keen to publish everything, so we should definitely ensure that that is in the public domain. Key points from the response. Firstly, recognising that there are increasing demands on government, despite that there was a commitment to prepare for the future. Secondly, the First Minister confirmed that she accepted our interim recommendations. Thirdly, she expressed an interest at that time to meet the international reference group, which we should revisit. She recognised the urgency of the importance of surveillance data and analytics and the necessity for Scotland in the future to have a core data infrastructure, which will actually enable pandemic preparedness. She noted the urgency of that and asked us to push on that agenda as quickly as possible. Finally, at that time, she asked the Cabinet Secretary for Health and Social Care, Mr Yousaf, to take forward the work necessary. Those were the conclusions of the letter. Okay, thank you. That was back in December. Have you been following that with the Scottish Government? You say that they said that they accepted all your recommendations. Are you aware that they are taking work forward on this? The way that the groups constituted, because I am an independent chair and I have a day job, a learning from the pandemic was deep collaboration across science, service delivery, NHS, industry and policy makers. The way that we have constituted the group is that we have Scottish Government representation on the group. I see it as a continuous process, rather than a periodic. Here is our report. Although it is an independent report to Government, in my view, to make it the best quality product requires ongoing dialogue. For example, the chief scientific adviser is on the group. For example, we get great support from the deputy director who has oversight of public health Scotland on the group. I think that that is a more dynamic approach. I see it as continuous, rather than a periodic. It is a work in progress. In light of that, the question for the committee is what is the state of readiness in your view of Scotland should we have another pandemic? Perish the thought that another pandemic will come along next year. Do you think that we are now in a better place to handle a pandemic than we were pre-COVID, or, if we are not, what more need we do to be there? This is an important question. We may be both taking a vote. Of course. It is a very important question. We are certainly in a better place than we were before COVID without question. We have learned so much. If I were marking the current response, I would give it a B. That is partly why we have this committee, because what we are trying to do is to ensure that we elevate that mark to an A. Across a number of things, there are clearly things that we need to do better. They all interrelate. The data infrastructure is critical. We did really well with that. Scotland contributed hugely, both in analysis of data, participating in clinical trials and so forth, where we really were world leading in that. I use the term advisedly because it is often overused, but that was a really key part of our response. The danger is that that falls by the wayside as other things take precedence quite understandably. It is really important that that is absolutely embedded in infrastructure. We accept that we cannot be at a pandemic level the whole time, but that the mechanisms, the ways of ensuring that clinicians and others can set up trials very readily, that the data can be acquired without losing public trust in their data, because we enjoy a very high level of public trust in the health service in Scotland. We must make sure that that is protected, but at the same time oil the wheels to make sure that that can always be, you know, we can get the data, analyse it as quickly as we can. I think the other issue that was highlighted in our interim report was in ensuring that the right advice and independent advice is available and rapidly available as well. Again, I think we are moving in the right direction there. I think we learned a lot, certainly I learned a lot, on a variety of scientific advisory committees, on the sort of advice that is useful and who you need to have. Again, we are working towards that. I think that this linkage between, we call it, others have called it the triple helix between academics, between public health and industry. You know, we have got a good life sciences industry or base in Scotland and in the United Kingdom, and really to ensure that that can continue, we can get the most out of it in terms of a future pandemic is really vital. Again, we can't have labs sitting empty, factories sitting empty, so they have to be purposed for something else while able to react to that once that's called on. You may have read that Moderna, the very large American vaccine company is situating a plant within the United Kingdom, which is very welcome. I think anything that can be done to reinforce those interactions which are so fruitful during during Covid-19 will be very welcome. So those, I think, are some of the areas that we're certainly working towards. Tom's covered that very eloquently. There is a cultural dimension to this, and I do worry about complacency. You know, the geopolitical and economic pressures are immense globally, but we mustn't forget the pain the pandemic called, and I do worry about complacency, you know, Covid's done or pandemics are done. So I think, you know, that awareness, and that's why this committee is so important, because there's a real opportunity to learn and to gear up our preparedness. Keep it warm, so if unfortunately another pandemic did come along, we can pivot readily towards it. So I think complacency is the second observation is slight elevation in bureaucracy and a tendency for us to go back into our sectoral silos, if I put it that way, because another feature of the pandemic response was working with the publics. We required policy makers, the academic community, the industrial community to co-create really innovative solutions at pace, and what I observe is a tendency to go back into our boxes, if I could, for want of a better phrase. So I think, I have to agree with Tom, we're a B, but we want to be an A, and that's the opportunity for Scotland. Okay, thank you. At the time, one more question, community? Yeah. Just to follow that up. I mean, clearly we see a huge pressure on public services post Covid, particularly the NHS, a lot of emphasis on NHS recovery, you know, catching up with a lot of what was lost during Covid. Do you think there's a risk therefore that, as you say, we take our eye off the ball and we think Covid's done and we don't need to have that drive that's needed? And if I can just slip in a second point to that, where do you think the public are on this? Do you think the public have basically decided that Covid's done? And do you think that we had another pandemic, you would have quite the same public buy-in that we saw during Covid to, for example, restrictions on people's activities that we saw during Covid? All right. So there's two very good questions. Edych chiwyddu? Which one do you want? I think I'll take the public response now. I'm not a behavioural psychologist. I interact obviously with the public and my work as a clinician. I think we're privileged and lucky to have some real experts in behavioural psychology, both on the scientific advisory group on Covid-19 and continued into the outstanding committee. I think what was key was a public response, I think, was overwhelmingly fantastic compared to, I think, what people feared. And, you know, almost overwhelmingly, most people adhered to what they were told to do because they recognised the real need. It was spelt out very clearly. Would that happen again? I think it would if it was clear that this was going to have a major impact. Now, I think we've learned a lot about the forehorms, that obviously we focus very much on Covid on the immediate health consequences of it, but there are clearly other consequences on other diseases, on society and on the economy, which I would say are not devoid of an impact on health either. Unemployment is extremely bad for your health, so I think that somehow got lost a bit in that. So I think people, it's a bit of a crystal ball, but I think people would adhere to what they were told because I think we do have good channels of communication and I think there was a huge amount of public trust in those decision making processes. But yes, you have to be very clear and you have to be transparent and express very very clearly exactly why you're being asked to adhere to these principles. But yes, it has fallen obviously from the public consciousness, but it will come back, I think, very rapidly should there be a further threat. That's my personal opinion. I think we discussed last time the public are the solution, not the problem in a pandemic. I think the social contract in Scotland was strong and we should endeavour to maintain that through. We're very fortunate to have deep wells of expertise in Scotland, folk like Stephen Riker, Linda Bald, and they're actually leading work on this. On the NHS and our question and our international advisory panel was really useful. If one establishes the skills and capabilities for a really effective pandemic response in isolation, then it won't work. What we need to do is make the exceptional routine by embedding best practice between pandemics and keep it warm. Actually, looking to Singapore, that's the phrase of their chief scientist. They've had a similar process to us and it's about having expertise, capabilities networks that are kept warm between pandemics so that that capability is there when, unfortunately, we might need it in the future. I think embedding it within an efficient, effective, safe health system is the key rather than seeing it in isolation. Thank you. You've raised lots of issues. I'd love to explore further, but I appreciate that my time is up. Others will come in, I'm sure, and proceed. Yeah, good morning. Can I pick up on that point where you said that we're in a better place now in terms of preparedness and I suppose it's what is it that you're actually measuring in terms of preparedness? Because I think Professor Morris, you did say, I think you said there again just now, but in terms of the principles of good pandemic preparedness, this was in September first a very good, strong health and care system. For the evidence that we've taken throughout the last year or two, that's what people have told us, is how best can we be prepared, you need a good health and social care system. Now, if what I can see in Scotland right now, the social care system is falling round about itself, massive shortages, massive burnout of staff that are still there, and then we have record waiting times. So I just wonder what you're meaning when you say we're in a better position now in terms of being prepared for something when everything tells me the opposite. I can speak to the clinical side, because that's where I work during Covid and continue to do so. Before Covid, I work in infectious diseases, so that's what I do, what I'm trained to do. Most people aren't, and that was a very steep learning curve for those who were at the sharp end of dealing with patients with Covid-19. That has expanded the knowledge base and the training hugely, so we're undoubtedly in a better place than we were, and also that goes for those who work in social care as well, who again had had very little experience or a limited experience of dealing with infections on the scale that Covid-19 presented us with. The real danger is that that level of training, that level of expertise has to be maintained, and therefore there is a danger that over time, as memories fade, as new people come and go within the health service and social care system, that that expertise will begin to be lost. It's not the job of our committee to operationalise, but we can make scientific advice, and obviously all the points you've highlighted are very key, and we have to ensure that there is resilience there. We can highlight the areas, particularly in terms of staff training, both within the NHS and within the social care system, to ensure that that is maintained, and that there is adequate provision of all the necessary personal protective equipment, the necessary infrastructure and so forth, to make sure that that can continue. So certainly there are many challenges facing health care at the moment, as you all are very well aware. We are in a better place in terms of that general institutionalised memory of what to do during a pandemic. I think the real issue that we have to make sure that we emphasise in our report is that that needs to be maintained because there is a real danger, I think, as Andrew alluded to, that complacency will creep in. But it's not our role to operationalise that, if you see. We can offer that advice, and then it's up to others then to say how that will be embedded in the system. But if the system's fallen down around about itself, I get what you're saying, that there can be the expertise and the knowledge that you've gained, and that different professionals within health can have that. But if social care's fallen down around about itself, if the hospitals are early coping, I mean there is another question there that people are asking around. Did we do the right thing when we shut down so much that we've now got excess deaths, cancer rates much higher, waiting times for operations, people are suffering as a result of all these things. Is there a balance to be struck, and did we get that balance right? And the fact that we've come out this side of Covid where health systems and social care systems are really creaking and struggling. So those are obviously really important questions. By and large, those will have to be addressed by the relative Covid-19 enquiries. So it's not our role to comment on or provide evidence about what we did during the pandemic, what worked well and perhaps what didn't. And that will be, I'm sure, revealed in great detail during the various enquiries. Looking forward, I think what we will be keen to provide in our report, and we can't provide everything, but to make sure that we highlight those areas of resilience in healthcare and social care that need to be absolutely robust. And as you say, to factor in the other elements of the non-immediate Covid harms in terms of waiting times, other activities in healthcare, in education and so forth, which clearly were very badly affected during the pandemic, understandably. But it's really for Government and other agencies to decide what policies are put in place in order to ensure that that is carried forward. But I absolutely agree with you that all those things are really important and need to be. And we will highlight those as important, but it's for others to carry that forward. I don't know if, Andrew, if you'd like to. Yeah, so this specific role is to look forward, pandemic, future pandemic preparedness. And we have to be sensitive not to comment on issues that are more appropriate for the multiple Covid enquiries, which is another part of my life. Okay. Now just finally, then, as you did say there that you've set up a subgroup to look at the centre and work up the detail. I think you did say when we talked in September you were starting to work out what that centre might look like. Would you be able to maybe elaborate on that a bit as there's been progress made and what is the thinking behind the centre? Do you want me to do that? So we've established a group, which is in terms of the process, established a group, met twice, and in June we're having open meetings, I think one in the central belt, one in Perth, to take comments from the community around the purpose and the functions, the structure and the governance options for such a centre. So I think that's moving on. And we hope to have that framing by the end of August. So I think that's moving well and we're looking to consult openly on how that centre might work. Second comment on it, and actually this came from our international advisory board, they suggested that the terminology of centre is unhelpful because what we're trying to achieve is a collaboration across boundaries. So we might actually even look at the terminology. The third comment on this is because we often get really embroiled in process, but we should be really clear on what outcome are we trying to achieve. So what we really are looking for is for Scotland to be in an excellent place where we can rapidly detect new and emerging pathogens. Secondly, understand transmission, severity, high-risk populations and health consequences. Thirdly, deliver scalable testing tracing isolation as required and lastly be plugged into an effective diagnostics vaccines and therapeutics system. And this must all be underpinned by the social contract and working as a team across policy makers, industry, academia. So that's what we want to achieve. And to do that you need certain capabilities and that's what the discussion is about in terms of what is our need and what's our current capability and future need in surveillance and diagnostic and testing. You sort of break it down into the so-called buckets or capabilities which we will need to have at our disposal in Scotland. And some of those include surveillance diagnostics, non-pharmaceutical interventions, decision-making structures. So that's the way we're doing it. And we'll make sure you're invited to one of the meetings. Yeah, so I think a couple of things. Clearly at the moment we can't tell you that this is exactly how it's going to work and this is what we're going to do, this is the responsibilities and this is the leader. That will happen. At the moment they are clearly in a phase of ensuring that they consult with relevant stakeholders and as Andrew says a number of meetings plan during June for that and I think that's really important. I think what we learnt and has always been emphasised by all those dealing with Covid and indeed our international group is that you have to be local to be effective. The most effective responses were in countries that had that very strong local sense of how this is dealt with and I think that comes through in the short-life working group. They're very much taking that on board. It's not that whole idea of a centre is good in the sense that you have to know who's in charge but at the same time you have to involve people who are working at the Colface in terms of local public health teams for example. And the thing that we've got to make sure is that those very good collaborations between particularly academia and public health that were so helpful during Covid that people don't retreat into their individual status and so on. I'm only interested in that and already I think we've seen really good examples where public health have for example leveraged the scientific expertise in the centre for virus research in Glasgow to say look we've got this outbreak of really unusual hepatitis in children. Can you help us? We can provide the date for acquisition and so forth if you can look at the science for that. And that was extremely helpful and led to the discovery of an unusual and novel virus that seemed to be precipitating that cause. So I don't want to get too much of the detail about that but I think that's a good example where the two groups came together. So we want to be sure that I think that a centre for that pandemic preparedness encapsulates that joint working together as well and hopefully very much to bring on industry as well. So I appreciate that that's a little bit vague at the moment but I hope you can see the direction of travel there and that we very much hope that by the end of the year we can put some flesh on those bones. Thank you. Can I add this? Yep, just to add to Tom. An important dimension to this is the industrial science base. So if we look back at Covid the UK and global response would not have been the same unless we had partnered with the industrial science base. Two examples. Firstly it used to be called the AZ Oxford vaccine. So the mechanism of using a viral vector to get the immune response was devised by Oxford University. The scale-up, the manufacturing, the quality control, the clinical trials had to be done by industry. Likewise, and this is an example, Patrick Vowins gives the Covid infection survey. We had some of the best, some of us might have been in it actually, it was run by the Office for National Statistics and you'll recall we had some of the best information in the world on surveillance run through the Office for National Statistics. The natural history of that is the ONS had the methodology but we required 25,000 house visits a week to actually do the testing. And actually that was provided by a clinical research organisation who'd had to lay off their staff because we weren't doing clinical trials. And so those are two examples where we can't ignore the industrial base. Effective pandemic preparedness is that really tight partnership. Okay thank you. Can I very quickly ask one question, Tom, about what you just said about we need the centre but we also need the localisation. Does that mean then that local authority health boards would have to have the people in place to be able to tap into it if there's an outbreak in any particular area of Scotland? I think that policy hasn't been finalised of course but yes the direction of travel is very much towards ensuring that that local expertise that was so useful in the test and trace programme and in interactions with the various communities I think that's very much that their desire and that they're very keen to make sure that that's embedded in the system. Okay thank you. John. Thank you very much. First of all I want to follow up one or two points that you've already made. The answer I think it was to Murdo Fraser. You made the point that decisions were made quicker during Covid and that was generally a good thing. Now at the finance committee at the moment we're doing a look at how government makes decisions and on the one hand we were also told that decisions were made better and quicker during Covid but the counter was especially I think from engender the women's group that there was a lack of consultation and women suffered through the pandemic in a variety of ways because that we hadn't spent the time to think through policies maybe we didn't have the time to think through policies so I just wonder how you would react to that kind of comment. It's a very good point. There is a balance. The pace of Covid was incredible. I mean we were I well remember moving from a time when it was a theoretical risk of someone coming from Wuhan to then a few skiers coming back from holiday who were very very well to an absolute onslaught of seriously ill people many of whom tragically died so the need to formulate policy and to react to it very was a tantamount so that's the real need during a pandemic the downside of that is of course as you can say that without broader consultation that you might miss things and as I'm sure the inquiry will reveal I've no doubt you know no one is perfect and I'm sure mistakes were made what can we learn about that as we move forward I think we do have to ensure that there is rapidity in the system and that's part of what the whole package that we're trying to formulate in in our committee is that those systems are in place so that they can react rapidly and providing independent rapid advice to government is very much a part of that. I think it's clear moving forward that we have to understand and actually perhaps implement because we do understand the differences in in health inequalities across the country not just for for women but in different ethnic groups those are less well off and so forth and we've known about those for a long time to be fair ever since the bike report and subsequently as well it's not for our committee to decide on that but clearly we will hide like that I'm sure and then it's up for policy makers to say well how do we ensure that we can react rapidly but at the same time not leaving behind these very important. Is it just inevitable that there has to be compromise on these things? Yes, in my view. Public participation involvement and engagement has I think shown its its its value because it actually allows you to make better decisions and in the pandemic I think there are good examples where public involvement at an early stage actually did despite the despite the the need to make decisions urgently actually added value. The key to it is to have an existing engagement capability in place that you can pivot so I think and that's why I'm really pleased that Linda and Stephen are leaving leading our behavioural science group. I think there are things we can do looking ahead for the future that bakes in public participation into the into the framing and decision making process. Okay, that's not unique to pandemics. No, I do get that. There's some general problems out there. The other side I wanted to touch on was the kind of what we can learn from other countries and the whole international aspect of this and first of all I mean you've used a few phrases already and I'm not sure if we're talking about the same body. You said international steering group, international reference group and international advisory panel. Are these different things? Are they the same? I think apologies then for misleading you potentially there so yeah they are all the same thing it isn't it's a small but highly knowledgeable group of individuals who we have been fortunate enough to take some of their very valuable time but also I think all of us are looking at what and certainly during the pandemic looking at what other countries we're doing what seem to be working what didn't seem to be working as well and clearly what works in country X might not necessarily work very well in Scotland so do you have to temper that with what we have locally and so forth and even with the United Kingdom there are clearly differences in how we deliver healthcare we have a much more remote and rural population I think compared to the rest of the United Kingdom so there were clearly important differences that we had to take on board but yes we are very keen to learn from best practice and that goes across all the different groups I'm also on a a committee led for the out of the national services Scotland on antimicrobial resistance and healthcare associated infection where we have which has a number of different arms across all areas of different healthcare delivery but key to that we've established international group that is having participants and across all different continents to try and understand that best practice as I said so I think it is a really important part and where should we be looking at me I think Singapore got mentioned earlier on are they a good example of being prepared for the next pandemic or you know can you point this to any countries which are really on top of this I think Singapore would be a good example amongst others yeah so context and culture is always always important so Singapore is a case study it's not the case study as well however they have they've done two or three things they've been through their inquiry process they've published a white paper it's being discussed by their parliament next week I think and they've very clearly said this is what we did well these were the gaps and they're putting a real emphasis on on filling the gaps and they're also going back to that phrase keeping it warm they've created a a pandemic fund called prepare of all things it's programme for research and epidemic preparedness and response and it's a you know it's an investment it's about a hundred million Singapore dollars over five years which is about 10 million pounds a year so it's a lot of money but it's not a lot of money but they recognise they needed to do that to keep the connections across the ecosystem primed at keeping it warm we're also learning from other initiatives you may be aware of the g700 days mission which is now being picked up by the g20 the thesis is that you know if this was unfortunate to happen again within a hundred days we should have diagnostics vaccines therapies that's a within three months three and a bit months so how do we how do we do that and that's about targeted investment against the who are prioritising pathogens that they think are the highest risk ones so how do we how do we target rnd across those pathogens secondly especially in vaccines the so-called platform technologies so the mrna capabilities are platform capabilities a bit like do you remember meccano on lego you can you can tweak it you're showing your age very established and the oldest member of this committee yes but you can these platform technologies means that you don't need to go back to the drawing board you can tweak it based upon the antigen that you're trying to target and as you know when we were in covid we were targeting the spike protein but then you can modify it as mutations develop so just to clarify what you said so within a hundred days we would next time we would hope to have a vaccine well that is the bold ambition but but saying that you know and that's the global ambition being supported by the g7 and also an organisation called sepi which is the coalition of epidemic preparedness innovation which is a global and and there are some evidence of that because you may be or you may recall that in october there was a sudanese ebola virus strain so ebola is you know is a an emerging pathogen which we don't want so a sudanese strain arrived in Uganda and within 79 days after that outbreak was declared in Uganda a candidate vaccine actually arrived so we're beginning to see the ability that if we get alignment collaboration joint strategy we can be globally more a long way to go but the g7 hundred days mission is is something that we should be aware of and you know we're not going to we're going to we should contribute to it through our scottish capability plus our partnerships with the uk hsa and others that's quite exciting that's very positive thanks convenient can i just add one thing to that because the only thing i'd add is that the need to for trials because it's the technology that can be developed now with these platform capabilities quite rapidly but you do need to know that it it works and that it's safe in the real world and that does unfortunately take time but i think correspondingly the fantastic contribution that scottler made to the vaccine trials means that people have trust in the product because they say you can say look this is what we did and we tested it and these were the likely side effects at this level and this was the effect and i think that if you think about vaccinating a population you have to have those data very clearly particularly safety and that does take time so it's just to make sure that those expectations are managed yeah well i think one of my colleagues will be on about data shortly can i just say this session is fascinating we could run for hour would you mind if we go 10 minutes over do you have time we'll go 10 minutes over is everybody comfortable if we do that yeah agreed i'm on a meter but it's fine we can do that we'll speak to the party Brian thank you thank you good morning professor morris and professor Evans i am the data gate canisters i think you know we will look at the preparedness is trying to understand what that really means in practical terms i suppose it's understanding the threat and then our ability to sort of deploy solutions to protect the public and i think and to go to the data is this ability to gather and you know and assess and deploy data i think initially would be internationally because you know we look back at covid we watched it almost this morbid fascination move across the world inextricably towards us and yet when it got here we weren't ready and then the data locally across all of our health boards our ability to to tap into data on the front line in almost in real time i think you know i'd be interested in what your thoughts are where we are with both of those platforms if you like because i think you know over the you know a period of years in what working here i think it's it's but a recurring theme that we don't have a platform really a healthcare platform in scotland yet that allows us to move around the country and pick up data in real time i'm a bit interested to see where your thoughts were on both of those to start with so a few thoughts i think looking forward in terms of pandemic preparedness we need to see data as core infrastructure because otherwise a phrase i sometimes use is if you if one does not have real-time intelligence of how the pandemic is presenting it is like driving at night with no headlights but what i think we showed with covid was how useful it was to use routinely collected data to link it to demonstrate how the pandemic is progressing who are the high-risk groups what are the pressures on the healthcare system how are the vaccines working are the vaccines safe now there's a myriad of questions that we were able to answer if you've got good data infrastructure to give you an example clinical trials are absolutely essential you can get a vaccine to market having tested on about 30 40 000 and then what did we do in the UK was expose it to 40 million 50 million people so we need to understand is it safe is it effective in all groups for example children and pregnant people different ethnic groups and unless you've got a data capability that is linked and accessible we would be driving at night with no headlights so scotland's in an interesting place because it has it has a good track record of using data in the pandemic some of the work that came out of scotland was truly world-leading using the term advisedly i think you met sir izzy shake did you meet who will have told you about the eve to study however the capability in scotland lacks what i call the critical mass and what i call the it is scalability sustainability interoperability reliability and security and what we've seen since the pandemic is that we've regressed and it's sometimes it's taking over 200 days to actually access data from some of our most eminent researchers to ask the most relevant questions because we've not got the data infrastructure and the underpinning governance in place to enable access to those data for trustworthy purposes so for me scotland has a huge opportunity in the use of data as infrastructure for trustworthy purposes but we're at risk of squandering that opportunity sort of have to do yeah so just to follow on from some of his points there i mean and to go into a bit more detail i've been involved in looking anti microbial resistance across where i work and also across scotland in research capabilities where the system is good and we saw some fantastic examples as andra has said but the real issue for those who want to join up nationally is that the silos these data are kept in understandably very protected to be sure that patient confidentiality is maintained but if you want to work across if i want to look at data from tayside or islands and islands i can't do that without going through an enormous set of bureaucracy that it's there for a reason i don't think anyone would dispute it's very important that the public has trust that their data are maintained but it really hinders that kind of approach so i think part of what the the data group is working on is how do we how do we maintain that integrity of confidentiality while making it much much easier so that you can go from making a proposal to it being able to be carried through in much much less than it currently takes because that's a real sticking point in the system so i think that i'm sure that's going to come out very strongly in the report and we're talking here about crossing health boards here but we're only six million people in scotland i know you know and then when we talk about working internationally as well so you know you have to share data with with other countries as well so i think i don't know if we'd agree the opportunity here is to create that environment in scotland where there are only six million people we can be agile with our data platforms i very much hope for and scotland has numerous strengths on this we have a the unique health identifier the community health index number the chi number enables you to link up anyone across scotland that's fantastic and i think the envy of many other health systems we have very little in the way of private medicine so most people are enrolled and use the national health service scotland so that the data is there if you like and it's just making sure that we can ensure that scientists and clinicians can access it as quickly as possible but at the same time make sure that the public trust is maintained because without that people are not going to be happy but i embedded in our healthcare system in scotland i think we have a real potential to use that very much so and you know they're you know it's not when you're extracting what we call metadata you know simple things about age ethnicity and so forth those can be absolutely anonymized or pseudo anonymized so that those working with it don't know the people they're coming from and i think maybe that needs a little better communication so that when we receive data we're not actually looking at mrs blogs for number two it's actually just a number but it has that richness of detail that you really need thank you the other thing that struck me there was this international collaboration when it's a pandemic it seems absolutely logical we have international cooperation so i suppose then if we're going to tackle a pandemic in the future we need international preparedness because preparing ourselves you know we can be as prepared as we like in isolation but if the rest of the world are struggling we inevitably are going as well so where are we globally then with international preparedness and i think on the back of that you know the side of international preparedness i'm reminded of the scramble for vaccines and how all of a sudden those international cooperations kind of broke down at everybody you know we could say that we were the winners in that but i don't think anybody's doing us and there was kind of the situation so where are we sort of with international collaboration it's not in our remit our committee but at the point you make is really really important i mean i think obviously we have the world health organization and various other international bodies as well who have emphasized throughout the pandemic about i like the expression we weren't all in the same boat we were all in the same storm but we had different boats and vaccine nationalism as we saw i quite agree with you doesn't it ultimately doesn't help anybody there are a number of non-governmental organizations who've worked in vaccines for many years there's a global alliance for vaccine initiative gavi for example which is really it works very much in that field to make sure that effective vaccines are available into countries lower middle income countries to be sure that they are then offering and i think all we can do i think in in our committee and in scotland is to emphasise the importance of that to ensure that that voice doesn't get lost but to accept that our leverage over a global situation is is not huge but at least we can be sure that we we consistently give out that message very quickly very quickly thank you indulging me um i think you know what just to follow on from my colleague alex royally there i think part of preparedness is is our ability of you know the our system to cope with our healthcare system to cope with with what tends to come down the line i suppose if the same thing happened again i would i would fear for those in the front line if they were asked to step into the breach in the way they were the last time so i'm just wondering what was part of the what you're doing you'll be looking after how we look after our healthcare professionals you know going forward again an excellent point i think i would just say again we can highlight that as very important it's not the role or the remit of our committee to say how that will be enacted but i think by putting all these structures in place or recommending that these are structures that we would think valuable i hope that that will improve the resilience of those who work in the front line i don't know and if you wanted to comment more on that well i think the principle is that good pandemic preparedness needs a skilled and supported interdisciplinary workforce and how we provide those support mechanisms but you're you're you're quite right we have a pastoral responsibility to our staff there's something that we can highlight but thank you we will move on to stewart thank you convener can i just go back to something that was touched upon earlier and that was regarding the the centre for pandemic preparedness and it was highlighted that about the language used by the advisory board the use of the word centre so can i just clarify are you considering or are you looking at actually setting up a building somewhere as a centre or is it is it a bit more flexible than that so it's still under discussion my sense is this is not about bricks and mortar it's about interdisciplinary expertise and how we create a a network that delivers that expertise consistency to all four corners of scotland rather than a building it will be my sense yes i think the work of that of that group is very much it's a virtual centre i don't think there's any aspirations for something in concrete and that gives it much greater agility because the last thing you know in five years time there will be different technologies there will be different knowledge will expand and so forth so it has to be able to respond to that and i think that's very much their hope okay thank you and just in terms of this network i'll use network it's going to be at the centre so in terms of the network in terms of the private sector do you have full support from them thus far in terms of your engagement with them so it's it's work in progress private sector is a very broad term if we consider capabilities then you know you've got vaccines you've got diagnostics in the data space you've got analytics you've got vaccines so what we're currently doing as a group is challenging ourselves to say how can we in a trustworthy way have a dialogue with these multiple capabilities the industrial science base is what i i call it because i don't think as we've discussed pandemic preparedness needs to engage that community in a transparent way and that's something that we are grappling with at present and i think to add to that i mean we can't tell industry what to do and clearly they they're not charities that they may have very charitable thoughts but you know they have to to turn a profit i think one of the things that we are exploring well one of the things that came out of covid was rapid development of technology for example the we test that we all had the little lateral fo devices and so forth which which were really incredibly important in terms of allowing people then to decide um i need to self-isolate and so forth and in healthcare vital that we had those rapid diagnostics that's a very emerging area and has many applications beyond a pandemic every year the front doors of our hospitals are full of people coming in the respiratory illnesses many of them will be influenza but other respiratory viruses as well and developing those rapid diagnostics for that for those groups is certainly something that industry i think will be very interested in and clearly has the spin-off that developing that technology is certainly something that could then be applied to a future pandemic and the real balancing act is what can you do now in peacetime if you like that maintains that expertise and technological development that can then be ramped up in the face of a pandemic and you know that that's really challenging but i think making sure that we keep those interactions warm that we're able to promote the interactions between healthcare science academia public health and industry so that they can see that this is something they can invest in now which in the future so again it's a wee bit nebulous at the moment and i don't think by the end of our report we will have that absolutely set in stone but i think it's a it's a route map if you like that we can continue to follow up on the reason why i ask a question because it's touched upon the issue of complacency earlier on now first of all i mean that the language that's that's used for the public is usually important i mean there were politicians in this parliament 12 months ago we're claiming the pandemic was over and clearly that wasn't the case and there are still people going into hospital now with covid so politicians have got a role to play but also in terms of i mean with what you've just said regarding the private sector and i accept that it's a broad term if there's a if there's a a sense of cooling from them with regards to to looking ahead then i would suggest that as a bit of a concern um and is there just in terms of that dialogue with them um are they purely just thinking about about a proper opportunity in the future or um or do do they generally do they want to engage so i i i again looking ahead i think it's really essential that that scotland does what i call environment scan of its industrial base i think we employ 40 000 people in life sciences in scotland in terms of the uk's capability during covid we did well in vaccines and therapeutics we didn't do as well in diagnostics so thinking through you know is is there um is there an opportunity in the diagnostics saying that this is a global no it's a global market but i think our point is that for for excellent preparedness one needs to in an open way um discuss with the industrial science base their contribution to various components of what are good pandemic responses whether that's in the data side of things whether there's in genomics whether it's in surveillance because they have a key role to play we can't do this all certainly not from academia or the NHS so so i think that but how we set those they they would be an integral part i anticipate of a future network how we make that work is something that we're looking at okay and i think i think just we need to see industry as partners absolutely and there has to be perhaps a slight culture shift in how we view social delivered healthcare versus private industry the two can work very well together industry in terms of clinical trials and so forth to look at vaccine platforms you know the nhfs both in scotland and the uk offers a fantastic resource to them so of course they'd be very interested in that and likewise universities academia very good at coming up with blue skies thinking and ideas but as and you said with astro zenica vaccine it took an industrial complex to actually scale that up to population level so we need both and we need i think perhaps a slight culture shift which i think is already happening that we can embrace industry not as um the other but actually as partners in this as well and many of these things have been developed vaccine platforms these new vaccine platforms already going to be turned to other diseases you know the people are very interested can we make a vaccine against flu that works a bit better than our annual vaccine is it something that will be resilient to future variants and so forth and that goes for a lot of other infectious diseases as well so i think there's there's real hope there but it's it is a work in progress okay and i couldn't agree more regarding the partnership approach absolutely and just a final question it's just it's regarding the regarding the network and you touched upon earlier regarding an answer to brine's question regarding bureaucracy and certainly so looking at the looking at the data and the issue regarding the confidentiality so the network that's been considered going forward could that then be the mechanism to then potentially access the data from across the different health board areas in scotland because that could guarantee the confidentiality but it also then provide information that is required to assist going forward with with any research so i appreciate that so in brief i think that is a real opportunity to provide a a trustworthy data platform for the population of scotland that links what i call journeys of care primary secondary tertiary into social care in near real time to answer the questions that we will need for future pandemics we actually have a vehicle called research data scotland which has been set up by the scottish government to do this but that's still hitting blockages that we need you know 10 15 30 approvals for the same study across different parts of scotland can i just say that we've actually included this in our long covered report that we have requested the scottish government update this committee on the work and its delivery and its priorities are health and social care and the data sharing so it's something we are actually looking at already we were a national health service and we should have a national data capability have you got time to take one very small very small supplementary from alec of course thanks you talk about future pandemic you know i've heard people describe and and covid as a once in the hundred years event so what is the threats has the world changed i mean what is the threats and are we are we likely as evidence suggests we are likely to see a future pandemic within our lifetime ah well we'll both do this one well i think if you look back over the last 100 years we had the pandemic of influenza in 1918 1919 we've had HIV as a completely novel pathogen and now we've had in the last few years we've had the original SARS SARS-CoV-2 SARS fortunately not becoming a pandemic and related virus middle east respiratory syndrome which again fortunately has remained quite geographically localized why that's happening multiple reasons essentially the expansion in human population so we're encroaching more and more on you know urban centres are spreading out and most of these new infections are what we call zoonosis they've been acquired from animals that have made that jump from an animal host into the human host so our exposure to those animal reservoirs is continually increasing and the second thing is is is travel i mean the number the numbers of flights and people moving around the world increases year on year as the human population increases so i think um it's always dangerous to make uh prognostications but i think um the threat is very real and not just from something we know about um there has always been a bit of a danger to think oh it's going to be flu it's going to be this but actually it could be disease x something we've not come across before and it's very important we take that broad view depends on how long you live as to whether it's going to occur in in my life to um all your lifetime but um i think it would be foolish to assume that that this is not going to happen for another hundred years i think there is every possibility that we're looking at future pandemic within the next hundred years certainly very briefly the world's changing you know i was born in 1964 3.2 billion people on the planet 30 of the november last year they estimated 8 billion people that plus air travel climate change urbanisation increased human animal contact so i just think that the conditions for um pandemics are tilted towards you know this being a real risk we should take it seriously i have one very final question and i promise you it's a very quick one um you've twice mentioned right at the start of the session the importance of this committee which committee were you talking about your this committee okay that's all the clarification i was being gentlemen not us i see yours is rather important as well um i'd very much like to thank the witnesses for giving extra time it's been a fascinating session um if the witness would like to raise any further evidence for the committee you can do so on writing in the clerks will be happy to lize with lize with you about how to do that and that concludes our public part of this meeting so i suspend this meeting now and allow the witness to leave and we will move into private thank you