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NL Associates News for January 2012

New for 2012

Professor Lightfoot has had a great start to 2012, visiting Brussels for an important meeting with the Kangaroo Group in the European Parliament, receiving an honorary fellowship from Chatham House and developing a number of new information services, which NL Associates will launch later this month.

 

His motto has always been Expect the Unexpected and his method, preparation. These new projects for 2012 are linked by the central theme of preparedness, and the development of systems for staying ahead of the curve, in Professor Lightfoot’s own words,

‘Early information is key to effective responses and has the added benefit of making you feel more comfortable as a crisis evolves’.

The challenge to everyone working in the field of emergency response is how to get access to, and generate, early information – the difference between a crisis situation spiralling out of control and confident resolution.

 

Brussels and the Kangaroo Group

Professor Lightfoot travelled to Brussels in early January to meet with the Kangaroo Group to discuss their upcoming spring workshop, ‘Cross-Border Health Threats: is the EU prepared for a bioterrorist attack?’.

 

The Kangaroo Group is an informal forum, based in the European Parliament, in which politicians, officials and the social partners come together to exchange information and opinion regarding the issues of the day and to devise future initiatives for the development of the European Union.

 

Professor Lightfoot briefed assembled experts, including MEPs, on the new proposal for European legislation, which aims to provide coordination during crises involving cross border issues.

 

The main issue under discussion will be how to work towards efficient cross border communication and cooperation in an emergency, no easy task.  Public health crises and bioterrorism threats will always have massive implications for neighbouring countries, because of the inevitable delay between outbreak/attack and recognition. In this vulnerable window of time, people will have travelled, and the acute effects of a crisis ripple out undetected.

 

Proposed legislation includes a mechanism for the joint procurement of medical counter measures. This mechanism means that a small group of countries can work together to help each other in the dual task of preparedness and response.

 

This legislation specifically addresses issues that arose during the recent influenza pandemic when access to vaccines was not equal and some countries were left at a major disadvantage. Professor Lightfoot’s recommendation to the important players in Brussels was clear-cut – sharing of counter measures across borders will be absolutely essential in any bio-terrorism event – and it is hoped that the planned workshop will expose multisectorial issues, weak spots and cross border challenges.

 

The Working Group will be in the format of a roundtable discussion on the threats and current levels of preparedness within the EU. It is vital that the most is made of this opportunity in order that the proposed legislation has the best chance of being approved my member states in the Council of Europe. Emerging public health threats continue to surprise us by their spread and impact – it is crucial that Europe is properly prepared.

 

Chatham House

Professor Lightfoot has been made Associate Fellow of Chatham House, an honorary appointment bestowed in recognition of his work on global heath security. He continues to be involved with the Centre on Global Health Security and has been asked to lead on their new biosecurity project – ‘Safe and Secure Biomaterial in Developing Countries’.

 

Biosecurity has increased in importance since 9/11. Western countries have raised standards for the safe and secure keeping of potential bioterrorist threat agents, which has often required expensive modifications to laboratories. Bioterrorist threat agents exist, however, as natural infections in many parts of the world, especially in developing countries and the challenge remains of how best to improve biosecurity in poorer nations.

 

Innovative solutions need to be sought alongside the established route of high-tech facilities, as the Chatham House brief explains, ‘New approaches should be sought that both represent good value for the donor community and leave a lasting and affordable local solution to the challenge of effective disease surveillance, diagnosis, biosafety and biosecurity in resource-poor environments.’

The project aims to inform policy at an international level, resonate with practitioners on the ground and to foster an ongoing engagement with the challenges of global health security.

 

NL Associates Information Services

Designed to help individuals and organisations stay informed and aware of public health threats worldwide, Nigel Lightfoot Associates Ltd has developed a set of new Information Services for launch in 2012.

 

Professor Lightfoot and his team of analysts keep a close watch on breaking news, ongoing crisis situations and comment in the international press every day. They are now offering that information and expert advice in a new, streamlined and client focused format:

 

The Daily Alert mailout, On Demand risk-assessments and Tailored consultancy.

 

These services are unique to the field and real-time, reducing the hours an individual or a company spends searching online and providing the reassurance that every decision maker needs.

 

In the context of a public health threat, there are three questions you may be asking:

What is it?

What does it mean?

What does it mean to me?

 

Our new Information Services have the answers you need. To find out more click here.

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This is a new report from Hyderabad in India of the occurrence of Bacillus anthracis, the bacterium that causes anthrax, in samples taken by students from drinking water sources: http://bit.ly/yUBEr8

The explanation given is that the waters have been contaminated from dead infected animals.

These results need to be confirmed by a reference laboratory.

A boil water notice has been issued to protect the public but the authorities say that the risk to humans is low as the levels found are very low. The organism does not multiply in water and a person will have to drink about 10,000 organisms to become infected. There is no person-to-person spread. Tourists are routinely advised to drink bottled water in these areas and are therefore at minimal risk.

In Bangladesh there has been an ongoing outbreak of anthrax in cattle in since 2009 and there have been over 600 cases of intestinal anthrax in humans after eating infected meat. Many cattle have been infected in over 10 districts. Infected cattle nearly always die and the organism that causes anthrax, Bacillus anthracis, that is highly resistant to destruction survives in the ground where the cattle die or are buried. There is therefore widespread contamination of the environment. The necessary intervention is control of anthrax in animals through vaccination and the proper disposal of infected animals.

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Providing Independent Expert Advice

Clients turn to NL Associates when they have an emerging public health issue on their hands. This could be an obvious outbreak situation or an incident that may contain potential health risks. Whatever the specifics of the case, an independent assessment of any potentially hazardous situation is vital. NL Associates provides you with the expert scientific advice and support you need in a crisis – minimizing impact and helping senior decision makers to take effective next steps.

Professor Lightfoot has spent years honing his skills and his experience in outbreak investigation is unparalleled.

In 1979 he was working as a consultant microbiologist to the Royal Navy and received an unusual call from the Navy Medical Services – ‘we’ve got a problem on our hands, some sort of nasty skin infection in royal marines recruits; it’s leaving them unfit for training and we’ve got no idea what’s going on. Get yourself down to Woodbury Common and sort it out.’

Dr Lightfoot, then a sprightly 32, already had a reputation for solving infection problems and duly set off for a site visit. He went on to employ a risk assessment methodology that he stands by to this day:

+Prologue: Solid preparation

ACTION

+On the ground observation

+Systematic data collection

+Quantitative analysis of risk

+Identification of possible interventions

+Recommended next steps

 

+Epilogue: Lessons learnt

These phases of outbreak response play out simultaneously and are subject to the constant arrival of new information; as such Professor Lightfoot’s approach has always been characterized by adaptation, logic and good communication.

In the case of the Woodbury Common incident as above (of which he went on to publish the paper – A large outbreak of streptococcal pyoderma in a military training establishment) Professor Lightfoot led a detailed investigation. He began with face-to-face conversations, visual examinations of the victims in their usual environment and interviews. He then broke the process down into discrete steps and examined the risks associated with each of those steps, identifying and referring back to the science evidence base at each stage. It was a systematic way of identifying what was known, and what remained unknown. Assumptions could be legitimately formulated and numbers applied to a quantitative risk assessment, giving a good sense of the magnitude of resulting health effects and how long it would take to recover to normal operations.

Now, as then, pre-planning is essential. Good preparation allows NL Associates to identify discrete steps for investigation and follow these through systematically when meeting people on site. It’s crucially important not to jump from one thing to another, otherwise mistakes and oversights occur. The real challenge is that new information is becoming available with each passing hour and this new data must be prioritised and integrated into the process that has already begun. Managing information flow in a crisis is the keystone to effective emergency response.

NL Associates continues to provide independent expert advice, empowering governments, institutions and businesses to make effective decisions in the context of contamination and crisis. When called to an outbreak situation, Professor Lightfoot will produce a detailed and quantitative risk assessment that reassures and supports senior decision makers. His challenge is to work out the probability of resulting harm and to recommend appropriate actions to minimize public health implications.

Most recently, in the case of Polonium 210, a risk assessment had to be made extremely rapidly so that the public could be protected from radiation exposure. Professor Lightfoot set to work immediately – observing and gathering information whilst constantly referring back to his experience of past contamination investigations. His knowledge of the evidence base enabled him to swiftly identify the real questions and put together a coherent hypothesis of what had occurred and what was likely to occur. Working collaboratively with his team he was then able to build successful intervention strategies to protect the public and at the same time not cause alarm.

The important final stage of any risk assessment is the question of lessons learned. In looking back over how the investigation has played out, where it succeeded and where it failed, loopholes and blindspots can be identified to prevent reoccurrence, and effective strategies can be reemployed with confidence.

NL Associates empowers leaders to take care of their team and reduce the risk to public health – the essence of good governance.

Please get in touch if you would like to know more.

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Global Risk Update

When is flu going to hit the northern hemisphere? What’s happening with Chinese food safety? Should I be worried about recent press reports about bird flu experiments? We answer all these questions and more in our weekly Global Risk Update:

Global Risk Update – November 28 2011.

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Real World Scenarios in WASHINGTON

Professor Lightfoot recently visited the US to attend meetings on international cooperation and risk management – with particular focus on the design and execution of emergency response exercises.

Working with Emergent BioSolutions, Professor Lightfoot discussed the planning of a bio-terrorism scenario, to be played by top European officials and MEPs, with a view to identifying key issues in need of European level solutions.

This exercise is currently being developed by NL Associates and will be put on by the Brussels based Kangaroo Group in mid 2012.

Professor Lightfoot knows from experience that exercises such as this expose important difficulties and blocks, even when plans have been carefully drawn up. Before he became the Director of Emergency Response at the Health Protection Agency, he created the first health led, mutli-sectorial CBRN exercise for the Department of Health in 2002 – Exercise Snowball – in response to ministerial request.

He worked closely with the Metropolitan Police Counter-Terrorism Unit to put on an exciting and challenging day for health professionals. The lessons learnt were clear and failures in communication were shown to be critical.

Professor Lightfoot later went on to conceive, develop and run Exercise Magpie in a live field scenario in Newcastle upon Tyne in 2004. This exercise involved a simulated chemical gas attack on a crowded city centre theatre and hundreds of doctors, nurses, ambulance staff, GPs, firefighters and police officers took part.

As part of the simulation, 14 people ‘died’ when the deadly poison Sarin was released into a lecture theatre. Another 30 showed symptoms of the nerve agent, while the remainder of the 200-strong audience were examined by medical staff. Fire crews in protective chemical suits and police in gas masks rushed to the city centre to deal with the catastrophe.

Health Minister John Hutton commented at the time “We are testing our ability to respond, to decontaminate and finally provide treatment. It is particularly important for the emergency services to test their plans and today is a very important part of that process. It is also not just about the North East, as emergency services across the country will be watching and learning from this.”

 

An exercise is the key test of your crisis response organization. NL Associates is available to develop exercises to meet your specific needs. We create, plan and administer real world scenarios designed to identify and deal with blindspots. If you are interested in testing your emergency response plans please get in touch.

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Bringing Experts Together in JAPAN


At the start of November Professor Lightfoot spent a week in Tokyo and attended meetings hosted by the Japanese government, drawing together experts in risk management from several nations.

Professor Lightfoot was happy to see Japan back to normal, although the road to recovery has been tough and there are still difficulties in the Fukushima prefecture.

Whilst in Tokyo, he also met with Tesco Japan, who he has been working with in the aftermath of the nuclear power accident. He provided an update on food procurement strategies to ensure safe food for customers.

Professor Lightfoot thoroughly enjoyed his time in Japan, especially his stay in the Shinjuku district, which gave him a great slice of Japanese life away from the more touristy areas.

A few personal photos from his trip:

Tokyo Riverside

Park next to the Ministry of Health

A Chrysanthemum Show

Professor Lightfoot has been invited to take part in international work for many years now and since 2001 has specialized in inter-sectorial responses to the CBRN Terrorist threat. From his unique perspective effective international cooperation is the future of emergency response.

Professor Lightfoot is an experienced chairman and well recognised for his ability to synthesize diverse expert inputs into coherent strategy. His approach is based upon a number of key strategies:

+Keep people together socially, which promotes trust, friendship and understanding. These links become vital in discussion when issues can be discussed from different cultures in a spirit of cooperation.

+ Summarise progress regularly in order to maintain focus.

+Identify blocks as soon as they appear and create mechanisms to park these for later discussion. This safeguards the key issues under consideration.

+Provide an opening address that identifies specific goals for the meeting – where the group expects to get to by the end and what the outputs of the meeting will be.

+Set work in the landscape of the big political agenda.

+Take care with communication. It must be recognised that when working in English, non-native speakers need to be given time and support to ensure a full understanding key principles.

 

Professor Lightfoot has the expertise to bring groups of people together, to chair meetings effectively and to deal collaboratively with complicated areas of emergency response.

He is also in demand as an expert scientific advisor and recently submitted written evidence to the Joint Committee on National Security Strategy. His paper focuses on the continuing Anthrax threat and provides detail on impact and the requirement for vaccine response in the recovery phase of an attack.

It is available online here:

http://www.parliament.uk/documents/joint-committees/national-security-strategy/nsscollatedevidencefinal.pdf

If you are in need of Professor Lightfoot’s unique expertise, please contact NL Associates.

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In October Professor Lightfoot travelled to Sweden to speak at the European Centre for Disease Prevention and Control (ECDC).

Sponsored by Europol (www.europol.europa.eu), the ECDC workshop ran for three days and focused on issues of European inter-agency cooperation in the field of CBRN (Chemical Biological Radiological Nuclear) response.

Professor Lightfoot presented an analysis of international cooperation over the past decade, with particular reference to bridging the gap between security and health. His key message was that integrated approaches give the best results.

Since the Anthrax attacks of 2001 countries have been working together on a scale greater than ever before. Growing collaboration has played a vital role in preparedness – emergency response plans are being completed faster and at less cost and there have been noteworthy developments, such as increased stockpiles of the smallpox vaccine.

Anthrax remains a threat today. Professor Lightfoot emphasised the importance of an ongoing dialogue between the health and security sectors. Adequate preparedness requires a cross-governmental response plan for antibiotics and vaccines. Anthrax is not a communicable disease so there are opportunities for the provision of mutual aid between countries.

Meetings such as these hosted by the ECDC fertilise effective collaboration between the security and health sectors. Security is constantly working to prevent acts of bio-terrorism, but when a CBRN threat occurs the immediate focus shifts to health. It is crucial, however, that the health sector response is organized with a continuing view to issues of security. This is in turn dependent upon strong teamwork.

Bringing representatives from the security and health communities together, to plan in parallel and take part in combined exercises is of immense value. It allows different groups to become familiar with eachother’s operational plans.

Following any bio-terrorist attack, evidence needs to be gathered for criminal prosecutions and at the same time public health must to be protected. The complex systems necessary to manage these dual priorities cannot be underestimated. Encouragingly, the interviewing of victims jointly by security and health sectors is now being practiced.

A truly effective response to any given CBRN threat requires inter-sectorial cooperation at all levels, from on the ground tactical decision making to high-level strategic planning.

NL Associates provide unique expertise on the creation of platforms for inter-sectorial cooperation. We bring people together, foster dynamic and efficient communication and facilitate high levels of preparedness for our clients. Please get in touch if you would like to find out more.

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Weekly Global Risk Update

NL Associates provides regular news alerts and risk assessments of emerging public health threats.

We keep a constant watch on global events. We use sophisticated search tools to identify potential issues that may cause a threat to human health.

As part of this activity we regularly summarise stories of interest from around the world. Here’s our weekly update for last week:

Weekly Global Risk Update – October 24 2011.

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NL Associates is currently tracking a rise in the number and frequency of reports of suspected human cases of avian influenza (AI) in Indonesia.

Two weeks ago we received reports of 2 suspected cases of AI in Bali. Both cases were fatal and confirmed to be AI.

This week we received reports of 5 suspected cases of AI in Lombok, a neighbouring island. Of these cases 4 have now tested negative for AI.

Today there are reports that samples that were taken from chicken that have died suddenly in large numbers in Lombok in recent weeks have tested positive for AI. Local authorities are asking residents to reduce contact with chickens and to remain vigilant for humans that have symptoms associated with AI infection.

Both clusters involved people who were:
  • Showing symptoms commonly associated with AI
  • Recently in close contact with domestic birds that had tested positive for AI
But at this point there is no evidence to indicate that human to human transmission is occurring and so based on current information this situation does not pose a heightened level of risk to global public health.

We will continue to monitor this situation closely.

If you would like further information please contact us.

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