Health protection in England and Wales underwent a major reorganisation on 1 April 2003 with the establishment of the Health Protection Agency (HPA), which brings together local, regional, and national public health resources for the investigation, control, and prevention of infectious and non-infectious environmental hazards into one organisation for England and Wales (1). In this context, the publication last week of a report on communicable diseases by the House of Lords Select Committee on Science and Technology provides challenges that the newly established agency will need to be able to respond to (2). (Select committees conduct, on their own initiative, enquiries on issues that affect public policy. See http://www.parliament.the-stationery-office.co.uk/pa/ld/ldselinf.htm). Other countries may be interested to learn from the organisational and managerial opportunities and threats that the report is highlighting.

Fighting Infection, the fourth report on science and technology from the 2002-3 session of House of Lords in the parliament of the United Kingdom, much of the evidence for which was taken before the establishment of the HPA, recommends general improvements in infection control in England, greater understanding of the roles and responsibilities of relevant organisations, extra resources for the new HPA, and further facilitation of international collaboration.

Although acknowledging that communicable disease services in England are better than those found in many countries worldwide, the report notes that they are under-resourced and overstretched, and sees a need for major improvements to avert major epidemics of infection in the future.

The report recommends publication of a document that outlines the roles and responsibilities of all organisations involved in communicable disease services, and also calls for the creation of infection centres, which would integrate scientists, clinicians, and microbiologists, and be associated with academic and tertiary referral centres and the regional HPA laboratories. It recommends that the minister for public health publish an annual account of progress made in cross-departmental work relating to communicable disease. Gaps currently exist between surveillance of human, animal, and foodborne infection at national, regional, and local levels, and the report recommends providing the HPA with resources to take primary responsibility for integrating this surveillance.

Resources for international collaboration and global partnerships with international bodies such as the World Health Organization must continue to be made available to the HPA, so that infectious disease experts can continue to collaborate both between laboratories, and by placing experts on short term secondments. The HPA is a member of WHO's Global Outbreak and Response Network (GOARN, http://www.who.int/csr/outbreaknetwork/en/), by which experts can both alert others to possible outbreaks and provide response.

The report also notes that the European Union's hope to develop a European centre for infectious disease (since adopted as a proposal, see (3) and accompanying report in this issue) would be important in fostering closer collaboration relating to surveillance and control measures, but expresses the fear that a 'large, heavily staffed, CDC-type venture could contribute to loss of experts in infectious disease from nation states'. Facilitating collaboration between laboratories (as in the recent response to SARS) is preferable to siphoning off experts who are already in short supply.

Recommendations are also made on improving information exchange by further integrating and developing electronic surveillance procedures, maintaining the public health laboratories, and promoting vaccine development. The report notes that the HPA acts independently of the UK government, and should be seen to do so.