Public health professionals need to regain the public confidence lost in the BSE crisis. Claire Laurent reports

Politicians need to be honest - and act fast - when public health crises emerge, chief medical officer Professor Liam Donaldson warned last week.

He told the annual conference of the Public Health Laboratory Service that he believed the public's loss of confidence in public health, rooted in the BSE crisis, has created a widespread mistrust of science.

Professor Donaldson said politicians had to be honest in the information they gave the public:

'People in my position have a responsibility to insist that they're honest. Sometimes the situation moves very fast, the pressure of time on decision-making is very intense and it's in those circumstances that you sometimes get it wrong. '

He said: 'We have to regain public confidence by explaining the concept of risk better and presenting it in more practical ways that the public can understand, and we have to be much better at conveying uncertainty. '

'Short-term thinking in these situations is all wrong. You have got to be prepared to make an intervention because protecting the public is top priority. '

Maintaining the commitment of health professionals was key to ensuring public health remained good and that targets for immunisation and screening were met, and antibiotic resistance and hospital-acquired infection were tackled, he said.

Concern about antimicrobial resistance was a key theme at the conference, with many presentations outlining research investigating the extent of the problem and information about European-wide attempts to harmonise approaches to tackle it.

Dr Angus Nicoll, acting director of PHLS communicable disease surveillance centre (CDSC), told HSJ that drug resistance was not yet a cause for concern among HIV and AIDS patients - but it would need to be watched.

He said the two main issues were the number of people living with the disease and needing lifelong care and the establishment of national ante- natal HIV testing.

'There has been a substantial rise in the number of adults living with diagnosed HIV - up by 4,000 to 18,310 in 1998, and numbers are continuing to rise somewhere over 10 per cent per annum. '

Dr Nicoll said this was down to the success of highly active anti retroviral therapy and because there was more success with diagnosis. But he warned that the level of new infections remained 'at best static'.

He said the government's commitment to an integrated sexual health policy was vital if efforts to prevent HIV were to be realised. The message about prevention needed to be got across to young sexually active people who were not exposed to the public health campaigns of the 1980s.

With regard to antenatal HIV screening, he said advances were being made in London, but 'a lot of progress needed to be made elsewhere in the country'.

Part of the surveillance work of the PHLS is determining which influenza viruses are circulating, checking whether they are incorporated into this season's vaccine, and detecting an early start of the influenza season.

This year's flu vaccine contains components of flu A and B - the major types - and has been updated with the most recent strains.

But John Watson, CDSC consultant epidemiologist, said it was 'impossible' to predict whether the number of flu cases this year would meet the proportions of last winter's 'crisis'. It's no more predictable than the weather, whether we will see flu activity, 'he said.