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Mr. Deputy Speaker (Mr. Michael Lord): Order. I now have to announce the results of Divisions deferred from a previous day.

On the motion on Sport, the Ayes were 318, the Noes 5, so the motion was agreed to.

On the motion on Legal Aid and Advice, the Ayes were 427, the Noes 4, so the motion was agreed to.

On the motion on Local Government, the Ayes were 426, the Noes 7, so the motion was agreed to.

On the motion on Prevention and Suppression of Terrorism, the Ayes were 433, the Noes 1, so the motion was agreed to.

On the motion on European Communities, the Ayes were 425, the Noes 8, so the motion was agreed to. [The Division Lists are published at the end of today's debates.]

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Public Health

Mr. Deputy Speaker (Mr. Michael Lord): Mr. Speaker has selected the amendment in the name of the Prime Minister.

7.28 pm

Dr. Liam Fox (Woodspring): I beg to move,

When we debate health in the House, we often debate the structure and financing of the national health service, rather than considering health policy in detail. Health policy is an issue that we should discuss more. In this necessarily short debate, I intend to concentrate on areas of public health policy about which there is public anxiety, or in which I believe there to be a lack of information or a need for correction in the Government's position.

Those who take an interest in these issues expect public health policy to have more all-party support than most others. Indeed, I hope that this will be a matter on which the public can take reassurance from the agreement on both sides of the House when we come to decisions on the basis of the proper scientific evidence before us. That is why we have tabled a relatively modest motion on the failures, rather than the failure, of the Government's policy on public health.

In that spirit, I shall begin by speaking on immunisation. We need to congratulate the Government and the Department of Health on the success of the influenza vaccination campaign, and on the campaign relating to meningitis C, both of which we supported. Indeed, it shows exactly what can be done when the Department, through its advertising agencies, makes great play of such policy. We look forward to the development of a pneumococcus vaccine, for example, which offers great potential for advertising campaigns.

There has been great focus in recent days on MMR. As the House will know, MMR is the vaccine given to protect children against measles, mumps and rubella. There has also been much media coverage in recent weeks of possible links between the MMR vaccination and the incidence of both autism and Crohn's disease. We believe that MMR is still the best and the safest way to protect children from those diseases and that there is no evidence published that proves a link between MMR and those diseases. None the less, the vaccination uptake rate has declined.

The World Health Organisation recommends 95 per cent. as the figure needed to ensure herd immunity--in other words, that is the point at which the immunisation of others protects the rest. Immunisation reached 92.5 per cent. in 1995, but has fallen to 88.3 per cent. More important, the children who did not receive the vaccine when the health scare came to light are now reaching school age, and school is an environment in which the transmission of measles is much more common.

It is worth pointing out to those who fear MMR that 1 million children die from measles worldwide each year. In developing countries with poor vaccination programmes and poor nutrition rates, measles is an even

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more severe disease. It is rare in the United Kingdom but, even here, complications are common when children catch it. Those complications include a severe cough and breathing difficulties, pneumonia and eye infections. Most are caused by secondary bacterial infections, but there is a one in 1,000 chance of measles leading to encephalitis from which three in 10 will die.

It is important that those who make a choice about immunisation understand the relative risks that they may encounter. Those who do not die from encephalitis can suffer severe disabilities, including brain damage. Ireland is having similar immunisation problems. In 1999, there were more than 1,500 cases of measles and hundreds of young children had to be hospitalised, some suffering from dangerous inflammation of the brain. Two died, and many were left with long-lasting disabilities.

Another risk is that rubella and mumps will return. One mumps sufferer in 25 will suffer a degree of hearing loss. Before MMR was introduced, mumps was the most important cause of viral meningitis in children. We forget such statistics at our peril. Equally, before 1988 there were more than 40 cases of congenital rubella syndrome every year, which is not an insignificant number.

We need to immunise at a level sufficient to prevent any possible epidemic. We are below the level required, and recent events in Ireland and the Netherlands show the tragic consequences of failure to immunise. I believe that the scientific evidence clearly shows that MMR is safe and we are not convinced that there is any link between autism and MMR. However, many members of the public and some in the medical and nursing professions believe otherwise. That failure of confidence in the programme is resulting in a considerable public health risk.

I wrote to the Secretary of State on 1 December 1999 and, for the sake of giving information to the House, it is worth referring to that letter and his reply. I said:

Well, that was right. I added:

The Secretary of State thanked me and said that he would get in touch with the Minister for Public Health to decide how we could take forward an all-party initiative on improving uptake. I am sorry that it has taken longer than I would have liked for the Government to suggest the programme to educate the public about MMR, which I welcomed this week.

Mr. Stephen Hesford (Wirral, West): Will the hon. Gentleman deal with this point? He may know that I am secretary of the all-party group on primary care and public health. We organised a meeting in June on that very topic.

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He was invited, as was my hon. Friend the Minister for Public Health, who attended. We had a good meeting to take evidence, but I am afraid that the hon. Gentleman did not attend. Given his remarks about a bilateral approach to the issue, where was he that evening?

Dr. Fox: Considering the spirit and the tone of my remarks, the hon. Gentleman does himself and the House no service by making such a puerile point. The position of the Opposition was and is clear.

The Secretary of State will be aware that many people will be listening to the debate, hoping for reassurance. What would the Government's position be should MMR rates continue to fall? I do not ask him for a figure at which he might decide to alter policy because that would only encourage those who are sceptical not to opt for immunisation. However, I put it to him that if trends continue to fall, he may face the extraordinarily unpalatable decision of accepting single-dose vaccines as preferable to no vaccine at all.

I understand that that would not be an easy choice in terms of public health because the Secretary of State would not want to send out a wrong signal that might encourage people to believe that MMR is not safe. Nor do I believe that it would be responsible to leave people no option should parents decide that they were not satisfied about the safety of MMR, perhaps because of stories that they have read in the newspapers. In a spirit of co-operation, will he seriously consider how the Government would respond in such a situation?

On tuberculosis, the problem is twofold. The school immunisation programme has been suspended in many parts of the country. At the same time, the number of TB cases is rising appreciably. The BCG vaccination was introduced in the United Kingdom in 1953, but the number of vaccinations fell from 476,000 in 1998-99 to only 196,000 in 1999-2000 due to the shortage of the vaccine, which we all understand.

The Government's most recent position was set out in a written answer on 8 January:

I ask the Secretary of State to give us an idea of when the programme may resume because we are all receiving letters from concerned parents, especially those in areas where the health authority policy has for some time been not to immunise and the rate of TB infection has risen.

Tuberculosis has increasingly been associated with areas of urban decay. In 1998, the national survey of TB found that 56 per cent. of cases were in people born abroad, many in Africa. According to the Public Health Laboratory Service, there were 6,143 notified cases in 1999, 40 per cent. of which were in London. That has a massive implication for how the public health service is organised in the capital.

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One major problem is lack of staff. Only 14 per cent. of the 43 health districts with the highest TB rates meet the minimum staffing standards. In Newham, for example, there are only two nurses to deal with 240 cases. The British Thoracic Society recommends one nurse per 40 cases. There are also problems with maintaining screening of asylum seekers--only 80 per cent. of asylum seekers at Heathrow are screened, for example. I should like to know what discussions the Secretary of State has had and what measures might be taken to increase that figure, especially for those coming from high-risk areas.

The number of cases of multi-drug resistant TB is increasing: there were 50 in the UK last year. A patient with multi-drug resistant TB costs the NHS an average of more than £60,000. That TB is usually caused by unmonitored patients failing to take the drug treatment correctly and developing resistance to effective anti-TB drugs. The Public Health Laboratory Service has reported a cluster of drug-resistant TB in north London. Twenty-six cases have been resistant to Isoniazid--25 in north London and one in south London. Again, that is an issue of concern. The House would welcome any comments that the Secretary of State can make in his reply on the implications for the organisation of health care services in London.

The next issue that I want to touch on briefly is CJD. There are two separate issues in this regard: the first is haemophiliacs, and the second is the measures that the Government introduced over Christmas and new year. Among haemophiliacs--I am sure that all hon. Members will have received correspondence on this--there is a feeling that there is unfairness in the United Kingdom. Patients with haemophilia in Scotland and Wales can obtain genetically pure recombinant factor 8, which poses no risk to the recipient. However, haemophiliacs in England still receive blood-derived products, which necessarily entail a higher risk. Haemophilia groups have made major representations, and I should like to ask the Secretary of State what measures the Department intends to take in future to minimise the risks for haemophiliacs.

Haemophiliacs have already had to endure a far higher risk of most diseases than any of us will ever have to endure. Having run the gauntlet of hepatitis and HIV, it is intolerable that they should have to go through further risk to save what is not a large amount of money for the NHS. At the very least, patients in England should be brought into line with those in Scotland and Wales on what is available from a publicly funded service.

Will the Government provide further information about the decision on tonsillectomies and single-use instruments that they announced over the Christmas recess? Last November, John Collinge of the Imperial College school of medicine claimed that half the surgical instruments used for tonsil operations could be contaminated by variant CJD. The Department issued guidelines and announced at Christmas that tonsillectomies would be performed using single-use instruments at the end of this year.

Concern has arisen because prions, which are believed to cause variant CJD, are far more resistant to cleaning and heat sterilisation than normal bacteria and viruses. The tonsils are believed to be infected with variant CJD before obvious symptoms of the disease appear. It would therefore be possible for a surgeon to carry out a

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tonsillectomy on an apparently healthy person, contaminate his instruments and pass the infection on to someone else.

The infectious protein has also been found in the spleen, thymus, brain and lymph nodes. From the current debate on MMR, we are all aware that, if the public believe that information is not being made fully available, they are far less likely to listen to any messages coming from the Department. The Secretary of State may not be able to tell us this evening, but perhaps he can publish information and advice he has received about the relative risk of the operations that I have mentioned and the capacity of different tissues to harbour the protein that causes CJD. The more open we are about this debate and the more information that the public can have at the earliest possible date, the more likely we are to persuade them of the safety of this health policy.

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