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7.25 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on securing this debate, and on choosing a subject that is of immense importance to the health and lives of people across the country. My hon. Friend is right to say that we should not underestimate the impact on public health of immunisation programmes such as the NHS programme. Immense improvements have been made not through treatment but through vaccination—a fact that is of worldwide significance.

It is because of the immunisation programme that the incidence of childhood disease in this country has fallen to its lowest ever levels, greatly reducing morbidity and mortality from such diseases. In 1940, before vaccination was introduced, there were over 46,000 cases of diphtheria. Recent data show that, some 60 years later, the annual number of cases has reduced to single figures. In 1940, there were over 400,000 cases of measles, but recent data show that the rate is now less than 200 cases per year. In the same year, there were over 50,000 cases of pertussis—whooping cough—but recent data show that there are now less than 3,000 cases per year.

In 1989, when monitoring began, there were more than 24,000 cases of rubella. The most recent figures show a rate of less than 100 cases a year. Here, the most important issue is the prevention of congenital rubella syndrome. As a result of measles, mumps and rubella

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vaccination in young children, there were no such cases in England and Wales between 1997 and 1999. Childhood vaccination has repeatedly been demonstrated as cost-effective—indeed, even cost-saving—and the World Bank has identified it as one of the most cost-effective health strategies.

My hon. Friend is right to say that vaccination is a rapidly moving field. Recent developments in this country include the introduction of meningococcal C conjugate vaccine. Before its introduction, there was an increase in the number of notifications of, and laboratory-confirmed cases of, meningococcal disease, and a relatively greater increase in cases of disease caused by group C infection, particularly in older teenagers. In the light of that increase, the UK took a leading role in developing a new meningococcal C conjugate vaccine, and was the first country in the world to introduce it.

In 1994, the Department of Health funded an accelerated research programme to evaluate the safety and efficacy of the new vaccine. It involved collaboration with the Public Health Laboratory Service, the National Institute for Biological Standards and Control, the institute of child health, and the Centre for Applied Microbiology and Research. My hon. Friend referred to that centre, and I shall discuss it later. That is an interesting example of work carried out in partnership with vaccine manufacturers such as those that he mentioned. They have the capacity to respond and to adapt, and were keen to work with the Department on developing a new programme.

The meningitis C campaign, which was introduced to offer the vaccine to everyone under the age of 18, has been extended to include older age groups. The programme has been completed, and has had a dramatic effect on all immunised age groups, resulting in the near disappearance of meningitis C disease in people under the age of 20. The incidence of serogroup C disease in targeted age groups fell by more than 80 per cent., and the number of deaths among the under-20s decreased from 78 in 1998–99 to 11 in 2000–01. The provisional data for the last year show that we have not had a laboratory-confirmed case of meningitis C in infants under one year of age since the beginning of December last year. From July 2001 to date, there have been only five cases of meningitis C in the 15 to 17-year-old age group, whereas we saw 73 cases in the same period three years ago. Those are recent examples of the huge impact of developments in vaccination programmes. We have also seen developments in flu vaccines.

My hon. Friend the Member for Norwich, North mentioned issues for the future and the progress that needs to be made. He will know that the chief medical officer has recently published a report entitled "Getting Ahead of the Curve: A Strategy for Combating Infectious Diseases", and a key aspect of future policy is continuing to secure the benefits of safe and effective vaccines in future. Other aspects include influenza and pneumococcal vaccine; coverage in childhood immunisation programmes; the examination and introduction of new vaccines; and research and investment, including international research to develop a new vaccine against HIV.

My hon. Friend asks what more can be done. He raised issues connected with the Centre for Applied Microbiology and Research—CAMR—and what role the Government could play in ensuring strategic capacity for

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the manufacture of vaccines. It is rarely likely for it to be sensible or economic for the Government to manufacture the vaccines that we might need for a population of 50 million, with the problems of patents, property rights and licence fees. Vaccine production can be achieved most economically for markets bigger than the UK, so it is not a worthwhile use of resources for the Government to manufacture vaccines directly. However, we can work in partnership to great effect, as we have done with three vaccine manufacturers to develop the meningococcal C conjugate vaccine.

CAMR is a special health authority, funded by the Department of Health and located alongside the Ministry of Defence establishment at Porton Down. As part of its work CAMR undertakes small-scale vaccine manufacture and research. Current work includes the manufacture of anthrax vaccine under a five-year contract for the Ministry of Defence. My hon. Friend was right to refer to the importance of such work. There was no commercial producer of that vaccine because there was only a limited demand for it and it was not considered to be commercially profitable. However, in the UK there has been a long-standing demand for that vaccine for military personnel and therefore CAMR took on its development and production, albeit on a relatively small scale, in order to meet the Ministry of Defence need.

The vaccine was not available in the United States, but since 11 September and the anthrax releases there, substantial demand has been generated and the vaccine is now being produced commercially. Where there is a military need, which is usually a low-volume need, or a requirement for capacity to respond rapidly, there remains a need for the Government to fund research and development for vaccines. We may also need to respond, as we have in the past with anthrax, to demand for vaccines. Before 11 September, my right hon. Friend the Secretary of State for Health agreed to the establishment of a strategic response capability at CAMR, which is part of its long-term development.

My hon. Friend raised several issues related to bioterrorism and our response to it. He will know that the planned response to any terrorist attack is co-ordinated between several Government Departments and agencies and facilitated by the civil contingency secretariat in the Cabinet Office. The Department of Health has issued guidance to regional and health authority directors covering the planning of the health service response to any deliberate release of biological and chemical agents and has issued guidance to regional directors of public health on mass decontamination and related matters. Further guidance has been issued to health authorities on the procedures to be followed in the event of the covert or overt release of smallpox, anthrax, plague, botulism or unknown biological or chemical agents.

In October last year, the Public Health Laboratory Service also issued guidelines for action in the event of a deliberate release of smallpox. It is important that we have the right preparation and planning in place. That work is ongoing and has been part of the Department's activity for a long time.

As part of its contingency planning since 1988, the Department has reviewed its stocks and supplies of medical countermeasures. Additional stockpiles of appropriate antibiotics and other medical countermeasures

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have been put in place, as have additional stocks of smallpox vaccine for use in the event of a bioterrorist attack.

My hon. Friend the Member for Norwich, North will be aware that my right hon. Friend the Minister of State has set out, in answers to parliamentary questions, many of the decisions taken in this connection, including the decision about the strain of vaccine. Advice about that decision was taken from across Government, especially from the Joint Committee on Vaccination and Immunisation. That is an important body, providing well-established independent expertise for the Department. It regularly reviews UK epidemiological evidence on disease and progress on vaccine development. It also has the important function of horizon scanning, so that priorities can be set against the assessments of disease burdens and the predicted pace of new vaccines.

My hon. Friend referred to matters to do with communication, and the importance of providing people with accurate information. I agree that people need more information, and that they want it to be clear and comprehensible. When complex scientific matters are involved, that is often not a simple task. It is an important challenge, and we must accept that people increasingly want information in which they would not have been interested, and would not have expected, 20 or 30 years ago. That information is now very much part of current expectations of the health service.

My hon. Friend mentioned MMR. Parents have understandably been worried about media stories over the past few months. The Department has conducted extensive research to find out parents' concerns, and to determine what sort of information they want. It is important that we answer the questions that people want to ask, and that we respond to their concerns in this area.

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