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Dr. Liam Fox (Woodspring): I am grateful to the Secretary of State for his statement and I thank him for making it available to the Opposition in advance.
He is absolutely right in the main thrust of his comments about the present situation in the United Kingdom. We are fortunate, especially given the amount of passenger traffic coming into the United Kingdom, that we have not had more cases of SARS, as has happened in Hong Kong and China. The staff who have looked after the cases in this country are to be congratulated on that. The question is, however, whether we are doing all that we can to keep it that way.
I am sure that the Secretary of State would be the first to agree that reports that the worst is over might lead to complacency, which would be highly regrettable. The outbreak in China is still gathering pace and is certainly not contained. If we look at the measures that have been taken in Asia over the past few days, we see that Taiwan has imposed a two-week ban on the entry of visitors from badly affected areas after the island announced its
first SARS death on Saturday, that South Korea and the Philippines are taking new measures, and that in Singapore, although cases are declining with the imposition of stringent measures, including thermal imaging of air passengers, the quarantine regulations are being strictly enforced. To those who say that those Governments are going over the top, I point out that the director general of the WHO said this morning that such measures are not over the top, but prudent and necessary.The Secretary of State said that we have had just six probable cases in the UK. Are any suspected or probable cases being investigated at the present time? If so, how many?
The issue on which I have the greatest disagreement with the Secretary of State is that of the notifiability of the disease. He says that it is extraordinarily unusual for a person in this country to reject advice and persuasion and to require detention. That is, of course, correct, but his approach is based on the presumption that somebody who is unwell with a high fever will act rationally. He says that if the situation gets worse, the Government will make it a notifiable disease, but, by his argument, they will do so only if the processes that have already been put in place have failed. The 1979 regulations that he mentions are inadequate, because they allow only for individuals to be detained for examination: they do not require someone to be quarantined and treated. Why are the Government denying the protection that the Public Health (Control of Disease) Act 1984 was introduced to provide? It is pointless to say that if the situation gets worse we will use the powers that we already have, as we should be using them to ensure that it does not arise in the first place.
I welcome what the Secretary of State said about increased information for passengers—that should have been done long before now—but I wonder whether the checks that are supposedly taking place at airports of departure are really taking place. I can say from my own experience that when I recently passed through Singapore as a passenger I was not given proper information about what would be happening in relation to SARS.
May I ask the Secretary of State about one or two of the measures that he proposes to introduce? He says that he will defer the start date for those coming into the United Kingdom to work in the NHS. For how long will he do so, and how will that be determined? Will that measure be kept in place until the entire SARS outbreak is under control? He says that if we send observers to airports of departure and they see that checks are not being made, he will ask for a declaration from passengers that they have not been in contact with SARS and do not have the symptoms of SARS. How will people who have been in Hong Kong or Singapore know whether they have been in contact with someone who has had SARS? That makes such a declaration utterly meaningless.
I am sure that the Secretary of State's officials looked at all the tests that could be of assistance, given that he said that we may find that passengers are not being properly screened before arriving back in the United Kingdom. For example, what advice has he received from his officials about using an actin serum screening
test, which was originally developed as a screening test for blood transfusion, to act as an early marker for infection of donated blood?It is used widely in Belgium and Germany. Someone who contracts a virus has an increased rate of apoptosis—more cell death—which produces actin fragments in the blood stream. Although it is non-specific, it becomes positive during the incubation period. Will the Secretary of State and his scientific advisers re-examine the experience of the use of the test and its possible application in the case of the failure of policies in airports to which he referred? We should use everything at our disposal to maximise public safety.
The judgment is not whether all that needs to be done but whether all that can be done is being done. The last thing we want is an increase in the number of cases when we could have taken action to prevent that.
Mr. Milburn: I thank the hon. Gentleman for his comments and questions. He said that we were fortunate not to have more cases in this country. I believe that it is a not question of good fortune but of good policy, good judgment and, most important, the action of the NHS and our public health services in this country. We are extremely fortunate to have one of the best public health systems in the world. The hon. Gentleman is aware of that and the measures that have been taken in the past few years to strengthen that system, most notably the creation of the Health Protection Agency. Steps have also been taken to strengthen public health powers locally through primary care trusts and regionally through the appointment of directors of public health.
The hon. Gentleman asserted that the spread of SARS was gathering pace. He should be cautious. Before I came to the House, I heard the latest advice from the WHO. It said that although there were major anxieties about China, it was pleased with progress in other countries, notably Singapore and Vietnam. It is important to maintain a sense of perspective and proportion. Otherwise, we simply will not get the policy right. The hon. Gentleman and I want to get it right.
The hon. Gentleman asked about the number of suspected cases as distinct from probable cases. The WHO has advised that we should try to identify the numbers of suspected cases and probable cases. In the latter, the balance of probability is in favour of the presence of a SARS infection. At this time of year in the part of south-east Asia that we are considering, there is a high incidence of flu-like illnesses alongside the new and emerging infection of SARS. It is therefore unsurprising that some people who return from those countries report symptoms that could be a cough, a cold, flu or, in the worst case, SARS. To date, about 50 suspected cases have been investigated and dismissed. The number of definite probable cases remains six.
The hon. Gentleman mentioned notifiability and considered whether the powers under the 1979 aircraft and ship regulations give us powers that he claimed that we did not have. Our lawyers advise me that we have precisely the powers that we need both to take people off a plane and ensure their hospitalisation.
I have taken clinical and scientific advice about the start date for new staff. We are proposing a 14-day breathing period to the NHS. Again, that is a
precautionary approach given that the incubation period for SARS appears to be two to seven days or perhaps 10 days.The hon. Gentleman asked whether the declaration from passengers would mean anything if we took that route. He will find on examination that that is being done in other countries. I am not sure whether it is done in the United States but, for example, Air France has adopted such a policy. It is important to get some indication in the absence of any screening test.The hon. Gentleman knows the science as well as I do. There is currently no diagnostic test.
There is no blood or urine test to detect whether a person has SARS. The only screening that can be undertaken is to ask people some questions, and that is precisely what we propose to do.
I should have thought that the hon. Gentleman, who has been droning on on the radio and on television over the past few days, although thankfully he kept his remarks to a minimum today, would welcome the measures that we are taking because they are precisely in line with the precautionary but proportionate approach that is necessary.
The proof of the pudding will be in the eating, but what the hon. Gentleman cannot get away from is that, despite the many visitors that we have each and every week from those areas that have been affected by this appalling new SARS virus, the cases that have presented, precisely because of the precautionary and proportionate approach that has been put in place, number just six. That is not a ground for complacency, but it is the foundation on which we seek to build, and it is important that we do so on the basis of the best scientific and clinical advice and avoid the situation that we have seen in previous public health scares, including those under his Administration, where it is politicians who decide the course of clinical and scientific policy.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich): The Secretary of State is sensible to make it clear to the population that there is a problem but that it should be kept in proportion, and both his Department and, in particular, the chief medical officer are to be congratulated on the sensible advice that they have given. However, will my right hon. Friend keep reminding those who are most at risk—primary care and emergency workers and those in A and E departments—that they must continue to be vigilant? It would be particularly sad if they were to relax their vigilance, even for a short time, because they believed that the problem had been dealt with. Will he offer to areas such as Hong Kong and Singapore, which have a high standard of public health, any possible support that can be given by the NHS and its specialised services?
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