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Mr. Milburn: I very much agree with my hon. Friend, and I echo the tribute that my hon. Friend paid to the chief medical officer, Professor Sir Liam Donaldson, who throughout has played an important and leading role in handling the SARS problem.
My hon. Friend is also right about the need for vigilance. We have distributed two alert notices to doctors in the NHS already, of which I think she is aware. We have also provided further detailed guidance through the web so that doctors can access information quickly and easily.
I also agree with my hon. Friend's point about our international responsibilities. Our predominant responsibility is to serve this country and to ensure that we protect its public health, but we also have some wider international community obligations, particularly in countries that have been more adversely affected. As I said, experts from the HPA will travel to Canada this week and we will also send HPA experts to other countries that have been adversely affected.
Dr. Evan Harris (Oxford, West and Abingdon): I, too, welcome the statement and the advance sight that we had of it. We share the concern of the House about the potential impact of the epidemic, not only on Britain's public health and on the well-being of world economies, but particularly on populations in developing countries that have neither the hospitals nor the public health structures adequately to treat the infection or to contain its spread. In that respect, reports of cases in India now are extremely worrying.
Liberal Democrats believe, as I think does the Minister, that in public health matters it is important to take advice from professionals and from the science base, which is now global. But is it not also incumbent on Ministers, when formulating policy to tackle an epidemic such as this to set out the detail of the advice and the reasons why those decisions have been taken?
For example, with regard to the MMR vaccine, the right hon. Gentleman will know that Liberal Democrats have no criticism of Ministers' decisions, nor of the way in which they explained precisely why they took such an approach, but does he understand why it is difficult for those of us who broadly support the Government's approach to understand why Ministers do not take the opportunity now to require SARS to be notified in order to give environmental health departments and hospital authorities reserve powers to insist on compliance with public health authorities? He needs to explain why that is not happening.
The Minister with responsibility for public health has merely cited the chief medical officer's advice, without setting out the evidence and reasons for it. Given the potential seriousness of a UK outbreak, does the Secretary of State accept that claiming that notification would be too bureaucratic is not a satisfactory reason for not making the disease notifiable and providing those powers? Is it not the case that the so-called bureaucratic system of reporting need not replace the current system? If the Secretary of State believes that the Public Health (Control of Disease) Act 1984 is unwieldy, does he not agree that it is regrettable that successive Governments have not followed the advice of the chief medical officers, given in 1988 and more recently, to update that legislation?
On airport screening, does the Secretary of State accept that, while World Health Organisation guidance recommends screening at the airport of departure, it does not advise against screening at the airport of arrival? Would it not be appropriate to use our immigration and entry system to provide the information needed and, possibly, to provide temperature screening? Will he also explain what advice he has had from the chief medical officer on asking passengers to sign forms when they might not even have the language skills to do so? No clinician would take such an approach, as such action would require a consultation.
Does the Secretary of State agree that the isolation of asymptomatic people—even if they have passed through Singapore, as the hon. Member for Woodspring (Dr. Fox) has done—is, as the CMO advises, unnecessary? It could be counter-productive, as it could lead to unjustified discrimination and stigma, and might deter people with symptoms from coming forward. This problem is going to be with us for months, at best, and probably for years. The worst-case scenario is that it could affect the world for decades. The House must revisit the problem, and I hope that the Secretary of State will take the opportunity of forthcoming health legislation to provide the framework to update our public health legislation in the way that has been recommended serially by chief medical officers over the last 14 years.
Mr. Milburn: I am grateful to the hon. Gentleman. I think that isolating the hon. Member for Woodspring (Dr. Fox) would be rather a good policy. The hon. Member for Oxford, West and Abingdon (Dr. Harris) must have written his speech—I know that it is only hand scribbled, but for him that is progress—before having read my statement, because I have tried to explain precisely the reasons for our decisions on the notification of SARS. We keep an open mind on that matter, however, and if I get the advice from the CMO to change that, I will.
The hon. Gentleman made two important points. First, on the modernisation of public health legislation, the chief medical officer made recommendations to us about modernising the notifiable disease framework within a broader context, and I have some sympathy for them. We shall obviously keep that issue under review. The second point that the hon. Gentleman made, which is extremely important in dealing with these issues, is that while our action must be proportionate, it must also be based on the best scientific and clinical advice that we can get. There are good reasons for that. Anyone who remembers the outbreaks of bovine spongiform encephalopathy and variant CJD will know how important it is for Ministers not to give false assurances from the Dispatch Box, but to rely in as open and transparent a way as possible on the best scientific and clinical advice that we can get, precisely so that we can take a precautionary and proportionate approach.
Dr. Howard Stoate (Dartford): May I congratulate my right hon. Friend and the chief medical officer on the measured and sensible way in which they are handling this situation? It is very reassuring for everyone in the country. I also thank my right hon. Friend for his assurance that he is to send observers to other parts of the world to ensure that, as far as possible, people are screened before they get on to aeroplanes. Clearly, the most effective way of controlling this outbreak is to ensure that people who are suspected of having the disease are prevented from travelling before they can spread it any further.
Will my right hon. Friend comment on recent reports that China has severely under-reported the number of cases there? There has certainly been a big stir in the media about that. Is he now confident that the Chinese
Government have a policy and measures in place accurately to report the number of cases, so that we can be sure that we are getting the full facts?
Mr. Milburn: I am grateful to my hon. Friend. So far as observers are concerned, we have been in contact with the various British embassies in the affected countries about the situation. As I said in my statement, we shall be sending observers during the course of this week, particularly to the worst-affected areas, to double-check that the procedures that those countries say are in place are properly in place and that they comply with WHO guidance.
As for the under-reporting of the number of SARS cases in China, we rely not only on our excellent embassy staff in Beijing, Hong Kong and other parts of China that are affected, but on the guidance and expertise of the WHO. If the WHO is satisfied that the reporting in China is now accurate, we can also be satisfied that that is so.
Mr. John Wilkinson (Ruislip-Northwood): Those of us with constituencies in boroughs containing major ports of entry into the United Kingdom will not be wholly reassured by the Secretary of State's statement. Will he institute right away a proper screening of inbound passengers from areas that are already seriously affected by the disease? Is it not better to be over-cautious than under-cautious, especially in view of the great risk of further spread of the disease in environments such as the London tube system, where as everyone knows there is close contact between individuals? What measures are airlines taking to protect air crew, especially flight attendants?
Mr. Milburn: The hon. Gentleman asks me to do the impossible and to come up with a form of screening that can detect the virus. We do not have the technology or the science to enable us to do that.
Mr. Wilkinson: Temperature screening.
Mr. Milburn: Temperature screening does not give us an indication either. The virus, particularly in its early presentation, shares many symptoms with coughs, colds and other viral infections. There is not a simple test. If there were, we would put it in place, as would Governments throughout the world. I am sure that the WHO would quickly advise us to do so. The only screening that we can do is to try to ascertain from passengers coming from SARS-affected areas whether they have been in contact with the disease. I realise that that is far from perfect, but the hon. Gentleman must understand that this is a new and emerging infection, that we are trying to learn as we go, and that the best scientific experts in this country and throughout the world are being deployed on that task.
The hon. Gentleman said that he was neither satisfied nor reassured by my statement. I accept that he has a view about that. However, if he is not prepared to believe me, I hope that he will believe some of the leading scientific and clinical experts in this country. Professor Roy Anderson, who is a leading
epidemiologist from Imperial college in London, was interviewed by John Humphrys on the "Today" programme on Saturday. John Humphrys asked:
- "Professor Anderson, are we sufficiently on top of this one do you think?"
- "I think so, yes. I think the sort of doom and gloom predictions have been rather exaggerated. This is not a highly transmissible infection. It's been effectively contained in most of the developed countries in the world with very limited number of cases, Britain being a good example".
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