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Angus Robertson (Moray) (SNP): The hon. Gentleman will appreciate that many of the subjects that he mentioned relate to devolved issues. Is it the position of the Conservative Opposition here that Scottish Executive Ministers should be directly answerable to a UK Government Minister on this question?
Mr. Lansley: Not all the issues are devolved. The functions involved in a response to avian flu are clearly not devolved and the Scottish Executive will be directly responsive to a UK-wide plan in those circumstances. The way in which the hon. Gentleman asks the question slightly begs a question. Scottish Ministers should not necessarily be answerable, but they should be accountable for adherence to one single plan. It is difficult to achieve the necessary co-ordination within the UK in the absence of that kind of responsiveness and responsibility.
Steve Webb (Northavon) (LD): Will the hon. Gentleman give way?
Mr. Lansley: I will, but then I shall need to move on, as I have a great deal to say about avian flu.
Steve Webb: I am following with interest the hon. Gentleman's argument for a Minister for homeland security. I presume that his proposal is for a Minister of Cabinet rank. Will he clarify whether that Minister would have his own Department, or whether he would be a stand-alone Minister with perhaps just a secretary? What is the scope of his proposal?
Mr. Lansley: My proposal is for a senior Minister, but not necessarily one of Cabinet rank. He could indeed have their own Department within the Cabinet Office. As someone who has worked in the Cabinet Office, I am familiar with the way in which it can support a Minister in that way. The Minister would have to be someone with sufficient authority—in this case, that authority would be derived from the Prime Minister—to implement the necessary co-ordination and linkages across the services that were required.
We all have to challenge ourselves constantly in regard to these issues. For example, in respect of 7 July, at the same time as we express our deepest thanks to the emergency services, we must look at what happened and ask how compatible the communications systems were. What risks for failures of communication were disclosed by those events? Why is breathing apparatus not compatible between the emergency services? Why were there not enough stretchers pre-positioned at King's Cross, which is a prime terrorist target? We have to look at such issues. The present combination of natural
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disasters, threatening pandemics and terrorist threats means that the risks with which we are dealing are many, real and, frankly, increasing. Our response must be proportionately thorough.
When my hon. Friend the Member for Newark (Patrick Mercer) winds up this debate, he will have the opportunity to respond to questions and to amplify on these issues. However, I want now to take this opportunity to deal with the specific threat of an avian flu pandemic. I shall not speak about seasonal flu, although the EU Health Commissioner, Mr. Kyprianou, might have unhelpfully confused the public last week into believing that the seasonal flu jab offered some protection against a future flu pandemic. There are good reasons, of course, for at-risk groups to get their seasonal flu jabs, and I wrote to the Secretary of State for Health on 5 October about delays in the availability of vaccines. I am afraid that she has not replied. It was denied on Monday that there were any such problems, so I should be grateful if the Minister would procure a reply for me on the matter, and perhaps even respond today.
The issue concerns an emergency: lack of preparedness for an avian flu pandemic. The House will be aware of the scale of the threat. On Sunday, the chief medical officer referred to the planning assumption of 50,000 excess deaths, based on an infection rate of one quarter of the population, assuming a mortality rate of 0.37 per cent. A range of mortality rates up to 2.5 per cent. have been considered. We simply do not know what the virulence of a flu virus that is readily transmissible between humans will be. The worst case scenario implies as many deaths in the 15 weeks of the first wave of a pandemic as would normally occur over a whole year.
We know that the H5N1 strain present in bird populations is highly virulent, with 117 cases contracted by humans who were in intimate contact with birds, of whom 60 died. We have no evidence of sustained transmission between humans. A genetic mutation leading to human transmission can be expected substantially to reduce the virus's virulence and the mortality rate among humans affected. We must assume, however, that we are dealing with a dangerous virus, in respect of which we have virtually no natural immunity in the population. We do not know when a virus capable of human-to-human transmission will occur, and given the increasing prevalence among large bird populations in south-east Asia, it must be far more likely that such a mutation will occur there, and the time at which it will occur must be approaching. As the World Health Organisation says, the question is not if, but when.
I do not now doubt the Government's awareness of the threat. The publication today of an updated contingency plan by the chief medical officer shows that the key issues are identified. Let me be clear, however: the threat has been evident for a long time. In June 2004, I pressed the Government to produce a contingency plan and prepare a stockpile of antiviral drugs. The French Government, for example, published their plan and procured 13 million courses of Tamiflu on 13 October last year. For a long time, Ministers were complacent. The multi-phase contingency plan was published shortly before the 1997 election—I emphasise that because the Secretary of State said that the
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Government had published a plan in 1997, but it was the Conservative Government who did so—and it was not updated until March this year. Then, an order was placed for antivirals. The stockpile will not be complete until September 2006. On Monday, I called for an advance purchase order for pandemic flu vaccine. Today, the Government responded.
I should not have to do this—the Opposition should not have to come to the Dispatch Box to call for action by the Government and for such measures to be taken. It is all very well the chief medical officer saying, on about 14 October, "Not this year"—I am not here to criticise the CMO, as I think that he does a fantastic job and Ministers are responsible. The issue is that we cannot exclude the risk of pandemic flu next year and we are not yet ready.
In comparison with previous pandemics, we could do very well: we have the best science in the world, an NHS that has shown itself able to respond to emergencies, and new antiviral and vaccine technologies. All those resources, however, must be brought into action well in advance if we are to obtain the full benefits. As we shall see, however, we do not have the antiviral stockpile that is necessary, nor the millions of face masks and gloves needed. Research into vaccines, and priming the vaccine manufacturing capability, has not happened. Contingency plans, including today's, do not show how the NHS would cope with the tripling of demand for critical care beds that would result. The public and NHS professionals are confused and uncertain about how we would cope. All those things must change.
The United Kingdom Government's plans may be better than those of many other countries. Indeed, many countries have no plans. They have been slow off the mark, however, and the delivery of key elements has not even begun in some cases. Our planning should not be among the best in the world; it should be the best in the world, and that is what we will press for.
I am grateful for the presence of the Under-Secretary of State for Environment, Food and Rural Affairs, the hon. Member for Exeter (Mr. Bradshaw). I want to say three things about avian flu in the bird population. First, we think it is time to warn free-range poultry keepers of the restrictions that may be placed on them, although not necessarily now, if there is evidence of high pathogenic avian influenza entering the United Kingdom in migratory birds. They need to know the plans for containment and how they can be helped to prepare for it now.
Secondly, poultry workers and those involved with game birds need information about what to look for and the personal protection measures for which they may be responsible in due course. Thirdly, there is the need to monitor wild birds. The Government and, indeed, scientists are not yet clear about the manner in which avian influenza is being transmitted among bird populations as a result of migration. It is all the more important in the game-shooting season for game birds to be sampled to establish whether the virus is present, and in what part of the wild bird population it occurs.
There is an important difference, which is not yet well understood, between avian flu in the bird population and pandemic flu in the human population. We know that there are serious major risks of transfer from the bird population by means of genetic mutation. Recent
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evidence from modelling in both this country and the United States suggested that the use of antiviral drugs and other public health measures where an outbreak of pandemic flu first occurred—in south-east Asia, for instance—could achieve significant progress in containing the outbreak at the outset, and could give everyone, worldwide, a breathing space in which to complete preparations for, say, a vaccine. Can the Minister tell us what specific measures our Government have taken to ensure that some of our resources and those of other countries in the developed world can be used to support an aggressive containment strategy?
We know that we do not yet have a stockpile of antiviral drugs, but we should ask how such a stockpile would be used. The pandemic flu contingency plan tells us that the stockpile should be the size recommended for treating the infected population—roughly enough for a quarter of the UK population to be treated. On page 150, the plan states
"It should be emphasised that those national stockpiles provide no allowance for prophylaxis to protect key workers or maintain business continuity."
Earlier parts of the plan, however, make it clear that part of the intention is to use antiviral drugs for prophylaxis for health care workers in the initial stages of an outbreak, and post-exposure prophylaxis for people in confined communities such as nursing homes.
A good question, to which we increasingly need an answer, if there is one, is whether post-exposure prophylaxis—not for the whole population, as that would not be cost-effective, but in the event of initial outbreaks in populations, and perhaps in families when one family member has contracted the disease—can be used to constrain the spread of the disease and reduce the severity of symptoms. Is there a viable strategy for such a preventive measure to be employed? There may well be, but at the moment the stockpile being procured on the UK's behalf makes no such provision. The plan and the stockpile are not matching up. The Government should have procured a stockpile for treatment purposes. Moreover, by this stage they should have considered the need for prophylaxis and placed orders beyond September 2006, so that they could not only replenish the stockpile when necessary, but add to it for prophylaxis purposes.
There is also a limited risk of resistance developing to Tamiflu, which is the antiviral stockpile of first choice. I ask again the question that I asked on Monday but which the Secretary of State did not answer: have the Government considered making, or do they intend to make, Relenza available as a second-line antiviral drug?
On vaccines and their preparation, the Government say that they are going to buy 2 million doses of the H5N1 vaccine, which is a generic vaccine for treating avian flu itself, not the virus that might develop in humans subsequently. What exactly is its intended use? According to the plan, it will be piloted to see whether it is effective in treating those who are, or might be, in direct contact with avian flu, and also in treating health care workers. Is 2 million doses the right number, therefore? If the vaccine is likely to be effective in treating health care workers, does it not follow that it is likely to have some effect on the wider population? What assessment is being made of such effectiveness? The Joint Committee on Vaccination and Immunisation discussed whether an H5N1 vaccine should be
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developed for the whole population in order to prime its immunity against an avian flu strain that transfers to the human population, but which retains characteristics closely linked to the original virus. The French Government intend to do exactly that, and we need to know whether our Government are working on such a plan.
On face masks and gloves, the Australians have purchased 50 million face masks and a similar number of syringes, needles and so on. They placed the order in May, and they anticipate that they will be available in December. The French are contemplating ordering 200 million face masks for use by health care and social care workers. Let us get this in perspective. On the outbreak of pandemic flu in this country, within the space of just weeks we would need that number of face masks for our health care, social care and emergency service workers alone. In the course of a typical year, the NHS routinely purchases some 31 million face masks, so there is an enormous difference between what we will require and what we currently have. No order has been placed, no tender has been made, no action taken on the part of the Government. This is a simple, straightforward measure that should arise from any contingency plan, but it is not being adopted.
The Government have today placed the order for vaccines that I called for on Monday, but as the Minister will know, according to the pandemic flu plan published today, there are other issues with which to deal. Curiously, those issues are framed as questions. The appendix on vaccine policy points out that there are constraints on vaccine production, such as the availability of suitable hen's eggs. It states:
Have they been put in place? Should they be put in place? Will they be put in place, and if so, when?
The appendix also points out that research into adjuvanted vaccines could be undertaken. That is interesting, given that last Monday, The Times reported that exactly such research into adjuvants to an H5N1 vaccine had been proposed by a combination of researchers, including researchers from the National Institute for Biological Standards and Control. They produced the proposal in the spring, but they have received no response. We need to know exactly what the Government are doing about that research. The Chancellor apparently plans to spend £2 million, but on what we do not know. We need to know whether it amounts to a response to that sort of research proposal.
Let us remember the importance of manufacturing capability. The public are being told that the Department of Health has purchased 120 million doses of vaccine for when pandemic flu occurs. It is not like that at all, though I am not blaming the Department: some press reports seem to suggest it, but that is not what is going on. What is really going on is an advance purchase order for 120 million doses, once we have been able to develop a vaccine, but significant manufacturing constraints have to be overcome before that can happen. The Government need to take certain measures.
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To put it in perspective, 300 million doses of flu vaccine are produced worldwide each winter for seasonal flu, yet one country, the UK, would need 120 million doses to deal with pandemic flu. Just imagine the scale of the increase in production capability that would be required. Back in April, the influenza sub-group of the Joint Committee on Vaccination and Immunisation said that, ideally, we should have an additional vaccine production facility in the UK. We are clearly not in such an ideal position, so we need to understand how the Government will minimise the constraints on manufacturing.
Critical care beds are another important issue. Professor Menon of Addenbrooke's hospital set out clearly in an article in Anaesthesia that the draft contingency plan published in March did not deal with the problem. He found that the requirements for critical care capacity in respect of beds and staff to support them would be so dramatic that they would literally overwhelm the NHS, which would be
That shows how important it is to manage demands on the NHS effectively. Professor Menon saw contingency planning as essential, but the contingency plan published today does not set out the necessary response. The NHS is told to respond in many respects, but at the local level, the NHS has proved unable to do the work or agree on what responses are necessary. In some cases, it is unable to put in place the resources for an effective response.
On communications with the public, the House should reflect on the communications plans set out in the back of the contingency plan published today. It states that there is virtually no recall of the launch of the Government's pandemic flu contingency plan among the general population. It also states that unless health professionals are directly involved in the planning for pandemic flu, they are likely to have only mixed awareness of its potential impact, of antiviral treatment and of the current contingency plan. An article in The Observer on Sunday pointed out that 77 per cent. of doctors did not know what the response to an avian flu pandemic would be.
I am sorry to have to take the House through all those details, but there are a range of deficiencies in our current preparedness. If action is taken now, major strides can be achieved in the coming months. This time next year, we will be better prepared for a flu pandemic, but if a contingency plan had been published a year ago, as it was in France, we would be better prepared now.
Today, the Minister has an opportunity to clarify whether the Government will take the actions that we have called for. This week, we secured action from the Government on advance purchases of vaccines, but much more remains to be done. I commit the Opposition to work proactively and constructively to secure the best possible preparedness against pandemic flu. In pursuit of that objective and on behalf of all those we represent, I urge the House to support the motion this evening.
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4.49 pm
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