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Ms Winterton: As I explained, the Department for Environment, Food and Rural Affairs contingency plan for avian flu was published in July and is regularly updated. It contains up-to-date biosecurity and health advice and can be found on the DEFRA website. Earlier this week, the National Farmers Union praised the action being taken by DEFRA to ensure that poultry farm workers are aware of what to look out for. I can assure him that DEFRA is working closely with the industry, which supports the Government's current assessment of the risk and the advice that is being given. I hope that that reassures him.

The hon. Member for South Cambridgeshire asked for details about the H5N1 vaccine. We are going to stockpile 2 million to 3 million doses of the H5N1 vaccine, and are about to place the order. We did not do so earlier, because we wanted to use the latest research to inform product development. A traditional vaccine for H5N1 would not create a high enough immune response in people vaccinated with it, so we used the best and most recent research to ensure that we will get the best product. As the hon. Gentleman will know, H5N1 vaccine protects against human transmission of the virus. At the moment, birds with avian flu can give it to humans but, as I have said, there is no conclusive evidence that it can be transferred from human to human. The French contract is not for H5N1—it is exactly the same as our sleeping contract, and is for whatever vaccine is required to deal with a pandemic once we know the strain that has developed if, indeed, it does. We will use the H5N1 vaccine for NHS workers only if appropriate—it may well be the case that it is not suitable for what develops from the H5N1 influenza.

This is a precautionary measure, but the JCVI said this afternoon that if the risk assessment of H5N1 coming into our poultry flock rose we would add seasonal flu vaccine to the existing recommendation on Tamiflu treatment. If a poultry worker became ill we would treat them with Tamiflu, and we would give other people who were not ill but exposed to the virus prophylactic treatment with Tamiflu. Vaccination for seasonal flu would be given at the same time to stop anyone getting the seasonal flu virus. If they had that virus and the avian flu virus there would be a risk of recombination and an extremely dangerous human-to-human infection. We shall therefore use that combination of two treatments for affected poultry workers.

Mr. Lansley: If the risk assessment suggests that that is the right action it is a very good protective measure for poultry workers. Clearly, there will come a point— I accept that it may not be now—where the evidence suggests that there is a risk of a genetic shift so that the virus that is transmissible between humans bears a close relationship to the H5N1 virus. In that case, the vaccine that has been developed using reverse genetic engineering may be effective. Presumably, that is when the Government would say that they would use the
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vaccine for NHS workers, for example. If that looks like it might be effective, is there not a prima facie case for population vaccination, rather than just NHS vaccination? I am asking that that be considered, and that we be informed as soon as possible if the evidence points in that direction. We need to know whether that is likely to happen. We would have to wait about five months for the minutes of the JCVI to find out what was discussed and agreed.

Ms Winterton: If it became obvious that the H5N1 vaccine was appropriate for a mutation that had occurred and could be transmitted between humans, we would ensure that our sleeping contract delivered the vaccine for the whole population. At present, however, there is little point in our ordering 120 million doses of a vaccine that we are not sure would work in those circumstances. We have ordered 2 million to 3 million doses so that we have that ready in case it works. That is precautionary. It would not be wise for us to order 120 million doses at this stage without knowing whether it worked.

We have set in train our ability to order as soon as we can. If we know the strain, we can order the vaccine that is needed. In advance of that, antiviral drugs are the most effective way of treating patients and reducing the impact of the pandemic. We spent almost £200 million to create a stockpile of 14.6 million treatment courses of antivirals. That will be enough to treat the 25 per cent. of the population who may become ill with pandemic flu. As the hon. Gentleman said, the stockpile will be complete by September 2006. We have 2.5 million treatment courses available at present.

The hon. Gentleman asked about our strategy for antivirals. We would use antivirals for treatment of those who become ill with pandemic flu. As I said, they are not generally intended for prophylactic use. The stockpile is intended to be large enough to treat all those who become ill, based on the estimates that we have received from experts. The question who should receive priority ought not to arise.

Of course we are aware that there is a risk—currently a very small risk, we believe—that the pandemic might strike before the stockpile is complete. In those circumstance, we would prioritise the treatment of front-line health care workers and then those in at-risk groups. I can assure the hon. Gentleman that we have not completely ruled out the use of antivirals for prophylaxis—for example, we would keep under review the need to protect poultry workers where there is an outbreak of avian flu among birds, or to protect the close contacts of someone arriving in this country with symptoms of avian flu.

Comparisons have sometimes been made with France's Tamiflu order. As the hon. Gentleman said, it is exactly the same as ours. It will not be complete until the end of the year. It has been ordered in powdered form, which means that it then has to be turned into capsules, whereas we have taken the decision to order it in capsules so that it can be distributed quickly, as soon as it is needed. We have taken what we believe is the simplest course in that respect. Roche, the manufacturers of Tamiflu, announced on Tuesday that the United States Food and Drug Administration had granted approval for an additional manufacturing site
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in the US for the supply of Tamiflu. The company recognises the need to expand production and is prepared to discuss all available options for doing so.

It has been suggested that we should also be stockpiling the other antiviral drug that is available, Relenza, but the issue is not quite as straightforward as it might seem. Relenza is given by inhalation and is licensed only for those aged 13 and over. It also needs to be used with great caution by people with asthma, and there is also some evidence that elderly people might find an inhaler difficult to use. However, we will continue to review our policy if new evidence emerges.

The challenges facing the health and social care system would undoubtedly be on an unprecedented scale and would be felt across all sectors. The hon. Gentleman asked about critical care capacity, and we are very much aware of the paper prepared by Professor Menon and have set up a group chaired by the deputy chief medical officer to look at the very issues that he raised. We have invited David Menon and other experts on to the group and we will keep that issue under constant review.

Dr. Andrew Murrison (Westbury) (Con): I should be grateful if the Minister could clear up one matter that has caused some confusion. In the publication "Pandemic Flu" on page 122 there is talk of the use of prophylaxis for key workers, yet on page 150 it specifically excludes the use of prophylaxis for NHS workers as part of the Department's purchasing plans, so there is some confusion there. It would seem sensible to make provision for prophylaxis for NHS workers if for no other reason than to give them confidence, because I suspect that sickness absence might be significant in the event of an outbreak.

Ms Winterton: As I have said, we want 14.6 million courses available for treatment if necessary, but we will keep our policy under review. If we need to make decisions on priorities because it is not all available at the same time, we will consider that.

The hon. Member for South Cambridgeshire also asked about medical equipment such as gloves and masks for health workers, and we have taken action in that regard and have agreed the requirements with the Health and Safety Executive. It was important to ensure that we ordered the right type of masks and gloves. We have had advice from the HSE, but we are also discussing the matter with health care professionals, because we need to ensure that we provide them with the most effective gloves and masks, and we want to get that right before we place an order. As soon as those discussions are complete, we will do so.

David T.C. Davies: Is the Minister suggesting that the Australians have not got it right, or did they get it right and get it right several months before her colleagues did?

Ms Winterton: We discuss with the HSE its recommendations, but we also want to ensure, through discussions with health care professionals, that what is ordered is appropriate for their use.

I can assure hon. Members that planning for a flu pandemic is a top priority for local and regional resilience planners in the UK. Within health and social
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care, we are working with NHS and social care organisations to help them make plans to deal with the practical consequences of a pandemic, including increased demand for services, possible shortages and staff absences.

The operational guidance issued in May encourages close collaboration with local stakeholders to ensure that robust local plans are put in place, are regularly tested and are updated. Central Government are working closely with the organisations concerned to make sure that those plans are implemented.

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