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The flu contingency plan states that if a WHO phase 5 alert is declared, UK Health Departments will run a national door-drop and advertising campaign. Are the Government ready and willing to do that, were it to be triggered today? Why is the EU Commission offering travel advice while the WHO and the UK Government
are not? Will those who are travelling to Mexico or the south-west states of the US have access to antiviral treatments for prophylactic purposes on the NHS, rather than just through private prescriptions, to reduce the risk of transmission?
I welcome what the Secretary of State had to say about updating the House regularly and I heartily endorse what he said about the general importance of hand hygiene. I look forward to further updates in due course.
Alan Johnson: I agree with the general points that the hon. Gentleman made. It is important that we deal with this across parties and across all the devolved Administrations. That is how I intend to proceed. He is also right to draw attention to causes for optimism, and it is important to get the balance right. We do not want to frighten the lives out of individuals unnecessarily, but we do want people to be properly alert to the dangers. The media yesterday were fairly well balanced, but some hyperbole crept into some reports this morning.
It is important to stress that there is no pandemic at this stage. The scientists are working hard on the issue, and we will know from the WHO meetings later whether we move to a phase 5 alert. I agree with the hon. Gentleman that that is still not phase 6, but it is important to recognise also the mild nature of the symptoms outside Mexico.
The hon. Gentleman mentioned the dramatic differences in countries preparedness. I am not prepared at this stage to say what happened in Mexico, but what I do know is that Mexico has been a very active member of the WHO and it is always present at the G7-plus and is always keen to talk about this issue. I want to know more about what happened before I say anything that is even mildly critical of the Mexican authorities.
The House has discussed pandemic preparedness. I know that we have not discussed it on numerous occasions, but we have probably discussed it more than many other Parliaments. There is a broad measure of agreement between us and, as the hon. Gentleman knows, the matter has been discussed between Ministers and shadow Ministers and with officials, so I think that we have given sufficient time to it.
The hon. Gentleman asked whether we are ready for a national door-drop. Yes, we are. He mentioned face masks. I wish we were further ahead with face masks, but we have nearly enough face masks for staff, and it is important to note that they are not just ordinary face masks. The face masks that we would give to NHS staff have much better filters and are much more sophisticated, as they need to be. We need to ensure that we address that situation quickly.
The UK and the US are working closely together on vaccine research, in which GlaxoSmithKline, in particular, is an important player. The partnership between the US and the UK will lead the way in vaccine research. If this turns into a pandemic, the key issue will be to identify the strain of H1N1 and to produce a vaccine. It is likely to take between six months and a year to identify the strain and to produce and manufacture the vaccine.
The hon. Gentlemans final point was about prophylactic drugs. The last time we debated this subject, we were prepared for an H5N1 virusan avian type of flu. As the hon. Gentleman mentioned, this is a human typeH1N1which gives us some cause for optimism that we can tackle it. We do not know yet, but the general flu injections that people take might help. However, the H5N1 prophylactic that we had available is not applicable in this case.
Alan Johnson: The hon. Gentleman says from a sedentary position that he was talking about antibioticsI am sorry, I misunderstood him. We have sufficient stocks of antibiotics. They are very important, because most of these cases will lead to complications, which antibiotics will deal with. If he was talking about using antivirals as a prophylactic, we have sufficient quantities. The hon. Gentlemans point was whether we should give prophylactics to people who go to the affected countries. My view at the momentwe will discuss this furtheris that we should not, because we need to ensure that we have sufficient stocks for 50 per cent. of the population if an outbreak occurs. We will obviously keep that under examination, but at this stage I do not think that that would be wise.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): I, too, want to thank the Secretary of State for coming to the House at the earliest opportunity to give this statement on what must be a busy day for him as he assesses the advice that he is getting. My hon. Friend the Member for North Norfolk (Norman Lamb) wants to apologise for his absence.
Does the Secretary of State agree that the difficulty in understanding the nature of the threat is caused by some of the mysterious aspects of this outbreak? Why do the cases appear so much more severe in Mexico than elsewhere in the world? Will the outbreak always be this virulent? Did it actually start in Mexico? The Secretary of State said he was convinced it did, although one cannot be certain that there were not sub-clinical strains elsewhere before the first Mexican report? Has the antigen drift made it less pathogenic as it has spread from Mexico? That is one cause for hope, and it is why we are seeing different pathogenicity elsewhere.
How easily is the disease spread from human to human? That is not yet known, but how easily the disease is spread from human to human and whether that transmissibility is sustained as the virus changes, as such viruses do, will determine as much as anything else the extent to which the disease is likely to become a pandemic. Of course, we do not know what protection, if any, is available from the H1N1 seasonal flu vaccines.
It is important to note that only one published paper on the two isolates from California has been available on the CDCUS Centres for Disease and Control
Preventionwebsite. It is not yet possible to compare those isolates with the Mexican isolates to see whether the genetic changesthe genetic assortment that appears to have taken place, according to that paper, between the 1918 north American strain and the 1979 Europe and Asian strainare replicated in all such cases. There are simply too many unknowns, so I share the Secretary of States caution, but it is wise to assume that the worst may happen and to plan for it, which the Government appear to be doing.
I have a number of questions. First, may I pursue the issue of preparedness in other countries? We are in a world of global travel, so the weakest link in surveillance and reporting will be the one that causes delay in bringing the virus to scientists to study so that public health experts can give advice. Will the Secretary of State say more about what we can do to improve surveillance and public health in areas such as central Americanot just in Mexicoas we needed to do, and still need to do, in the far east in relation to the threat of bird flu?
Is the Secretary of State certain that we have right the proportions of the antivirals, Relenza and Tamiflu? If there is a differential, and it is possible for the virus to become resistant to one but not the other, which would be unusual but possible, it might be good to have a balance of both. As I understand it, we have a preponderance of the oral form but not a huge amount of the inhaled versionfor obvious reasons in terms of ease of deliveryand that might become a factor.
Has the Secretary of State given any thought to what might happen if the worse comes to worst and the buying of antivirals by asymptomatic people, privately or over the internet, causes problems for public confidence in the distribution system? I share his scepticism about the appropriateness of providing prophylactics to travellers, as that might be an inappropriate way, outside a countrys plans, of introducing antivirals that could lead to resistance.
Dr. Harris: Finally, can the Secretary of State reassure us that there will be full international co-operation between scientists and countries? That scientific effort will give us the information we need, and the hope of a vaccine sooner rather than later.
Alan Johnson: I think the hon. Gentleman was musing aloud during the first part of his contribution. I do not know the answers, and the WHO does not yet know the answers to the issues he raised about the strain and how we can deal with it.
The hon. Gentleman asked what we can do on the weakest link argument. What we can do is support the WHO. Although the WHO is keen to ensure that all countries co-operate, he knows that one country in particularIndonesiais refusing to provide certain information about avian flu that could help us. It is very important that every country gives information to the WHO so that it can co-ordinate activity. Supporting Margaret Chan and her colleagues at the WHO is the greatest contribution we can make.
The hon. Gentleman says that there is a preponderance of Tamiflu, which is quite true. I understand that Relenza can be used by women who are pregnant or breastfeeding,
for whom Tamiflu is inappropriate, so I think that we have the right balance. There is a preponderance of Tamiflu because it can be taken by most of the population, except pregnant and breastfeeding women and some other groups. We are fortunate to have Relenza for them because many countries have only Tamiflu.
It is important that hon. Members do not get into the issue of buying antivirals yetthere is not a phase 6 alert. We have talked about all the things that we need to do at this stage, and the hon. Gentleman is right that full international co-operation is absolutely essential, which is why the WHO deserves all our support.
Madam Deputy Speaker: Order. I ask Back Benchers to limit their supplementaries to one brief question, and for similar responses, because many hon. Members wish to catch my eye and we have important business on the Budget to follow.
John Reid (Airdrie and Shotts) (Lab): There is absolutely no complacency on such issues, but we are all reassured that the Secretary of State has made a statement in the House immediately and that the UK has been singled out as one of the better prepared countries.
The Secretary of State will know that I have a particular interest as one who initiated some of the preparations and as the MP for Monklands hospital. The situation at Monklands is being dealt with by the Scottish Government. I have been in touch with the local MSP, Karen Whitefield, and the Minister, Nicola Sturgeon, who has acted with commendable speed. Will the Secretary of State reassure the House that there will be maximum co-operation, liaison and exchange of information between the devolved Governments and central Government, because something such as this is no great respecter of borders inside or outside the United Kingdom?
Alan Johnson: I can give my right hon. Friend that assurance. Two of the three cases under examination involve people from Scotland. I spoke to Nicola Sturgeon yesterday and again today. She has acted with admirable promptness and has been extremely co-operative. We will work together on this, because it is otherwise no good talking about international co-operation [ Interruption. ] Of course, this is international co-operation. This is a UK-wide issue, so we will deal with it as such through Cobra. We will ensure that there is absolute solidarity and close working between all the devolved Administrations.
Mr. Philip Hollobone (Kettering) (Con): The Secretary of State said that if the virus starts spreading widely in the UK, the Government propose to use their antiviral stockpile to treat symptomatic patients. What would he say to elderly and vulnerable constituents in Kettering and elsewhere, and to the parents of young children, who might not have the symptoms, but want to ensure that they do not pick up swine flu if it spreads widely in this country?
If people do not have the symptoms, the advice at this stage is that which I gave in my statement: catch it, bin it, kill it. People should ensure that they use a handkerchief or tissue when they cough
or blow their nose, ensure that that is thrown in the bin, and then ensure that they wash their hands. That advice is very simple, but it is the most profound that can be given in such circumstances.
If people do not feel unwell at allif they feel fineI would not want them to be concerned, whether they are elderly constituents in Kettering, Hull, Cambridgeshire or anywhere else. If they start feeling sickly but have not been anywhere near Mexico or the US, they will, in all probability, have a cough or coldadults get between five to eight doses of that each yearand they should deal with it in the normal way. If, however, they have had contact with anyone who has been in those affected countries, they should go home and contact the Health Protection Agency or a health professional. That is the advice that we should give, rather than giving anyone the feeling that we have moved to a phase 6 alert when we have not.
Jeremy Corbyn (Islington, North) (Lab): I thank the Secretary of State for his statement and the information that he gave. May I take him back to a point made by the hon. Member for Oxford, West and Abingdon (Dr. Harris)? There is a marked difference between the death rate reported in Mexico and that reported outside it, apparently due to the same strain of flu. Does the Secretary of State think that more than one type of flu might be going around, which would make the dangers more complicated than have been realised, and is he in close touch with the Mexican authorities, especially those in Mexico City, about the public health warnings and advice they are giving, especially regarding people cleaning their noses and wearing face masks to try to reduce the spread of the virus?
Alan Johnson: My hon. Friend is right: the situation in Mexico is complex. I mentioned 800 cases and a large number of deaths, but at the moment only 18 of those cases are linked to H1N1, which is why there is the suspicion that there are other illnesses involved in Mexico. We are in close touch with the authorities there through the WHO, but I can assure my hon. Friend that no one is in closer touch with them than the US authorities, because of course this is a cross-border issue for the US. We want to help the Mexican authorities to deal with the matter, and we want to help them to help us understand what is going on there, because until we do we will not have the key to whether this is the kind of pandemic that we all hope it is not, but that we fear it may be. The key is finding out what happened in Mexico.
Mr. Shailesh Vara (North-West Cambridgeshire) (Con): I appreciate that the Secretary of State has given thought to prioritising to whom to give vaccines should the need arise, but, following on from the question put by my hon. Friend the Member for Kettering (Mr. Hollobone), does the Secretary of State feel that there is an argument that some priority ought to be given to certain groups of peoplefor example, to those on the front line of health services, who may well be dealing with people who come in with the relevant symptoms, or those working in airports and port authorities?
It is important to be clearI am not saying that the hon. Gentleman is notthat we do not have a vaccine. We do not have something that can be
injected or taken to prevent anyone from getting this flu. We have an antiviral; if people develop the symptomsif they are symptomaticand take it, all the evidence is that they will recover very quickly. We cannot take that action until they are symptomatic. There is a view that one could use those antivirals as a preventive measure, but no one is absolutely sure of that. As for using up that precious stock of antivirals, it should be borne in mind that we were catering for 25 per cent. of the population; we have now expanded provision to cater for 50 per cent. of the population. We do not want to diminish and dilute that by using the antiviral in a way that we are not sure will have a beneficial effect. There is not a vaccine, a pill or tablet, or medication that anyone can take to prevent the illnessyet. There may well be, once the scientists have had a chance to examine the strain and produce a vaccine, but that will take some time.
Andrew Miller (Ellesmere Port and Neston) (Lab): My right hon. Friend the Secretary of State will know that modelling the spread of such illnesses is incredibly difficult. As by the hon. Member for Oxford, West and Abingdon (Dr. Harris) indicated, that is partly because of the way in which we travel today and because such a virus can mutate and change, hopefully becoming less harmful. Perhaps that is where we are. It requires a hugely challenging laboratory exercise to maintain a full understanding of what is happening. Is my right hon. Friend satisfied that he and his colleagues in the Department for Environment, Food and Rural Affairs have at their disposal the resources for that, so that we can not only follow the path of the illness, but ensure that we learn lessons from what has happened?
Alan Johnson: I am entirely satisfied that that is the case, and entirely satisfied with regard to the NHS. The matter has been a tier 1 priority in the operating framework for the past three years. However, I am not complacent about the issue. The hon. Member for South Cambridgeshire (Mr. Lansley) raised an important point: we are talking about something that is actually happening, as opposed to preparing for something that we were worried about, so we have a chance now to modify our approach, depending on what we find. However, I think that we are in a better state of preparedness than most other countries.
John Mason (Glasgow, East) (SNP): Will the Secretary of State assure us that just as there are good relations between England and Scotland at ministerial level, there are good relations between officials?
Alan Johnson: Yes, I can. At the officials Cobra meeting yesterday, Scottish officials were involved and made an important contribution. There must be good relations, and that is the case at ministerial level and at official level.
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