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Mr. Andrew Lansley (South Cambridgeshire) (Con):
On that point, the Secretary of State will recall that on 27 April, when he made his first statement on the issue, I asked about people who necessarily had to travel to infected areas. One might argue that that now includes such a wide area—including the US—that any measures are impractical, but it is difficult for those travelling to Mexico City, for example, to access Tamiflu, even on a private prescription. Does the Secretary of State have
any measures in mind to allow modest access to the Government’s stockpile for people who have to make such journeys?
Alan Johnson: The hon. Gentleman’s sense of the stage that we have reached is right. However, such a proposal might still be pertinent for Mexico, where there have been the most fatalities. I shall look into that. It has not been raised as an issue in the wider discussions that we have had with people who are in this situation, but I know that the hon. Gentleman has raised it before. It is a valid point.
We would expect to move away from this containment phase to a mitigation phase only when it became apparent that there was sustained community transmission at a level that made containment futile.
My second point is that there are steps that people should be taking now so that they are fully prepared for the next stage. The principal objective is to avoid those who are symptomatic spreading the illness further by continuing to move around the community. Everyone should think about identifying what we have termed as “flu friends”—neighbours, friends or relatives who live nearby and who can pick up medication and food for those who develop the disease so that they can avoid leaving the house and spreading the virus further. We should also all be thinking about friends, neighbours and family members who live on their own, and how we can best help them should they fall ill. Primary care trusts are already identifying patients they know to be vulnerable and making sure that they have someone who can help them.
An essential element of the mitigation phase will be a system for ordering and distributing antivirals. As I explained in my statement last Thursday, the flu line will be ready in the autumn. It is a ground-breaking system and the first of its kind in the world. It will be able to assess people via either the internet or telephone, it will be able to co-ordinate the distribution of antivirals and it will be fully plugged in to local health services. It will have the capacity to cope with the huge surges in demand that are likely if the virus becomes more widespread. It will have been thoroughly tested so that staff, patients and the public can have full confidence in its efficacy.
If we need to move from containment to mitigation before the flu line is ready, we will need to have arrangements in place that enable those who develop the disease to get treatment as quickly and effectively as possible without unnecessarily exposing more people to the virus. In addition, local health services will need to be able to respond to people’s everyday health needs, as well as concentrating their efforts on providing specialist support to those who develop this strain of flu and are severely affected, and those who have underlying complications that make them particularly vulnerable.
The interim service that we expect to have ready shortly will consist of a phone service that the public can access through a single 0800 number, and a supporting website application. That will mean that people can have their symptoms assessed either over the phone or online. Those symptoms will be checked against an algorithm—a list of the key symptoms and factors that determine whether the patient in question has been
exposed to the infection. This is a system similar to NHS Direct, which is currently used by millions of people every year.
If it is established that someone has developed swine flu, they will be issued with an authorisation number that they will then need to access antivirals. Their go-between—their flu friend—will then take that authorisation number to their nearest collection point to obtain the antivirals. That system is being thoroughly tested over the next few days, and we expect the online aspect of it to be fully operational as soon as it is needed—within a week if necessary.
Mr. Lansley: The Secretary of State says that the flu line might be available in the intended form in the autumn, but the deputy director of national influenza-pandemic preparedness told the Lords Select Committee on Science and Technology in March that it would be available in May. It is now May, and we have been told that it will not be available until the autumn. Will the Secretary of State explain?
Alan Johnson: I think that the director concerned would say that that was an over-optimistic assessment. It is a very complicated system. There was a need to ensure that it was tested thoroughly and that we did not bring it into use before it had been rigorously tested, although we could have done so in this particular pandemic. As I have said to the House before, I believe that it is best to have that system ready to come online in the autumn and to have something available. We might not need it until the autumn—we might not move to a mitigation phase by that time or be at the level of mitigation that would mean that such a distribution system would be necessary. I am confident that once the flu line is up and running it will do what it says on the tin, and will do everything that we have planned for it to do.
Finally, I want to update the House on our work to secure a vaccine. The best protection we can offer people is vaccination, because by giving people some form of immunity to the virus, even at a low level, we would achieve a significant reduction in the severity of any pandemic and, in particular, in the number of deaths or serious complications. We are now much closer to obtaining a vaccine. British scientists working for the Health Protection Agency in Colindale have already identified the genetic fingerprint of the virus. The National Institute for Biological Standards and Control in Potters Bar has now taken that isolate and is developing it into a vaccine strain.
It is a long journey from identifying the virus to making a vaccine available. It is our intention to acquire sufficient stocks to vaccinate the entire UK population. We have advance purchase agreements with manufacturers that will be activated if the World Health Organisation moves to phase 6—that is, if it declares a pandemic. We are still at phase 5 at the moment. However, we have always known that it might take four to six months before a matching vaccine becomes available, and more than a year before it can be manufactured in sufficient quantities for the entire population, given that international demand will be high.
Mr. Mark Field:
Given the delay that the Secretary of State has mentioned, can he give the House some historical indication of how quickly phase 5 turns into a phase 6 pandemic? I appreciate that we are dealing with a
unique sort of influenza, but can he give some indication of whether the four to six-month delay to which he refers might be overtaken by events? When we move to a phase 6 pandemic, we need to ensure that we have gone through this phase in such a way that we will be able to mitigate at the earliest opportunity.
Alan Johnson: I cannot give any indication of that. Phase 5 means that a pandemic is imminent—it does not mean that it is inevitable. There is no historical precedent for how long we are likely to stay at phase 5. The WHO meets in Geneva at the weekend and it might decide then to move to phase 6. My feeling is that it will not and that it will be a little while yet. Nevertheless, I believe that we will get to phase 6, but I cannot give any indication of the timing.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): Will the Secretary of State clarify whether the delay is caused by scientists all around the world going flat out to devise a vaccine, or perhaps it lies in the production of the vaccine once it has been designed, because it takes so long when we use an egg-based system? Are there new systems that mean that once we get the vaccine and manufacturers allocate capacity to it—if that is the decision—it will be available, at least for the countries that buy it?
Alan Johnson: It is a mixture of the last two points. It takes a long time to produce the vaccine. We have one contract for an egg-based vaccine and another for a cell-based vaccine with Baxter. Getting the virus is a labour-intensive system. It is not like the identification; that bit has been done, but the next bit is what takes a long time. Manufacturers need to obtain sufficient quantities to manufacture, and the manufacturing then takes a long time. Given that countries in every part of the world are entitled to a proportion of the vaccine—our advance purchase agreement is good, and other countries have advanced purchase agreements, too—it would be wrong for 100 per cent. of it to be coming to the UK while people were dying in other countries.
For all those reasons, it is important to be clear to Parliament. Some of the commentary that I have heard has mixed up our saying that we will not begin to have this vaccine ready for four, five or six months with a belief that it will be ready for 100 per cent. of the population within that time scale. Our national framework always set a period of between 60 and 79 weeks for completion of the process for 100 per cent. of the population, but we are currently in negotiation with manufacturers to see whether we can obtain early supplies at this pre-pandemic phase. We hope that that will enable us to vaccinate front-line health and social care staff and vulnerable groups who prove particularly susceptible to infection, before a predicted second wave hits.
Mr. Robert Syms (Poole) (Con): On a related point, I know that masks have been ordered for NHS staff, but are there any plans to distribute them more widely? What impact do they have? When there were problems in the far east, one saw members of the public wearing masks on trains and so on. Secondly, what about hand wash? I notice that some London schools are asking parents to wash their hands as they go in and out. Is that effective? What are the Government’s views on that?
Alan Johnson: We have discussed face masks before, and we are ordering 226 million surgical face masks that are coated and have a protector, as well as 34 million respirators. They are for front-line NHS and adult social care staff, not for the general public. As we have said before, the WHO and all the relevant experts have made it clear that it is fairly futile for people simply to put a strip of cloth over their mouths; indeed, that may even be counterproductive, because it can cause people to believe that other safeguards need not apply.
That leads me to the hon. Gentleman’s second question about basic hygiene. Hand washing is probably the most crucial part of dealing with this infection.
Mr. Lansley: The Secretary of State said that 226 million face masks had been ordered, but when and how will they be supplied? Does the Department have some stockpiled? The normal use is 31 million a year, so there is a big difference between the target and what we have. Secondly, the Department’s guidance on face masks made it clear that there is no evidence that they do much good when used by the general public—but the exception to that involved infected people who are shedding the virus. The guidance suggested that they should wear a mask if they have to leave home, because that would reduce the risk of other people being infected by the virus that they emit.
Alan Johnson: We do have stock from some suppliers, and the first supplies are due to go to the NHS this weekend. The company manufacturing the product has done extremely well, and we are expecting something like 20 million masks to be available every month. I shall check the precise figure, but that is what I recall. The total will also ramp up over time, so we are expecting our order to come through pretty quickly.
The hon. Member for South Cambridgeshire (Mr. Lansley) is absolutely right about the guidance on masks. Our supplies will be focused on front-line NHS and adult social care staff, but other people too would benefit from wearing them. They include those in the categories that he described, as well as those who for other reasons will be in close proximity to symptomatic patients.
We cannot move to a pandemic-specific vaccine and trigger our advance purchase agreements until there is a pandemic, and, as has been noted, we do not know for how long we will be at phase 5 as a precursor to phase 6. If a pandemic is declared, manufacturers would be expected to switch from production of the seasonal flu vaccine to a pandemic vaccine.
Our ambition is to secure a swine flu vaccine without jeopardising our supply of the seasonal flu vaccine. It seems likely at this stage that manufacturers can complete the production for this winter over the next month or so, and have that ready before capacity is switched entirely to the production of swine flu vaccine.
John Mason (Glasgow, East) (SNP): Will the Secretary of State clarify what he means by securing and purchasing early supplies of vaccine? Does that mean that we are somehow jumping the queue? My colleague in Edinburgh said the same thing this morning.
Alan Johnson:
We are not jumping the queue, and the discussions are still going on. They are commercially sensitive, but although we cannot access our APAs until
we are at phase 6, we have an opportunity to make some progress before the pandemic takes hold. We are exploring how much we can produce in that period, and other countries will be doing the same. It seemed sensible to us to see what we can do, rather just waiting to activate the APAs. It is by no means certain that we will be successful, but it seems the proper thing to do, and I shall say a little more about that in a second.
Understandably, hon. Members will want to know whether a vaccine that is developed today, based on what we currently know about the virus, will be effective if the virus mutates. The immunologists, virologists and epidemiologists who advise the chief scientist and the Health Protection Agency are very clear on this point. Even on their most pessimistic estimates—that is, if the vaccine were to give only a low level of protection—that would significantly dampen the virus’s severity and its ability to spread, and reduce the possibility of people developing complications.
The unanimous advice of the scientists is that we should move as quickly as we can to get as much vaccine as we can at this stage. That is what we are attempting to do, although we are not trying to deny other people the chance to get the vaccine as well.
Dr. Evan Harris: I fully support the Secretary of State’s basing his decisions on scientific advice. The Phillips report showed how important such advice is, but does the right hon. Gentleman accept that, in a few aspects of vaccination policy, there will also be questions of judgment that go beyond scientific advice on the ethics? One such question—about jumping the queue—has been raised already, but others involve exactly who gets the vaccine first, and how we deal with supplies in the private sector. Although the answers to those questions can be informed by Government policy to an extent, I hope that he will accept that the wider House beyond the Front-Bench teams should be engaged, as well as civil society. We need to have those debates now, before the vaccines become necessary and the arguments rage, because that gives us a better chance of achieving consensus.
Alan Johnson: I have no problem with such ethical debates taking place. When a pandemic is declared, the whole system and all the manufacturing capacity must in effect be put at the service of the WHO, because that is how we can ensure a proper spread of vaccine. That is the important ethical point at this stage.
No single action will prevent this outbreak from becoming more widespread, but we can continue to contain the virus, using antivirals as a prophylaxis. We can make sure we have the drugs that we need to treat the virus and any complications that occur, and we can begin to vaccinate the whole of the population as soon as possible. We can keep people informed and enable them to protect themselves and their families. Finally, we can be thankful for our NHS and the people who work in it and with it. Throughout its history, and in the most critical situations, it has proved its ability to rise to any occasion.
Although the threat of a pandemic is unlikely to diminish in the weeks and months ahead, we can be reassured that our preparations are thorough and that our actions in dealing with this infection are in the hands of dedicated professionals. I commend the motion to the House.
2.28 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): May I first thank the Secretary of the State for Health and the Government for responding positively to our suggestion that we have a debate? Hopefully, it is not premature; we entirely understand all the uncertainties that remain. In truth, it is less than a month since the circulation of the virus was first identified to the World Health Organisation, so there will be uncertainties about the nature of the virus, its characteristics, how it affects humans and what we should do about it. However, it is a good time to consider how we should approach the issue, particularly with regard to vaccines, not least because the strategy is beginning to take shape. I agree with the hon. Member for Oxford, West and Abingdon (Dr. Harris), who was in the Chamber earlier, that it is also a good time to discuss prioritisation, use of resources and the ethical issues that might emerge from that if there were to be a substantial spread of the virus in the months ahead.
May I echo what the Secretary of State said about our thanks to the NHS? I thank not only NHS staff generally but, through him, those working in the Department of Health and the Health Protection Agency. In particular, the staff in pathology laboratories in heath protection units across the country have literally worked 24/7 on very large numbers of suspected cases. I know that we are dealing with 72 confirmed cases, but they have now dealt with perhaps tens of thousands of suspected cases, and pushing those cases very rapidly through the system has been a tremendous burden on them.
Mr. Syms: I know that a lot of the technical staff in the NHS who work for pathology labs have, in the past, felt a little under-appreciated, in terms of pay and conditions. Given that they are doing an excellent job, it might in future be worth reflecting on the fact that when a doctor decides to do a test, it is actually somebody in a pathology lab who carries it out.
Mr. Lansley: Since my father was, 30-something years ago, chairman of the Institute of Biomedical Sciences, I am sure that biomedical scientists will not be least among those who will appreciate what my hon. Friend says on that matter.
A debate gives us an opportunity to discuss some of the issues, as distinct from asking questions, as we have been able to do after the statements that the Secretary of State has kindly made. In particular, as we begin to discuss the nature of the virus and how it might spread, there has been a tendency on the part of many in the media to assume that even though the flu that we are discussing is very much milder than the 1918 flu, the pattern of its impact will be like that of the 1918 flu. In 1918, of course, there was an initial, relatively mild spread, in which no very large proportion of the population was affected. About three months later, there was a severe impact, with large numbers of cases and a very high fatality rate. In early 1919, there was a third wave. The assumption is that, somehow, it must happen like that.
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