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Baroness Linklater of Butterstone: My Lords, I sincerely thank all noble Lords who have contributed to this extraordinarily interesting and important debate. We have heard eloquence and expertise. There has been real knowledge in the breadth of subjects that we have covered. I am so grateful.
I am particularly delighted that both the noble Lords, Lord Rea and Lord Dearing, were prevailed upon—indeed "charmed", as the noble Lord, Lord Rea, said. It showed how very important it was to widen the debate to those whose expertise is outside the box of criminal justice and that noble Lords were here and participated.
I should say to my noble friend Lord Carlile of Berriew that if the mantra is not enough, it is a good start to say, "Cut crime with courage". We should remember that. I was particularly glad to hear the Minister say that he would take on board the issues raised by the reports and thank him especially for that. That was music to my ears. I had a peculiar feeling that everything he said echoed what I had said. When I said that we should be pushing at an open door, I hoped that there would not be a black hole on the other side, but that the rhetoric would meet the reality. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.
Vaccination Programme
Lord Hodgson of Astley Abbotts asked Her Majesty's Government what they propose to do to increase the level of public trust in their vaccination and immunisation programme.
The noble Lord said: My Lords, the trigger for my decision to ask this Question was the Government's sudden decision in August this year to introduce a new five-in-one child vaccine called Pediacel. Pediacel replaces the four-in-one vaccine previously used and adds polio to the diptheria, tetanus, pertussis and haemophilus influenzae type B—HIB—vaccine. The other critical by-product of the introduction of Pediacel has been the withdrawal of the preservative thimerosal which consists of 50 per cent ethyl mercury.
The withdrawal of a toxin as potentially harmful as that contained in thimerosal from infants' vaccine, however small the amount contained therein, is a
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positive development on which the Government are to be warmly congratulated. However, I am not clear as to why this step was taken, if one is of a cynical turn of mind, in early August during the holiday season when minimum press comment could be expected.
The withdrawal of thimerosal from vaccines in this country has been widely advocated over the past decade, but until now it has been resisted by the Government. It has already been withdrawn from almost all child vaccines in the USA and has even been withdrawn from animal vaccines in that country. A sizeable proportion of European countries have also discontinued its use. Those who have advocated the withdrawal of thimerosal have done so on the grounds of a possible relationship between the ethyl-mercury in thimerosal and ADD, which is attention deficit disorder, ADHD, which is attention deficit hyperactivity disorder, and autism in susceptible predisposed children. As long ago as 2000 the Committee for Proprietary and Medicinal Products of the EU recommended that manufacturers move to thimerosal-free vaccines. It is good that, albeit four years later, the Government have implemented that recommendation.
Most recently, a study by Doctors Hornig, Chian and Lipkin of Columbia University, published online on 8 June 2004 in the Nature publication, Molecular Psychiatry, indicated that postnatal exposure to thimerosal can lead to the development of autism-like damage in autoimmune disease susceptible mice. This reinforces previous studies, such as the works of Dr Mark and Dr David Geier, showing that a genetic predisposition in combination with certain environmental triggers can cause an increased risk of an adverse reaction.
To a Written Question I put down on 22 January 2003, the noble Lord, Lord Hunt of Kings Heath, the Minister's predecessor, answered that,
"there is no evidence of harm from thiomersal contained in vaccines. Therefore, the CSM advised that the benefits of immunisation with thiomersal-containing vaccines outweigh any potential risks of vaccination".—[Official Report, 22/1/03; col. WA 101.]
Such responses exemplify the Government's reaction to the thimerosal debate over the past two years. Until August this year the Government gave the impression that it was much ado about nothing and there was no reason for thimerosal to be withdrawn. In August, at the height of the holiday season, thimerosal was suddenly withdrawn.
Whether thimerosal does have an effect on certain autoimmune disease sensitive infants may be proved or disproved in times to come or there may never be a conclusive result. But what does matter is that the Government should maintain the highest degree of transparency and openness in their communications with the public in this important and sensitive area.
That leads me to the crux of what I wish to raise with the Minister this evening. Transparency and openness are themes on which this Government have placed great emphasis. In such circumstances it is rather strange, therefore, that the Government's vaccine programmes have so often seemed to be carefully shrouded. Communication concerning the MMR vaccination
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and its possible side effects has been ineffective. I respect the decision of the Prime Minister to avoid disclosing whether his own newly-born child had been given the MMR jab. I accept that this is a sensitive issue. All of us, including the Prime Minister's children, are entitled to privacy regarding our medical history. But, given the controversy surrounding MMR, that refusal to answer was bound to impact upon public confidence in the vaccination policy as a whole. There is hard evidence to prove that, for a number of reasons, including the one that I have given, the level of public trust has dropped dramatically.
In some areas of London less than half the children have been immunised with the MMR vaccine. Kensington and Chelsea recorded an uptake of only 49 per cent. Figures from the Department of Health show that the number of children given the MMR vaccine by their second birthday has fallen to 80 per cent. Epidemiologists suggest that the required level for the population to be safe from an outbreak of measles, mumps and rubella is set at 95 per cent.
Equally ham-fisted was the Government's decision to release information to doctors about the introduction of Pediacel well before any public announcement. Unsurprisingly, the news leaked out and, again, the public and the media felt bypassed and, rightly or wrongly, were suspicious that the Government had something to hide. In reaction to the headlines which followed, the Government countered one scare by starting another scare, stating that children would be in great danger if they were not given the vaccine. This neither convinces parents to give their children the appropriate vaccine nor helps establish public trust in the programme. If the Government, through the Minister, express surprise at the growing public distrust in their vaccination programme I hope that these brief examples will help to show how this has come about.
I appreciate that the Government face a complex set of issues in this matter. Scare stories in the media are not unknown and the last thing that any of us wants is to trigger a reaction among the public that discourages essential vaccines from being taken. However, transparency on such issues is essential, as public confidence in vaccination policy will inevitably dictate how widespread the use of the vaccines will be. For it is only natural for the parents of a newly born child to be concerned about the impact of the injection of single vaccines, let alone multiple ones.
Government health Ministers, medical experts and many doctors have warned about the dangers of parents conducting their own research and drawing their own conclusions. However, parents are bound to search for alternative information when they feel that the Government's policy lacks credibility. Information about vaccines and drugs is now available from thousands of sources on the Internet—some of them undoubtedly reputable and informative, but some of them no doubt unfounded and damaging. The NHS has a useful immunisation information website with fact sheets which cover both the practical and medical implications of each vaccine and answer some frequently asked questions. While that is all highly
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commendable, the fact sheets, for example, give no trial or clinical data. Such data as are referred to in the fact sheets are never disclosed.
There is also the problem of the perceived independence, or lack of it, of the NHS—a large bureaucracy with its own agenda. One wonders whether it can ever win the full confidence of the public. Therefore, I believe that there is a case for considering the establishment of an independent institution to evaluate research, issue appraisals and secure full disclosure of clinical drug trials.
Several experts, including Dr Richard Horton, the editor of the Lancet, have suggested the creation of such a new body—the national agency for science and health, called "NASH" for short—which would evaluate scientific studies and provide impartial guidance. It would mean that research findings would be free from the influence of industry, and scientific outcomes would be free from political considerations.
In proposing the creation of such an independent national body which focuses on the accuracy of medical research, it is possible to draw on lessons learnt in the development, structure and experience of organisations that already exist in this country as well as overseas—most notably in the United States.
The Food Standards Agency is a good example of an independent watchdog body within this country. Although it is only four years old, it has begun to build an impressive reputation for independence. The FSA, government-funded though it may be, operates at arm's length from the Government. It is free to publish what it wishes and has no requirement to report to a particular Minister.
The FSA's key principles are: first, to put the consumer first; secondly, to be open and accessible; and, thirdly, to be an independent voice. A wealth of information about the FSA is readily available to the public. The introduction to the FSA's Strategic Plan 2001–2006 states that its central aim is,
The Strategic Plan goes on to say on page 5:
"The Agency aims to be candid where there is doubt; when decisions need to be made on the basis of incomplete information we will explain both what we know and what we do not know, and what we are doing to decrease the uncertainty".
That approach appears to be light years ahead of the Government's communication policy on science and health. If it is agreed that public confidence is a matter of significant concern for the Government when it comes to the nation's food, surely the nation's health and science policy deserves at least equal scrutiny.
A more precise example exists in the United States, where the Institute of Medicine (IOM) provides science-based advice on matters of biomedical science, medicine and health. Its website explains:
"The Institute provides a vital service by working outside the framework of government to ensure scientifically informed analysis and independent guidance. The IOM's mission is to serve as adviser to the nation to improve health. The Institute provides unbiased, evidence-based, and authoritative information and
- advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large".
The aims, priorities and remit of the IOM appear eminently sensible and they could form the basis of a model for such an institution within this country.
In conclusion, when he comes to reply, no doubt the Minister will point to the Government's plans to merge the Medicines Commission and the Committee on Safety of Medicines next year. I understand that that will see new arrangements for those employed in the licensing and safety of medicines, enforcing full declaration of financial interests and debarring from the commission anyone who has personal interests in the pharmaceutical industry. While that is unarguably a positive step, it appears to be one with a narrow objective; namely, to allay fears over potentially unethical relationships between industry and medicines regulators. However, I am advocating the creation of a much broader advisory body, independent of both industry and government.
NASH would end the culture of secrecy. The establishment of a body of scientists and specialists, independent from the Government, to evaluate research, promote openness and influence health policy would encourage renewed trust among the public. It would also help to remove the concerns that have led many to lose confidence in the Government's vaccination policy. The nation's health demands no less.
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