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Earl Howe: My Lords, I am grateful to the Minister for repeating the Statement. It is a Statement which I welcome as providing a good opportunity for the Government to lay out the extent of UK preparedness for a possible pandemic of avian influenza.
The Minister will not share the perception held on this side of the House, but from where we sit, the actions that the Government are now taking, although
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welcome in themselves, appear insufficient in comparison to the scale of the threat and could certainly have been got off the ground sooner. This is not the luxury of hindsight. The signals of a possible pandemic have been around for months, and the UK was a long way behind other countries in drawing up national contingency plans and in putting in orders for anti-virals. However, we are where we are.
The Statement leaves open a number of questions. In particular, what is the Government's strategy for the use of antivirals? Are they seen as being prophylactic, to enable health professionals to have a degree of protection during an outbreak of avian flu, or are they seen as being primarily for treatment? There is a very significant difference between the two in terms of the quantities of these drugs which would be needed for each purpose. Are general practitioners aware of what the intention is in this regard, because the poll carried out by doctors.net.uk this week made it clear that 77 per cent of GPs felt that they had not been fully informed about avian flu? I wonder whether the information packs to which the Minister referred will make it clear whether antivirals are intended as prophylaxis or treatment. Indeed, have the Government got beyond the rather uncertain form of words in the influenza plan, which state,
Why is it that the quantity of antivirals now on order is far, far lower than the comparable quantities in other EU countries, and on the actual types of antivirals, why is it that the NHS is stockpiling Tamiflu and not also Relenza, which other countries have favoured and which could be of use if the initial avian flu virus were to mutate?
On the question of vaccines, how long will it take for the 2 to 3 million doses of H5N1 to arrive? Taking a step back from that issue, on what basis has the figure of 2 to 3 million been reached? Does not this figure stand in sharp contrast to the figure of 40 million doses ordered by the government of France? Is the Minister able to offer any insight as to why this difference exists? What manufacturing capacity is needed in order to increase the UK vaccine supply to considerably higher levels were that decision to be taken? What is being done to achieve this expansion in capacity? What progress has been made in agreeing advance purchase orders with vaccine manufacturers? On the technology of vaccine manufacture, what is being done to encourage the use of reverse genetics, which has the potential to cut very considerably the delay in manufacture?
Turning to other supply issues, I ask the Minister about supplies of gloves, needles and face masks. What orders have been placed for these items in anticipation of a possible avian flu outbreak, bearing in mind that France has placed an order for 600 million face masks?
The plan prepared by the Government presupposes that a pandemic strain will originate in China or the Far East and that the incubation period of the virus will be between one and three days. What if these assumptions are wrong? As we know, avian flu in birds has appeared in Turkey and Romania. In addition, the
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upper limit of an incubation period can be as long as eight to 17 days. If the epicentre of a pandemic were not after all the Far East, the UK might not have the time cushion that we would otherwise have in order to prepare for an outbreak. This could apply even more seriously if the incubation period turned out to be longer than forecast, because infected people could travel around the world before their symptoms appeared. Why does the Government's plan not reflect the consequences of these not-impossible models?
Finally, perhaps I may ask the Minister about critical care services. What is the current estimate of the shortfall in critical care beds on the basis of current assumptions about the incidence of an avian flu outbreak? Has the Minister read the study published in the journal Anaesthesia criticising the flu plan for failing to consider the impact of a pandemic on critical care services and saying that in the worst case the UK would be short of some 6,000 beds?
Baroness Barker: My Lords, I, too, thank the Minister for repeating the Statement. This issue has reoccurred throughout the summer. The news of the past few days about the incidence of flu in Romania has once again led to misleading newspaper headlines. On this side of the House, we feel very strongly that the provision of accurate information is essential to any strategy to inform the public and enable them to take steps to safeguard their own health. My intention today is to seek that information and I hope, in so doing, to allay rather than to augment fears in the general public.
I was very struck by one article in a newspaper I read a few weeks ago. I understand that some research has been carried out which has modeled all the great flu epidemics since 191819. What lessons have the Minister's department taken from that particular piece of research?
I, too, want to concentrate on drugs. What plans have the department made to stockpile drugs other than oseltamivirfor instance, zanamivirin case a new strain of influenza develops resistance to oseltamivir used on its own. I heard the Chief Medical Officer yesterday talking about the limitations on preparing new vaccines until new strains become apparent, but it seems short-sighted not be to trying at this stage to diversify the range of drugs which are available.
The Minister referred to relationships working across government and across government departments. What is the relationship with Defra? What are the appropriate steps, which the Minister mentioned, that Defra is taking to assist with the strategy? Also, is the Department of Health working with its colleagues in the Foreign and Commonwealth Office to give accurate information to people travelling abroad?
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The noble Earl, Lord Howe, referred to the Government's repeated assertion that available drugs will be given to specific groups of people. I have read the UK's strategic framework on the issue and agree with the identification of the groups of people listed in the appendix. It includes, for example, people who have chronic obstructive pulmonary disease, and older people, whose immune systems are compromised. However, the Minister will know that, on the general strategy for flu vaccination, I have long said that it is a limited approach simply to target the individuals listed and not those who work with them; for example, people who work in residential homes or those who care for older people or those with long-term respiratory conditions. Will they also be prioritised in the framework?
What plans do the Government have to update legislation covering public health and infectious diseases? If we do not have a strategy, we are likely to be assailed by different conditions. Furthermore, what negotiations are taking place with Roche to speed up the manufacture of Tamiflu? For example, are other companies being asked to help with manufacturing, without Roche losing intellectual property rights over the drug?
The Minister referred to the EU Health Ministers' meeting later this week. Last week an internal European Commission report highlighted the tensions within the EU between western countries which had already ordered Tamiflu and poorer accession states which would now have difficulty in buying it even if they wanted to. We believe that it is short-sighted to adopt an "I'm all right Jack" attitude. What will the Government do to work with other countries to ensure that there is an international response in stocking the correct medicines?
The Minister also referred to the work that PCTs and strategic health authorities have been instructed to do. They have been charged with setting out their own strategy for local implementation. Does he agree with me that the proposed reorganisation of both those bodies is likely to have a severe impact on their capacity to deliver any such strategy within a very short period?
Lord Warner: My Lords, there have been a lot of questions. I will try to answer as many of them as I can, and I will write to the noble Earl, Lord Howe, and the noble Baroness, Lady Barker, with those points where I fail the exam paperor, more accurately, where I do not attempt the exam paper.
Both the noble Earl and the noble Baroness asked about antiviral drugs. My understanding is that Tamiflu would be administered after a doctor had
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made a diagnosis. That is the working assumption on which most work has been taken forward, but such matters are always kept under review.
In terms of readiness, I am advised that the main distinction between us and, for example, France, is that it has Tamiflu in powder rather than capsule form. The reasons that it has many more dosages is that it does not have it in such an easily-administered form as in the UK. The officials who have had many meetings at the World Health Organisation on this issue suggest that the UK and Australia are the countries most advanced in planning in this area, and that the issue of whether we should use Relenza as well also comes down in part to the issue of the ease of taking it. Relenza is, if I may put it this way, taken through the nose, and is not a capsule, which is the easiest way of taking the vaccine. This poses great difficulties if you are trying to protect children.
I hope the answers I have given reassure noble Lords that a good deal of expert thought has been given to these issues. To illustrate the preparedness of this country, the United States is way behind, and has nothing like the antiviral provision being made by this country in relation to the population. We have to be careful before we indulge in the great British disease of slagging off ourselves about our preparedness.
The noble Earl raised the question of reverse genetics. I am not in a position to answer that, but I can write to him about it. There have been discussions with vaccine manufacturers on the best way forward in this area, and these will continue. On some of the other detailed questions he asked meabout critical care beds, supplies of gloves and needles and so onI will have to write to him. I say to him that we are trying to have an organic contingency plan for an emergency. We are not saying it is fixed for all time. We are keeping this area under strict review, and, as we get more information and new advice and assimilate it, we will adapt the plan accordingly.
The noble Baroness, Lady Barker, raised a number of questions regarding lessons to be learnt from earlier epidemics. I gently remind her, and I think the Chief Medical Officer said this, that those epidemics were in other times. Antivirals were not available, global movement was not the same, and we have much more knowledge about both the extent of our ability to combat epidemics and an honest understanding of the limitations on what we can do. To combat a strain of flu, we know we would need to take four to six months to produce a vaccine that was effective for that particular strain. That is why we are stockpiling antivirals, to mitigate the effects of a pandemic while that vaccine can be manufactured.
Regarding combinations of antivirals, we have taken our position on Tamiflu on the basis of the best medical and scientific advice we have at the moment, but no doubt the Chief Medical Officer and his colleagues will keep under review the scope for using combinations of antivirals, and if there is anything more I can report on that I will write to the noble Baroness.
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The relationship with Defra is close, as always, and there is a good working relationship in this area. We are in contact with the FCO on travel advisories, and my understanding is that the advice being given out, especially with regard to south-east Asia, is for visitors not to go into rural areas where there may be exposure to avian flu.
We offer healthcare and social care staff the opportunity to be priority groups in the case of an epidemic, and we believe that the work with Roche is the right way forward. From my experience in my previous job, I know that setting up manufacturing plants for the required quality for this product is not easy or quick, and we have a manufacturer equipped to provide the necessary volume and quality.
We have been working closely with other countries through the World Health Organisation and the European Commission. It is not a question of us "pulling up the ladder, Jack"; it is in all our interests to work together, to share information, to have good information about outbreaks and to make sure that we can take appropriate action on travel, when the need arises.
I am sure that the noble Baroness will not be surprised to hear that I do not think that the consultation that is in progress on reshaping PCTs and strategic health authorities will in any way jeopardise the implementation, should it be necessary, of our plans relating to a flu pandemic.
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