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Lord Clinton-Davis: My Lords, does my noble friend agree that it is not helpful for certain experts to cultivate a wide disparity of views regarding the possible consequences of pandemic avian influenza, as is happening at the moment? He spoke about the action being taken by the WHO, the EU and other organisations. Would he expand on that? Although it is sensible to prepare for the worst, there should also be a rational belief that this will not have the immensely grave consequences that some experts envisage.

Lord Warner: My Lords, we live in a democracy, and there is nothing to stop anyone expressing their views on anything on which they wish to express views. However, as a Government, we expect people—including the media—to try to exercise judgment and discretion in the way in which they cover the story, so that we do not cause unnecessary public concern. We realise that it is a difficult issue, and we listen to experts in all areas. The Chief Medical Officer and his staff, the Health Protection Agency and others are co-ordinating that. We recognise that there will be a slight difference of view among experts about what is a sensible judgment of the risks. We have struck a cautious balance in the work that we have done to plan for a pandemic.

I have been to one meeting of EU Health Ministers in this area. There has been regular work in the EU on the exchanging of information. The Commission has made a lot of information available to countries to
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make sure that they keep a close eye on the matter and make preparations for things that may happen. One has to pay tribute to the WHO for the work that it has done to bring countries together and to make sure that we get a flow of information from countries in which avian flu, in particular, has broken out. We are, I think, getting improved, speedier data from south-east Asia as a result of those efforts.

Lord Turnberg: My Lords, I want to ask two brief questions, but, before I do so, I commend the Government for the care and attention that they have given to the planning process. In particular, I commend the Chief Medical Officer for trying to spread the message of what it is all about to the public.

My first question relates to funding for the Health Protection Agency. The Health Protection Agency plays a major role in all of this preparation. Can we be reassured that its funding is sufficient for it to fulfil its roles adequately?

The other question relates to the use of the antiviral agents. I am sure that my noble friend is aware that many in the front line in the field are beginning to take individual action, stockpiling a small supply of antivirals for their own use and keeping them handy. Can he reassure us that there will be sufficient antivirals available in a timely way to prevent people being panicked into trying to stockpile such material?

Lord Warner: My Lords, I am grateful to my noble friend, as I am sure the Chief Medical Officer will be, for his kind remarks. I, too, share those views. In a difficult area, Department of Health and HPA staff have worked very closely to construct and to give out public messages which are accurate, are not phonily reassuring and are not exciting people unnecessarily. I think that I can reassure the noble Lord as regards HPA funding. We will of course keep an eye on the work of the HPA in order that, should the situation change, it is adequately resourced for the important work that it does.

As regards antiviral agents and stockpiling by resourceful NHS staff, which, as I understand it, is the drift of the question, I do not think that they have access to our stockpile. It is tucked away and will be used in accordance with the emergency plan. If people are making their own arrangements to access antivirals, that is of course a matter for them. But this material has to be used within a certain date, so we will be maintaining that approach in relation to our stockpile. We will need to ensure that it is kept up to date.

Lord Walton of Detchant: My Lords, I have one comment and two questions. First, I mentioned briefly in the House last week that the American group of scientists who reconstructed the virus responsible for the pandemic episode of Spanish flu after the First World War has found that that virus shows certain structural characteristics similar to those present in this HM1N virus that is causing avian flu, which is a disturbing find. Secondly, can the Minister confirm that in the Far East the only human cases of avian flu
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have been in people who have had direct contact with birds carrying the virus and that there is as yet no evidence of human-to-human transmission? Is that correct?

Thirdly, if and when the virus in birds comes closer to the United Kingdom, what arrangements are being made to advise the public on how to handle and perhaps look at dead birds that may conceivably be carrying that virus? What advice is being given to the public at large on that question?

Lord Warner: My Lords, I became briefly aware of the point that the noble Lord, in his very learned way, made about the possible connection between the virus in the 1918 flu pandemic and the current virus strain in relation to avian flu. I do not know enough about that subject to do other than say that I am aware of the point that has been made. I will find out more about it and will write to the noble Lord.

As regards cases of avian flu jumping from birds to humans, and then from humans to humans, as I recall there have been about 60 deaths in south-east Asia from cases of avian flu and many more cases of infection. As far as I am aware, in all of those cases the person infected has been closely connected with poultry in some way. The only known death in Europe of which I am aware is a vet in Holland who was actively involved with poultry. I am unaware of any cases where the infection has moved from human to human. We are aware only of cases where it has moved from poultry to human.

Lord Soulsby of Swaffham Prior: My Lords, I return to antiviral substances. The Minister will be aware that antimicrobial resistance may develop against antiviral substances by viruses. If that occurs with Tamiflu the duration of its usefulness in an outbreak may be limited to a few months rather than on a continuous basis. Should that occur, what are the Government's plans and strategy to handle that should there be evidence that a resistance is developing to antiviral substances?

Lord Warner: My Lords, I am aware of the risk relating to antimicrobial resistance that the noble Lord suggests. I cannot answer that question, but I will take advice and write to him.

The Countess of Mar: My Lords, will the Minister say what action Defra is taking to trace all the small poultry producers—I am thinking of people with two or three hens in their gardens, or perhaps a couple of geese—who are not registered with Defra as poultry producers but who may need to know what to look out for if their poultry become infected? The public can be generally reassured that the major producers are all aware of what to look out for, how to protect their birds and what action they should take, but the smaller producers are more difficult to trace. Will he also say what the Food Standards Agency and Defra together
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are doing to reassure the public, especially with Christmas coming up, that not only chicken but goose and turkey are safe to eat?

Lord Warner: My Lords, all I can do is to take away the points and talk to my colleagues in Defra and the Food Standards Agency and write what I hope will be a reassuring letter to the noble Countess.

Lord Colwyn: My Lords, will the Minister confirm that the worry about avian flu is in no way changing the amounts of vaccine that we would normally have in store at this time of year for routine flu that we would expect in the winter? I was under the impression that the dangers of avian flu were to patients who already might have contracted routine flu and could get avian flu on top of it.

Lord Warner: My Lords, the noble Lord is right. We will be working through in the normal way the vaccination programme for the priority groups for the seasonal influenza outbreaks that there usually are in the British winter. They tend to originate from south-east Asia—as does the current year's strain. He is right that the concerns related to avian flu moving through a human population are about the inter-relationship between avian flu and other influenza strains that may produce a potent mix that spreads quickly. I can do nothing other than commend his science on that issue.

Baroness Masham of Ilton: My Lords, is the Minister aware that there is concern that some PCTs in London have been cutting the services of district nurses? Will he ensure that there will be enough district nurses to look after people in their homes should a pandemic occur? Will there be adequate supplies of oxygen for those people who have breathing problems? As he knows, breathing problems and asthma are on the increase and that would be a serious problem. Is the Minister aware that a Question on avian flu was asked in the House last Thursday and that the answer from Defra to a question from me about dead birds was that there was a lot of information on the website? There is, because I looked it up.

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