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Flu Vaccine

4.58 pm

The Minister of State, Department of Health (Lord Warner): My Lords, I would like to repeat a Statement made in the other place. The Statement is as follows:

"With permission, Mr Speaker, I would like to make a Statement about seasonal flu vaccine. Five years ago, we decided to give higher priority to protecting the health of the public from winter flu. We introduced the annual seasonal flu vaccination programme targeted at those of increased risk from seasonal flu—that is, those aged 65 and over, and those below that age in certain clinical risk groups, as identified by the Joint Committee on Vaccination and Immunisation. This is an annual programme because, of course, each year new strains of influenza can emerge and therefore the flu vaccines need to be reformulated accordingly. In this way, each year the vaccine provides the best protection against the influenza virus circulating.

"Since the programme was introduced in the winter of 2000–01, vaccination uptake in people aged 65 and over has increased year on year. In the first year of the targeted programme, just over 65 per cent of those aged 65 years and over were vaccinated. Last year, 71.5 per cent of those aged 65 years and over received the seasonal flu vaccine—some 5.2 million people. In addition 1.2 million people in the clinical risk groups were vaccinated.

"The responsibility for ordering seasonal flu vaccine and the administration of the vaccine has always fallen to general practitioners—this is a GP-led programme. General practitioners order their own supply of vaccine, based on the number of eligible patients on their register. They make contractual arrangements with any of the six manufacturers who supply flu vaccine to the UK.

"In addition to the GP orders, the Department of Health purchases a stock of flu vaccine each year as part of our contingency planning measures. This is held for emergency use should GPs run into difficulties with vaccine supply.
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"The department routinely meets with representatives from the UK Vaccine Industry Group (UVIG) towards the beginning of each year to inform the industry group how much seasonal flu vaccine will be required in the UK. This is based on the numbers of people covered by the current Department of Health policy.

"This year the estimated production total from all UK vaccine manufacturers was over 14 million doses, which is more than ever before. This is sufficient to immunise 100 per cent of those in our targeted groups; in other words, the elderly, and the young in clinical risk groups, as described in the Chief Medical Officer's letter to the service in July.

"We began to hear anecdotal evidence in late October that some GPs may be facing a shortage of flu vaccine. In order to assess the potential problem, officials wrote on 3 November to all primary care trust flu immunisation co-ordinators. This letter provided a reminder of the priority groups for flu vaccination, and how additional stocks of vaccine could be ordered from the Department of Health contingency stock, should extra be required by practices in their area.

"The current problems may be due to a combination of factors, such as the under-ordering of vaccine on the one hand, and possibly vaccination of 'worried well' on the other hand. It seems likely that awareness may also be higher this year due in part to the very high level of media interest in the threat of avian flu in birds and of pandemic flu. We do not expect seasonal flu vaccine to protect against avian influenza or against pandemic influenza. However, it is important to remember that seasonal flu vaccine is important for those aged 65 years and over, and the clinical risk groups, and high uptake level in these groups is to be welcomed.

"We need to ensure now that GPs prioritise their remaining stocks of flu vaccine to those who will really benefit from the vaccine—those aged 65 years and over, and the clinical risk groups. Officials wrote to influenza immunisation co-ordinators to this effect yesterday.

"The department is helping GPs by releasing flu vaccine from the contingency stock that we have purchased. We have taken orders against this stock, and deliveries are being made and will continue into December. In the face of exceptionally high global demand for flu vaccine, the department has been able to secure an additional 200,000 doses of flu vaccine, despite the intense global demand for vaccine—that will be delivered in January. We are also discussing with manufacturers whether additional supplies can be made available over and above the 200,000 doses and, if so, when these stocks would be available.

"In previous years, the GP-led arrangement that I have described has, on the whole, worked well. In view of what has happened this year, however, I am
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reviewing the arrangements currently in place for the seasonal flu vaccination programme and will consider this matter urgently".

My Lords, that concludes the Statement.

5.4 pm

Earl Howe: My Lords, the House will be very grateful to the Minister for repeating the Statement. This is certainly a worrying state of affairs. I appreciate the sense of urgency in the tone of the Statement but the Minister will understand that a number of important questions are begged by it. First, what has happened to the 14 million doses that have been manufactured? It is suggested that vaccines may have been under-ordered or that supplies may have been used on non-priority groups. There are at least three more possibilities, which are that some vaccine may have been ordered but not yet delivered; or that the take-up among high-risk groups has been greater than predicted; or that appreciable stocks are still being held unused at a number of GP practices. If the last of those is true, will the department please encourage GPs to share around any surplus stocks with neighbouring practices who find themselves short?

I do not think that it is wholly fair for the Government to blame doctors for over-prescribing. I am not aware of any evidence to that effect, and indeed the deputy chair of the BMA's GP committee and the chair of the Royal College of General Practitioners have strongly repudiated that suggestion. If it has happened, whose fault is it? During all the publicity in October about a possible pandemic of avian flu, I do not remember any statements being made by the department to make it absolutely clear to the public that the winter flu vaccine would not be effective against a strain of pandemic flu derived from avian flu. If statements were made, they were not sufficiently loud and clear.

One does have to wonder what would happen if a pandemic of avian flu were to occur, because the flu pandemic contingency plan explicitly recognises that,

The confident statements of Ministers as recently as 24 October about the adequacy of vaccine supplies for winter flu do not suggest that communications are as effective or as timely as they should be.

I welcome the 200,000 additional doses that the Government have secured, but the largest flu vaccine manufacturer, sanofi-aventis told the Government on 21 October that it had already distributed all its reserve stock. Why did it take until now for the Government to order a further supply, which we understand will not be available until late January? If it does not arrive until then, there must be a strong possibility that many people in at-risk groups will remain unvaccinated.

Can the Minister confirm one part of the Statement? He said that the production of 14 million doses this year was more than ever before. But was it in fact more than last year? The noble Lord himself told this House on 26 October 2004 that there were,
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But since then two additional groups have been added to the routine flu immunisation programme—people with chronic liver disease and people who are the main carer for an elderly or disabled person. Were those two groups fully factored into the Government's calculations?

We need to know a number of things as soon as possible. What percentage of the at-risk groups remains unimmunised? Why has it apparently taken so long for the Government to acknowledge that there is a problem and to place an order for further stocks? What is the evidence for the suggestion that GPs have been inappropriately administering flu vaccines, which has never been reported in the past? And how can we—and for that matter Ministers—be more confident in the future that timely, up-to-date information is available on matters such as these, which have enormous implications for public health?

Baroness Barker: My Lords, in August 2005, the department issued the UK operational framework for stockpiling, distributing and using antiviral medicines in the event of pandemic influenza, which received a lot of coverage at the time in the newspapers. On 17 October this year, coming to the end of a Statement about pandemic flu, the Minister said:

Does the Minister agree that what has happened since then is that people have heeded his warning? In the past year, 70 per cent of people in at-risk groups took up the offer of a flu jab. This year, given that people have been hearing about flu all through the summer and have been exhorted to be vaccinated, they have done just that. Was it not possible to predict back in the summer that the take-up rates would be greater than in previous years? After all, we know that every year 10,000 people in high-risk groups die during the winter of cold and flu-related illnesses. Our present situation is not exactly surprising.

The noble Earl, Lord Howe, talked about the inclusion of carers in the key groups. The Minister will know that that is something that I have advocated for some time. It makes sense when trying to combat outbreaks. I believe that other key workers such as NHS and emergency services staff also have been included. Indeed, this afternoon a number of GPs have taken to the airwaves to explain that they have used their common sense to ensure that those emergency workers have been deliberately targeted to receive the small stocks that that those GPs have. They see that not as profligate but as a sensible way to manage the position they are in.

Does the Minister agree that one of the problems is that the vaccines are ordered by GP practices whose margins are extremely tight? A GP practice that over-orders only a small amount of vaccine is unable to recoup the money that it has spent, which makes a great difference to its overall budget for vaccinations throughout the year.
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I have two final questions. First, in view of what we now know about the deficiency in stocks for December and January, and given the weather forecasts, will the Government support a range of winter warmth and anti-hypothermia initiatives for at-risk groups? Secondly, at a time when they face severe difficulties due to reorganisation, will the Minister ensure that PCTs rapidly co-ordinate the practice groups in their areas? It is imperative that the shortage of vaccines is dealt with now if people in vulnerable groups who are not yet vaccinated are not to be left out and the number of winter deaths is not to rise.

5.12 pm

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