Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 220 - 239)

TUESDAY 1 NOVEMBER 2005

Ms Rosie Winterton MP, Dr David Harper and Dr David Salisbury

  Q220  Chairman: What is your assessment of the recent media coverage of avian flu and the possibility of a pandemic?

  Ms Winterton: I think the recent media coverage has shown how important it is for us to perhaps redouble our efforts to make sure that the media are aware of the true situation, that they understand the difference between avian flu, seasonal flu and a pandemic and the fact that at the moment there is no evidence of a pandemic, but obviously, there have been occurrences of avian flu being caught by humans. But the fact remains the same, that this avian virus is not something which is easily passed between humans. I think it is very important that we are quite clear about the distinction between that, because otherwise we do get rumour and misinformation which gets in the way of communicating a clear message to the public and also to other professionals.

  Q221  Earl of Selborne: Minister, I wanted to ask about costs and projected costs, first of all of the Government's contingency planning for pandemic influenza, how this might compare with the possible cost of pandemic, and perhaps to what extent the Government investment in contingency planning has been subjected to any cost benefit analysis.

  Ms Winterton: There are some very clear figures that we can give in terms of costs. For example, £200 million that we are spending on antivirals, and some slightly broader figures that we can give in terms of the H5N1 vaccine that we are purchasing. If you were to take the same cost as that would be for seasonal flu vaccine, that would be in the region of £30 million. In terms of communications plans, we would be able to put a figure in the region of £25 million, but I should emphasize that that is for a full escalation as well of a communications plan, in a sense, the worst case scenario. We have obviously said that we will put in orders for something like 120 million doses of vaccine if and when that becomes possible. Those are some straight figures, along with something like £0.5 million to the World Health Organisation to improve surveillance in south east Asia. Those are some figures that we can be firm about. Other figures - it is not quite so easy to separate that out from general resilience planning, which has taken place across government for all sorts of emergencies, for general emergency preparedness. That happens across government, but it is quite difficult to put an actual figure on that, except to say that there has been an increase in general planning for emergencies since, obviously, 11 September 2001. There are some very firm figures, there are wider figures for cross-government planning and it is quite difficult to separate out a pandemic cost in that, and in terms of the wider figures, we have submitted some figures to the Committee which talk about possible costs to the economy itself, but again, some of those depend, of course, on the severity or otherwise of a pandemic.

  Q222  Earl of Selborne: I wonder, Minister, if you could relate that to the possibility of a cost benefit analysis. Has that been practical or possible or has that not been attempted?

  Ms Winterton: In a sense, what we have to do is look very clearly through all the advice we have as to what we need in terms of combating any pandemic, and I suppose if we were to talk about cost benefit analysis, would it be appropriate to use the example perhaps of purchase of antivirals, where we have said that we believe that this should be used for treatment and not used prophylactically? I do not know whether that would have been subject to a cost benefit analysis. Perhaps I could ask David Salisbury to come in on that.

  Dr Salisbury: In principle, vaccines are by and large cost-efficacious compared with many other medical interventions. When we routinely do cost benefit analysis, we find that for the greater part vaccines are favourable. Certainly, in this instance, we would anticipate that, given the potential burden for a pandemic, both in direct and indirect costs, and what we know of vaccine costs and what we know of antiviral costs, we would expect, again, that this would be a good investment in everything that we can do to either prevent or mitigate the consequences. Since we do not have prices for a vaccine that does not yet exist, of course, the best we can come up with is indicative guides, but were we to undertake the sort of routine cost benefit analysis that we would do under other infectious disease circumstances, we would find that this would be a good use of resources.

  Q223  Lord Mitchell: I want to ask whether new money is being made available from the Treasury with respect to this whole pandemic issue. We are going to be asking several questions today. We have talked about vaccines, we have talked about antivirals, and we are going to be talking about manufacturing capability and many of the other things. I just wanted to know whether, since the heightened awareness of this pandemic issue over the last six months or so, new money has been put into the equation, or is it just shuffling around within the Department to make it available?

  Ms Winterton: As I understand it, there is a mixture of the two. Some of the planning that is done has involved using existing resources, but certainly in some of the more far-reaching expenditure, we have obviously had to seek Treasury approval. Perhaps I could give the example of the purchase of vaccines, where in a sense we would undertake a contract which would mean that we have to put some money down to say that if necessary, we will purchase 120 million doses of a vaccine. That obviously requires getting approval for a figure in the future but that is not spent at the moment. Do you see what I mean? The sleeping contract requires agreement with industry about securing a future order, but the payment for that is as and when it becomes necessary.

  Q224  Lord Mitchell: If we were speaking to Roche or some of these companies, would they see it that way as well? Would the manufacturers of the vaccines see that that is the case?

  Ms Winterton: The discussions are ongoing with manufacturers at the moment, and my colleagues here will be undertaking those, obviously with all due commercial considerations taken into account. To what extent they will be entering into discussions that they may or may not have had with the Treasury with manufacturers, I would not like to speculate.

  Q225  Lord Sutherland of Houndwood: Minister, you suggested money would be payable ­as and when". Does that include ­if" it is necessary? In other words, is it possible that the money would not be payable? I think this is part of the point that Lord Mitchell was pressing.

  Ms Winterton: If it was impossible to actually manufacture a vaccine to deal with the virus, which I suspect is highly unlikely. Once we know what we are up against, the work can take place to put the manufacture of it into practice, but the idea of the contracts that we have secured is that the final payment is made on delivery of the vaccines that we have ordered. If for any reason they could not make it because they could not identify the virus, then obviously, that would not happen, or if they could not manufacture the appropriate vaccine that dealt with it, but I think that is highly unlikely, is it not?

  Dr Salisbury: Clearly, the best circumstances were that we did not have a pandemic.

  Q226  Lord Sutherland of Houndwood: Precisely. What happens then?

  Dr Salisbury: We are not planning to pay for something that is not even manufactured. The purpose of the sleeping contract arrangement is to guarantee that once production takes place, you are well positioned to get a product. There are some things that no doubt industry would see the sleeping contract as funding, for instance, their mock-up dossiers that they would require, so the advance payment is certainly taking forward industry's preparedness, but you are not paying for something that you do not have, and hopefully it would be a very long time before we had to.

  Q227  Lord Sutherland of Houndwood: How long does the contract run? One year? Two years? Three years?

  Dr Salisbury: These are currently under negotiation.

  Q228  Baroness Sharp of Guildford: So in effect, you are dividing efforts really. At the moment there is the issue of preventing a pandemic from appearing and the sleeping contract means, should a pandemic emerge, you have plans to tackle that, and to some extent the costs could be divided between those two?

  Ms Winterton: Yes, because essentially, you cannot manufacture a vaccine until you know the virus that needs to be combated.

  Baroness Sharp of Guildford: Yes, I understand that.

  Q229  Lord Patel: Minister, this might be a question for Dr Salisbury but I will ask you. You may have seen the evidence that the vaccine manufacturers gave to us last week. Their concern was that they need to enter into negotiations with you now to increase their capacity in the event that vaccine production has to be geared up to the level that you require, 120 million doses. If they increase this capacity, they need to have a guarantee that the British Government would increase its requirement for flu vaccination in between pandemics, otherwise the cost will be considerable. Hitherto, they have not had this negotiation or any contracts. These are virtually their words.

  Ms Winterton: I will ask Dr Salisbury to take up some of the individual points about discussions that have been held between the Government and the manufacturers, but I actually think it is worth reminding the Committee that we constantly look at the number of people for whom seasonal flu vaccine is available and we have doubled the number of people who are eligible and who receive seasonal flu vaccine over the last five years. It used to be over 65s. It is now people with asthma and diabetes. We constantly keep that under review. We have a very good track record in terms of achieving the targets we have set, which was something like 70 per cent of people over 65, or 60; I cannot remember which. There is a bigger issue that is in a sense about what we do to increase worldwide capacity. That is something that was discussed in Ottawa last week at a meeting of about 30 countries to discuss the whole issue of pandemic flu. Many of the points that were made there I think would be of interest to the Committee, because really, we were talking with other countries about how they needed to increase their purchase of seasonal flu vaccine. This is an issue which is worldwide, and if there really is to be a dramatic increase in the amount of manufacturing capacity available, that does need to be something that we work on through international contacts as well. There are some countries that are not up to the level that we are in terms of seasonal flu vaccination and manufacturing thereof. Another point that was made in Ottawa was that the WHO would go away and look at what was generally available in terms of the ability to manufacture vaccines worldwide and look at the various options there might be for expanding that. Dr Salisbury might like to talk a little bit about the individual points made by the companies at the Committee.

  Dr Salisbury: The first thing is that, with colleagues both from my team and others, we have had a series of meetings going all the way back through this year with individual vaccine companies. All of the companies who could possibly provide flu vaccine came into the Department. They explained to us issues to do with their capacity. They explained issues to do with their research and where they saw their new influenza pandemic products going. So we have already had a complete round of these and we have come close to completing our second round of these meetings with all the manufacturers. I was also surprised when I read the comments, but I think the comments made to this Committee were made by UVIG, which is the United Kingdom Vaccine Industry Group, rather than the individual companies. It is the case that we have met with all of the companies and we have discussed with all of them their capacity and their products that are in development. Where seasonal flu is concerned, the Minister has exactly given you the information that we are one of the higher-achieving countries in our ability to reach our seasonal flu coverage targets, both for those over 65 and now, increasingly, pushing for higher coverage of those with risk factors. There are many countries with far lower utilisation of influenza vaccine. If one really wanted to push at the places where improvement needs to be made for the greatest, it would be those countries with lower utilisation of influenza seasonal vaccine. Nevertheless, we do need industry to be able to increase capacity so that it can both respond to demands for seasonal vaccine and respond to requirements for a pandemic vaccine, and that is a problem that is not just for the industrialised countries; that is a problem that is going to be global, and there are many countries that have no utilisation of seasonal flu vaccine and will be in an extremely difficult position when they have to try to deal with accessing pandemic vaccines. This is a real issue and we take it very seriously, not just whether capacity needs to increase, but industry - and quite rightly, they are already doing this - needs to look at ways of making the current vaccines even more effective so that you could use smaller doses and thereby maximise capacity.

  Q230  Lord Patel: In the event that appropriate vaccine is available or can be manufactured, the citizens of the United Kingdom will be able to get that vaccine?

  Dr Salisbury: That is the reason for the sleeping contracts, so that we can ensure that once industry starts making pandemic vaccine, we will be well placed to receive product as quickly as possible.

  Q231  Lord Paul: Minister, we are talking of advance payment for the sleeping contracts. What kind of money will we have to pay for that?

  Ms Winterton: Discussions are ongoing at the moment and it is rather difficult to give figures, frankly, just at this point in time. Dr Salisbury is engaged as we speak in discussing with manufacturers some of the issues around that.

  Q232  Lord Paul: Cynics say that because of the advance payment questions, the whole problem is being exaggerated to a scare level.

  Ms Winterton: I would hope that people would not take that view. I think it is our job in Government to take advice from the experts, to evaluate it as best we can and then take the action that we think is most appropriate. The evidence that we have been given, as I said earlier, has been put together by national and international experts. We take that advice very seriously and that is why we are entering into the contracts.

  Q233  Chairman: I would just like to ask one question, Minister, before we leave these costs. I think you mentioned that we are going to be giving the WHO £0.5 million. How does that compare with contributions from other countries? It strikes me as quite low.

  Ms Winterton: That is particularly to improve surveillance at the moment. Dr Harper may have further figures about other contributions that we make and how that compares to other countries. I am not sure whether it actually comes through the general UN funding as well.

  Dr Harper: This is an extra-budgetary payment that was made about 12 months ago, when we first engaged in the international discussions on the risks in south east Asia, and it was specifically £0.5 million to bolster the arrangements in south east Asia for transport of specimens for analysis at laboratories in third countries. We are also, of course, one of the major funders of the World Health Organisation in terms of its core funding, so there are a number of ways in which we are supporting the WHO, in terms of their internal prioritisation and how the intellectual capacity is created within the organisation to be able to tackle some of these issues.

  Q234  Chairman: So this is just a supplementary payment, is it?

  Dr Harper: It is a supplementary, extra-budgetary sum of money for a designated need that was identified 12 months ago.

  Q235  Baroness Sharp of Guildford: To some extent, the question I want to ask you picks up the same issues of co-ordination of international efforts, and in particular, given the difficulty of gaining access to China and the somewhat chaotic situation in both Vietnam and Indonesia, how are we keeping tabs on the situation and linking up with other developed countries, the WHO and UN agencies and for that matter the EU and G7 countries? What is happening at the international level?

  Ms Winterton: Most of the international effort is obviously being coordinated through the WHO, but the European Union also plays a part. We had an informal meeting on 20-21 October of health ministers within the EU where we discussed the issue of pandemic flu. In addition, as I said, there are a number of meetings that take place both at political and official level. I thought the Committee might be interested in some of the deliberations at these types of meetings, so I have the communiqué which came out of the Ottawa meeting. I thought you might be interested to look at the areas that that covered, which were to do with further assistance in terms of surveillance, greater cooperation on research, looking at issues around containment, looking at how we can increase the number of vaccines available or the vaccine manufacturing capacity available worldwide. If you feel that that would be useful, we could circulate that to the Committee later. At the same time, there are other meetings. There will be meetings between UN agencies and the World Bank next week to look at the pandemic flu issues. The UK also co-chairs the Pandemic Flu Working Group of the Global Health Security Action Group, which brings together the G7 nations and Mexico. There is a lot of co-ordination going on at international level and, as I have said, through the European Union as well.

  Q236  Lord Mitchell: If we can continue on the international theme, clearly, the monitoring of avian flu and in particular the spread and mutation is very important. I just wondered what steps the Government are taking to actually support the efforts of the United Nations and other international bodies in monitoring any developments in south east Asia.

  Ms Winterton: As I say, this is something which there have been ongoing discussions about. To a certain, extent, it was taken even further at the meeting in Ottawa. Not only are we pressing through the World Health Organisation for increased cooperation, but we are also taking some quite specific steps. For example, representatives from the Medical Research Council have been out to south east Asia to see whether there is more that we can do in terms of technical assistance. The Health Protection Agency also offers its technical expertise to other countries. Using our research facilities and evidence we have and making that available to international partners and working with them is an important part of the overall strategy we have. I do not know whether Dr Harper wants to say anything in particular about the situation in south east Asia that may have developed recently.

  Dr Harper: One of the issues that was recognised a little while ago was the urgent need for the animal experts to work very closely with the human health experts, and there have been a number of meetings that the Minister has referred to, not least the meeting in Washington a few weeks ago, where the international partnership on pandemic influenza was launched. This brought together at a high level officials from the various countries, the countries most affected, but also experts within the animal health area and the human health area. The issues that are being identified will be picked up in various ways, not least at the meeting in Geneva next week, where the World Health Organisation, with its sister organisations, the FAO, the World Animal Health Organisation and the World Bank, will be looking specifically at surveillance and infrastructure issues in south east Asia and in those countries that are currently affected by the avian flu problems. The samples that are being taken, sampling the virus itself in those areas, are being sent to laboratories around the world where the expertise exists to do the sort of molecular sequencing that I think you are referring to, to keep a very close eye on the changes in the virus itself, in the bird population. So our laboratories are very much involved in the molecular typing and the molecular sequencing of the viruses to keep an eye on how this virus is changing as it goes from country to country and as time passes.

  Q237  Lord Mitchell: You mentioned the FAO. We hear that they face a serious shortfall in their funding. I just wondered first, is this true and, if so, on an international basis, how is this being addressed?

  Ms Winterton: This was certainly not something that was raised at the meeting in Ottawa. As we have set out, at the Ottawa meeting we emphasized the need for greater international cooperation, and in terms of the work that will come from that meeting, if that was an issue that was raised, it would be something we would give consideration to, but it is not something that was drawn to our attention, as far as I am aware.

  Q238  Chairman: While we are still on this matter, we also gather that the HPA is not funded to take part in international activities, unlike many of its international equivalents, for example, in Canada, and has to fund such activities out of its own current budget. Furthermore, it appears that it cannot be funded directly through DfID but that DfID funds have to go through a supported country. Do you plan any changes in these arrangements?

  Ms Winterton: In terms of DfID funding, I know that DfID has adopted quite strict criteria as to how it makes funds available. A lot of it is to do with making sure that it is going through the most appropriate channels within each country. I cannot say I am aware of whether it is stipulated in terms of anything to do with the Health Protection Agency. If the Committee would allow me to take that away, I will certainly look at the points that are raised, but I am not aware of that. However, I understand that the HPA is involved in some of the work that is being undertaken, and certainly is not prevented from doing it.

  Dr Harper: The remit of the Health Protection Agency is to protect the health of the population, as you might expect. International work is very much a core part of the work that the Health Protection Agency does. It needs to be aware of what is going on internationally, in particular, if you like, with communicable diseases that do not recognise international barriers. They need to be working scientifically and administratively at an international level, and that is exactly what they do, and they contribute a great deal to the Department of Health's activities in that international sense, but also they are working very closely with other departments, so they are playing a major role with Defra at the moment in terms of the avian flu side of the whole influenza preparedness situation.

  Q239  Chairman: You are saying that its activities are funded by a ­business as usual" budget, as it were?

  Dr Harper: There is a core budget that is provided by the Department of Health. There are lots of other sources of income that are open to and used by the Health Protection Agency, but as part of the core funding there is an expectation that international business, where it is necessary and appropriate, is a part of that core funding.

  Ms Winterton: Perhaps I could just add that the HPA is also leading in terms of European Union exercises on pandemic flu, so it is working at that level as well.


 
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