Examination of Witnesses (Questions 220
TUESDAY 1 NOVEMBER 2005
Ms Rosie Winterton MP, Dr David Harper and Dr David
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
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
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
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
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
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.