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The modelling shows that antiviral prophylaxis of the household contacts of infected cases given within 24 hours of symptoms appearing in index cases could have a greater impact on a pandemic than a simple treatment policy, reducing cases and hence deaths,
Why cannot the Government now take a decision to embark on this policy? I had a long discussion this afternoon with the noble Lord, Lord May of Oxford, who has repeatedly asked the same question. We are told that the Government are actively examining the feasibility of introducing the policy, but does the noble Lord accept that that is not enough; that there has to be a clear decision that this will be used? If this is not done, I suspect that the Secretary of State will find himself in an extremely embarrassing position if this pandemic subsequently spreads to the whole country.
Lord Darzi of Denham: My Lords, I am grateful to the noble Lord for his advice and for highlighting the evidence base. I agree that there are plenty of studies looking at seasonal flu in which prophylaxis for post-exposure has been used quite successfully, and I have no doubt that that information could translate into a pandemic situation as well. We do not have a view on this now for the simple reason that we need to consider the size of the stockpile we havewhich, as I said earlier, will treat 50 per cent of the populationversus the worst-case scenario.
A simulation of, what is the worst-case scenario, what is our stockpile? will be carried out and a decision will be made about a post-exposure prophylaxis. I am not excluding it; I am just making the point that we need to wait for evidence of the transmission of the virus and how quickly it is progressing to enable us to evaluate the worst-case scenario versus the stockpile. Otherwise, we may end up in the situation where we do not have a stockpile for treating patients who are infected with the flu. I promise the noble Lord that I will keep a close eye on this. The whole department, including my right honourable friend the Secretary of State, is looking at our policies on a daily basis.
Lord Turnberg: My Lords, I have two questions on the antivirals. My first question is whether we have a sufficiently rapid distribution process to make sure that the antivirals reach the GPs and patients when they need them. My second question relates to the availability of the doses. It is good to hear that we have enough for 33 million peoplehalf the populationbut would it not be wise to develop a greater stockpile? We would not then run into the problems that we have heard about in deciding whether to give the drug to close contacts.
Lord Darzi of Denham: My Lords, I am grateful for my noble friends intervention. On his first question on distribution, absolutely we need to have a streamlined
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I am also grateful for my noble friends advice on greater stockpiling. I reassure the House that everyone in the department is calling every manufacturer to ensure that we increase our stock. We have every intention of making sure that we have as much as possible. I have just given the figures about our stockpile of antivirals before the pandemic even hit the news. The House can be reassured that we are doing everything possible to increase our stockpiles, not only of antivirals but of the other medications that might be required in the event of a pandemic.
Baroness Finlay of Llandaff: My Lords, I thank the Minister for the leadership that he is providing and for the Statement he has given us today. However, I want to ask about antivirals and their distribution. Have healthcare workers currently looking after patients who are in isolation been given antivirals that they can start taking at the very first hint of a symptom? In their planning, are the Government considering distributing to first-range frontline workers antivirals that they can hold and start taking at the very first symptom occurring?
The reason that this needs careful consideration is that we know that containment is crucial in any type of epidemic. In the SARS epidemic, from which we can learn a lot of lessons, it was clear that containmentgeographical containment and the complete prohibition of movement in and out of the areawas key to what happened. That included the isolation of the healthcare workers who were involved in looking after those cases. I declare an interest as a co-opted member of the committee that is looking at pandemic influenza.
Lord Darzi of Denham: My Lords, I am not entirely sure about the healthcare workers involved in treatment, but I am more than happy to look into that and come back. The current policy, although we are always reviewing this, is that healthcare workers who get symptoms will be given the antivirals, but not in advance of seeing a patientin other words, not pre-exposure but post-exposure. I am happy to look into that further, though. That policy will continue to change. We are fortunate to have enough stockpiled to treat 50 per cent of the population, so we have leeway, but we could do more. The policy for staff regarding pre-exposure, post-exposure and symptoms could always change.
Lord Walton of Detchant: My Lords, it is reassuring to learn that this virus, H1N1, has, in many cases outside Mexico, produced a mild illness from which people have quickly recovered. There is, however, a microbiological principle that has been recognised for years, although I do not think it happens very often
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Also, is it not in fact an influenza A virus? The seasonal vaccine is effective against certain strains of influenza A. If it is likely that the seasonal vaccine might be of value, would it not be appropriate to be willing to distribute that at an early date if the number of cases increases in the UK?
I am grateful for the fact that there is no ban on travel at the moment, because at the end of next week I am due to travel for 48 hours to Boston, Massachusetts, to speak at a memorial service for a greatly revered colleague with whom I worked in 1953. Perhaps it would be wise if I took some Tamiflu with me. Would the Minister advise me to do so?
Lord Darzi of Denham: My Lords, I am grateful for my noble friends comments. I agree with him that the virus could behave in any way. We do not have sufficient evidence to see how it has behaved so far. There are all sorts of thoughts out there about whether it has become milder since it has been in the US. We do not even know where it started, although the major cases are in Mexico. We need to keep a close eye on these issues.
I do not know exactly how much of a stockpile of the seasonal vaccine we have from last year. I do not think the new vaccine is out yet. I am grateful for the noble Lords input on that, though, and I will be happy to look at it. Let us not forget that we do not yet have a case in the UK, but I hope I have reassured noble Lords that if there is one, we will look at all these possibilities.
Viscount Montgomery of Alamein: My Lords, the answer to the noble Lord, Lord McColl, about direct travel to Mexico seemed to be slightly equivocal, in as much as it is okay to go there from the UK but not from France. Will he clarify what the position is? What would he recommend with regard to direct travel from the United Kingdom to Mexico, as there is a large volume of traffic? I declare an interest in this.
Lord Darzi of Denham: My Lords, as I said earlier, today, we are not advising any restrictions on travel to Mexico. However, we are advising any person who is travelling to Mexico to be aware of the symptoms and to have clear advice on returning to the UK and on engaging with any passenger who becomes ill. The advice is that we do not have any restrictions, but people should be aware of the issues that have arisen. That could change tomorrow. I made it clear that the FCO is in charge of making the decision, and if it changes, as it did about travelling to Hong Kong during the SARS epidemic, then we will recommend that.
Lord Crickhowell: My Lords, I am a member of the Science and Technology Committee looking at this issue and a regular traveller to Mexico; I have been there every year for the past 10 years. I notice that
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My experience of the medical services in Mexico is that they are usually of outstanding quality, and I often wish that our hospitals could be as clean and kept in such a good state as many of its hospitals are. We are quite fortunate that the epidemic has come from a country with high medical standards and not from one of those parts of the world where the attention given to it might have been rather less efficient.
Lord Darzi of Denham: My Lords, I have no experience of the Mexican healthcare system, so it would not be appropriate for me to comment on that. I am aware, however, that at every port of entry there are clear signs saying that if you are arriving from Mexico then you need to contact an office, irrespective of which carrier is bringing you in. It is not a carrier issue, nor is it about your previous port of embarkation; it is about where you are travelling from.
Lord Soley: My Lords, the Minister may recall a debate in this House on 24 February of the ad hoc Committee on Intergovernmental Organisations, which dealt with the issue of the spread of pandemic diseases. It confirmed one of the things he has said: that this country is highly regarded around the world for its work within governmental and international organisations.
The committee was concerned about the area between the time that the disease is identified in animals and the time that it transmits to human beings. The majority of these diseases, as the Minister will know, come from the animal population. I appreciate that he may not have the answer to this immediately, but what involvement have we had with the office in Paris that deals with animal diseases, with regard to learning from the current situation, about the transmission point? When did the Mexican Government first become aware that this disease had emerged in the pig population, and at what point did we identify it as transmitting to the human population?
Lord Darzi of Denham: My Lords, I am grateful to my noble friend. I do not have any details about what contacts have happened. I reassure the House that the cross-Government contingency committee in this country, which we have described before as COBRA, is meeting, and the Secretary of State has attended. With regard to our information internationally, however, I could be reassured only that the WHO, as the noble Lord, Lord McColl, said, under the leadership of Margaret Chan, is doing a fantastic job in co-ordinating activities across the globe and trying to address some of these challenging scientific questions.
I also reassure my noble friend that in this country, when it comes to epidemiological science and the issue of cross-transmission, we have the best scientists and they are actively looking at this question.
Baroness Masham of Ilton: My Lords, how long do the results of a test take? Is this not an illustration of the need for rapid test results? Also, has there been a restriction on pigs in the infected areas, as pigs are carriers of heavy viral loads?
Lord Darzi of Denham: My Lords, the test takes a matter of hours. It is a PCR test, not a culture-type test, so I can reassure the noble Baroness on that. If there is a pandemicI hope that there will not bemost people will have their symptoms treated before the test. At the moment, we are testing anyone who may be infected. As for the restriction on animals, I have no information that any pigs in this country are infected with the virus, although I am not entirely sure what is happening in Mexico. We say that this is swine flu, but only a component of the virus is pig-related. This is not a situation in which a pig will infect a human. The virus is mutated. We believe that it has parts of human flu virus, parts of pig flu virus and parts of bird flu virus, but it is H1N1.
The Countess of Mar: My Lords, does the noble Lord agree that we cannot expect a vaccine soon, because the virus mutates rapidly? Therefore, it is important that we should observe simple hygiene practices at home when people have flu. For example, people should not use the same cutlery and crockery as someone with flu, they should not use the same towels, flannels and soap as someone with flu and, if possible, the patient should be isolated within the home, so that the vulnerableyoung children and the elderlyare not in immediate contact with them. Would that not be helpful? Will he also say for how long a patient is infective and can pass on the virus?
Lord Darzi of Denham: My Lords, on that note, as we are coming to the end, let me say that I could not agree more with the noble Countess. The most important message that we can get out is about preventive measures. We have all sorts of campaigns, such as Catch It, Bin It, Kill It, which means that, if you sneeze, catch it in a tissue, destroy that tissue immediately and wash your hands. These are the most important principles in preventing a pandemic. We are doing everything possible to get that message out to the community. I do not have information on the infectiveness of the virus, but I remind the House that in some cases the patient may be completely asymptomatic but still infective, so the infectivity period is so far hard to judge.
In May 2008, Richard Hoopers team produced its interim report, The Challenges and Opportunities Facing UK Postal Services. I remember reading it for the first time and thinking that Richard Hooper, whom I had met only a couple of times, had produced a pretty good report. However, it is a pity that it was ignored, or not developed, in the final report, which was published in December.Somewhere between the interim report and the final report, something must have affected the thoughts of Richard Hoopers team.
Most notable of these changes or omissions was the critique of the results of Postcomms botched introduction of competition, which was absent in the final report. Equally, the final report failed to add anything much on the universal service. The interim report noted of the universal service obligation:
It helps social cohesion by linking rural communities with more densely populated areas of the country, and ensures that older people and those with disabilities have an accessible, reliable means of communication and the capacity to send and receive,
mail. This was not developed in the final report or in the Bill. After all, the Bill removes the protection that these groups currently have under the Postal Services Act. Be that as it may, the failure of Hoopers final report to develop the debate on the future of the universal service is notable because the inquiry took submissions specifically on this question. However, the final report did not come to a conclusion on whether the universal service represents a burden for Royal Mail.
Probably the biggest indicator that the universal service involves a burden is the failure of the competition to make any moves towards competing for the universal service obligation. The obligation involves the creation of a network of capital, as we discussed on previous amendments, and workers capable of delivering the service. The competition has drawn the conclusion that it is not worth while challenging for the obligation. The only explanation is that this is a burden that the competition will not shoulder and that Royal Mail is too efficient in the delivery of this service for the competition to defeat. Such a conclusion would obviously be against Hoopers findings, but many of those findings are beginning to look faulty anyway, so perhaps the truth is both that the universal service is a burden and that it is delivered too effectively by Royal Mail for anyone else to consider shouldering that burden.
For the purposes of regulatory clarity and cost-efficiency, the amendments would direct Ofcom to analyse and come to a decision on the universal service costs. Postcomm failed to do this throughout its entire history, which was a pivotal point of its general failure. We must direct Ofcom towards a better policy. It may be argued that this would impose on Ofcom a very difficult task from the outset. Well, there is already a mass of material on methodologies that could be used.
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Lord Hoyle: In speaking to the amendments, my noble friend has made clear what he is aiming to establish. It is certainly a fact that no competition can be provided to Royal Mail at present or in the foreseeable future. We know that some people hope that one of the competitors may at some time be able to take over the full service, including the extra mile, but the competition is not there at the moment. In the mean time, as my noble friend says, there is no doubt that the universal service provider is losing money in taking on what is being asked for; the service is a financial burden to it. My noble friend is quite right to say that this matter should be looked at quickly. He is right to set a date by which it should be done and to say that we ought to know the cost to the universal service supplierRoyal Mailof undertaking these tasks. The service should not be a burden on it and we need a report as soon as possible. I am pleased to support the amendments that my noble friend has put forward.
Lord Razzall: I shall speak to various amendments in this group. I should assure the Committee that the reason for the state of my right eye is not that the debate on the Postal Services Bill has become aggressive behind the scenes. Nor is it anything to do with the noble Lord, Lord Mandelson, although I know that he gets blamed for a lot of things.
We propose that Clause 39 should not stand part of the Bill, and we have tabled Amendments 91 to 93, because our party has taken the view that one of the significant errors that has occurred in the operation of the services in question in the past few years is that the regulator was not tough enough to ensure that the Royal Mails competitors provided the appropriate payment for the universal service obligation. As we all know, many bulk mail producers have been using other contracts which have then required the Royal Mail to deliver through the post box. Many of those competitors have therefore been taking advantage of the universal service obligation and should compensate for it. Our amendments indicate that we do not think that there is any need for an Ofcom review, but that the Bill should state that those people should pay their appropriate proportion of the USO.
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