May 14 2009 ~ "Swine Flu" debate in the House of Commonshttp://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm090514/debtext/90514-0010.htm
That this House has considered the matter of swine flu.
The likelihood of the current outbreak of swine flu developing into a full-blown pandemic remains high. According to the latest figures, there are now 6,497 confirmed cases across the world, including 2,446 in Mexico, 3,352 in the US and 389 in Canada. Every continent has confirmed cases and there have been 60 deaths in Mexico, three in the US, one in Canada and one in Costa Rica. There are currently 78 confirmed cases in the UK—one in Northern Ireland, five in Scotland, 72 in England and none in Wales. There are cases in every region of England except Yorkshire and the Humber.
While there are still many uncertainties about this virus, scientists are learning more every day, and their findings are informing the preparations of the World Health Organisation and Governments across the world. The Scientific Advisory Group for Emergencies, chaired jointly by the chief scientific adviser, Professor John Beddington, and leading independent scientist Sir Gordon Duff, are gathering and assessing all the latest information available. This includes the work of researchers at Imperial college who have studied the evolution of the epidemic and whose findings were published earlier this week, and of course the Health Protection Agency, which has been to Mexico to study the virus in its place of origin.
Early studies indicate that this virus has pandemic potential. However, it is still a novel virus and it is difficult to say anything concrete about its severity, not least because there are many local factors that have an influence - availability of antivirals, the robustness of local health systems, standard of living and the prevalence of underlying health conditions. Currently, the virus appears to be milder than the most severe previous pandemics - notably the pandemic of 1918. But flu viruses are prone to mutation - it could become more virulent or it could lose strength over time.
Mr. Mark Field (Cities of London and Westminster) (Con): Obviously, all of us hope that this outbreak will not be as serious as the worst-case scenarios and projections. I thank the Minister for being in touch with me about one of the earliest cases in this country which affected a constituent of mine. I was grateful to be tipped off about that so early.
On 1 May the Evening Standard claimed that the response plan for London envisaged 94,000 deaths, with a hit list for every borough. Does the Secretary of State regard that as irresponsible, and was his Department involved in putting that press release out to that newspaper, whose Armageddon-type projections panicked people in London and beyond?
Alan Johnson: That was irresponsible, but as I have said before, the media's response has generally been responsible. That was an exception and, to its credit, the Evening Standard has apologised in advertisements throughout London.
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We do not know enough about the virus yet. It is important to note that countries in the southern hemisphere are entering their flu season, which may mean that the disease gains a firmer global foothold during our summer period. Past flu pandemics in the UK have been light in the summer with an increase in cases in the winter. It is possible, therefore, that there will be a second wave of the virus in the autumn.
We have yet to see sustained transmission within communities in the UK - that is to say, a significant number of cases between people who have no obvious connection to each other. We have one so-called de novo case, where someone has developed the disease apparently without being exposed to any close contacts who have the virus. The containment strategy that we have adopted - supplying antivirals as a preventive measure both to those who develop the disease and to their close contacts, and in certain circumstances closing schools, where disease can spread particularly rapidly - is effective in that it is delaying the spread of the disease, and buying valuable time.
It is unlikely that we can prevent a more widespread outbreak indefinitely. But while the number of people developing this disease will certainly rise over the coming weeks, we do not expect to have to move from containment to mitigation for several weeks. None the less, everyone needs to be prepared for the next stage, in which the outbreak can no longer be contained and has spread more widely.
There are three aspects that I want to touch on today. First, as I explained to the House in my statement a week ago, when the number of cases increases beyond a certain level, we will have to keep under review to what extent we supply antivirals prophylactically - in the first instance supplying them only to immediate family and household members and, on a post-exposure basis, to health and social care workers, rather than to all contacts.
Dr. Vincent Cable (Twickenham) (LD): Has the Secretary of State considered the special case of cabin crew of airlines travelling to and from the highly affected regions? They operate in a very unhealthy environment, and the airlines, especially BA, will not at present participate in prophylactic schemes. Can he give us some guidance on that?
Alan Johnson: My understanding is that airlines are prepared to give their staff antivirals. They are part of the employer groups to which we talk all the time through the business advisory group on the pandemic. They tell us that they are seeking to do so post-exposure and if any of their cabin staff are symptomatic. There are good occupational health systems in place. If the hon. Gentleman believes that that is not the case with some airlines I would be grateful if he could let me know, so that we can talk to the people concerned.
Mr. Andrew Lansley (South Cambridgeshire) (Con): On that point, the Secretary of State will recall that on 27 April, when he made his first statement on the issue, I asked about people who necessarily had to travel to infected areas. One might argue that that now includes such a wide area - including the US - that any measures are impractical, but it is difficult for those travelling to Mexico City, for example, to access Tamiflu, even on a private prescription. Does the Secretary of State have
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any measures in mind to allow modest access to the Government's stockpile for people who have to make such journeys?
Alan Johnson: The hon. Gentleman's sense of the stage that we have reached is right. However, such a proposal might still be pertinent for Mexico, where there have been the most fatalities. I shall look into that. It has not been raised as an issue in the wider discussions that we have had with people who are in this situation, but I know that the hon. Gentleman has raised it before. It is a valid point.
My second point is that there are steps that people should be taking now so that they are fully prepared for the next stage. The principal objective is to avoid those who are symptomatic spreading the illness further by continuing to move around the community. Everyone should think about identifying what we have termed as “flu friends” - neighbours, friends or relatives who live nearby and who can pick up medication and food for those who develop the disease so that they can avoid leaving the house and spreading the virus further. We should also all be thinking about friends, neighbours and family members who live on their own, and how we can best help them should they fall ill. Primary care trusts are already identifying patients they know to be vulnerable and making sure that they have someone who can help them.
An essential element of the mitigation phase will be a system for ordering and distributing antivirals. As I explained in my statement last Thursday, the flu line will be ready in the autumn. It is a ground-breaking system and the first of its kind in the world. It will be able to assess people via either the internet or telephone, it will be able to co-ordinate the distribution of antivirals and it will be fully plugged in to local health services. It will have the capacity to cope with the huge surges in demand that are likely if the virus becomes more widespread. It will have been thoroughly tested so that staff, patients and the public can have full confidence in its efficacy.
If we need to move from containment to mitigation before the flu line is ready, we will need to have arrangements in place that enable those who develop the disease to get treatment as quickly and effectively as possible without unnecessarily exposing more people to the virus. In addition, local health services will need to be able to respond to people's everyday health needs, as well as concentrating their efforts on providing specialist support to those who develop this strain of flu and are severely affected, and those who have underlying complications that make them particularly vulnerable.
The interim service that we expect to have ready shortly will consist of a phone service that the public can access through a single 0800 number, and a supporting website application. That will mean that people can have their symptoms assessed either over the phone or online. Those symptoms will be checked against an algorithm - a list of the key symptoms and factors that determine whether the patient in question has been
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exposed to the infection. This is a system similar to NHS Direct, which is currently used by millions of people every year.
If it is established that someone has developed swine flu, they will be issued with an authorisation number that they will then need to access antivirals. Their go-between - their flu friend - will then take that authorisation number to their nearest collection point to obtain the antivirals. That system is being thoroughly tested over the next few days, and we expect the online aspect of it to be fully operational as soon as it is needed - within a week if necessary.
Mr. Lansley: The Secretary of State says that the flu line might be available in the intended form in the autumn, but the deputy director of national influenza-pandemic preparedness told the Lords Select Committee on Science and Technology in March that it would be available in May. It is now May, and we have been told that it will not be available until the autumn. Will the Secretary of State explain?
Alan Johnson: I think that the director concerned would say that that was an over-optimistic assessment. It is a very complicated system. There was a need to ensure that it was tested thoroughly and that we did not bring it into use before it had been rigorously tested, although we could have done so in this particular pandemic. As I have said to the House before, I believe that it is best to have that system ready to come online in the autumn and to have something available. We might not need it until the autumn - we might not move to a mitigation phase by that time or be at the level of mitigation that would mean that such a distribution system would be necessary. I am confident that once the flu line is up and running it will do what it says on the tin, and will do everything that we have planned for it to do.
Finally, I want to update the House on our work to secure a vaccine. The best protection we can offer people is vaccination, because by giving people some form of immunity to the virus, even at a low level, we would achieve a significant reduction in the severity of any pandemic and, in particular, in the number of deaths or serious complications. We are now much closer to obtaining a vaccine. British scientists working for the Health Protection Agency in Colindale have already identified the genetic fingerprint of the virus. The National Institute for Biological Standards and Control in Potters Bar has now taken that isolate and is developing it into a vaccine strain.
It is a long journey from identifying the virus to making a vaccine available. It is our intention to acquire sufficient stocks to vaccinate the entire UK population. We have advance purchase agreements with manufacturers that will be activated if the World Health Organisation moves to phase 6 - that is, if it declares a pandemic. We are still at phase 5 at the moment. However, we have always known that it might take four to six months before a matching vaccine becomes available, and more than a year before it can be manufactured in sufficient quantities for the entire population, given that international demand will be high.
Mr. Mark Field: Given the delay that the Secretary of State has mentioned, can he give the House some historical indication of how quickly phase 5 turns into a phase 6 pandemic? I appreciate that we are dealing with a
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unique sort of influenza, but can he give some indication of whether the four to six-month delay to which he refers might be overtaken by events? When we move to a phase 6 pandemic, we need to ensure that we have gone through this phase in such a way that we will be able to mitigate at the earliest opportunity.
Alan Johnson: I cannot give any indication of that. Phase 5 means that a pandemic is imminent - it does not mean that it is inevitable. There is no historical precedent for how long we are likely to stay at phase 5. The WHO meets in Geneva at the weekend and it might decide then to move to phase 6. My feeling is that it will not and that it will be a little while yet. Nevertheless, I believe that we will get to phase 6, but I cannot give any indication of the timing.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): Will the Secretary of State clarify whether the delay is caused by scientists all around the world going flat out to devise a vaccine, or perhaps it lies in the production of the vaccine once it has been designed, because it takes so long when we use an egg-based system? Are there new systems that mean that once we get the vaccine and manufacturers allocate capacity to it - if that is the decision - it will be available, at least for the countries that buy it?
Alan Johnson: It is a mixture of the last two points. It takes a long time to produce the vaccine. We have one contract for an egg-based vaccine and another for a cell-based vaccine with Baxter. Getting the virus is a labour-intensive system. It is not like the identification; that bit has been done, but the next bit is what takes a long time. Manufacturers need to obtain sufficient quantities to manufacture, and the manufacturing then takes a long time. Given that countries in every part of the world are entitled to a proportion of the vaccine - our advance purchase agreement is good, and other countries have advanced purchase agreements, too - it would be wrong for 100 per cent. of it to be coming to the UK while people were dying in other countries.
For all those reasons, it is important to be clear to Parliament. Some of the commentary that I have heard has mixed up our saying that we will not begin to have this vaccine ready for four, five or six months with a belief that it will be ready for 100 per cent. of the population within that time scale. Our national framework always set a period of between 60 and 79 weeks for completion of the process for 100 per cent. of the population, but we are currently in negotiation with manufacturers to see whether we can obtain early supplies at this pre-pandemic phase. We hope that that will enable us to vaccinate front-line health and social care staff and vulnerable groups who prove particularly susceptible to infection, before a predicted second wave hits.
Mr. Robert Syms (Poole) (Con): On a related point, I know that masks have been ordered for NHS staff, but are there any plans to distribute them more widely? What impact do they have? When there were problems in the far east, one saw members of the public wearing masks on trains and so on. Secondly, what about hand wash? I notice that some London schools are asking parents to wash their hands as they go in and out. Is that effective? What are the Government's views on that?
Alan Johnson: We have discussed face masks before, and we are ordering 226 million surgical face masks that are coated and have a protector, as well as 34 million respirators. They are for front-line NHS and adult social care staff, not for the general public. As we have said before, the WHO and all the relevant experts have made it clear that it is fairly futile for people simply to put a strip of cloth over their mouths; indeed, that may even be counterproductive, because it can cause people to believe that other safeguards need not apply.
Mr. Lansley: The Secretary of State said that 226 million face masks had been ordered, but when and how will they be supplied? Does the Department have some stockpiled? The normal use is 31 million a year, so there is a big difference between the target and what we have. Secondly, the Department's guidance on face masks made it clear that there is no evidence that they do much good when used by the general public - but the exception to that involved infected people who are shedding the virus. The guidance suggested that they should wear a mask if they have to leave home, because that would reduce the risk of other people being infected by the virus that they emit.
Alan Johnson: We do have stock from some suppliers, and the first supplies are due to go to the NHS this weekend. The company manufacturing the product has done extremely well, and we are expecting something like 20 million masks to be available every month. I shall check the precise figure, but that is what I recall. The total will also ramp up over time, so we are expecting our order to come through pretty quickly.
The hon. Member for South Cambridgeshire (Mr. Lansley) is absolutely right about the guidance on masks. Our supplies will be focused on front-line NHS and adult social care staff, but other people too would benefit from wearing them. They include those in the categories that he described, as well as those who for other reasons will be in close proximity to symptomatic patients.
We cannot move to a pandemic-specific vaccine and trigger our advance purchase agreements until there is a pandemic, and, as has been noted, we do not know for how long we will be at phase 5 as a precursor to phase 6. If a pandemic is declared, manufacturers would be expected to switch from production of the seasonal flu vaccine to a pandemic vaccine.
Our ambition is to secure a swine flu vaccine without jeopardising our supply of the seasonal flu vaccine. It seems likely at this stage that manufacturers can complete the production for this winter over the next month or so, and have that ready before capacity is switched entirely to the production of swine flu vaccine.
John Mason (Glasgow, East) (SNP): Will the Secretary of State clarify what he means by securing and purchasing early supplies of vaccine? Does that mean that we are somehow jumping the queue? My colleague in Edinburgh said the same thing this morning.
Alan Johnson: We are not jumping the queue, and the discussions are still going on. They are commercially sensitive, but although we cannot access our APAs until
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we are at phase 6, we have an opportunity to make some progress before the pandemic takes hold. We are exploring how much we can produce in that period, and other countries will be doing the same. It seemed sensible to us to see what we can do, rather just waiting to activate the APAs. It is by no means certain that we will be successful, but it seems the proper thing to do, and I shall say a little more about that in a second.
Understandably, hon. Members will want to know whether a vaccine that is developed today, based on what we currently know about the virus, will be effective if the virus mutates. The immunologists, virologists and epidemiologists who advise the chief scientist and the Health Protection Agency are very clear on this point. Even on their most pessimistic estimates - that is, if the vaccine were to give only a low level of protection - that would significantly dampen the virus's severity and its ability to spread, and reduce the possibility of people developing complications.
The unanimous advice of the scientists is that we should move as quickly as we can to get as much vaccine as we can at this stage. That is what we are attempting to do, although we are not trying to deny other people the chance to get the vaccine as well.
Dr. Evan Harris: I fully support the Secretary of State's basing his decisions on scientific advice. The Phillips report showed how important such advice is, but does the right hon. Gentleman accept that, in a few aspects of vaccination policy, there will also be questions of judgment that go beyond scientific advice on the ethics? One such question - about jumping the queue - has been raised already, but others involve exactly who gets the vaccine first, and how we deal with supplies in the private sector. Although the answers to those questions can be informed by Government policy to an extent, I hope that he will accept that the wider House beyond the Front-Bench teams should be engaged, as well as civil society. We need to have those debates now, before the vaccines become necessary and the arguments rage, because that gives us a better chance of achieving consensus.
Alan Johnson: I have no problem with such ethical debates taking place. When a pandemic is declared, the whole system and all the manufacturing capacity must in effect be put at the service of the WHO, because that is how we can ensure a proper spread of vaccine. That is the important ethical point at this stage.
No single action will prevent this outbreak from becoming more widespread, but we can continue to contain the virus, using antivirals as a prophylaxis. We can make sure we have the drugs that we need to treat the virus and any complications that occur, and we can begin to vaccinate the whole of the population as soon as possible. We can keep people informed and enable them to protect themselves and their families. Finally, we can be thankful for our NHS and the people who work in it and with it. Throughout its history, and in the most critical situations, it has proved its ability to rise to any occasion.
Although the threat of a pandemic is unlikely to diminish in the weeks and months ahead, we can be reassured that our preparations are thorough and that our actions in dealing with this infection are in the hands of dedicated professionals. I commend the motion to the House.
Mr. Andrew Lansley (South Cambridgeshire) (Con): May I first thank the Secretary of the State for Health and the Government for responding positively to our suggestion that we have a debate? Hopefully, it is not premature; we entirely understand all the uncertainties that remain. In truth, it is less than a month since the circulation of the virus was first identified to the World Health Organisation, so there will be uncertainties about the nature of the virus, its characteristics, how it affects humans and what we should do about it. However, it is a good time to consider how we should approach the issue, particularly with regard to vaccines, not least because the strategy is beginning to take shape. I agree with the hon. Member for Oxford, West and Abingdon (Dr. Harris), who was in the Chamber earlier, that it is also a good time to discuss prioritisation, use of resources and the ethical issues that might emerge from that if there were to be a substantial spread of the virus in the months ahead.
May I echo what the Secretary of State said about our thanks to the NHS? I thank not only NHS staff generally but, through him, those working in the Department of Health and the Health Protection Agency. In particular, the staff in pathology laboratories in heath protection units across the country have literally worked 24/7 on very large numbers of suspected cases. I know that we are dealing with 72 confirmed cases, but they have now dealt with perhaps tens of thousands of suspected cases, and pushing those cases very rapidly through the system has been a tremendous burden on them.
Mr. Syms: I know that a lot of the technical staff in the NHS who work for pathology labs have, in the past, felt a little under-appreciated, in terms of pay and conditions. Given that they are doing an excellent job, it might in future be worth reflecting on the fact that when a doctor decides to do a test, it is actually somebody in a pathology lab who carries it out.
Mr. Lansley: Since my father was, 30-something years ago, chairman of the Institute of Biomedical Sciences, I am sure that biomedical scientists will not be least among those who will appreciate what my hon. Friend says on that matter.
A debate gives us an opportunity to discuss some of the issues, as distinct from asking questions, as we have been able to do after the statements that the Secretary of State has kindly made. In particular, as we begin to discuss the nature of the virus and how it might spread, there has been a tendency on the part of many in the media to assume that even though the flu that we are discussing is very much milder than the 1918 flu, the pattern of its impact will be like that of the 1918 flu. In 1918, of course, there was an initial, relatively mild spread, in which no very large proportion of the population was affected. About three months later, there was a severe impact, with large numbers of cases and a very high fatality rate. In early 1919, there was a third wave. The assumption is that, somehow, it must happen like that.
It is important for us to bear it in mind that in 1976 in north America an H1N1 virus circulated. It was not particularly severe. It did not have a clinical attack rate on the scale of that in 1918. Quite properly, the American
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Administration at the time developed a vaccine, but in the expectation that the virus would recur in a second wave, in the way it had done in 1918, they vaccinated the whole population, which, as it turned out, was an error; they should not have done so. There were significant side effects. There was not a second wave. Clearly, with the benefit of hindsight, it is clear that the proper public health response would have been to acquire the vaccine - to stockpile it - and then to see whether there was an intimation that a second wave was coming. I hope that the Secretary of State does not dissent from that.
That is not to say that we necessarily know what the strategy needs to be, but it is important that we do not make an assumption at this point about the future profile of the spread of the virus. For that matter, we do not know whether there will be sustained transmission in other countries. Clearly, from Mexico to America, between, it turns out, the middle of February to the middle of April, there were significant opportunities for the virus to spread from Mexico to America, which made it very difficult for the Americans to achieve containment. However, in many other countries, we are achieving containment. If we can continue to do so, we may find that we can delay phase 6 until we have made dramatic progress in the development of a vaccine. That is important to bear in mind.
I confess that this is entirely speculative, but when one looks at the genetic make-up of the virus - as I know will be done, not least in Mill Hill - and compares it to viruses in the past, it is interesting to see that it emerged in north America, and that H1N1 in 1976 was, to some extent, related to the outbreak in 1918 in a very limited way. It is also interesting that in Mexico, the virus has impacted on younger adults. Arguably, it is possible that some older adults in Mexico had some vestigial immunity from exposure to it in 1976. It may or may not bear some genetic relationship to the H1N1 that circulated in 1976, but if it does, that would point to it being less likely to be virulent and severe than was originally feared when it first emerged.
The Secretary of State and I share a view about how to respond to this matter. I score no points on this. The Opposition have raised issues with Ministers on 77 occasions since June 2004, and we have talked to Ministers repeatedly, including the Secretary of State's predecessors, about the importance of pandemic preparedness - admittedly in the context of H5N1, which would be a major threat. Issues such as the antiviral stockpile, the stockpile of face masks, and the need for critical care capacity and for an advanced purchase contract have all been the subject of our questions to and responses from Ministers.
My only reservation about Britain's preparedness was that the extension of the antiviral stockpile could have been initiated sooner, rather than when H1N1 emerged in Mexico. Clearly there is the issue with the national flu line, which I asked the Secretary of State about, and the Government would have achieved that sooner had it been possible to do so. As for stockpiling face masks and gloves, the French bought 200 million, from recollection, in about the latter part of 2005, so there is a gap between what we were asking about and what has been achieved. None the less, we are among the best prepared countries in the world, and I will return to what that might mean in terms of our obligations in relation to other countries.
I want to raise about half a dozen points, both to express a view and to see whether the Minister can add anything beyond what the Secretary of State has already said when she replies. The Secretary of State knows the Opposition's view on vaccine availability, because he has kindly involved us in conversations about this from time to time. By way of a brief detour, I should say we must not get this out of proportion. The Imperial college modelling talked about a central estimate of a 30 per cent. clinical attack rate, and a 0.4 per cent. fatality rate, but that was on a global basis. The virus may spread to a quarter or more of the British population in the longer term, but we have good reasons at the moment - not least because in America there have been just three fatalities compared with more than 3,000 confirmed cases - to hope that the fatality rate in this regard in a developed health economy will be low, and barely more than would be the case for seasonal flu. That being the case, it does not suggest that it is in the interests of a country such as Britain for seasonal flu vaccine production to be diverted at this point to pandemic flu vaccine production. Our view, which I expressed to the Secretary of State earlier in the week, is that we would certainly support the continuation of seasonal flu production, not least because we are probably only about two months away from the point at which, in a normal process, the availability of that vaccine would have been achieved. That gives us the basis on which we could move on towards pandemic vaccine production immediately.
We would support the securing of an additional supply of a vaccine for the novel H1N1 virus on a pre-pandemic basis in parallel with seasonal flu vaccine production if that is possible, as the Secretary of State says. If the seed strain is available in a matter of days, we may infer that, probably by the end of September, supplies of a vaccine would, if necessary, begin to become available for health care workers and others who are most likely to be at risk. The chances are that any second wave would be initiated by an event such as the return of children to school - schools tend to be the so-called super-spreaders and the virus tends to spread faster among young people, meaning that it could be transmitted through the population.
Mr. Syms: In recent years, there has been a lot of emphasis on GP surgeries writing to people on their lists to ask that they be vaccinated from ordinary flu. What advice ought the Government give to GPs about communicating with people who use their surgeries? Should surgeries hold back, or should they go on with the traditional campaign, which has increased the rate of vaccination quite substantially?
Mr. Lansley: I understand my hon. Friend's point. My answer - I hope the Secretary of State agrees - is that we would normally expect to invite people to come for seasonal flu vaccine in late September or early October, and I see no reason why we should do differently. The period between now and then gives us the opportunity to learn far more about the nature of H1N1 and who it is likely to impact.
It is important to remember that we may be dealing with very different kinds of flu. Obviously, seasonal flu tends to have an impact particularly on older people, which is why they are summoned for seasonal flu vaccination, but H1N1 has an impact on younger adults,
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so by late autumn we may be dealing with different vaccination programmes with different population groups being targeted as priorities.
To be absolutely clear about the use of the antiviral stockpile, I think we agree that for the time being, we are devoted to containment, which requires post-exposure prophylaxis, meaning that everyone who is known to have come into contact with the virus should get the antivirals. We should sustain that for as long as we know that containment stands a chance of success. However, it is important for the public to know something about the trigger for shifting from a strategy of containment to one of mitigation. For example, when we reach 200 cases of seasonal flu per 100,000 population in a week - that is on the Royal College of General Practitioners flu line - we say that the virus is circulating in the community. Are we talking about a similar or a lower number of cases in relation to the novel H1N1 virus? Are we talking about the point at which significant numbers of people are confirmed as having the virus but we cannot identify how they contracted it? What sort of volumes are we talking about? What are the triggers to shift from containment to mitigation?
Once we are in mitigation, I cannot see, given what we know about our access to antivirals now and for the rest of the year, why we should not sustain a policy of household prophylaxis to support families by reducing the impact, and post-exposure prophylaxis for health and social care workers to keep them at work. That will not stop people getting flu, but it may well mean that large numbers of people find they are affected very little. They can then be vaccinated which, in the long run, will reduce the number of people who have to be hospitalised or, indeed, the numbers who die.
The Secretary of State did not talk about school closures, but I should like to inquire whether the Government wish to have a debate on the matter. The Americans have moved quite quickly from a policy of closing a school at the point when a case is confirmed in the school to a policy of not closing schools but carrying on, because the economic detriment is greater than the benefit to be derived from school closure and the virus is now assumed to be circulating generally in the population in America. Those are difficult judgments, because one is balancing, on the one hand, the pace of spread of a virus with a health impact on the population against, on the other, the economic, educational and other impacts of maintaining a policy of school closures. The Americans have chosen the path of stopping automatic school closures quite quickly. Clearly, in our present circumstances, it is right for us to implement school closures where cases are confirmed. The Government's contingency plan does not contemplate moving away from a closure policy, but given the American experience and the nature of the virus, is it not time for us to think about and discuss such a move?
Mr. Syms: Whose decision is it to close a school? Is it the Department of Health, the chief executive of the local authority, the education authority or an independent body? Who decides and what is the policy?
Mr. Lansley: The decision is taken by the head teacher and governors of a school, but essentially the head teacher, on the advice of the health protection unit. My
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assumption is that if we were experiencing a pandemic involving a virus with very severe effects, it would be possible for local education authorities to take a general decision, which clearly they would do based on advice from the chief medical officer and the Government. However, I do not think that we are contemplating anything of that nature; at present, the decisions are made by schools. I do not anticipate head teachers, where they have a confirmed case and where the health protection unit is pursuing a containment strategy, would do anything other than close the school, for at least a week and perhaps, it could be argued, for a little longer.
I should be grateful for further opportunities to discuss the policy and what the modelling might tell us about the benefits and costs of a different strategy on school closures. The original scientific modelling of a pandemic suggests that a school closure strategy with prophylaxis would have a significant benefit, but of course that modelling related to a virus that probably had more severe effects than the one we are dealing with now.
We have not previously raised this in detail with Ministers, because it seemed premature to do so, but given what the Imperial college modelling suggests about the impact of the virus, I think it is appropriate to do so now. The Americans have a 5 per cent. hospitalisation rate, so although they are handling the virus successfully, not all victims are staying at home. Our critical care capacity compared with that in other countries is therefore an important matter for us. I hope that the Minister of State will be able to tell us what measures the Government have taken to support additional critical care capacity - for example, ensuring additional ventilators are available.
The latest data on adult critical care services in a number of the most developed health economies are found in the Society of Critical Care Medicine's 2008 study. It sets out the number of adult intensive beds per 100,000 people - that is the relative measure. France has 9.3 per 100,000, Canada 13.5, the Netherlands 8.4, Spain 8.2 and the United Kingdom 3.5. The House will note the apparent substantial disparity in the availability of critical care capacity in this country and in many other countries.
Anyone who has visited critical care units recently will know that they are generally full. The ethical and prioritisation impacts of a pandemic are therefore likely be encountered rather faster in this country than in many others. Fairly quickly, we will have to turn beds that would otherwise be occupied by elective patients into beds where there is some degree of high-dependency support for patients suffering the complications of flu, because we do not have spare capacity in our critical care units.
My last point, which we have discussed during each statement that the Secretary of State has made, is about what we can and should do - alongside our primary responsibility to ensure that Britain is as well prepared as it can be for a pandemic - to support other countries. The Secretary of State will know that the Department for International Development has made additional money available to support the relevant UN unit and £5 million in special support to the World Health Organisation. When the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), replies, however, will she say some more about our approach as time goes on, not just as a contributor of financial support to other countries, but in respect of
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critical resources, particularly antiviral stockpiles and vaccines, when - later in the year, perhaps - we know that we are relatively secure against the impact of the virus while other countries may be anything but, having neither antivirals nor vaccines, poor surveillance and limited health care resources?
There are relatively few cases in Africa, but the WHO in Africa is already only too aware of the risk. To add to the risk, southern Africa in particular has large immune-compromised populations as a result of HIV. There may come a time, if the virus were to spread as a pandemic, when we have to make tough ethical decisions about the proper use of our stockpiled resources for the greater good, rather than for pure self-interest. I am grateful to the Secretary of State for giving us a further update and enabling a discussion of the issues, and I look forward to the right hon. Lady's response.
John McDonnell (Hayes and Harlington) (Lab): I shall briefly raise some constituency concerns about the issue. I must apologise, however, because I am supposed to be chairing another meeting so, although I shall try to return for the ministerial response, if I cannot, I look forward to reading Hansard or any correspondence that I receive.
With Heathrow in my constituency, there is a particular concern about the vulnerability of its staff and the wider community. It is the largest airport in the country, so, naturally, it is potentially the country's largest entrance point for virus carriers. Concerns have been raised about cabin staff, but the issue goes wider than that, because anyone entering the country will come into contact with other passengers, cabin staff, immigration officers and staff in the wider terminal. Our concerns are that the infection could spread to the wider community and place demands on our local services.
I should welcome information, advice and assurances about the procedures that have been established to deal specifically with ports of entry. In particular, I should like assurances about the dissemination of information to staff, their training to spot the factors that they must consider regarding passengers, including the symptoms that passengers report, and the advice that staff relay to passengers about the actions that they should take. The issue is about ensuring that not just cabin staff, but a wide range of staff are properly informed and advised.
In addition, has there been any consideration about additional protection for staff members at ports of entry? There have been discussions about masks, but it is also important to bear in mind that, apart from health staff and others, staff at airports may need priority vaccination.
I am also concerned to secure assurances about the resourcing of Heathrow's health unit, because, over the years, I have made representations about its funding. The unit now comes under the Health Protection Agency, and the Government have allocated additional investment over the years, so I hope that we have resolved many of those past complaints. However, there have been some media reports about under-resourcing at the health unit at Heathrow. I would welcome assurances on that and on what discussions and consultations are taking place, particularly with staff at the unit, about the need for additional resources to cater for the virus.
The other issue for me is that if a carrier infects members of staff at Heathrow, they will in turn infect the wider local community. I welcome assurances that the situation is to be specifically monitored in my area. If we find higher incidences of infection there, what resources will there be for the local primary care trust and, in particular, for Hillingdon hospital? Over the years, the hospital has played a vital role in responding to passengers' health needs as those needs are identified at Heathrow; if a passenger becomes particularly ill, Hillingdon hospital will normally deal with them.
There might, however, be a wider incidence of infection among the local community as a result of Heathrow staff's vulnerability, so I would welcome information about what discussions have taken place with the primary care trust and Hillingdon hospital trust about planning for that situation and the additional resources required. The issue is not about raising fears and anxieties among the local community, but about reassuring airport workers that their concerns are being taken into account and that plans and consultations are taking place to ensure that they are properly protected. The wider community will also be protected as a result of such efforts.
I am not yet aware of the various structures that have been put in place. The Secretary of State referred to industry discussions; I would welcome further information on those and his assessment of how the industry and the individual companies are responding to their discussions with the Government. I am particularly interested in the response from the local primary care trust and Hillingdon hospital itself. I should like to know about what additional briefings have been provided to my local general practitioners. As I said, I do not mean to raise anxieties, but Heathrow is the largest point of entry so there is a particular vulnerability. I would welcome assurances that the issue was being specifically addressed.
Heathrow has learned lessons from various health incidents, and that has enabled the development of a robust system that has stood the test of time. However, our anxieties about the scale of the potential pandemic mean that we in the local area need to be even more assured that the Government have given attention to Heathrow, its role with regard to the virus and the additional resources which may be required and which the Government are willing to allocate.
Norman Lamb (North Norfolk) (LD): I start by expressing my appreciation of the fact that this debate is taking place; it is an opportunity to discuss further the development of a potential flu pandemic. I join the hon. Member for South Cambridgeshire (Mr. Lansley) in thanking the Secretary of State for updating us between the debates in Parliament; that is appreciated, and helpful from our point of view. Finally, I pass on my thanks and appreciation to national health service staff - pathology staff, in particular; the hon. Member for South Cambridgeshire also referred to them. They are working beyond the call of duty at the moment, and that is appreciated by all. The Secretary of State gave encouraging news about a pre-pandemic vaccine. That is an encouraging development.
We face something of a difficulty at the moment in that this item has slipped off the news agenda, not only because other items relating to this place are rather
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dominating things, but because the prevalence and virulence of the flu has so far been slight. There is therefore a danger that we are lulled into a false sense of security and people start to say, “What's all the fuss about? Hasn't there been an overreaction? People who have suffered from it have recovered very quickly.” It is very important - the Secretary of State made this clear, and I share his view - that we maintain absolute focus on this, and get the message across to the public, in recognising that we do not know the implications of this or the extent to which the virulence will increase as the strain develops and potentially changes in character.
I was struck by a recent BBC report about what is happening in the United States, which noted that there has been a significant increase in reported cases. The numbers have gone up by 600 since last Friday, and there have been 2,532 cases. As the Conservative spokesman said, the Americans are no longer closing schools because the disease is now recognised to be in the general community. The truth is, of course, that the American health system has no mechanism for controlling or monitoring the development of this epidemic. There are genuine concerns about its potentially spreading very rapidly from the US into Europe. Of course, the amount of travel between Europe and the US is vastly greater than that between Europe and Mexico, so we have to be prepared for a rapid advance.
Mr. Lansley: Before we leave what the hon. Gentleman says about America on the record, I think, having been in the control room at the Department of Health and Human Services in Washington and discussed with people how they would respond to a pandemic, that the Americans have all the resources and legal powers that are necessary for surveillance and counter-measures to respond to a public health impact. We should not confuse the limitations of access to American medicine with limitations in the American response to public health demands.
Norman Lamb: I hear the hon. Gentleman's reassurance, but the views that I have heard expressed do not match his confidence about the American capacity to spread messages and to ensure concerted action that is similar to how we have been able to produce a national plan that can then be implemented at all local levels. He may be right, but concern is being expressed that the system in the US makes things more difficult.
If there is to be a rapid increase in the number of cases in the US, what is the Secretary of State's advice for people travelling there - they may be planning holidays now - about whether to go and what precautions they should take when they get there? A report that appeared in The New York Times a couple of days ago refers to a leading American infectious disease expert who has been in Mexico helping the Mexicans to tackle the swine flu outbreak and learning the lessons from that. It reports that many people who are suffering from the disease appear to be showing no symptoms of fever, which makes screening much more difficult and increases the difficulty of controlling it. I am not sure whether the Secretary of State and the authorities in this country are fully aware of what is being discovered in Mexico, but it is critical that we rapidly learn the lessons from that. According to the report, half those with the milder cases did not at any stage develop fever.
It is also reported that 12 per cent. of patients in two Mexican hospitals are suffering from diarrhoea as one of the symptoms of their condition together with respiratory problems. The point is made in the article that there are implications for infection control, particularly in poorer countries, if diarrhoea is one of the symptoms that emerges from this strain. The advice that is reported is that stools should be tested for the presence of swine virus. When she winds up the debate, will the Minister of State say whether any such advice is coming across to the Health Protection Agency? There has been no reference so far to such testing, so has that been properly monitored?
It is also reported in the article that the expert doctor from the United States, Dr. Wenzel, suggests that there should be testing to determine whether there are people without symptoms who are still carrying the virus. The Secretary of State mentioned one case in the UK of someone who has had a confirmed diagnosis but who has had no apparent contact with anyone who has suffered from the condition. Is a possible explanation that people carrying the virus may not be showing any symptoms? That would make control much more difficult. It is also reported that an unusual feature of the Mexican epidemic is that there are apparently five different influenza viruses circulating at the same time, making it much more difficult to plan and to judge how the swine flu virus will develop.
All the things that I have mentioned from the article are happening in Mexico. Will the Minister comment on the international learning process to ensure that what we are finding out from Mexico is being fed into public health messages in this country, and that the appropriate advice is being disseminated?
It is also reported that pneumonia rates at one hospital were at 120 a week, compared with an average of about 20 a week. That is clear evidence of the complications that can emerge from flu, which the Secretary of State has previously mentioned. That significant increase in pneumonia cases reinforces the importance of preparedness for such complications. Will the Minister comment on the development of the purchase of antibiotics? I know that the Secretary of State has addressed that, but I should like to know where we have got to on that.
The final, really important, point in the report is that Mexican doctors have apparently activated a programme to allay the anxieties of health staff. The expert from the United States commented that that matter had not been sufficiently addressed in the US. It is critical to remember that there will be health and social care staff who are extremely anxious about their own health and family circumstances. The programme has been activated to provide information to staff, a hotline, psychological support - that is critical - and medical examinations. I am sure that that is part of the planning process, but can the Minister reassure us that the matter is fully recognised as an important priority?
My hon. Friend the Member for Twickenham (Dr. Cable) mentioned BA cabin crew, and the hon. Member for Hayes and Harlington (John McDonnell) raised concerns about both cabin crew and airport staff. The reports that my hon. Friend has had suggest that cabin crew working on the route between Heathrow and Mexico City have not been receiving the duty of care from BA that one might expect. It is worth making the point that the circumstances have provided a potential profit for
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BA. I saw a report that single tickets from Mexico City to Heathrow are being sold at $4,000 each. There is a premium in getting out of Mexico -
Norman Lamb: I note the hon. Gentleman's comment. BA has been making good money out of the situation, but BA staff have been anxious about whether they are being sufficiently protected. Professor John Oxford has expressed surprise that BA has not ensured that all cabin crew are given Tamiflu. He makes the point that toilets on board on aircraft are the focus for infection during a flight, because people sneeze, then visit the toilet, and the infection gets on to handles, taps and so on. In the Minister's closing remarks, will she confirm the specific advice being given by the Health Protection Agency to airlines to ensure that every step is taken to protect the health and safety of cabin crew and passengers on flights, particularly those flying between heavily infected areas and the UK?
Mr. Syms: The rate at which cabin air conditioning works is also an issue. When smoking was allowed on flights, the rate had to be very high, but it is turned down now that smoking is not allowed. Given the relationship between the air conditioning units and fuel, that means more germs can circulate. What advice are the Government giving to airlines?
Norman Lamb: The hon. Gentleman makes a good point. We all know that flights are a perfect breeding ground for infections, and it is important to take every step to ensure that all airlines meet the highest possible standards, and that they meet their duty of care to their staff and passengers. I have had reports that different airlines are responding differently, but the same high standards should apply to all airlines, so that all staff are protected.
Critically, the Treasury appears to have delayed the implementation of the flu line for some seven months. Under freedom of information legislation, I am seeking further documentation about why the implementation has taken so long. From newspaper reports and board minutes, we know that the NHS Direct board was getting increasingly frustrated by the apparent delays at the Treasury. Will the Minister comment on the costs incurred from the temporary arrangements that will apply until the flu line proper is in place?
The BMA makes the point that some primary care trusts are setting up their own arrangements for local flu lines. It comments that long waiting times have been experienced by people calling NHS Direct. One case was reported of a wait of eight hours, which seems fairly incredible, but that is what the BMA reports. Is there sufficient co-ordination? If local flu lines are set up at the same time as the Government introduce temporary arrangements nationally, we need to ensure that everyone knows which line to use. The BMA also states:
“The publication of the ‘Manual Flu Line Algorithm' is regarded as crucial to ensure consistent messages and avoid postcode variation.”
“Formal notification that antivirals will all be distributed centrally rather than through GPs or pharmacists is still awaited.”
Last weekend, newspaper reports said that primary care trusts across the country had been making variable progress on implementing plans. The BMA complains that GPs in some areas have not been involved in the planning process locally. The reports suggested that the Department of Health was refusing to publish details of the state of preparedness of primary care trusts around the country. It seems to me that publication of where every PCT has got to would help to concentrate minds and ensure that the laggards get up to the state of preparedness of the best. I ask the Minister to consider publishing where every PCT around the country has got to in its plans on preparing for the pandemic.
The hon. Member for South Cambridgeshire raised concern about critical care capacity. That has also been raised with me. I was told by the Royal College of General Practitioners that in the last two pandemics in this country, in 1957-58 and 1968-69, more people died of conditions other than flu. There was a higher excess mortality of people suffering from other conditions who were displaced from hospital by those who went there because of the flu pandemic. I suspect many people do not recognise that. It reinforces the absolute importance of having clear guidelines on prioritisation of cases for hospital treatment during a pandemic. The communication of those guidelines to the general public is critical. There will be many cases in which people are due to go into hospital - they may well have a planned operation - but are told that they cannot because the hospital is full as a result of the flu pandemic. That will cause a great deal of anxiety for many people. The communication of that prioritisation is vital.
The briefing by the British Red Cross highlights the importance of the voluntary sector and the role that it can play in supporting statutory services in dealing with the challenge of a flu pandemic. It makes the point that it is essential that all volunteers who are participating in any way in support of statutory services get treated in the same way as staff to ensure that they are protected, given that they are giving their time voluntarily to help. The British Red Cross also makes the point that many volunteers will prepare to go overseas during a pandemic to help to make a difference in the real hot spots. It says that it is important that those people get access to medication speedily so that they are protected.
I have appreciated the opportunity to raise these issues. I recognise that the Minister may not be able to deal with all the concerns that I have highlighted, but perhaps she can respond to those that she is unable to answer in writing.
Mr. Robert Syms (Poole) (Con): I thank the Secretary of State for again updating the House on progress on this very serious matter. I am glad to note that when it comes to such matters the House can be constructive, we can make suggestions to the Government, and we can learn of preparations that I consider sensible. I think it is a case of “so far so good”, but as we know, it is still early days. I pay tribute, as others have done, to the staff of the national health service, who are working terribly hard, and to those who are working long hours in the pathology labs to deal with the crisis.
I think that the national public information campaign is being run very well, and is having an impact. I presume that it will roll on in the coming weeks and months, and may be uprated if the profile of what is happening changes. It sends a very good message with regard to flu in general, and not least with regard to this very serious form of flu. However, I have a few concerns.
It is easy for those who have bins in which to chuck paper handkerchiefs and somewhere to wash their hands, but if a pandemic does develop, we shall have to make an effort to provide better hand-washing facilities in public places. Perhaps the Minister could tell us whether it has been established that there are enough of the various soap products that people use to disinfect their hands as an alternative to ordinary hand washing. When I was at Euston station the other day I noticed that it costs 20p to go into the toilets, and I know that nowadays a number of other major rail centres charge people for using public facilities. I believe that that applies at Paddington station, for instance. I hope that the Government will consider allowing such charges to be waived in the short term if the situation deteriorates, so that people can have access to hand-washing facilities.
We have already had an exchange about masks, and I understand the medical advice about them, but I think that ordering a lot more and distributing them widely would be a sensible precaution. Many people work in the public services. If someone does not turn up for work because they are ill at home, a police officer or local authority representative, for example, may have to ring the front doorbell and go in to see them. It is true that in the short term, the sight of people wearing masks on the tube will not do a great deal for the tourist trade. However, notwithstanding what was said by the Secretary of State, I think that if the pandemic becomes much more widespread, seeing people walking around wearing masks would be a good way of reminding others that there is a crisis, and that they need to take the sensible advice being issued and use a paper handkerchief, “bin it”, wash their hands, and generally conduct themselves very carefully.
I have a few more questions for the Minister. So far, the scientific information is that the genetic make-up of the flu virus does not seem to be quite as virulent in north America - or, indeed, here - as it is in Mexico. Is that related to diet, or to the general health levels in the population? We know that a number of drugs are available on the internet, such as Tamiflu and Relenza. If people do not take prescribed drugs but obtain them from the internet so that they are used more widely, there is a risk that a resistant strain of the virus will develop. Have the Government any plans to try to restrict online provision?
Last week a useful leaflet about flu from the primary care trust was delivered in Bournemouth and Poole. We have heard a little about the swine flu information line; is there a plan for its capacity to be increased if the number of cases multiplies? As we have heard, in the event of a relatively rare occurrence it may be possible to get through on the line, but if thousands of people suddenly become infected, more phone lines and volunteers will be needed so that the service can be expanded rapidly rather than crashing. I welcome what the Secretary of State said about going online and setting up a website.
I would like the Minister who responds to the debate to say a little more about the role of the national director of pandemic influenza preparedness. What meetings have taken place, and how is it envisaged that the role will unfold if a crisis develops?
On the flu line, there is a difference between people phoning up about symptoms and decision makers trying to get sensible advice. In earlier exchanges, we talked about who was responsible for making decisions about whether to close a school, a place of work or a particular institution. I presume that the primary care trust would be the body to which people would refer at the local level. This is an interesting issue, however, because public health decisions will have to be made at various levels, and I wonder what the hierarchy of decision makers is. I presume that at the top will be the national director of pandemic influenza preparedness, or Richmond house, but what will be the local decision-making hierarchy in, for instance, Dorset - or around Heathrow, as we have heard about the special risks that that area of London faces? Who will be in charge? We must ensure that people make proper and informed decisions at all levels, so we do not get panic, but rather a response that is measured, proportionate and sensible.
Mr. John Gummer (Suffolk, Coastal) (Con): I too would like the Minister to elaborate on that. We in Suffolk have an extremely good operation for dealing with crises, and I would like to know how that local hierarchy will fit into this situation. In the past - for example, when we have had to deal with animal diseases - it has been hugely successful. I think the Minister will know that the Department congratulated Suffolk on what we did in the last epidemic, and we had to congratulate the Minister concerned for keeping us in touch. I wonder whether the same system will operate.
Mr. Syms: That is a good point. I wonder whether there ought to be a chart setting out who is on top of the hierarchy and who takes decisions at various different stages. That would be particularly useful for Members, who could put it up on their wall, and there might also be relevant phone numbers for their area, so if a situation developed we would know who to talk to and who to refer people to. I suspect that if the swine flu emergency line has difficulties and PCTs are overwhelmed, people will phone up Members asking for their advice. It would be useful, therefore, if the Minister were to say a little more at the end of the debate about what we can have in our offices for our staff, so that we know who to go to, and to whom to refer people in our area if a situation develops.
We must wait and see how the situation develops. History teaches us that these events can get very bad - I am thinking about the events of 1918 - and it is best to take the precautionary approach and to plan for the worst. I am pleased with the preparations that the Secretary of State for Health has taken so far, and I hope that we will get a little more information from the Minister at the conclusion of the debate. Let us keep our fingers crossed and hope that this is not as bad as some people think it will be.
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Perhaps unsurprisingly, I shall refer to Scotland in my speech. Scotland was very much the focus at the start of this outbreak, as the first two confirmed cases in the UK were in Scotland. I join other Members in expressing appreciation to NHS staff for acting rapidly and wisely in admitting the couple concerned to Monklands hospital and isolating them there. That helped to protect those people - although, fortunately, their symptoms were not serious - and it also reassured the public that the matter was being taken seriously. It helped us across the UK to study that case and understand better what had happened and how it had happened, and issues such as contacts.
It is worth noting in passing that Monklands hospital had previously been earmarked for closure, and one of the many good decisions of the current Scottish Government was to keep it open. I particularly wish to mention the way in which the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, has been leading in the Scottish Government on this matter.
Reference has been made to the booklet that has been widely distributed. One of the advantages of having two houses is that one gets two leaflets. As far as I can tell, the one distributed to my Glasgow flat some time ago is exactly the same as the one that I received last night in Lambeth - except that the Scottish paper seems to be of a slightly higher quality. This raises the question of whether we have a guarantee that all these good-quality leaflets have been distributed. I only got mine in Lambeth last night, and as that seems a little late I wonder whether everybody else has got one. I did think that they were sensitively produced, given that they detail what the UK Governments - rather than just the UK Government - have done; again, full marks to the NHS and the Department of Health.
The Minister of State, Department of Health (Dawn Primarolo): I hope that the hon. Gentleman will acknowledge in this House that we have a national health service that goes across the whole of the UK, and that the people in it are working in unison to protect all our citizens. I do not think that we should imply or make any asides to suggest that that is not happening.
John Mason: I thank the Minister for her intervention, and I agree with her. Indeed, the main point of my remarks is about the good relationship on this issue between the Governments of Scotland and the UK. Our respective countries are working extremely well on this matter, and I hope that that can be extended to other matters. We are all - those on the Government side and ourselves - committed to the NHS, although there are some differences in how we view the way ahead for it. For example, I believe that the approach of “no private GP practices” in Scotland is fundamental to the future of the NHS, whereas a different view has been taken in England.
I understand that further cases are being investigated in Greenock, which has led to the closure of a primary school and a nursery there. As I said, I wish to make my main remarks about the good relationship between Scotland and the UK on this matter. When a previous statement was made, the right hon. Member for Airdrie
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and Shotts (John Reid) asked about the relationship between Ministers in the two Governments and I asked about the relationship between the officials. We were both given very positive answers, and all that I have become aware of since then shows that that continues to be the case. For example, I understand that antibiotics are being procured by the Department of Health for the whole of the UK, and that as Scotland has a stockpile of some 9 million face masks, which is probably more than it needs at the moment, it has offered 1.45 million of those to England to help its supplies.
I reckon that this is one of the many situations in which the Scottish and UK Governments seem to be working well together, and that is the way we want things to be. We do not want constant bickering, people picking fights or people putting party before country. The more responsibility the Scottish Parliament is given, the less dependent we are financially on Westminster handouts and the more likely it is that our two countries can have a mature and grown-up relationship with each other. Of course England is the larger country and it is likely to have more experts on many subjects, be it health or whatever, but that does not prevent us from mutually respecting each other as neighbours and working together on issues such as swine flu, which clearly is no respecter of international boundaries. Perhaps one of the good things that can come out of this episode is a good and strong relationship between our countries' respective health services. I very much hope that other Departments in the London Government will follow the lead of the Secretary of State for Health.
One area in which England has been ahead of Scotland is in closing schools when there is an outbreak. I understand that the experience is that very early precautionary closure, such as occurred in Paignton, has been instrumental in disrupting the further spread of the virus. The topic has already been raised, and perhaps the Minister could confirm whether the advice continues to be that schools should be closed for seven days, whether there is some other optimum time, or whether we have to examine each case individually.
I also understand that that Health Ministers are working together to secure and purchase early supplies of vaccine. That sounds encouraging, and I hope that we will be kept updated when negotiations with manufacturers are concluded. As we are talking about vaccines, I understand that our Cabinet Secretary this morning pointed out that if a pandemic is declared, global demand for a vaccine will outstrip the capacity to supply it. That point has also been made in this debate. There may be a danger in countries such as the UK and US squabbling over vaccines, but perhaps the more serious danger is that poorer countries will be left without adequate supplies. Maybe if we ourselves struggle with a shortage of resources to combat flu, it will test our resolve to help countries less fortunate than ourselves. I would be grateful for reassurance on that point from the Minister.
Finally, we have seen various reactions to this outbreak. The very word “pandemic” can be a problem. It sounds very dramatic and suggests that the outbreak both widespread and serious. However, I understand it to mean that a disease is widespread, but is not necessarily serious. That understanding is gradually spreading. We could have what is technically a pandemic that is not serious in its effect.
There is a balance to be struck between encouraging the public to be aware and careful, but not to panic. I accept that it is difficult for the WHO, and indeed all Governments, to get the balance right. The phrase “crying wolf” comes to mind, and the danger is that if something more serious comes along in a year or two, we will again call it a pandemic, but by that time no one will take us seriously. It has been suggested that it is inevitable that for every pandemic there are likely to be a dozen false alarms; I wonder whether the Minister agrees.
Perhaps one of the good results of the MPs' expenses debacle being all over the media is that it has reduced the level of media hype over swine flu. However, as has been said, it is better to be a little over-prepared than a little under-prepared. I liked the statement on the website of Steven Novella:
“When there is a rustling in the bushes it is appropriate to cry wolf, knowing most of the time it will just be a deer or something else. But if we wait until the wolf is at our throats, it will be too late to react.”
Bill Wiggin (Leominster) (Con): This is a subject on which I do not normally speak, but I have listened to the debate and, for once and perhaps uncharacteristically, I think that much of what the Government are doing is very good. I especially like the swine flu information leaflet, which explains the risks carefully and what people should do if they have returned from Mexico or have any fears.
Like all hon. Members, I treat the safety of my constituents as paramount. I am delighted by what I have heard today about the steps the Government are taking and the work that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has done to ensure that the Government do not neglect any area. They - and especially my colleagues on the Front Bench - are to be congratulated on doing a marvellous job on this subject. However, there is one little aspect of the debate to which I seek to draw attention, and that is the “swine” bit. I object to that name for this disease.
My constituency contains pig farmers, who are deeply worried that giving that name to this flu will have an impact on their business. I have looked up why it is called swine flu and I shall cite the definition in a moment. The concern is that the market for pig products will be affected because of public fear. That is especially unfortunate at a time when the industry faces enormous pressures. We need to ensure that this risk to our people from the current outbreak is not another nail in the pig industry's coffin. We have an opportunity to demonstrate that joined-up government is not just something that we talk about, but something that can be delivered so that the people are safe.
In the UK, there are 470,000 breeding sows producing just over 9 million pigs a year. England accounts for 82 per cent. of the UK's breeding pigs, Scotland for 4 per cent. and Wales for less than 1 per cent. About 92 per cent. of pigs are kept on modern commercial
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farms, of which there are about 1,400, and the rest on about 10,000 smallholdings. These pigs are well kept and not the dirty creatures that stories would make out. This is a modern and important industry, which is under pressure from red tape and bureaucracy, the outbreaks of foot and mouth disease in 2001 and 2007, and the loss of non-EU markets owing to exotic diseases. Like most industries, the pig industry is seeing increases in production costs, feed costs and fuel costs.
The average retail prices of pork and pork products have increased by 37 per cent. in a year - that is about £1.79 a kilogram - but the average price paid to farmers has increased by just 27p per kilogram. Estimates from the British Pig Executive, BPEX, show that in 2007 farmers are paid about £1.10 per kilogram even though it cost them £1.44 to produce. That led to the “Pigs are worth it!” campaign, which I thought was extremely helpful and successful. We are always, of course, subject to competition from cheaper imports.
Since 1997, the size of the English pig herd has reduced by 40 per cent. Despite the negative press for pigs and the pig industry, there remains some uncertainty about whether pigs in Mexico are the cause of this outbreak. The advice posted on the Department for Environment, Food and Rural Affairs website states:
“There is still considerable uncertainty as to the true situation in pigs in affected areas”
and that more information will be available following the completion of the OIE-Food and Agriculture Organisation mission to Mexico. I hope that the Minister will have the opportunity in her closing comments to provide us with an update on this mission and when it is likely to publish its findings.
I also wonder whether the Minister agrees that newspaper articles and internet blogs with headlines such as “Swine flu: British pig industry leaders ‘reckless and selfish'”, as put out by Animal Aid, and “Swine flu: is intensive pig farming to blame?”, as put out by a Member of the European Parliament, Caroline Lucas, in The Guardian, are not only potentially misleading to the public but extremely damaging to the pig industry? Farmers in this country take biosecurity seriously and take action to keep their animals safe from disease. They have the highest standards in the world. The Government could help to support pig farmers by reassuring the pig industry that they will send out positive messages about British pork. The current outbreak cannot be transmitted by eating pork products, according to the WHO and the Food Standards Agency.
The WHO has decided to back away from labelling this outbreak “swine flu” and instead refers to it as H1N1. That is proper and clear. The virus has elements of swine, avian and human varieties and it is yet to be determined whether pigs have caused the outbreak or not. Joseph Domenech, the chief veterinary officer in the UN Food and Agriculture Organisation in Rome, has said:
“It's not a swine influenza, it's a human influenza.”
In view of the potential damage to the pig industry that could be associated with negative perceptions of linking pigs to the outbreak, will the Minister consider referring to the flu by some other term, including in the information guide sent out to the public? Other names could include Mexican flu or H1N1, which is what I would prefer.
There can be a risk to pigs from humans. In Canada, a farm worker reportedly infected a herd of pigs with swine flu. In Afghanistan, the only pig has been quarantined. The contingency plan for exotic animal diseases published by DEFRA and last updated in December 2008 appears to make no mention of any variety of swine flu, despite there being cases of other swine-related influenza strains previously in the UK. Will modifications be made to the plan to cover further outbreaks, especially as the virus spreads to pigs? Will antivirals be available for workers on pig farms? Will a vaccine be developed for pigs? That is a question that I do not expect the Minister to answer today, but it is one that I shall leave for DEFRA. Will there be a mass cull of pigs, as happened in Egypt?
“risk assessment indicates that there is a negligible likelihood of introducing human influenza strain H1N1 to the UK by the legal import of pigs or pig products from North America.”
Air travel is one way for influenza strains to spread quickly across the globe. Last year, UK airports handled about 235 million passengers. What efforts have been made to put together a list of countries where the risk of infection is higher? Does the Minister know how many carriers of this strain might be coming into the country?
Current cases in the UK appear to be linked to those who have travelled to Mexico or had contact with people from north America. The first known case of infection here, on 26 April, involved Mr. and Mrs. Askham, who had been to Cancun on their honeymoon. It was reported that the authorities had no plans to trace the other passengers on the flight, as they were not classified as “close contacts”. However, a 12-year-old girl from Downend in south Gloucestershire was on the same flight as Mr. and Mrs. Askham, and she was diagnosed on 1 May.
With regard to those who have travelled to countries where there are cases of this influenza strain and who have been infected by it, will the Minister reassure the House that efforts will be made to trace people who travelled with them? In that way, they can be tested and, if necessary, treated. We need to know how the virus got into this country, what risk it poses to the population, and what the Government are doing about it.
“this preliminary analysis suggests at least two swine ancestors to the current H1N1, one of them related to the triple reassortant viruses isolated in North America in 1998.”
I am grateful to the Government for the steps that they are taking to protect people from the illness. I hope that the predicted level 6 pandemic does not arrive, but the Secretary of State's opening remarks were deeply worrying in that regard, as he made it clear that the disease is considerably more serious than had been thought. However, let us avoid collateral damage in our food-producing sector as well.
Mr. Rob Wilson (Reading, East) (Con): It is a great pleasure to follow my hon. Friend the Member for Leominster (Bill Wiggin). In his opening comments, he said he did not know much about this subject, but he showed that he is a great champion of the countryside, and of farmers in particular.
I want to ask some important questions arising from recent discussions with my local primary care trust, and I hope that the Minister will deal with them in her closing remarks. The questions are important, as swine flu has arrived in Berkshire: one case was reported in Slough and there is also a suspected case in Wokingham.
I was rather surprised to hear a so-called expert argue on the radio that we should allow the current milder form of the virus to spread widely through the population, as that would allow people to build up resistance to the more virulent strain that may arrive in the autumn. Will the Minister comment on that view? Does she believe it is a suitable response, and what are her own expert advisers telling her?
As I said, I have had discussions with my local PCT and have reviewed its pandemic plan, which I have with me this afternoon. I would like to congratulate the staff of the PCT on putting together a comprehensive and very welcome plan, but I am concerned about several issues.
First, I am not convinced that the out-of-hours GP service will be robust enough to handle the scale of a pandemic. Many areas of the country, and parts of Berkshire, have their challenges and problems with the out-of-hours service. I just hope that my local PCT will re-check the robustness of local out-of-hours GP services to ensure that those services can cope with all the circumstances that might arise. If they cannot, what contingency plans will the PCT have in place?
Bill Wiggin: My hon. Friend makes an important point. I have personal experience of the failures of out-of-hours services. When my daughter was ill on a Sunday in Herefordshire, there was no GP available for anybody in Ledbury, where we live, despite its having two GP surgeries, so we had to travel all the way to Hereford, where there was a Primecare centre, bang next door to an accident and emergency department. It totally defeats the point of having doctors spread through the community if people all end up in the county hospital at the same time. The Government have spent so much money on doctors and the health service, so I do not know why care does not reach the people who need it the most. That is perplexing. I wonder whether my hon. Friend agrees.
Mr. Wilson: My hon. Friend makes an excellent point. The out-of-hours service is particularly fragmented in countryside areas such as the one he represents. I think we would find general agreement across the House that there are significant problems.
Secondly, I am concerned that we have not heard much about so-called closed communities. I have a young offenders institution in my constituency, and I
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am worried that robust plans may not exist for those closed communities. I would welcome the Minister's comments on whether there are any national plans, and on what advice on best practice has been given to local PCTs. Obviously, we are talking not just about prisons, but about places such as residential homes.
Finally, my PCT's local plan does not allow for prophylaxis for family members, and I believe that that is a mistake. If we are to limit and subdue the spread of the illness, such prophylaxis is particularly necessary. I understand that national guidance is moving us towards prophylaxis for family members and those in close contact with people who have the illness. Would the Minister like to comment on the advice being given to local PCTs, so that their plans might be updated in the light of that? I expressed my view to my local PCT in no uncertain terms: I told it that I think the omission is a weakness in its local plan. Having made those few comments, I look forward to the Minister's response.
Mike Penning (Hemel Hempstead) (Con): Looking at the clock, it seems that the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), and I have about an hour each in which to speak, but with the permission of the House, I will not go over much of what has already been discussed this afternoon. It has been an excellent debate, and I hope in good faith that the Minister will understand that there are questions that need to be asked on various issues, with regard to the situation both in the UK and abroad. Bearing that in mind, I hope that she accepts that the questions are asked in good faith. Front Benchers on both sides of the House have worked closely together. I know that the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who is sitting beside me, is grateful for the briefings that the Secretary of State has given the Front Benchers throughout the past four weeks.
It is only four weeks since we first knew of the state of swine flu - I will call it that for the moment, but I will come on to the point made by my hon. Friend the Member for Leominster (Bill Wiggin) shortly. The debate's title is “Swine Flu”, but I agree that it should not be, and there are reasons why it should not. Sadly, in the past four weeks, there have been difficult articles in the press across the country that have, at times, genuinely frightened people. I pay tribute to the Evening Standard, which realised that it had got things wrong; the Secretary of State mentioned the matter earlier. It advertised extensively to address the mistakes that it had made. I know that the Evening Standard is a large newspaper, but I wish that some of the national newspapers would address the fact that they got some of the coverage wrong. There was a degree of scaremongering.
Some of the so-called experts on the periphery of the debate have also not helped in keeping the public not only correctly aware of what is going on, but factually aware, as has been shown by some of the polling over the last few days. About 50 per cent. of the public think that the reaction of Her Majesty's Government and the NHS has been correct and proportionate, and about 50 per cent. think that there has been an overreaction. As the leaflets drop through the letterboxes and the advertising campaigns on the websites and in the national
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media continue, the public will be more aware of the difficult situation that we are in, particularly in Britain where our responsibilities lie, but also elsewhere. It may be necessary to move to stage 6, the pandemic situation, and if we do, the pandemic flu plan structure will be the bedrock from which we go forward.
Much of what has been proposed cannot be rigidly adhered to within the planning structure. For example, according to the pandemic flu planning documents, in the event of an outbreak in a school, that school would expect to be closed for three weeks. Most schools have decided to close for a week and assess the situation as it develops, and that is a sensible way to proceed. What we do not want is headmasters deciding to shut a school for three weeks when the situation is fine within 10 days.
We have had an excellent debate, and many new points have been made, which shows that we are all on a steep learning curve as to the effect that this will have on our communities, whether we are on the Opposition Front Bench, in the Minister's Department, or on the Back Benches. The hon. Member for Hayes and Harlington (John McDonnell) has apologised to the House for leaving to chair a Committee, but he raised some important points on behalf of his constituents. Heathrow is smack-bang in the middle of his constituency, and he was very concerned about training not just for cabin crew - a point also raised by the Liberal Democrats - but for staff within the airport infrastructure, so that they know how they can help. [ Interruption. ] I welcome the hon. Gentleman back to the Chamber.
The hon. Member for North Norfolk (Norman Lamb) made some important points. Will the Minister tell us either when she replies or later in writing how the negotiations were taken up early on and why the national flu line is completely separate from NHS Direct and NHS Choices, the online information service. That may be because the NHS deals with about 6 million calls a year and we expect the national flu line at full on-stream capacity to be dealing with about 2 million a day. Such IT and telecommunications infrastructure will require a robustness and resilience that this country has never experienced before. I listened intently when the Secretary of State told us that we were piloting and testing, but there is no way that that infrastructure could be tested to that capacity, unless it went through a similar telecommunications system. Why has NHS Direct been asked to pick up the situation now - it is doing a good job, but it is struggling - yet it was excluded from the contract for the NHS emergency flu line?
The hon. Gentleman also dealt with the assessment of people who think that they may have swine flu. Why are we not using our skilled pharmacists to asses whether patients have swine flu before giving them the drugs required. I know that my hon. Friend the shadow Secretary of State has taken that up with the Secretary of State. Those pharmacists are the biggest point of contact in our constituencies for medication and the plan is to distribute the drugs through them. For years, we have quite rightly been increasingly using the expertise of pharmacists to diagnose, take blood pressure, undertake blood tests and lots of other things, so it would seem to be logical to use them for diagnosis. Will the Minister respond to that point?
I have been slightly confused in the past couple of days as to who is in charge of handling the pandemic situation. The people in charge of producing the
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November 2007 document were Professor Lindsey Davies and Mr. Bruce Mann. The former is the national director of pandemic influenza preparedness in the Department of Health, but last week, the chief executive of the NHS - completely out of the blue, because there is nothing within the document to indicate his involvement - indicated that he had appointed a national flu resilience director, Mr. Ian Dalton. Will the Minister indicate what the roles of those two people are? Has Professor Davies's role changed, and what role has Mr. Ian Dalton taken up? Who is in charge and to whom do they report? There seems to have been an important change in the protocols.
My hon. Friend the Member for Poole (Mr. Syms) raised many important issues, but hand washing is very important. We are conscious of the capacity of the influenza to spread. If we get to the pandemic stage, facilities for hand washing are absolutely imperative, especially where there are large congregations of the public, such as railway stations and airports. Hand-washing facilities therefore must be open to the public free at the point of use, which can happen at the flick of a switch. I am sure that the odd 20p that is lost to the people who operate those facilities is tiny in proportion to what we could lose.
Another important question raised by my hon. Friends the Members for Poole and for Reading, East (Mr. Wilson) is what we do about closed institutions such as prisons, secure hospitals and, especially, barracks. We know from experience that such influenza viruses move very fast through closed institutions and we have heard absolutely nothing, as far as I am aware, about what we are planning to do - that is not a criticism, but a genuine question. What are we planning to do about closed institutions? The Mount prison, which is on the edge of my constituency, has 640 inmates and most of the people who work there live in my constituency. If we go to a pandemic situation, we must have a strategic plan for those people. We have learned from experience, particularly of 1919, that flu flies through military barracks once inside.
The Secretary of State said quite a lot about the purchase of face masks - specialist face masks that can restrict the virus getting through rather than the sorts of things we saw on the streets of Mexico City. I have tried to find out from different organisations, especially in the NHS supply chain, about gloves. Within the pandemic flu protocols, disposable gloves are crucial in containing influenza, yet we do not seem to know how many have been purchased or how many are out there. It would be useful to know exactly what is happening.
The other question asked by my hon. Friend the Member for Poole is this: what happens if and when we move to the next level? Page 55 of the flu pandemic document shows that we should go to a gold command structure. The structure is quite complicated, but it is understandable. The civil contingencies committee is at the head of the structure, but who chairs that committee? I have experienced gold command in my constituency. The police tend to chair gold commands, but who will chair that committee?
Mr. Syms: I have not ploughed through the booklet, although I presume that my hon. Friend, as a health spokesman, has done so. I just think it would be useful if we had some information in our offices, particularly
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relating to our own area, so that we or our local authorities have the right phone numbers and know what the chain of command is.
Mike Penning: My hon. Friend is absolutely right to raise that important point. Smack-bang in the model set out in the document is the local resilience forum and strategic co-ordination group. I do not expect everyone to read the document, but it does explain the arrangements. The next step in preparing for the next stage - stage 6 - is ensuring that we in our constituency offices and, more important, our communities as a whole have the information needed on what to do next; it should not be left to gossip. We will be able to work with our constituents, local councillors and others to make that sort of information is available. In addition, local authority call centres need to know whom they should pass calls on to.
I fully understand the point my hon. Friend the Member for Leominster made about pigs. We should stand up in this place and the Minister should say from the Dispatch Box that there is no danger from eating pork: as long as it is cooked correctly, pork makes wonderful eating. I agree with my hon. Friend when he says surely this strain of flu could have been given another name. In fact, it has - we do not need to call it swine flu. The World Health Organisation calls it influenza H1N1 - that is the official title. It should not be called Mexican flu, either. As I was told a few minutes ago, the so-called Spanish flu of 1919 appeared in America. I think that people can understand its official title - it is in the papers often enough - and we should wean ourselves off calling it swine flu, because that has had a detrimental effect on pork sales here and in other countries. I know that we have no influence on decisions by other countries, such as Egypt, to slaughter their pigs, but, to be frank, what a waste that is of good stock.
My hon. Friend the Member for Reading, East talked about the quality of out-of-hours GP services. That topic was raised at Health questions this week and it is regularly discussed by Back Benchers and Front Benchers. The truth is that our GPs are the best people to commission the out-of-hours care that our constituents deserve, because they have the empathy, understanding and knowledge needed. In fact, the situation is a complete mess, with a postcode lottery for out-of-hours services. At a time of crisis, the last thing we need is confusion in such services.
My final point is on third world or less economically developed countries. It is possible that some such countries will suffer a pandemic outbreak and we will not. It is imperative that, with our European friends and the WHO, we have in place a structure or plan whereby we do not stockpile a vaccine here when we have not and are not likely to move to stage 6, and leave other countries to suffer because they cannot obtain supplies. Although I fully understand that we have a sleeping contract and will, we hope, get the vaccine within the next few months, if other countries, particularly third-world countries, suffer a pandemic and we do not, we will have to examine our conscience and decide how to help those countries in their hour of need.
The Minister of State, Department of Health (Dawn Primarolo): I thank all hon. Members for their contributions to today's debate. It will be clear to anyone listening to
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or watching the debate that all hon. Members, regardless of party, are focused on making sure that we have in place the best measures to protect our citizens, should that become necessary.
The challenges that swine flu poses in this country are real and considerable. Before I go any further, however, I should pick up on the point that the hon. Member for Leominster (Bill Wiggin) made about its name. If he turns to the leaflet that was sent out, he will see that it clearly states:
“There is no evidence of this...disease circulating in pigs in the UK”
and that scientists are investigating the origin. Linked to that, the hon. Gentleman referred to the statements that my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs and the chief veterinary officer made about the safety of consuming pig products in this country, and I agree with everything that the hon. Member for Hemel Hempstead (Mike Penning) said in his closing remarks about the safe consumption of pig products.
However, I must say to both hon. Gentlemen that, from tracking public recognition and measuring public awareness, we have found that the virus is clearly fixed in people's minds as being called swine flu. Indeed, recent information shows that 75 per cent. of people agree that the Government are very well or fairly well prepared, and that 80 per cent. are satisfied with the information available. I am sure that all of us agree that awareness, clear information and transparency are of great importance to the general public, so I caution the hon. Member for Hemel Hempstead and others that changing tack and calling the virus H1N1 - that snappy title - or anything else may not necessarily help in the communication of information. Nevertheless, I absolutely take his point that language is important to ensure that people are properly informed, while not causing concern elsewhere or, as he rightly and understandably pointed out, detriment to others' occupations, whether they are in the pig industry or anywhere else.
Although scientists are making progress on charting the genetic fingerprint of the virus, understanding its characteristics and tentatively assessing its impacts, there is still a great deal that we do not know about the infection and how it will develop in the weeks and months ahead. That point crucially underpins the information that we make available, and, as the hon. Member for South Cambridgeshire (Mr. Lansley) said in his opening remarks, transparency and proportionate information are crucial.
In the face of that uncertainty, it is imperative that we have the appropriate measures to protect the public and ensure continuity throughout the public services - all points, indeed, that hon. Members have addressed themselves to today. We must ensure also that when the virus becomes more established in this country, if it does, we are properly prepared and, as the hon. Member for North Norfolk (Norman Lamb) said, hope for the best but prepare for the worst.
My right hon. Friend the Secretary of State for Health made it clear that experts warn us to expect further increases in the number of cases in the short term, and we must brace ourselves for the strong likelihood of a serious pandemic in the next six to nine months. Fast, effective prophylaxis has so far helped to contain
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the spread of the disease in this country. I join other Members in expressing thanks to the national health service staff, health protection officers and Department of Health officials who have worked tirelessly in this containment phase. We have yet to see sustained, community-based transmission, but I reiterate that we need everyone, including the general public, to continue to do their bit. Preparing for a wholesale pandemic is important; appropriate plans and measures must be in place so that we will be ready if the virus becomes more established. That means monitoring and assessing whether and when the current policy of using Tamiflu is becoming ineffective or counter-productive as the virus becomes endemic.
In his opening remarks, the hon. Member for South Cambridgeshire posed a number of questions, as did all the other Members who spoke. When I can, I shall do my best to answer them. There is the issue of antiviral stocks and of the triggers that will move us from our current containment phase to a mitigation phase. How do we judge when that will be, given that all the current evidence is that in this country the infection is very mild and that people respond well to Tamiflu and recover? I am still taking advice and having discussions with scientists, but at this stage there are two principles. The first should be in respect of sustained community transmission. Secondly, we should consider the severity of the disease and take scientific advice at the relevant point on whether we can still contain it and whether we need to move to the next stage. We are doing a lot of work on that so that we understand precisely when that shift may be made. As the hon. Gentleman rightly said, that issue is important in respect of the impact on the antiviral stockpile and of moving to household prophylaxis as a sensible strategy in that period.
The hon. Gentleman also asked why our approach to school closures was different from that in the United States. He said that he thought that the US was now basing its considerations more on economic and educational outcomes than on the disease, and that might well have played a part in the decisions. The advice to us, however, is that the US is no longer in the containment phase; it has moved to the mitigation phase for reasons of geographical distribution and its ability to contain the viral infections. Given that, its attitude to school closures is different from ours.
Mr. Lansley: I am grateful to the right hon. Lady for giving way, but I was not asking about the difference between the position in America and that here. I entirely understand that the Americans decided that they could no longer contain the virus, which was circulating in the community; sustained community transmission was taking place. My question was different. Looking at the second principle, if we believed that there was sustained community transmission of the virus in this country, and if the virus was not severe, would we have begun the process of examining whether our advice would remain the same as that in the national contingency plan? The current advice is that a school closure should be triggered automatically when a case is confirmed. Alternatively, would we re-examine the issue? Clearly, the Americans have re-examined it and reached a different conclusion.
Dawn Primarolo: I misunderstood the hon. Gentleman's question - I hope he will forgive me. I can confirm that we are undertaking consideration of what advice would
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be given and what action we should be taking if the outbreak remains mild. I am sure that the Secretary of State will want to continue to keep the hon. Gentleman and the hon. Member for North Norfolk apprised of those considerations as we move through them. This goes back to my earlier point about a better understanding of the nature of the virus and the extent of the illness that it causes here in the UK. It is about not only the current investigations into the production of a pandemic vaccine, should that be necessary, but informing the other strategies in the plan.
The hon. Gentleman asked about critical care and ventilators. Trusts have been advised that they could double their critical care capacity for ventilated patients during a pandemic. The possibility of additional ventilators is being considered, including the question of whether all ventilators are being used. That will form part of the ongoing discussions.
The hon. Gentleman asked about support for other countries, as did the hon. Member for Hemel Hempstead, and referred to the money that has already been contributed by the Department for International Development. In addition, the World Health Organisation has a stockpile of drugs. The WHO meets this coming weekend and early next week, and those considerations will be very much on its agenda. We look forward to seeing exactly what type of measures will be necessary, and we have made it clear that we stand ready to make our contributions in exactly the areas that the hon. Gentleman mentioned.
Mr. Lansley: I welcome what the right hon. Lady says about our willingness to participate positively and constructively in the next few days in the discussions with the WHO. So that we do not convey any misleading impression, I should point out that its stockpile of antiviral drugs is probably no more than about 5 million doses, so its ability to satisfy potential demand in developing countries may be very limited.
Dawn Primarolo: The hon. Gentleman is right. However, he also knows that the WHO, the US authorities, the UK authorities and all the health authorities that are working on this are looking carefully at exactly what we are dealing with. The virus is being analysed to see what may happen - particularly, as we track it through the southern hemisphere's flu season, what that may mean in terms of where a returning virus, whether mutated or not, goes next and what arrangements therefore need to be in place. These are absolutely the right questions for the hon. Gentleman and others to be asking. The Government are very alive to this. We completely appreciate the dual wishes of this House: first, that we protect our own citizens; and secondly, that in a world pandemic, we play our part, particularly with the poorer and developing countries that may not have access to the drugs that we have.
My hon. Friend the Member for Hayes and Harlington (John McDonnell) referred to actions at airports, in particular, and ports of entry. He went on to ask several questions about the responsibilities of airlines to their staff, and about whether there is greater vulnerability among the communities around Heathrow. He has been able to return from his other duties, and I hope to address the points that he raised.
At present, with the Government deploying strategies within an attempt to contain the infection, the work being undertaken does not involve the screening of all
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passengers. It is simply not possible to model and undertake that, and when it has been attempted elsewhere it has been ineffective. What is going on is that, first, we are ensuring that passengers are provided with information and advice. Secondly, symptomatic passengers identified en route are seen by port staff. Thirdly, if necessary, contact tracing is undertaken with regard to passengers on particular flights and anyone else who may have come into contact with them, for the purpose of ensuring that those who need Tamiflu on a prophylactic basis have it provided.
Airlines are responsible for their employees, and there are already actions that they are required to take. They have received, and continue to receive, advice through the Health Protection Agency, and particularly guidance about their employees. With several hundred returning travellers, identifying those with symptoms has been crucial. It is important to keep things in perspective by noting that to date, only 31 cases have been confirmed among those returning travellers. The surveillance and work being undertaken are clearly doing their job.
On the wider considerations for the community, the question is whether there is sustained spread across the whole country, which would mean that we needed to move on from the containment phase. The primary care trusts and hospitals have plans for those circumstances. The hon. Member for Reading, East (Mr. Wilson) pointed out that he had had access to his local PCT's plan for a pandemic, and the responsibilities are the same for the PCT that covers the constituency of my hon. Friend the Member for Hayes and Harlington. If he feels that he has not received enough information or been given access to the PCT's plan as the hon. Member for Reading, East has, he can certainly write or speak to me and I will ensure that he has access to it. Local health authorities are making those plans, and that should be going on in my hon. Friend's local area, including at Hillingdon hospital in its role as the nearest hospital to Heathrow.
John McDonnell: I raised the specific point about the staffing of the health unit at Heathrow, and I would be grateful if the Minister could examine whether she is satisfied that the staffing and resourcing levels there are adequate.
Dawn Primarolo: I have already examined, as my hon. Friend would expect, the surveillance expectations at all our points of entry, and particularly Heathrow as a busy airport. However, I am more than happy to assure him that I keep that matter under review. I shall certainly return to it and satisfy myself about the situation again. If he has any concerns or examples, I shall be grateful if he lets me know about them.
I have already answered some of the points raised by the hon. Member for North Norfolk. As for travel restrictions, there are none to the United States at the moment. It is important that travellers going anywhere should have proper up-to-date information, and we are making sure that is the case. We are keeping under review the advice given to travellers to Mexico.
On the hon. Gentleman's question about understanding more about what has happened in Mexico, a team from the Health Protection Agency has been there over the past 10 days to work with the authorities. The team has returned to the United Kingdom with a great deal of
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information, which we can consider in greater depth. I hope that some of the questions that the hon. Gentleman and others are asking will be answered.
On antibiotics, I confirm that we are on track to have sufficient stocks to cover 31 per cent. of the population - 19.6 million courses by the end of September - with the stockpile reaching over 10 per cent., which is 6.3 million courses, by the end of May.
The hon. Member for Poole (Mr. Syms) asked various questions, some of which I have already answered. On face masks, no scientific evidence supports their general use, and such use is not part of the Government's strategy. Although television images from elsewhere in the world might convey an impression that such use should be made, there is no evidence for a general issue of such masks. As the Secretary of State said, the Government have increased our order to 226 million additional face masks and 34 million of the high-quality face masks.
The hon. Gentleman and others asked about the role of the national director for NHS pandemic influenza preparedness. Let me be clear: this person's role is to strengthen lines of communication and implementation of policy with regard to any operations of the NHS flu plan, and anything necessitated by the pandemic. Professor Lindsey Davies, who has been mentioned, remains responsible for national pandemic preparedness - but it is important to ensure that decisions are implemented promptly and smoothly across the NHS, and that information is available. The hon. Gentleman requested that more information be made available to Members of Parliament for their offices, should they be contacted. I am happy to consider that point, because it would be relatively easy to provide, over and above the information available to the general public, a simple guide for MPs' constituency offices about where to direct concerned constituents.
On the preparedness of primary care trusts' plans, we do not propose to publish them at this time; we are busy, as they should be, ensuring that preparedness is at the right level. PCTs are responsible for developing appropriate local plans for their communities, and the Department of Health has issued guidance on the interim arrangements that we would expect, including on the flu line.
The hon. Member for Reading, East asked me to comment on those who have suggested that the best thing to do is just to go out and get the flu, and not take any personal hygiene steps to prevent it. Indeed, one of his colleagues, the hon. Member for Mid-Bedfordshire (Nadine Dorries), gives the same advice on her website. The chief medical officer's advice is clear: that is not appropriate action in the current situation. There are still so many uncertainties about the virus that the best thing to do is to be prepared and to take the necessary steps.
I took note of what the hon. Gentleman said about his PCT's preparedness. He also raised the important point about closed communities and what needs to be done. Plans are in place to help those in closed institutions, such as prisons, and the PCTs should have that in hand, including the use of Tamiflu, should that be necessary.
Some scientists believe that swine flu cases could ease over the summer, but we most not signal a lowering of our guard or a downsizing of our preparations. The swine flu pandemic, and with it a serious outbreak in this country, may or may not be imminent, but the threat remains real, remains urgent, and demands our complete attention. We must continue along the same path of being neither alarmist nor complacent, taking the strong and sensible measures necessary to cope with all eventualities, and continuing to work in partnership across the Floor of the House to ensure the very best outcome.
That this House has considered the matter of swine flu.