Influenza Pandemic (S&T Report)

My Lords, I meant that the ducks live cheek by jowl with the population of China, particularly in the countryside. The front line of defence is therefore to try to snuff out outbreaks of avian flu wherever they occur. We saw that happen the first time the new strain struck, which was in Hong Kong in 1997. It was effectively eradicated. In 2004, Thailand—a middling developing country—has managed effectively to eradicate it. But that is very much more difficult in countries such as Indonesia and Vietnam which are extremely poor. We have seen how difficult it has been for Turkey to cope with the problem that has hit it. That is why the FAO follows up progress. As we have seen in Turkey, it follows domestic teams and monitors the effectiveness of the culling process in all the countries where the problem strikes. That is why the committee was so shocked to learn that at the time we interviewed the FAO, it had only some £25 million to $30 million in hand to undertake this sort of work, as compared with the $160 million it had asked for. The really good news of the past two days has been the outcome of the Beijing conference. The FAO asked for $1.5 billion and has in fact been over-subscribed. It has succeeded in raising $1.9 billion. The key is whether farmers can be compensated for the poultry they have lost. For many of these poor people, poultry is all they have. They will not say, ““I have a dozen chickens just round the corner”” unless they know that they will be compensated. If they are not, despite all the Turkish or Vietnamese soldiers sent in to make the cull, they will try to hide their poultry. In that case, avian flu cannot be eradicated. The extremely good news from Beijing raises the possibility that we can snuff this out right at the beginning. As the noble Lord, Lord Broers, said, one of our chapter sub-headings was entitled Prevention is better than cure. The recent outbreak in Turkey illustrates very well how easy it is for avian flu to break out and how difficult it is to contain it unless the local population are aware of and alive to its dangers. I do not know how many noble Lords saw the television broadcasts from Turkey, but I caught one or two. The three children who died had apparently been playing ball with the heads of dead chickens, the blood got on their hands and then they were eating. Almost inevitably, the children picked up the H5N1 strain, avian flu. In another case, a little girl had come home from school to discover that her pet chicken was unwell and she said, ““I hugged it””. It is not surprising that the FAO has to send in teams to monitor the problem. Turkey seems to have had some real problems in coping with the spread of the disease. It is vital that the FAO uses some of the money to make sure that we snuff it out in Turkey. It is, after all, as affluent or as relatively developed as Thailand, and if it can be done in Thailand they ought to be able to do it in Turkey. The Turkish experience also illustrates how important it is to monitor the mutation of the virus itself. This is where our own National Institute for Medical Research comes in to the front line. It is working for the WHO in defining the genetic structure of these strains. Here there are causes for concern. The Turkish gene sequences incorporate two changes which make human infection more likely. They have been seen separately before but never together. As the noble Lord, Lord Mitchell, said, at some point—this year, next year, sometime, never—it is quite possible that mutation will take place and we will be hit by pandemic flu, passing from human to human. As the noble Lord, Lord Jenkin, said, the danger of that mutation taking place in Africa, given the problem of AIDS, is very real. It is important that help is given to Africa if the disease breaks out there. The message is that if the virus is quickly identified and the cluster of those carrying it is effectively isolated, it might, like the SARS virus, be snuffed out very quickly. But if it gets into the wider population—like SARS, it will be highly infectious—and given travel patterns around the globe, it will be extremely difficult to contain. As noble Lords have indicated, our key concern was to see how prepared Britain was for an outbreak of pandemic flu, should it occur. We found that a good deal of planning had taken place, especially in the health service, and that the UK was regarded as one of the few countries in the world that had put serious thought into how to handle such a crisis. Nevertheless we were concerned that, even in the health service, not enough lateral thinking had been undertaken. For example, how would GPs’ surgeries cope when inundated with cases or suspected cases? Were GPs expected to give up all other duties? Were performance indicators going to be dropped? Given the present state of turbulence in the NHS and with the new reforms being rolled out, many of us were very sceptical that the NHS would be able to cope. We came to the conclusion, too, that at present regional and local planning was only skin deep. Yes, there were these splendid things called Regional Resilience Forums, which had been set up, and which had all had grand meetings and talked about grand plans, but we got the impression that that was about as far as the real contingency planning went, and that to date very little had been done to talk to people on the ground, let alone start co-ordinating actions or establishing priorities. For example, were schools to close and, if so, at what point within the pandemic would they close? Furthermore, it seemed that very little lateral thinking had been done by government departments themselves. We were, for example, struck by the degree to which no one had given thought to how absenteeism might hit all kinds of services, including fuel and food supply links. As the noble Lord, Lord Mitchell, said, absenteeism could be as high as 25 per cent. Above all, we were struck by the uncertainties created by the two main strategies for fighting the flu itself. As regards the first line of defence, the antiviral drugs that were to be used to treat the first cases and to provide prophylactic protection for health workers and those who came into close contact with those first cases, it was very unclear how far the government order of 14.6 million courses of Tamiflu was supposed to stretch, especially if, in order to be effective, more than one course of treatment was required. If taken preventively, one course lasts for five days; so front-line staff might need successive courses. Equally, treating patients and their families would rapidly eat into those courses—at the rate of 1 million a day into the 14.6 million stockpile. No clear priorities seem to have been given. What is the specific strategy if Tamiflu proves ineffective or requires larger doses and longer treatment than they have allowed for? The second line of defence is vaccines. It is clear that until the pandemic virus has been identified, no vaccine can be developed—and we all understand that. Further, using the current egg-based technology for vaccine production, it would take at least seven or nine months from the initial outbreak of pandemic influenza to prepare such a vaccine, by which time, if the 1957 or 1968 outbreaks are the pattern to go by, the pandemic will have passed its peak. The Government told us that they were negotiating an advance purchase agreement with Chiron, their main vaccine supplier, for 120 million doses of vaccine, two for each inhabitant of the UK, but I have a number of questions to put to the Minister about that. First, given the relatively large doses of vaccine required for the H5N1 type of virus as distinct from the normal flu virus—and I gather that you need at least four times as much as for the normal flu virus—and given maximum global capacity for production of an egg-based adjuvanted vaccine that is enough to cover a population of 225 million, which is approximately the population of the US, is it really feasible for the UK to pre-empt 25 per cent of that capacity? Secondly, since the Sanofi experiments using an adjuvant proved on the whole to be rather unsatisfactory, and given the disappointing results, why did the Government reject the advice that they were given over a year ago, at the beginning of 2005, to find an independent adjuvant study? Lastly and perhaps most importantly, why have the Government not supported accelerated trials for an emergency DNA vaccine—the UK leads in their delivery and has the capacity; and using existing bio-pharmaceutical facilities—to make it in a relatively short production cycle? We were in the lead on this, and we now know that the Americans are putting $2.8 billion into it. We could have contributed considerably to that at an earlier point. Why did we not do so?