Influenza Pandemic (S&T Report)

My Lords, I echo the congratulations that other noble Lords have offered to the noble Lord, Lord Broers, and to his committee on producing the report. The noble Lord entered your Lordships’ House later than me and is therefore a lot more energetic. I totter along to a few debates. However, the noble Lord has not only sat on a committee but chaired one and, as everyone can see, has done so magnificently. The report is exemplary. The fact that a report of such precision and clarity has been produced by Members of this House makes me proud to be a Member of it. Your Lordships’ reports tend to disappear into a void, no matter how good they are, but we must hope that that does not happen with this one. I am not a medical expert but I have spent a good deal of my career studying risk and I wish to contribute to the debate from that angle. It has already been mentioned that influenza pandemics go back well into history. I believe that the term ““influenza”” was coined in the 15th century. At that time it was the Italian word for influence. It seems an appropriate term for the disease, although the influence referred to celestial malign influence rather than to a disease which can be passed on through influence from one person to another. I want to consider in some detail the 1918–19 flu pandemic as that has figured so much in newspaper reports and other discussions of the possible implications of a pandemic occurring today. We have a great deal of material on the pandemic, especially in the form of new social history, which I find very interesting. It is also worth pondering the relevant contrasts. The 1918–19 flu pandemic was widely known as Spanish flu because one of the first reports of it emanated from Madrid and one of its first known outbreaks occurred there, although that was not a lethal outbreak. It occurred before people understood the lethal nature of the disease or, indeed, it might not have mutated by that time. Nations being what they are, the Spanish did not like to call it Spanish flu, just as we do not like to use English terms to describe our deviant sexual practices—we use French terms. The French in turn use English terms. The Spanish called Spanish flu the ““Naples soldier””. We know a lot but there is much that we do not know about the 1918–19 pandemic. There are wild differences in the estimates of how many people died from it. The lowest estimate suggests that about 20 million people across the world died. You will see stated everywhere in the literature, of which I have read a lot, that this is more than the number of people who died in the First World War. That may be the case but I do not think that we know. The highest estimate is much higher, at 100 million people across the world who died in the pandemic, but I think all these are pure guesstimates. Some say that a fifth of the world’s population was affected, some say a half. But, whatever way one looks at it, this was an amazing episode in relatively recent human history. An amazing ““Jurassic Park”” moment occurred too, which I am sure the medical experts here will know a lot about. Genetic material from a dead soldier was brilliantly reconstructed using scientific innovations and was then introduced into mice. The lethal nature of the flu was shown to be 100 times greater than that of an ordinary human influenza virus. It was almost certainly a form of avian virus which adapted to human beings and was then passed on between them. People were killed in every continent and therefore it was a global pandemic. The highest proportion of people affected died in India, probably because of relatively insanitary conditions in that country. Some famous people died—for example, Ergon Schile, one of the Sezession painters. I refer to the marvellous Klimt paintings in Vienna in that regard. Schile died young as a result of the influenza pandemic. What do we know about the pandemic? As has been said, it affected people from very different age groups. So far as I can tell, no one is quite sure why that was the case. Social historians have unearthed a lot of horrifying contemporary descriptions. It seems that healthy people could die in well under 48 hours. You could be a healthy young person but be dead, some say, within 24 hours. Doctors recorded such cases. Originally, many of the cases occurred in military camps so they were closely observed, and then there was a second wave—a civilian wave. A doctor stated that patients he observed,"““died struggling to clear their airways of a blood tinged with froth that gushed from their nose and mouth””." The old nursery rhyme, ““Ring of Roses””, famously originated at the time of the Black Death. At the time of the pandemic children had their own skipping song, which went:"““I had a little bird, its name was Enza, I opened up the window, and in-flew-Enza””." Great poetry it is not, but one gets the idea. Looking at what happened, you have to ask how instructive it is for us and what the differences are. I believe that the differences are profound. First, it is better to consider what happened in the US rather than in Europe because the US was more of a civilian society at that time, and therefore the situation there is more analogous to what would happen now should a pandemic occur, whereas Europe comprised a war-torn society. There were panics, a breakdown of social order and an upsurge of violence in a number of US cities. There was a great deal of emotional flux in communities where there was a fairly high incidence of cases. One should note the importance of rumour in these situations. A rumour went round some parts of the United States that dogs were carriers of the flu and people started to put their own and other people’s dogs to death on the basis of a completely false rumour. Secondly, governments did not tell people the truth. I am pleased that this Government—and now the American Government—are trying to tell people the truth, but I will come back to the complexity of that later because telling the truth about risk is not a simple matter. The surgeon-general of the United States tried to persuade citizens that the virus was no worse than ordinary influenza. Such statements have resonances of what happened here when BSE—mad cow disease—emerged. Those sort of statements start panics; they do not stop them. Thirdly, it was notable that most people reacted stoically to the original pandemic. Panics were relatively rare. However, people did not have relevant information and did not know what to do. Historians describe touching dilemmas. Members of one family wondered whether they should visit their infected daughter who was living on her own. They asked, ““What should I do? What should a family do in such circumstances?””. It was not clear to people. It is not completely clear to me what one should do. Presumably, one should arm oneself with protection before visiting an infected person. However, at that time it was not at all clear what should happen, so there was a lot of everyday social and moral confusion with very significant consequences for mortality as people did not receive the care that they might have done from other family members. As I say, this was an amazing episode. It was ill-publicised at the time. It was dug out mainly by later social historians. It did not receive a lot of press attention, largely because of the war but also because of the build-up to peace. President Wilson was busy making peace when this happened in the United States, and the amount of publicity that it got, given that it was an extraordinary global pandemic, was remarkably small. What can we learn from that episode, leaving aside the medical aspects? First, we have to see that the situation is very different now, and therefore some of the comparisons that people make with the 1918–19 pandemic should be treated with caution, but some of the comparisons are the worse for us. First, if there was a pandemic of the kind so well described in the report, it would be the most significant single episode of loss of life of a specific set of occurrences outside of war or outside of situations of deliberate genocide. We just do not know how the world would handle a situation like that. Secondly, there is something quite different to 1918–19, which is the pace of news and the universality of news. Would that situation further foster rumour, or would it serve to reduce rumour? That is not completely clear. Thirdly, we obviously have better medical technologies, but we also have advance warning. This is the first time when there would be a pandemic of which we had advance warning; so I support the report when it says that we should try to block the whole thing at source if we possibly can. We have to assume, however, that in a globalised world we may not be able to do that; the very things that allow us to have a more effective response are also the things that make that response possibly ineffective. I conclude with a few observations that I ask the Minister to bear in mind, and perhaps he could comment on one or two of them. They do bear a bit on the sorts of comments made earlier by my noble friend Lord Mitchell. First, we know very little about the moral psychology of a society in a televisual age. We just do not know what kinds of panic phenomena could develop in such a society. We know that this society is quite an emotionally febrile one. It may seem farfetched, but I ask noble Lords to consider what happened with the Diana phenomenon. No one quite understands how that happened, where those emotions came from and where they went to. Suppose those emotions were harnessed on fear or on anxiety, and perhaps consolidated around aggression. That would be a truly formidable problem. Secondly, the Government must be alert to the perversities of risk management. My noble friend Lord Mitchell said something about questions that we cannot answer. When we are discussing risks, by definition we cannot answer the questions. All we can say is, ““This is the current situation of our knowledge about risk at this particular time””. A risk means that you do not know what will happen. The risk of a pandemic is not like the risk that insurance companies cover when you drive a car; every time you drive a car you can calculate the actual statistical risk that you will have an accident. You cannot do that with an imminent pandemic. Therefore, it is very difficult to manage such risk situations. You have an oscillation between accusations of cover-up on the one hand if you get one kind of analysis wrong, and scaremongering on the other. It is even more perverse than that because in a sense you have to scaremonger to get people to take the risk seriously. Suppose there is no significant episode of avian flu, people will say, ““Why did you scare us so much in the first place?””, forgetting that the scaring mechanism is part of the way in which the world community responded. Those things are very difficult to manage. I have already noted down quite a few sceptics who were using the example of swine flu in 1976, when it was said that 1 million people might die in the US. How many people died? One person; so that was out by 999,999. People are now saying that Tamiflu and Relenza might not work; that is the other side of this risk management situation. The Government should be alert to the subtleties of it; it is not as simple as simply telling people the truth. It is much more difficult to manage than that. I shall move quickly to my last point. I had some interesting stuff to say about living in a risk society, which is the sociological notion of living in a society when you have many new kinds of risks, which come from sources that you do not understand. They are not like risks from Nazi Germany—they are much more diffuse risks, which are very difficult to live with. I will tell a joke in finishing from Private Eye. I do not know how many noble Lords here have dissolute backgrounds like me, but they might remember the Who’s ““My Generation””, where they sang the line:"““I hope I die before I get old””." In the cartoon, there is a kid walking past a billboard abut avian flu, the tsunami, global terrorism and global warming, and he says, ““I hope I get old before I die””. We must deal with the convergence of risks, which is the point that my noble friend Lord Mitchell made and on which I was going to elaborate. We live in a just-in-time society; that is very new. The Government must have joined-up thinking on the risk issue; they must. The Prime Minister and the Chancellor are always saying, ““Let us be a beacon to the world””; let us try to be a beacon to the world in respect of risk prevention too.