Influenza Pandemic (S&T Report)

My Lords, I thank the noble Lord, Lord Broers, for his excellent chairmanship of the committee, of which it was a pleasure to be a member. I also thank our specialist adviser, Professor Julius Weinberg, the Clerk of the committee, Dr Christopher Johnson, and the scientific adviser, Jonathan Radcliffe. We are debating an important issue, for we know that a pandemic influenza will occur. We do not know when, although recent events suggest that we might be closer to it. We do not know how severe it will be, but we know that if the worst-case scenario occurred it would change the whole fabric of our society and would be devastating, particularly to the developing world. What the public need, therefore, is an assurance that the Government’s plans of coping with the pandemic will reduce the risks to the population. I wish to address two aspects of the Government’s plans—the strategy for the stockpiling and use of antivirals and the plans for vaccine use. Before I do so, it might be helpful to put matters in context and comment on what we know. We know that flu regularly kills 100 to 200 people per million every year—mostly the elderly—but that the majority of people who are infected recover and develop immunity to that strain of the virus. Every now and again, however, a flu virus appears with surface protein that is different, so that the immunity acquired from previous infections does not help. It is a pandemic caused by such a virus that we fear. Some of the new viruses are more deadly than others. Right now, we are worried, because one strain of the virus H5N1, called the Z genotype, has now appeared with deadly effect in domestic fowl and has been able to infect people, again with deadly effect, although the human cases hitherto are still rare. What the scientific community fears is that the virus will undergo further changes and evolve into a form that is capable of spreading from person to person and causing a worldwide pandemic. It is possible that the last stage in the evolution of the virus, enabling it to spread from human to human, will occur in infected humans. Therefore, as the number of people infected rises, it is more likely that such a mutation will occur. For that reason, the UK Government need to play a strong role, and provide the necessary assistance, in helping to control the spread of the virus, both in domestic fowl and humans, in whichever part of the world it occurs. That is particularly the case in the developing world, where people rely on domestic fowl for their livelihood and where, if the birds are slaughtered or culled, people are not compensated. If there is such a worldwide co-ordination of efforts, as Dr David Nabarro of the United Nations asked for in his evidence, we may—just may—nip the pandemic in the bud and prevent it from becoming a global disaster. Can the Minister tell the House what the United Kingdom Government are doing to assist in such a global co-operation? Many of the Government’s efforts are aimed at minimising the effects of the pandemic on the UK population. I commend the Government for having a plan, recently updated, that is regarded as one of the best in the world. But events are moving fast and, as we acquire more knowledge of how the virus is behaving, the plans need to be modified. In the United States, President George Bush has announced a $7 billion investment for vaccine development and the stockpiling of drugs. Other countries, such as France, Canada and Singapore, have updated their plans, which go beyond ours in terms of the level of stockpiling of antivirals and vaccines. I want to comment on two aspects of the Government’s plan—one related to the use of antivirals and the second to the use of vaccines. The 1918 pandemic, when 98 per cent of the world’s population were exposed to the virus, resulted in over 25 per cent of the people becoming sick and 3 per cent of them dying. An estimated 40 million people were affected—1 per cent of the then known population of the world. The death rate was much lower in the two subsequent pandemics of 1957 and 1968, when 1 million to 2 million people died. That was because the H5N1 virus that caused the pandemic in 1918 was different from the human flu strain that caused the pandemics in 1957 and 1968. If the pandemic that we fear is caused by the current strain of H5N1, if the virus remains as virulent as it is now and if a third of the world’s population get sick, in the worst-case scenario between 3 and 10 per cent of the world’s population will die. I come to the Government’s strategy for mitigating the effects of the pandemic in the United Kingdom. The key strand is the Government’s strategy of stockpiling the neuraminidase inhibitor drug, Oseltamivir or Tamiflu. The Government intend to stockpile 14.6 million doses of the drug to be used for the treatment of the estimated 25 per cent of the population that will acquire the infection. There are several imponderables. How confident can we be that the virus will not affect more of the population? Neuraminidase inhibitor drugs are most effective when given within the first 48 hours of the symptoms and signs of the viral infection appearing. That means that we have to be confident of our ability to diagnose the infection early and to get the drugs distributed to those in need in time. Unless we have a specific rapid test that identifies infection related to the pandemic virus, many in the population who get flu-like symptoms, but not the pandemic flu, will believe that they have acquired the infection and will demand drugs. Can the Minister assure the House that the Government have the strategy in place to cope with that? I understand that every country in the world is now trying to stockpile the antiviral drug Oseltamivir. There are problems of production capacity, although that is likely to improve slightly once Vietnam and India begin to produce the drug. However, should the Government not look again to ensure that our current level of 14.6 million doses will be adequate, particularly as some evidence is emerging that suggests that higher doses of the drug than originally thought will be required? Should not the Government also consider stockpiling other neuraminidase inhibitor drugs, such as zanamivir or Relenza, or even the adamantane group of drugs? Hitherto, it has been considered that the virus has been resistant to those drugs when given to chickens, but the new virus that may emerge may not be resistant to them. I now briefly come to the strategy related to vaccines. Until the pandemic starts, we will not know the exact strain of the virus and thus will not be able to begin to produce a specific vaccine. As other noble Lords have said, by the time the vaccine is available, it will be too late for those who got the infection in the first wave, except for those who are lucky enough to survive, who will then have some immunity and may even be a useful source of plasma. The Government are stockpiling 2 million doses of vaccine against the existing strain of H5N1 to be used in the vaccination of key front-line workers, who will be identified at the start of the pandemic. Will that be too late? With 25 per cent of the population at risk of being sick from the infection, that strategy is based on the hope that, if the virus that causes the pandemic is not too different from the current strain, the vaccine will provide some immunity. We know that in the long term mass vaccination, and not antivirals, will be the best protection. Why are the Government not considering the mass vaccination of the whole population against the current strain of H5N1, as strongly suggested by Professor Hugh Pennington, president of the Society for General Microbiology? I know that the arguments put forward against that will be that the virus that causes the pandemic could be different and that, if the pandemic did not occur, some people would have suffered unnecessarily from the adverse effects of vaccination. The answer could be to stockpile the vaccine and use it once the pandemic starts because then the risk would become acceptable. Of course, there will also be a need for the Government to suspend some of the regulatory considerations related to the production and testing of vaccines, which will have to be addressed in a global context. For example, the Government could help to pilot such a project in south-east Asia, where the population is at greater risk, to determine the efficacy of such a policy. I realise that my suggestions in relation to the greater stockpiling of both antivirals and vaccine would be expensive and would require increased production capacity, but all insurance is expensive. Finally, perhaps I may refer briefly to the important issue, even at this stage, of planning for the pandemic in terms of the programme of research related to the use of antivirals and vaccines and epidemiological and clinical research. All that requires advanced planning, as the Academy of Medical Sciences and the Medical Research Council told us in their evidence to the committee. Again, some areas of research will require suspending the regulatory mechanism that usually has to be followed. I hope that we will soon see these research issues being addressed. Perhaps the Department of Health and the research bodies should work together to start that. In conclusion, I reiterate that there is much on which to commend the Government in relation to their plan for the pandemic, but some important issues remain to be addressed if we are to reduce the effect of the pandemic in the United Kingdom. I look forward to the Minister’s response.