Influenza Pandemic (S&T Report)

My Lords, it is a pleasure for me to pay tribute to our chairman the noble Lord, Lord Broers, who conducted this inquiry with impeccable chairmanship. I also thank our specialist adviser, Professor Julius Weinberg, and our clerk, Christopher Johnson, who were extraordinarily helpful during what was a relatively brief but difficult inquiry. If one takes all the risks that scientists reckon might threaten mankind—which would certainly include global warming, nuclear accident and collision with an asteroid or a planet—there is no question that infection must come very high on the list. It is a source of worry that in general our ability to combat infection is by no means total. It is true to say that no new antibiotics have been developed for probably two decades. Most of the antibiotics that we use come from quite old technology and there is certainly a problem there. As we have heard today, viruses are particularly nasty because they have a habit of mutating. Sometimes that is an advantage to us, but it is difficult to predict. I ask my noble friend, Lord Warner, to break with tradition—at least as far as I am concerned—and be kind enough to answer one or two questions that I put to him during the debate. As a committee, we were particularly perturbed during the evidence of the Minister, Rosie Winterton. Frankly, most of us felt that the evidence that we received was, to say the least, somewhat complacent. There are a number of unanswered questions that I would like to put to the Minister and it would be helpful if we could have him address some of the answers today and perhaps the rest in writing. There is a real need to take this very seriously. Of course, we all accept that the risk of a pandemic is small, but if it occurred there is unquestionable evidence that it would be disastrous. I want to concentrate on one aspect of the report: the evidence on pages 87 to 103. At the beginning of the Minister’s comments—they are interesting because they are relevant to communication—she said that the recent media coverage has shown how important it is for us to redouble our efforts to ensure that the media are aware of the true situation. I understand that that is quite a difficult thing to do. I would like to know how the Government envisage that public engagement. It is almost three months since that evidence was given to us on 1 November and I am not entirely convinced that there is any more public awareness of the situation nor indeed any media awareness. Recent events in Turkey are very worrying indeed. Should, by some horrible chance, there be the first evidence of human-to-human transmission, no doubt there would be serious panic, as my noble friend Lord Giddens has already mentioned. My second question refers to the issue of the 120 million doses of vaccine. If we saw human-to-human transmission, would we be able to get those doses immediately? How soon could that be done? The Minister also said in her evidence that £200 million was being spent by the Department of Health on antivirals. That is a considerable amount of money, but it was not clear to me how much of that might be spent, for example, on antivirals used for, let us say, HIV and how much would be used specifically for a flu epidemic of this kind. I would be very grateful if we could have that evidence so that we can assess that this afternoon. The Minister also talked about £25 million being spent on communication plans. Can we learn a little more about exactly what those communication plans might be? That might be quite a complicated point to answer this afternoon, but I think it would be helpful to know more about them. One matter that deeply concerns us as physicians and scientists is that so often—as happened, for example, with the foot and mouth outbreak and with CJD—again and again scientists get the blame for something that is actually not their fault. That is a very serious problem now because, as the Government recognise, the need for better public engagement and the need for better public dialogue in a scientifically literate and technologically advanced society is paramount. There is a very real risk that science can be brought into disrepute and, if it is brought into disrepute now by, for example, a mishandling of an epidemic of this sort, that would be catastrophic for our advanced economy. I beg the Minister to consider that matter briefly as well. What is the department doing to find other methods for making vaccines? At the moment, of course, vaccines are made using—slightly ironically—chicken’s eggs. We make viruses, which are the centre of vaccines, by many other methods. In my own laboratory we use cell culture. We have been doing that for a number of years and at the moment I think I am stockpiling enough virus—not influenza—to poison the whole of west London. But that is not the point. It is actually quite an efficient way of using cell culture. Have the Government any plans to consider that and to consider, if cell culture were used—there are specific problems about using those viruses in humans—how we might address how that would be used and how we would address safety? Another question that concerns me considerably is the regulatory process which could delay new drugs being offered to patients. Again and again, we heard from every witness that a key aspect of dealing with such a pandemic is to nip it in the bud as soon as possible—even 48 hours after infection is probably too late. The need to act really urgently is a key issue when using new drugs and in relation to the research and clinical trials on the use of new drugs. There are certain problems. At the moment there is no chance of getting approval for a randomised clinical trial, which would be needed in such an event, through the average ethics committee. At the moment, on average it takes perhaps four to six months, which is not unreasonable in view of the pressure, but I believe that the Government will need to consider that, speed up ethical approval and look at the issue of informed consent. Does my noble friend consider that the Human Tissue Act, as it stands, could cause serious problems when collecting specimens, with or without consent, for us to look at promptly in the laboratories and assess the virus under different experimental conditions? The scientists believe that that is a crucial point but there are certainly likely to be problems with the current regulation. If there were a national emergency, would the Government suspend that Act of Parliament? I want to ask about a point on which we had a very vague answer. If new drugs were seen to be useful, might it be possible for the Government to consider indemnifying manufacturers? On the whole, manufacturers do not find making vaccines a particularly valuable thing to do commercially. There are problems with vaccines, one of which might be the need to use them and antivirals urgently, perhaps without the full controls that we would usually expect, with the risk that there may be problems with insurance. I do not intend to speak for my full 15 minutes. This is a very useful debate on a very important issue, but I have one other question on which I think my noble friend Lord Patel—although we do not sit on the same Benches—agrees with me. I believe we agree strongly on many issues. One of the concerns is that the Government, as he said, have prepared pretty well. There is no doubt that we should pay a major compliment to the Government, which have done much more than other advanced countries. For example, we have stockpiled much more vaccine, I understand, than some of our neighbouring countries. But there is a problem, and it was raised very much during the evidence we took. The issue is, suppose there was an outbreak in a neighbouring country in Europe, would we be prepared immediately to release the drugs that might be needed to nip that infection in the bud so it did not spread beyond its confines? That is an important question. Certainly, the need to understand the international connections with many of these infections, not just flu but a whole range of them, needs to be taken on board much more clearly in future because obviously we are facing, even though it may be small, a very serious threat indeed.