Influenza Pandemic (S&T Report)

My Lords, I add my thanks to the noble Lord, Lord Broers, for this excellent report and congratulate the whole committee on producing it so quickly. As many noble Lords have mentioned, the UK is one of the best prepared countries for pandemic influenza. That is in no small part due to the John Major government, who were responsible for producing in 1997 the country’s first ever influenza contingency plan, which has been admired throughout the world and heralded as a model for other countries to follow. It was a little surprising and disappointing that it was not updated until 2005, especially in view of the clear warnings given in 2004 in another place by my honourable friend Andrew Lansley, stressing among other things that antiviral drugs should be stockpiled without delay. Despite some criticism voiced today about the Health Protection Agency, it has taken a leading role in this important work and has closely co-operated with academics in this country and the WHO. I was in Switzerland two weeks ago doing some important work on geriatric cross-country skiing, and I took the opportunity of talking to the WHO. They were full of praise for the work of the Health Protection Agency for what they regarded as some superb work on modelling to predict how a pan-epidemic might behave. I am very impressed by the agency’s excellent guidance material. They have trained some of the officials in Turkey, so we have every confidence that the laboratory work in Turkey is reliable. There is, however, a fly—a rather large fly at that—in the ointment, because the budget of the Health Protection Agency was cut last year on the basis that it was not a front-line service. It clearly is a front-line service which has responsibility for co-ordinating the health service response in England and Wales. With the prospect of a pan-epidemic hanging over us, the idea that the budget should be cut is very unwise indeed. I therefore make a strong plea that the Government must reverse their policy and restore that funding and increase it for this essential work. It could be said that the Government are spoiling the ship for a ha’p’orth of tar, but it is much more serious than that. The 1919 epidemic was, after all, one of the most devastating that this country has ever suffered. The noble Lord, Lord Giddens, has doubts about whether more people died of the flu than were killed in the war, but what everyone at that time knew very well was that servicemen coming back from the war would knock on the door of their house and find the whole family dead inside from the flu. As has also been mentioned, it destroyed a very large number of young men. What can the international community do for these poorer countries? As several noble Lords have mentioned, the international pledging conference in Beijing has been very successful in securing over $1 billion towards the problem. Our Department of Health, which was present in Beijing, announced that it would pledge £20 million over the next three years to help prepare for a pandemic influenza outbreak. The £20 million of untied finance will come from the Department for International Development. The statement went on to say that the UK could offer a range of expertise and experience such as laboratory testing, training, preparedness and planning, but that is exactly what the Health Protection Agency has been doing. Will the Government now channel some of the £20 million to that agency? The WHO has warned that the world is closer to an epidemic than at any time since the 1960s, as has been mentioned. Even though this country is one of the best prepared, it would take less than three months for a pandemic to hit the UK after an initial outbreak anywhere in the world. Three highly pathogenic flu sub-types are circulating among birds yet H5N1 seems to pose the greatest threat. It has jumped from birds to humans on at least 149 occasions since 2003. It was mentioned that 79 people had died; the figure is now 80, as somebody died yesterday—that is a mortality rate of over 50 per cent. So far six countries are involved: Cambodia, China, Thailand, Vietnam, Indonesia, and, recently, Turkey. Although the problem is on a much smaller scale than with the animal sector, every human infection gives the virus the opportunity to mutate, and it could change into a form that causes a pandemic by transferring from human to human. In this avian influenza disaster about 150 million birds have already been culled or died, which is the equivalent of 10 billon to 15 billion US dollars. That has seriously affected small farmers in developing countries; they are the ones paying the price. Those farmers are understandably reluctant to report unusual deaths, just in case they lose their livelihood and their protein source. Most human cases of H5N1 have involved backyard farmers and their children. The commercial poultry farms are much less of a problem, as they have good security measures and best practice; the small farmers are the problem. It is difficult to get human infection from those birds. It tends to happen in people who do not know how to reduce the risks of exposure, as the noble Baroness, Lady Sharp of Guildford, has pointed out. They are the high-risk people; they have close contact with birds and their conduct is not the best. What needs to be done is straightforward, but we need government commitment of human, infrastructural and financial resources to help to rebuild these countries and implement the essential measures. Control at source must be the best policy. The World Health Organisation stated that there has not been such a virus as this in years; it is so tenacious. It keeps appearing and reappearing, causing many human infections due to the unprecedented spread in the animal sector. This has not happened before; it has spread outside south-east Asia and is at the doorstep now of Europe. It has gone further and has recently infected tigers in Thailand, which could be very serious indeed. The tigers are eating the carcases of infected birds. First one has to control the animal sector and make preparations to prepare for the pandemic. This needs to be done, as has been mentioned, through disease surveillance in animals and human health, early warning systems, early containment response and preparedness to mitigate mortality and morbidity and to reduce the economic and social impact. Previous pandemics have involved different strains and we cannot be sure what future pandemics will involve. I find that prophesy and medicine are quite separate subjects, as I am sure the Minister would agree. But I think that the Department of Health has very wisely gone out to tender for sleeping contracts to give a guarantee to the successful firms that they will be involved in the preparation of a vaccine, so that they can start preparing well ahead. The department is to be congratulated on that. The antivirals available to combat H5N1 include Oseltamivir—we use the proper names rather than trade names for obvious reasons. Of the two agents available, the Government are stockpiling Oseltamivir, but I gather that that will not be fully in place until September. As the noble Lord, Lord Broers, has stated, the Government need to clarify their strategy for using these antivirals. At present, it is not clear whether they are to be used in part to prevent flu or only to treat it. If they are used to prevent it, a larger stockpile must be ordered urgently. Presumably those who contract the disease will be treated right at the beginning, but so will their contacts, their families and the people where they work. Like the German and United States Governments, the UK Government also need to consider purchasing alternative antivirals, and no doubt the Government are considering that. The argument that the Government have used until now for not ordering the Zanamivir is that it needs to be inhaled, which would be more difficult for elderly and young children who have the flu. In summary, the UK is well ahead of the world in its detailed plans, but it does lag behind in stockpiling the antivirals and this is regrettable. The Health Protection Agency has done a very good job. For the Government to cut it on the basis that it is not a front-line service is rather bizarre. I hope that the Government will agree to restore this essential funding.