Influenza Pandemic (S&T Report)

My Lords, the memorandum of evidence given to the Select Committee was submitted on behalf of the Government as a whole; the Minister from the Department of Health, Rosie Winterton, gave evidence to the Select Committee on behalf of the Government as a whole; and the Department of Health, which works closely with the Cabinet Office, tried to cover the issues that were of concern to the Select Committee. That is the straight answer to the noble Lord’s question. The House is already well aware of the existence of the UK influenza pandemic contingency plan, which was substantially updated in October last year. The Department of Health welcomes the Select Committee’s assessment that the plan is an excellent top-level account of the UK health response to a pandemic. Nevertheless, we are not being complacent and we are continuing to keep it under review to ensure that it remains as up-to-date as possible. Certainly the recommendations made by the Select Committee will help with this review process. Let me turn now to some of the issues relating to action in the NHS, including those around antivirals and vaccines. The Department of Health is implementing a range of practical actions in respect of treatment. Vaccines, the provision of information and the improvement of NHS preparedness are designed to mitigate the effects of a pandemic. My noble friend Lord Mitchell raised the issue of whether the IT systems are sufficiently robust. We are working closely in the Department of Health with the HPA to have in place a surveillance strategy that meets the needs of all those involved in the response to a flu pandemic. This is focused on the timely and accurate collection of data from NHS trusts to ensure that the necessary information is available to inform decision-making. As we take forward the continuing improvements of our IT systems in the Connecting for Health programme, it will make things easier. Antiviral drugs will provide the first medical intervention for pandemic flu. As a number of noble Lords have said, a stockpile of 14.6 million treatment courses of the antiviral drug Tamiflu is being procured for the UK. This will be complete, as the noble Lord, Lord McColl, said, by September 2006. Tamiflu has a limited shelf life of about five years and has to be replenished appropriately because of that. As to the point raised by my noble friend Lord Mitchell and other noble Lords about how that figure was computed, the number relates to the central estimate of 25 per cent of the population being infected in the event of a pandemic. This reflects the work overseen by the Chief Medical Officer using the models that we use to establish a working estimate of the population likely to be infected. There are also international networks monitoring any emergence of resistance to antivirals and we will keep a very close eye on them. A number of noble Lords mentioned the review in the Lancet on the effectiveness of antivirals, whichis largely about the appropriate use of antiviral drugs for seasonal flu in otherwise healthy people. In this respect, the review supports current Department of Health policy. The claim that Tamiflu and Relenza are ineffective against avian flu is, we believe, misleading. The researchers could find no evidence that either Relenza or Tamiflu were effective against avian flu because there was insufficient evidence on which to draw any conclusions. When used in countries where people have contracted avian flu, Tamiflu has had an effect. Tamiflu was chosen for the UK stockpile on the basis of independent experts’ advice that reflected its efficacy and ease of administration. The noble Lord, Lord McColl, recognised the downsides of Relenza, particularly in relation to children. It is licensed for people aged 13 and over, not younger children. The assumptions on which our plans have been made, in terms of the quantity of antivirals that should be stockpiled, are subjected to continuous review to reflect advances in knowledge and improvement in the international supply position. We recognise the need for rapid distribution in the event of a pandemic, as the noble Lord, Lord Patel, said. International and national modellers have yet to reach a clear consensus on the value of other strategies for the use of antivirals. The emerging conclusions of Professor Ferguson of Imperial College and modellers at the HPA, and the case for building further reserve stocks of Tamiflu or alternative antivirals, will be considered carefully by the Department of Health, advised by its scientific advisory group, and reflected in stocking policies. We believe that the vaccine will provide the best protection against pandemic flu, as a number of noble Lords said. The vaccine industry has already undertaken a great deal of work associated with developing and testing pandemic-type flus. However, a pandemic-specific vaccine cannot be manufactured until the exact flu strain is known. As a result, it will take a minimum of around four to six months for the first stocks of vaccine to become available. This is true for vaccine relating to H5N1, I assure the noble Baroness, Lady Masham, whatever the Times may report. However, the Government are actively engaged in discussions with international partners, the vaccine industry and regulatory bodies to ensure that a vaccine will be available as quickly as possible once the pandemic strain is known. A number of noble Lords mentioned the sleeping contract. The Government are tendering for a sleeping contract for 120 million doses of pandemic influenza vaccine that can be produced when the strain has been identified. This initiative aims to provide certainty to the vaccine industry as well as resources to develop products and carry out R&D. I am advised that the contract should be awarded in the spring. We have also been encouraging manufacturers to make submissions to the European Medicines Evaluations Agency in respect of mock-up dossiers, and GSK has already done so. This will help to speed up the licensing of a pandemic flu vaccine, should the need arise. Infection control guidelines that provide valuable advice on reducing the risk of the spread of the virus have been drawn up and issued to the NHS, and provisional clinical management guidelines have also been developed to help the management of patients suffering from pandemic flu. We are tackling the issue of ensuring that there are adequate supplies of masks and protective clothing in the NHS. I can write further to noble Lords on that issue. Before leaving the subject of vaccines, in response to a number of noble Lords’ points, I can say that DNA vaccines present an interesting potential avenue to explore, but they are at an early stage of development. No DNA vaccines are licensed for use in humans in Europe and it is likely to be several years before the efficacy and safety of such vaccines has been assessed. The pandemic plan contains a comprehensive health department communication strategy, which aims to ensure that health professionals and the public are provided with consistent, clear and factually accurate information. All GPs have already been sent information packs that include technical information for them and information for the public. Those resources are also freely available on the Department of Health website and provide clear information to explain the facts about pandemic flu. A number of noble Lords, including the right reverend Prelate, raised the issue of priority workers. We accept that antivirals will need to be prioritised, initially to healthcare workers and to those who fall into one of the clinical at-risk groups, as defined for seasonal flu and already published in the guidance framework. Final decisions regarding the prioritisation of medical interventions will be made on the basis of information about the virus and the population groups most at risk, emerging from the early stages of pandemic. The UK National Influenza Pandemic Committee chaired by the Chief Medical Officer will provide additional advice, as required during the pandemic. There will be no decision taken at this stage, so I cannot give the assurances that the right reverend Prelate was asking for, but I can say that the faith communities will be involved in contingency planning. I shall have to make some priority judgments myself on how many questions I attempt to answer in the time remaining. On business continuity, we accept that any pandemic will undoubtedly have a significant impact on the ability of a range of organisations and essential services to conduct their business. I am not ducking out of this, but I shall have to write to noble Lords on the range of those possibilities because of the time available. In conjunction with the preparations that I mentioned in the NHS, central government is working closely with local authorities and the business community to ensure that there is good preparation in this particular area. The testing of plans is a crucial part of preparedness planning, so the Health Protection Agency—which, I should tell the House, has not had its budget cut—has been funded to undertake the pandemic influenza training exercises in the various regions. I am in full agreement with the committee that international co-operation on this global issue is absolutely crucial. We are not alone in facing the pandemic, and we are working closely on these issues with organisations such as the EU, the WHO, the World Organisation for Animal Health and the Food and Agriculture Organisation of the United Nations. One example of the Government’s close involvement in the work of these international bodies is our role as co-chair with the United States of the influenza pandemic workstream of the Global Health Security Advisory Group of the G7 countries. We have played our full part in putting money into the World Bank’s pledge; the Government have made available an additional £20 million to support efforts in helping countries to avoid or contain a pandemic, and my colleague, Rosie Winterton, is in Beijing at the moment, and involved in those discussions. I have not had time to deal with all the issues around research, but I promise to write to noble Lords. In conclusion, the Government welcome the committee’s report and its recognition that the UK is among the best-prepared countries in the world, but we reassure noble Lords that we shall continue to track the whole issue carefully and keep our contingency plans up to date, nationally, regionally and locally.