Swine Flu Update

Business of the House – in the House of Commons at 1:08 pm on 7th May 2009.

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health 1:08 pm, 7th May 2009

With permission, Mr. Deputy Speaker, I would like to make a further statement on swine flu. The World Health Organisation alert remains at phase 5, which means that although the current outbreak is not yet classified as a pandemic, it could become one at any point as the disease develops.

At present, there are 1,518 confirmed cases across the world, and 29 deaths from swine flu have been confirmed in Mexico and two in the United States. The Health Protection Agency will announce this afternoon that there are currently 34 confirmed cases in the UK, but there is not yet evidence of sustained person-to-person transmission—that is to say, people in the community who have no obvious link with each other catching this disease.

Ten people who are not known to have travelled to Mexico caught the virus in the UK from other infected people who are close contacts. We can reasonably expect the number of such cases to increase considerably over the coming weeks.

Of the UK cases, 13 are children. Following expert assessment, four schools closed on the advice of local health protection officers to contain any potential outbreak. A fifth school and a linked nursery decided to close of their own volition after two pupils at the school were confirmed to have the disease, though they had not been at school when symptomatic. I can confirm that one of the two additional cases announced today is a child at that school.

We recognise the enormous disruption that school closure can cause pupils, parents and staff. I would like to reassure parents that my right hon. Friend the Secretary of State for Children, Schools and Families has well established plans, including procedures to handle any disruption to exams.

Although the overall number of cases in the UK is still relatively low, the situation remains serious and could rapidly escalate. Our current approach is one of containment while preparing for a further phase when that is no longer possible.

As I announced to the House last week, we have taken steps to increase our already substantial stocks of antivirals to enable us to cover 80 per cent. of the population, although I stress again that we do not expect anywhere near those numbers to be affected.

We are also increasing our stockpiles of antibiotics, which are essential for treating any potential complications caused by swine flu, so that we have enough to cover 30 per cent. of the population by September. We have ordered an additional 227 million surgical face masks and 34 million respirators, which, if used properly, can prevent transmission to NHS staff who are in close and frequent contact with patients.

As the World Health Organisation has made clear, one of the critical elements of any country's response to the situation is how the public are kept informed of developments, the steps they can take to protect themselves, and what they should do if they or a family member fall ill.

A mass public health campaign has begun with print, television and radio advertising. Leaflets are being delivered to every home with information about the outbreak and the preventive measures people can take. Recorded information is available on the swine flu information line: 0800 1 513 513.

The evidence so far shows that the message is getting through, not only in making people generally aware of swine flu, but, critically, in conveying the importance of good respiratory hygiene. The response from the public has been both responsible and proportionate, as, indeed, it has generally been from the media, which also have a vital role to play.

I turn now to the steps that we are taking to contain the current virus, all of which are based on the best scientific evidence. We can be thankful that we know a great deal more about these issues than Governments who had to deal with pandemics in the last century. However, we still do not know enough about the nature of this specific virus. Leading scientific experts in this country and across the world are urgently studying whom the virus is most likely to affect, whether it will mutate, and the possibility of its re-emergence in the autumn as a more dangerous strain.

While it seems that those who developed the disease outside Mexico have generally experienced only mild symptoms, there has been a second death in America, of a woman who apparently had chronic underlying health conditions. The Health Protection Agency and the scientific advisory group on emergencies, which is jointly chaired by the Government's chief scientist Professor John Beddington and by Professor Sir Gordon Duff, chair of the scientific pandemic influenza advisory committee, are clear that it is still too early for confident predictions about the possible severity of the flu in the UK.

The current containment phase means that all those who contract the virus are given antivirals to aid recovery, and close contacts, whether they have symptoms or not, are given antivirals prophylactically to reduce their chance of developing the disease and spreading it further. That strategy has been adopted because there is good scientific evidence that, in the early stages, it will stop some outbreaks and delay for as long as possible the establishment of an epidemic.

However, through that approach, we can hope only to delay a more widespread outbreak; we cannot stop it altogether. Once the virus becomes more established, providing antivirals prophylactically will be a less effective strategy. People who take antivirals who are not ill, and then cease taking them, could still contract the disease, and we would risk depleting our precious antiviral stockpile. There is also some evidence to show that widespread use of antivirals may drive the development of a resistant strain of the virus, making our major weapon in the fight against the disease less effective.

We will therefore need to consider moving beyond the current strategy of containment, in which antivirals are provided to all contacts, to a strategy of mitigation. At that point, we will need to take a view on how best to use our stock of antivirals to treat and limit the spread of illness. However, we would consider such a measure only if there is clear evidence of sustained transmission within communities and on the advice of the scientific advisory group on emergencies and the Health Protection Agency. I expect to be able to report to Parliament if and when such a change of approach becomes necessary.

Scientists are now much closer to developing a vaccine strain from the virus. Although the first strain of the vaccine may be ready in a matter of weeks, developing it into an useable vaccine will take several months. The UK Government and the devolved Administrations already have agreements in place with manufacturers to supply stocks of a vaccine as soon after production begins as possible. In the meantime, we will continue to get expert advice on the most effective vaccine strategy, and what would best protect us if the virus returned in a more virulent form in the autumn. We also need to assess the effects on the availability of the seasonal flu vaccine this winter.

To make sure that we can distribute antivirals effectively, we are working to get the flu line up and running as quickly as possible, and it will be ready by the autumn. In the meantime, we are finalising plans for an alternative system, which we aim to use in the short term, should the virus become more widespread more quickly.

The interim arrangements that we are putting in place mean that people with symptoms can be assessed quickly, and antivirals made available so that they can start treatment within 48 hours of symptoms developing, without having to leave their home. We will co-ordinate local arrangements with primary care trusts for assessment and collection, web access and also the potential for phone services. It is critical that any system is robust and as thoroughly tested as possible before it is made operational.

Prescription-only medicines such as Tamiflu can currently be supplied to a patient only by a doctor or other qualified prescriber. In the community, they can be prescribed to patients only from registered pharmacies. That is enshrined in statute. Statutory instruments will be laid in the House this afternoon to enable us to make the necessary legal changes to support any interim arrangements so that people can access antiviral drugs quickly, should they need them.

Even with the best available scientific evidence at our disposal, it is impossible at this stage to give a cast-iron prediction of how the virus might develop over the coming months. However, with the preparations we have made, the hard work of our exceptional scientists, and, above all, the dedication and commitment of NHS staff, I can reassure the House that we are doing everything possible to protect our citizens against any eventuality that might emerge in the coming months.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I thank the Secretary of State for advance sight of his statement. The House will be grateful to him for the further update.

As we discussed last week, there were grounds for optimism, which appear to have been justified. The severity and spread of the virus are much less than we might have feared. It is therefore a good moment to express our appreciation of the work of NHS staff, and staff in the Health Protection Agency, the pathology services and the Department on achieving such containment. We do, of course, still have a long way to go, and step one is to increase our knowledge of this virus and its clinical impact on those affected. Including Mexico, the case fatality rate is below 0.2 per cent., so this is broadly equivalent to a seasonal flu. However, the hospitalisation rate in the US is about 8 per cent., which is at least twice what we might have expected, although more precautionary measures are being taken at this stage.

As the House will know, the flu virus is capable of rapid mutation, and past experience has seen flu come in a number of waves with the later ones having significantly different clinical attack and fatality rates. We therefore support an aggressive containment strategy while we gather information and analysis on the virus. Subject to that, it may be desirable to maintain counter-measures to delay the spread while the vaccine is developed. Alternatively, it may be that our response should be more in proportion with that to a seasonal flu epidemic. A judgment to be made—not yet, but in the coming weeks—will be whether to continue with the production of a seasonal flu vaccine or to shift production capacity to a pandemic flu vaccine, at the risk of leaving us overexposed to seasonal flu as we enter the next winter. Will the Secretary of State undertake to include those issues for debate in the House next Thursday, once further analysis of the virus is available?

Can the Secretary of State confirm that the Government's approach is to close schools where a case is confirmed in order to stop the spread of the virus? The Centers for Disease Control in America has changed its guidance from advising closure to a policy of keeping symptomatic students and staff out of school while they are ill and recovering. That is based on the evidence that the virus is circulating widely in the US, whereas that is not the case in the UK. It is debatable whether isolating symptomatic students and staff is as effective as closure, as a combination of household prophylaxis and school closures appears to reduce significantly the spread of the virus. However, if the virus is mild and the impact of school closures is significant, not least during this exam period, it may be better to follow the US line.

Given that some schools in the UK—the five named schools that the Secretary of State mentioned—are closing and others are simply restricting year groups coming into school, can he clarify whose advice schools should follow? If schools do close, should that be for one week, which is the period adopted in the UK generally by the five schools affected so far, or for two weeks, which is the time scale advised in the US? Alternatively, should schools close for three weeks, which is the period denoted in the strategy, or 10 days, which is what is indicated for a virus such as this, whose characteristics—the ones known so far—are a 48-hour incubation period followed by an infectious stage of two to three days? Can the Secretary of State outline in what circumstances the school exam timetables and arrangements would need to be changed? Would it be fair, either to pupils forced to stay at home or to those still attending school, to use coursework in place of an exam in order to test and grade students—reports have suggested such an approach—rather than use, for instance, the retake system?

As regards other preparations, beyond bringing forward the distribution of the phase 6 information leaflets to UK households, TV and radio advertisements, and regional and local authority civil contingency preparations—I had a very constructive meeting with the leader and the chief executive of Cheshire East council on Friday, which confirmed their preparedness—I am glad to note that the Government have ordered extra antivirals, face masks and antibiotics, as we have asked them to do repeatedly over the past four years. Will the Secretary of State confirm that the use of Tamiflu for NHS workers and, equally crucially, for those working in the social care services—I noted that he mentioned only NHS staff in his statement, whereas in response to a question following his previous statement he said that this did extend to social care workers too, so I hope that he will be able to reconfirm that today—will occur only if people in these front-line jobs are symptomatic?

As the Secretary of State knows, I first asked a written parliamentary question about the important subject of the national flu line as far back as November 2008, in order to ascertain the Government's preparedness for a pandemic. In the light of the answers from the Minister of State, Department of Health, Dawn Primarolo last year, which revealed and admitted to the delay from last autumn to early this year and now until autumn this year, can he explain why the contract was held up for some months last year by the Office of Government Commerce and the Treasury? Can he also explain why the Department told the Select Committee in the Lords just in March that the national flu line would be available in May, when in fact it will now not be effective until the autumn?

Will the Secretary of State explain how NHS Direct will be able to scale up, to be the means through which symptomatic patients can access antivirals within hours? The plans would call for the national pandemic flu line to be brought into operation at World Health Organisation phase 6. Is that still the Government's intention? If so, how many of the planned 7,500 call centre seats will actually be available?

We have been receiving reports that there is a degree of confusion both among general practitioners and among pharmacists: when a GP gives a prescription for Tamiflu, pharmacists are not in a position to fulfil the prescription, as the Tamiflu is held effectively by the health protection unit. The confusion lies in the protocols, so who is to advise and authorise the administration of Tamiflu locally? I noted something additional in the Secretary of State's statement that was not in the bit faxed to me earlier: he added that with doctors only prescribing and pharmacists only dispensing, he will be laying statutory instruments before Parliament to ensure that the necessary legal changes can be made. That may be a partial answer to my question about authorisation, which is now on the minds of many GPs and pharmacists.

Finally, can the Secretary of State reassure us on our concern about the potential deep disparity between the resources available to respond in the US and Europe, and the impact on populations in the least developed countries. Flu is a dangerous enemy and we must be vigilant, as even this virus, in the absence of antiviral drugs in many countries, may prove very damaging. What further steps will our Government therefore consider to offer assistance through the WHO to combat the spread to the most vulnerable populations across the globe?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

I am grateful to the hon. Gentleman for raising those points for clarification, and I confirm my understanding that a debate will take place in this House on 14 May, when we will consider all these issues. By then, I hope we will be in a much better position on the science to answer some of the questions that at the moment are just imponderables.

The hon. Gentleman asked about school closures. Our policy remains that the Health Protection Agency and the health protection unit in the area should be the authoritative voice on whether or not a school needs to close. In one case, they decided that because the child, who was symptomatic, did not develop those symptoms at the school but did so when they were away from school, the school should remain open. They have taken different approaches in respect of other schools, but the length of time has always been the same—seven days. Paignton community and sports college is on two sites, so they kept one part of the school open. The decision depends on whether the pupils who have the symptoms have mixed in the same eating area as other pupils and whether they have the same restaurant facilities as other pupils—a number of measures need to be taken into account. At Alleyn's school, the pupils are all in one building and there is no separation between the different annexes of the school. The decision needs to be taken by the HPA, in conjunction with the local education authority and the school, based on the circumstances.

The HPA's advice is that this virus has an incubation period of seven days and that has therefore driven our approach on seven days. There is some evidence from the WHO that the period may be less than that, but that is where the seven days approach comes from. It is kept under review, and if at the end of that seven days the HPA decides that it can keep a school open for longer, it does so.

On the question of exams, which is tremendously worrying for pupils and parents, I refer the hon. Gentleman to the statement that Ofqual made on 1 May and the subsequent information that came from the Department for Children, Schools and Families. There has been a practised approach to this—most recently, it was used successfully in my constituency after the floods in Hull to deal with the problems—so it is not as if we are in uncharted territory. However, it is important that the information reaches parents and pupils as quickly as possible.

The hon. Gentleman raised the issue of the flu line and said that for the past four years he had asked for face masks and so on to be ordered. This is not the place or the time for political point scoring, although doubtless there will be a look back at what has taken place. I ask him and other hon. Members to recognise that we are well prepared, but that when we take the decision, as we have done in the framework, to order face masks, to increase the stock of antivirals and of antibiotics, we then need to go through the process of an outline business case, a full business case and proper procurement. In the case of flu line, the problem has been that this is a completely untested revolutionary system, and we have had our problems in the past with revolutionary IT systems that have not been tested and probed sufficiently.

I can think of no worse occasion than a pandemic for us to put all our eggs in one basket and then to fail, so a perhaps more cautious approach has been taken than in other areas of new technology. We signed the contract with BT in December 2008 and it will be ready in October, having been fully tested. We are not willing to take the risk of running the system any earlier in those circumstances. My noble Friend Lord Carter, the Minister responsible for telecommunications, has done a tremendous job in bringing together the current interim measure, which I shall say more about at the right time.

NHS Direct can double its capacity within 10 minutes. It is an amazing organisation, as the Prime Minister and I saw last Friday, and it is working extremely efficiently in the current circumstances. However, the interim arrangements—the pre-flu line arrangements, which I hope to say more about in next week's debate—will not rely just on NHS Direct, because it deals with all the other things that happen, such as people ringing about heart attacks and so on. We are not using up all of NHS Direct's capacity, but it will play a part, as I hope to explain next week.

As for the statutory instrument, I apologise to the hon. Gentleman. I realised after we had sent a statement across to him that we were due to lay statutory instruments this afternoon, to ensure other channels of distribution. It would have been quite wrong of me not to mention that to the House in this statement, so I added it at the last moment.

Finally, the international position is of course important. The World Health Organisation is co-ordinating help for less advantaged and poorer countries, so that they can have access to protection. I know that France has sent a supply of antivirals, and we have given money to the same extent—we have not put medicines in, but we have given £4 million to the World Health Organisation pandemic emergency fund through the Department for International Development. We have also given an amount to the UN contingency fund, which may or may not be necessary. We remain fully alert to the dangers, as the House would want us to be, and we are ready to help other countries. Thankfully, the problem has so far not spread to sub-Saharan Africa, but if it does, we need to be ready to counter it there, too.

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Photo of Nia Griffith Nia Griffith Labour, Llanelli

In talking to people about how we can prevent the spread of infection, I have been surprised to find out how few people know that a sneeze can be prevented by licking the roof of the mouth. Putting the tongue firmly against the top of the mouth can stop a sneeze coming out or at least stave it off long enough to get a handkerchief out. Will my right hon. Friend consider including that idea in advice to people about how to prevent the spread of infection?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

My hon. Friend helpfully passed me a note about that after the statement last week, which I passed on to the clinicians. I had never heard of it before. All I can say is that I have road-tested it, as has the Minister of State, my right hon. Friend Dawn Primarolo, and it does not work, so perhaps we need some instruction from my hon. Friend.

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Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health)

I join others in thanking the Secretary of State for early sight of the statement. I also thank him and the chief medical officer for the briefings that they have conducted away from the Chamber and join others in thanking staff across the NHS for their hard work in preparing for the potential pandemic.

There were reports last weekend of concerns contained in a Department of Health document about capacity that hospitals, including intensive care units, could be overwhelmed. What assessment has the Secretary of State made of current capacity, particularly in parts of the country where hospitals are operating at close to capacity, if not full capacity, and what are the potential risks?

There is reference in the same document to the potential for 10 times as many people requiring ventilators than the NHS can supply, owing to complications such as pneumonia. What plans, if any, does the Secretary of State have to increase the supply of ventilators? There have also been reports of GPs struggling to get access to swabs. Can he provide an update on that?

As for the use of antivirals prophylactically, the Secretary of State mentioned the potential for a change of strategy. It will obviously be difficult to persuade people who are potentially affected of the case for a change. Is that dealt with in the planning document? How will the judgment be made and how will it be communicated to people who will obviously be suffering considerable anxiety?

What assessment has the Secretary of State made of local preparedness around the country? There have been reports of PCT board minutes showing quite a variable picture around the country. Would he be prepared to publish every PCT's assessment of its current preparedness?

I note what the Secretary of State said about the flu line business case, but it took the Treasury 32 weeks to approve it. Does he share the frustration that was felt by NHS Direct at board level at how long that took? What pressure was his Department putting on the Treasury to speed things up? The statement refers to the fact that we now need to make alternative plans because the flu line is not ready. How much will those alternative plans cost? Surely that cost and inconvenience has been caused by inertia in the Treasury.

Finally, concerns have been expressed about action at EU level. There are reports that EU Health Ministers failed to reach agreement on the right strategy for travel bans and on plans for a European drug bank for flu remedies and vaccines. Can the Secretary of State update the House on the current position? Is he satisfied that the Council of Ministers is getting its act together and that there is a coherent action plan across the whole EU?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

On capacity in hospitals, we are sure that the plans are in place to deal with that. We are a long way from that stage yet, which will mean dealing with complications when we have a full-blown pandemic, which is the same reason why we need the antibiotics. In those circumstances, hospitals would delay non-essential operations and change their whole mode of operation to concentrate on that priority.

Compared with 1969 and 1957, fewer beds are available in hospitals. In 1950, the average stay in hospital was 45 weeks; now it is 4.5 weeks, so we do not need the number of hospital beds that we had then. However, I am assured that we have the capacity in beds and, in particular, intensive care beds out there to deal with the problem, and the same goes for ventilators.

With swabs, however, there was a problem. We are talking about one of those issues where we can have the best framework in place and everything can be set at the national level, but then we find glitches in the system. The British Medical Association was very helpful to us on that, as were others, and we have resolved the problem, which was one of the reasons why Ian Dalton has been appointed. I do not like the title that some of the newspapers have given him, but we need to bring him down from the north-east to look at the role of co-ordinating all the different systems. That was something that we planned to do later in the national framework, but which we are doing immediately.

An important point that the hon. Gentleman raised is how we explain moving from containment to mitigation. That is partly why I mentioned the issue today—to get us thinking about it, as it will certainly be an important element of the public health messages that we give people. I think that the public will understand that, whereas we can currently give this precious resource, Tamiflu, when people do not have symptoms and may not even develop them, when the problem becomes much more widespread, the help will still be available. We would still use household prophylaxis and post-exposure prophylaxis for NHS workers, but we would need to ensure that we got that to people within 48 hours, which is the essential time scale, only if they were symptomatic. That is the best way to use that resource. I agree with the hon. Gentleman that we need to explain the trigger points that move us from containment to mitigation, although I am sure that we will explore that much more in next week's debate.

I am not going to go through every cut and thrust of our discussions with the Treasury, but it has an important job to do. The Treasury needs to be absolutely sure that we are spending taxpayers' money on the right thing—that is, on something that will do what it is supposed to do and work properly—and it put us through a rigorous process. I think that Her Majesty's Treasury would do that under any Government; it is right that it should do so. This was a huge expenditure, and I have no complaints about that—no complaints that I am willing to mention publicly, anyway.

On the issue of action at the European Union, it is not the case that the EU failed to agree. The Minister of State, Department of Health, my right hon. Friend the Member for Bristol, South, was there taking a prominent role, and there was agreement after what I am told was a pretty amicable meeting. There was no move away from the importance of the EU acting within the World Health Organisation's international co-ordination role, which it does very well—without removing the oversight that each member state must have for its own arrangements, of course. Reports of rows were greatly exaggerated.

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Photo of John Battle John Battle Labour, Leeds West

I thank the Secretary of State for his statement, and I thank him and his colleagues for the calm and collected manner in which they, the Department and the PCTs have responded to this crisis. Some commentators have suggested that action to search for vaccines will jeopardise the provision of the flu vaccine in the winter. Will my right hon. Friend reassure pensioners, in particular, that the traditional flu vaccine will still be available to them in the winter months, when it is needed?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

That is our objective. Our objective is to use our sleeping contracts to get the vaccine for this particular virus in place without damaging the capacity for producing the seasonal flu vaccine. It is a difficult situation out there, because countries all around the world—particularly America—are trying to get protection for their own people as well, and there is only so much capacity in the system. But that is our objective, and I hope to be able to reassure the House on that, or at least explain why I cannot reassure the House on it, as developments move on.

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Photo of Nigel Evans Nigel Evans Conservative, Ribble Valley

It is right that we should not be complacent about what we are facing, as this flu virus seems able to mutate very quickly. The Secretary of State will have read over the weekend about the appalling incident involving an out-of-hours GP who came into this country. The consequence, sadly, was two deaths. Has the right hon. Gentleman assessed the impact that a pandemic could have on this country? Clearly, we would not be able to access doctors from other countries in such an event, because the pandemic would affect their countries as well. Will he tell us what procedures are being put in place to ensure that proper medical staff will be available in this country to provide the vaccines to patients?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

We have plans in place, including GPs returning to practise who have retired but who, of course, still have a wealth of knowledge. The important point about planning for the pandemic, however, is that people should go home and stay at home. The whole distribution system is based on people not clogging up their GP's surgery and not calling out their GP to go to them. It is about ensuring that they have someone who we have been calling a flu friend—we might want to change that terminology—who can go and get the antivirals for them and take them to their home. We should never detract from that message. This is not about needing to produce loads more GPs because the GPs' surgeries are being swamped. If that happens, we will have failed in our approach, but we are planning for the kind of complications that Norman Lamb mentioned. If we get to the stage at which more serious complications emerge, we have plans to put extra medical staff in place.

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Photo of George Howarth George Howarth Labour, Knowsley North and Sefton East

I, too, congratulate my right hon. Friend's Department on the manner in which it has dealt with this worrisome issue so far. I particularly want to thank the Minister of State, Department of Health, my right hon. Friend Dawn Primarolo, for giving me notice of a case that was reported in my constituency last Friday. Will the Secretary of State give us an assurance that those who might be more vulnerable to a second wave, such as pensioners, the very young and those whose medical condition would make the impact of the flu worse, are under consideration by the Department, and that plans will be brought forward in due course to deal with those particular problems?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

I can give my right hon. Friend that assurance. Of course, at the moment we do not know whom it will hit first. The evidence from Mexico is that the people who were dying were aged between 25 and 50, which is extremely unusual. It is usually the older population and the very young who are the most vulnerable. Until we know the characteristics, we cannot decide that question, but we are certainly thinking ahead to the vaccination programme and about whom we should vaccinate first, because the vaccine is likely to come on line over a period of time. Once we know who the most vulnerable groups are—they could well be the elderly and the very young—we will ensure that they will be first in line to be vaccinated.

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Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

The Secretary of State has said how important it is to deliver antivirals within the appropriate time window. There is public concern about the delays in the implementation of the flu helpline. Will he tell us what capacity that helpline will have, and what level of epidemic would be required to overwhelm it?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

We are working on an interim system that would replicate the flu line. There would be one number to ring—although there is apparently a different system for people who are hard of hearing—and one website to contact. An algorithm would then spark off the collection of the antiviral from a distribution point. The system is predicated on perhaps 28 to 30 per cent. of the population having the virus at the height of a pandemic, and on their being able to order their antivirals and to receive them within a maximum of 48 hours, and preferably within 24 hours. That is the system that we are planning. It is not as though we are giving up on the previous scale of ambition and saying that we will have to scale down to something different. We are maintaining that scale of ambition, and we think that we are close to replicating what we would have had with the flu line—without some of the more sophisticated elements, it is true, but still with the same coverage and in the same time scale.

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Photo of Adrian Bailey Adrian Bailey Labour, West Bromwich West

I reiterate the compliments paid to the Department by other Members on how this matter has been handled. I also thank the Minister of State, Department of Health, my right hon. Friend Dawn Primarolo, for notification of the case in my constituency yesterday, which seems to have been handled very quickly and effectively by the local PCT. My concern, which I am sure other Members share, is that unnecessary fears are perpetrated by reports of such a case. Will the Minister outline how press relations and publicity are being handled when a case is reported in a constituency such as mine?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

I thank my hon. Friend for his comments. I think that my Department, and the NHS in particular, have done tremendously well, but this has been a cross-Government approach, and other Departments have been extremely helpful. I mentioned the noble Lord Carter in regard to telecommunications, and I should also mention the Under-Secretary of State for Transport, my hon. Friend Jim Fitzpatrick, in relation to transport, as he is sitting beside me, and my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs, as well as others. This is a cross-Government effort.

On the issue of how we publicise this matter, we are careful not to publicise information on a case until the parents and those close to the person have been informed. That is why there is sometimes a delay between people on the ground hearing about a case, as the information spreads through rumours, and our being able to announce it publicly. However, I think that this is the right thing to do. If we get to the next stage and this becomes more widespread, it will obviously be more difficult. At the moment, the Minister of State, Department of Health, my right hon. Friend the Member for Bristol, South, is seeking to advise Members of Parliament on both sides of the House of any outbreak in their constituency, but that might be difficult to maintain as the system goes ahead. At the moment, however, we are trying to ensure that there is no publicity until the parents have been informed, and we try to inform the local constituency MP before the information is made public as well. We will do our very best to keep to that procedure for as long as possible.

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Photo of Evan Harris Evan Harris Shadow Science Minister

I should like to ask the Secretary of State about the importance of those making public statements sticking to a clear consensus expert view. One hon. Member has said on her blog, in relation to schools and nurseries closing, that

"it is madness. The Minister for public health should stop schools from closing. Far better everyone catches the virus now, and builds up their own anti-bodies whilst it's still relatively weak, and presents as nothing worse than a cold."

She goes on to suggest that children will be better off in the long run if they catch the virus now. She does say:

"Viruses are much cleverer than we are."

Apart from the obvious problem of the threat to the immuno-compromised and the frail of the virus becoming widespread, there is also a danger of viral reassortment within the human population if it goes wide. Will the Secretary of State give his view on whether it is wise to put out public statements such as that one?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

I am glad that the hon. Gentleman raised that matter; I did see it. I will give not my view, but that of the experts, including the chief medical officer—it is that such advice is totally irresponsible. We do not yet know enough about this virus; it is novel and we do not know its characteristics or how it mutates. It would be utter madness to tell people that their best bet is to get this virus and build up some immunity. Immunity from what? If it mutates, that will be an immunity from a previous phase. I have discussed this idea—it seems to be a piece of cracker-barrel philosophy that is going around—with all the clinicians and they say, without any hesitation, that it is totally irresponsible. I am glad that the hon. Gentleman has given me an opportunity to put that on the record.

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Photo of Kerry McCarthy Kerry McCarthy Labour, Bristol East

I repeat the congratulations to the Department on its handling of this situation. I apologise in advance for asking a slightly obscure question, but I understand that the vaccine that is being worked on involves the use of eggshells, as does the current flu vaccine. That means that it is not suitable for people who are allergic to eggs. Some people are so allergic to eggs that they cannot even touch the outside of the shell without breaking out in a reaction. Is there any way of getting around this problem so that we can develop a flu vaccine that is suitable for everybody?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

My hon. Friend has gone well past the limits of my knowledge on these issues. She is quite right that eggs are used to grow the vaccine— [Interruption.] "Eggs are eggs" as has been said. I have not heard the issue concerning people who are allergic to eggs; I will look into it and perhaps write to her separately.

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Photo of Roger Williams Roger Williams Opposition Whip (Commons), Shadow Secretary of State for Wales, Shadow Minister (Environment, Food and Rural Affairs)

It appears that this particular virus at this particular time is producing relatively mild symptoms, but the Secretary of State is right to say that it could easily mutate. What we do not know is where and when it might mutate. I am sure that the WHO has a worldwide observatory for the influenza virus and that it takes samples continuously to try to identify any new variety that might emerge. In less developed countries, however, it probably does not have facilities for taking the samples, getting them to the laboratory and carrying out the tests. Will the UK put more resources into that vital work, because identifying any new mutation and getting a vaccine ready for it will be absolutely essential to containing what could become a much more serious disease?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

Yes, the WHO has the necessary focus on this. One of the first statements made by Margaret Chan was that the WHO's major role was ensuring that once the vaccine was produced, we could get it to countries that do not have the resources that we have. That will be an important element of what happens. On the general point about the vaccine, both in this country and in America, GlaxoSmithKline and Baxter are working very hard. They have already identified a strain here, and we are well on the way to getting the vaccine, but as the hon. Gentleman and all Members know, getting it through the manufacturing stage and getting it delivered involves months rather than weeks. The vaccine will not come quickly, but when it becomes available, the WHO has plans in place to ensure that it is distributed around the world. There is nothing worse for developed countries than to resolve this pandemic among themselves, only to find that it is still prevalent elsewhere—and therefore still an international threat.

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Photo of Andrew MacKinlay Andrew MacKinlay Labour, Thurrock

I, too, congratulate the Secretary of State on his stewardship of this matter. I hesitated before getting up to speak, but one thing troubles me—patient confidentiality, which it seems to me has been breached. Once the storm broke, people had their photographs put in the newspapers. Vulnerable people facing a time of great crisis were harassed by journalists to produce photos, or their loved ones were asked, and so forth. Such people need some protection, and surely NHS staff need to be reminded of the law under the Data Protection Act 1998. Will the Department take these matters up with the Press Complaints Commission and with editors to ask for some restraint, as it is grossly unfair and deeply harrowing for people to have their medical conditions put on to the front pages of newspapers?

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Photo of Alan Johnson Alan Johnson The Secretary of State for Health

On the whole, as I said in my statement, media coverage has been responsible, but I agree that some individual cases are worrying. I have heard about instances in Dulwich, for example, of a stigma being attached to children who have this illness, leading to problems with bullying. That is very worrying. Parents have contacted us about the issue. I will try to ensure that the press plays its role in dealing with this problem and that the responsibility that it has shown in general at the macro-level is repeated at the micro-level.

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