Flu Vaccine

– in the House of Lords at 4:58 pm on 22nd November 2005.

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Photo of Lord Warner Lord Warner Minister of State, Department of Health, Minister of State (Department of Health) (NHS Delivery) 4:58 pm, 22nd November 2005

My Lords, I would like to repeat a Statement made in the other place. The Statement is as follows:

"With permission, Mr Speaker, I would like to make a Statement about seasonal flu vaccine. Five years ago, we decided to give higher priority to protecting the health of the public from winter flu. We introduced the annual seasonal flu vaccination programme targeted at those of increased risk from seasonal flu—that is, those aged 65 and over, and those below that age in certain clinical risk groups, as identified by the Joint Committee on Vaccination and Immunisation. This is an annual programme because, of course, each year new strains of influenza can emerge and therefore the flu vaccines need to be reformulated accordingly. In this way, each year the vaccine provides the best protection against the influenza virus circulating.

"Since the programme was introduced in the winter of 2000–01, vaccination uptake in people aged 65 and over has increased year on year. In the first year of the targeted programme, just over 65 per cent of those aged 65 years and over were vaccinated. Last year, 71.5 per cent of those aged 65 years and over received the seasonal flu vaccine—some 5.2 million people. In addition 1.2 million people in the clinical risk groups were vaccinated.

"The responsibility for ordering seasonal flu vaccine and the administration of the vaccine has always fallen to general practitioners—this is a GP-led programme. General practitioners order their own supply of vaccine, based on the number of eligible patients on their register. They make contractual arrangements with any of the six manufacturers who supply flu vaccine to the UK.

"In addition to the GP orders, the Department of Health purchases a stock of flu vaccine each year as part of our contingency planning measures. This is held for emergency use should GPs run into difficulties with vaccine supply.

"The department routinely meets with representatives from the UK Vaccine Industry Group (UVIG) towards the beginning of each year to inform the industry group how much seasonal flu vaccine will be required in the UK. This is based on the numbers of people covered by the current Department of Health policy.

"This year the estimated production total from all UK vaccine manufacturers was over 14 million doses, which is more than ever before. This is sufficient to immunise 100 per cent of those in our targeted groups; in other words, the elderly, and the young in clinical risk groups, as described in the Chief Medical Officer's letter to the service in July.

"We began to hear anecdotal evidence in late October that some GPs may be facing a shortage of flu vaccine. In order to assess the potential problem, officials wrote on 3 November to all primary care trust flu immunisation co-ordinators. This letter provided a reminder of the priority groups for flu vaccination, and how additional stocks of vaccine could be ordered from the Department of Health contingency stock, should extra be required by practices in their area.

"The current problems may be due to a combination of factors, such as the under-ordering of vaccine on the one hand, and possibly vaccination of 'worried well' on the other hand. It seems likely that awareness may also be higher this year due in part to the very high level of media interest in the threat of avian flu in birds and of pandemic flu. We do not expect seasonal flu vaccine to protect against avian influenza or against pandemic influenza. However, it is important to remember that seasonal flu vaccine is important for those aged 65 years and over, and the clinical risk groups, and high uptake level in these groups is to be welcomed.

"We need to ensure now that GPs prioritise their remaining stocks of flu vaccine to those who will really benefit from the vaccine—those aged 65 years and over, and the clinical risk groups. Officials wrote to influenza immunisation co-ordinators to this effect yesterday.

"The department is helping GPs by releasing flu vaccine from the contingency stock that we have purchased. We have taken orders against this stock, and deliveries are being made and will continue into December. In the face of exceptionally high global demand for flu vaccine, the department has been able to secure an additional 200,000 doses of flu vaccine, despite the intense global demand for vaccine—that will be delivered in January. We are also discussing with manufacturers whether additional supplies can be made available over and above the 200,000 doses and, if so, when these stocks would be available.

"In previous years, the GP-led arrangement that I have described has, on the whole, worked well. In view of what has happened this year, however, I am reviewing the arrangements currently in place for the seasonal flu vaccination programme and will consider this matter urgently".

My Lords, that concludes the Statement.

Photo of Earl Howe Earl Howe Spokespersons In the Lords, Health 5:04 pm, 22nd November 2005

My Lords, the House will be very grateful to the Minister for repeating the Statement. This is certainly a worrying state of affairs. I appreciate the sense of urgency in the tone of the Statement but the Minister will understand that a number of important questions are begged by it. First, what has happened to the 14 million doses that have been manufactured? It is suggested that vaccines may have been under-ordered or that supplies may have been used on non-priority groups. There are at least three more possibilities, which are that some vaccine may have been ordered but not yet delivered; or that the take-up among high-risk groups has been greater than predicted; or that appreciable stocks are still being held unused at a number of GP practices. If the last of those is true, will the department please encourage GPs to share around any surplus stocks with neighbouring practices who find themselves short?

I do not think that it is wholly fair for the Government to blame doctors for over-prescribing. I am not aware of any evidence to that effect, and indeed the deputy chair of the BMA's GP committee and the chair of the Royal College of General Practitioners have strongly repudiated that suggestion. If it has happened, whose fault is it? During all the publicity in October about a possible pandemic of avian flu, I do not remember any statements being made by the department to make it absolutely clear to the public that the winter flu vaccine would not be effective against a strain of pandemic flu derived from avian flu. If statements were made, they were not sufficiently loud and clear.

One does have to wonder what would happen if a pandemic of avian flu were to occur, because the flu pandemic contingency plan explicitly recognises that,

"Effective communications provide the backbone for an effective and co-ordinated response".

The confident statements of Ministers as recently as 24 October about the adequacy of vaccine supplies for winter flu do not suggest that communications are as effective or as timely as they should be.

I welcome the 200,000 additional doses that the Government have secured, but the largest flu vaccine manufacturer, sanofi-aventis told the Government on 21 October that it had already distributed all its reserve stock. Why did it take until now for the Government to order a further supply, which we understand will not be available until late January? If it does not arrive until then, there must be a strong possibility that many people in at-risk groups will remain unvaccinated.

Can the Minister confirm one part of the Statement? He said that the production of 14 million doses this year was more than ever before. But was it in fact more than last year? The noble Lord himself told this House on 26 October 2004 that there were,

"around 14 million doses of flu vaccine available for this year".—[Hansard, 26/10/04; col. 1173.]

But since then two additional groups have been added to the routine flu immunisation programme—people with chronic liver disease and people who are the main carer for an elderly or disabled person. Were those two groups fully factored into the Government's calculations?

We need to know a number of things as soon as possible. What percentage of the at-risk groups remains unimmunised? Why has it apparently taken so long for the Government to acknowledge that there is a problem and to place an order for further stocks? What is the evidence for the suggestion that GPs have been inappropriately administering flu vaccines, which has never been reported in the past? And how can we—and for that matter Ministers—be more confident in the future that timely, up-to-date information is available on matters such as these, which have enormous implications for public health?

Photo of Baroness Barker Baroness Barker Spokesperson in the Lords, Health

My Lords, in August 2005, the department issued the UK operational framework for stockpiling, distributing and using antiviral medicines in the event of pandemic influenza, which received a lot of coverage at the time in the newspapers. On 17 October this year, coming to the end of a Statement about pandemic flu, the Minister said:

"Nevertheless, it is very important for protection against seasonal flu that people aged over 65 and other at-risk groups recommended to have the vaccination should make sure that they receive their vaccinations as normal".—[Hansard, 17/10/05; col. 567.]

Does the Minister agree that what has happened since then is that people have heeded his warning? In the past year, 70 per cent of people in at-risk groups took up the offer of a flu jab. This year, given that people have been hearing about flu all through the summer and have been exhorted to be vaccinated, they have done just that. Was it not possible to predict back in the summer that the take-up rates would be greater than in previous years? After all, we know that every year 10,000 people in high-risk groups die during the winter of cold and flu-related illnesses. Our present situation is not exactly surprising.

The noble Earl, Lord Howe, talked about the inclusion of carers in the key groups. The Minister will know that that is something that I have advocated for some time. It makes sense when trying to combat outbreaks. I believe that other key workers such as NHS and emergency services staff also have been included. Indeed, this afternoon a number of GPs have taken to the airwaves to explain that they have used their common sense to ensure that those emergency workers have been deliberately targeted to receive the small stocks that that those GPs have. They see that not as profligate but as a sensible way to manage the position they are in.

Does the Minister agree that one of the problems is that the vaccines are ordered by GP practices whose margins are extremely tight? A GP practice that over-orders only a small amount of vaccine is unable to recoup the money that it has spent, which makes a great difference to its overall budget for vaccinations throughout the year.

I have two final questions. First, in view of what we now know about the deficiency in stocks for December and January, and given the weather forecasts, will the Government support a range of winter warmth and anti-hypothermia initiatives for at-risk groups? Secondly, at a time when they face severe difficulties due to reorganisation, will the Minister ensure that PCTs rapidly co-ordinate the practice groups in their areas? It is imperative that the shortage of vaccines is dealt with now if people in vulnerable groups who are not yet vaccinated are not to be left out and the number of winter deaths is not to rise.

Photo of Lord Warner Lord Warner Minister of State, Department of Health, Minister of State (Department of Health) (NHS Delivery) 5:12 pm, 22nd November 2005

My Lords, I have been asked a number of questions to which I shall respond as best I can. There are two issues relating to vaccine production: the figure which the Government give the industry as their estimate of the numbers in priority groups who would need vaccine; and the figure which it subsequently turns out that the industry produced at the end of the period in question. The figure which I have for vaccine production for the winter of 2004–05 is 12.3 million. The figure that we gave the industry at the beginning of this year for this winter was about 14 million, as I have indicated. By definition, we will not know until the end of the winter how many vaccinations have actually been administered. It is worth bearing in mind that in the past GPs have tended to vaccinate in November; but, looking at the figures we have for the end of October, there does not seem to have been a significant change in the coverage of at-risk groups. There is nothing to suggest that there has been a dramatic change in the rate of vaccination.

We know that all ordered vaccines have been delivered, and that is down to the judgment of GPs. It is not a question of me blaming GPs; the truth of the matter is that GPs have registered lists of people and they know from those lists which patients at their surgeries are aged 65 and over and which patients are at risk. They are best placed to make judgments about the amount of vaccine to order, and that system has been in place for a long time—certainly preceding this Government. It is worth bearing in mind that in 1996–97 vaccine production was 6.1 million doses, so over the past decade there has been a substantial expansion of vaccine production and usage in this country.

I turn to some of the other issues raised. We first ordered a tranche of extra vaccine at the beginning of November and, at the same time, we put in place a national audit of suppliers. It is worth bearing in mind that you cannot just turn on seasonal flu vaccine. We give the judgment about the risk groups and the numbers involved to the manufacturers at the beginning of the year so that they can prepare the appropriate vaccine in the summer for the coming winter's flu strain. Once we are into that winter, the ability dramatically to expand production globally is very restricted. We are now hunting around the world for supplies of vaccine, but we cannot dramatically expand the number of dosages beyond 14 million because the manufacturers will have limited the vaccine that they are producing for a given winter to an amount appropriate for the strains.

The noble Earl, Lord Howe, referred to pandemic plans. The system used for seasonal vaccination is fundamentally different from that for pandemics. The pandemic plans for antivirals and vaccines are based on central purchase and distribution. They are not GP-based, and so a totally different system is in place in that regard. I reiterate our confidence in the contingency plans for a pandemic and I remind the noble Earl that our level of preparedness was well supported by the World Health Organisation.

The other points raised relate to over-ordering. GPs do not have sale-or-return arrangements for excess stock. We expect them to make judgments on the basis of the information they have on their lists about priority groups and to order accordingly. Our letter yesterday specifically asked GPs to move vaccines between one another if they had stocks which they did not need. So we have asked people to share in these circumstances, and the flu co-ordinators, whom I mentioned in my Statement, can facilitate that at the local level.

The noble Baroness, Lady Barker, raised the subject of hypothermia. A substantial number of measures are already in place for keeping warm in winter and, again, we are having a campaign on the issue in the current year. We will continue to do the best that we can at the local level through the NHS and social services to ensure that people are well informed about what they can do to guard against extreme cold.

Photo of Baroness Tonge Baroness Tonge Liberal Democrat 5:19 pm, 22nd November 2005

My Lords, is the Minister able to assess how much flu vaccine is left in the private sector and in the drop-in centres? Approximately how much does it cost to have a flu jab at those centres, and are GPs directing patients to them if they feel that they should have the vaccine but do not have any themselves?

Photo of Lord Warner Lord Warner Minister of State, Department of Health, Minister of State (Department of Health) (NHS Delivery)

My Lords, as I think the noble Baroness knows, there is a fee payment for GPs vaccinating the at-risk groups. I do not know whether they are referring to other sources of vaccine. It is more likely that they would seek to obtain supplies of vaccine to vaccinate their own at-risk groups within their own practice. As I said earlier, we have reminded them of the importance of sharing. We have flu co-ordinators at the PCT level who are expected to facilitate those kinds of arrangements.