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Swine Flu

Ministerial Statement – in the Northern Ireland Assembly on 15th June 2009.

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Photo of David McClarty David McClarty UUP

I have received notice from the Minister of Health, Social Services and Public Safety that he wishes to make a statement on the outbreak of swine flu.

Photo of Michael McGimpsey Michael McGimpsey UUP

I take this opportunity to provide Members with a further update on the Northern Ireland response to the swine flu virus. On Thursday 11 June, the World Health Organization announced that it considered the swine flu virus to have reached global pandemic levels. That announcement means that we have moved to phase 6 of our pandemic flu preparations. I reassure Members, as I did following the announcement, that the declaration does not reflect the severity of the virus; it means that the World Health Organization thinks that the virus has spread more widely around the world and now fulfils the definition of a pandemic.

The Scottish Government confirmed yesterday that a patient with underlying health problems had died after testing positive for the H1N1 virus. She is the first person in Europe to die from the virus, and she had other, underlying health problems. Her death does not mean that the virus is becoming more severe. Indeed, the evidence to date suggests that the virus is not changing at all.

There have been confirmed cases of the virus in 74 countries and large increases in the number of confirmed cases being reported in the UK, Australia, Chile and Japan. Globally, there have been 30,128 confirmed cases and 165 deaths. Throughout the UK, there are 1,277 confirmed cases, eight of which are in Northern Ireland. We have also seen more cases of the virus in the Republic of Ireland, with 12 cases now confirmed. Given the increasing number of cases worldwide, we can expect more cases here.

The World Health Organization considers the pandemic to be moderate, with the majority of people affected by the virus recovering well, without the need for hospitalisation or medical care. Our experience in the UK has been that the levels of clinically severe or fatal cases appear to be similar to that of seasonal flu. In the majority of cases, the disease has generally been mild, but it is proving to be severe in a small minority of cases. I am pleased to report that all the people in Northern Ireland who contracted the virus have fully recovered or are recovering well.

It is important that Members be aware that the World Health Organization’s move to phase 6 does not change the UK’s overall assessment of the virus and does not trigger any material change in our public health response. The World Health Organization, in determining its pandemic alert phases, needs to consider what is happening globally, and, as I reported, although the number of cases throughout the world continues to rise, there continues to be only a small number of cases in Northern Ireland.

As in the rest of the UK, we have been planning for a potential pandemic for some time, and, since the emergence of swine flu, we have been operating at a heightened state of readiness. Our plans are robust and well rehearsed. We are continuing with our preparations based on prudent planning assumptions, because it is still too early to predict accurately the impact of the pandemic on the UK. The move to phase 6 vindicates our planning for a pandemic and the possibility of large numbers of people catching swine flu. I understand how the further development in Scotland may cause public concern, but the UK is one of the best-prepared countries in the world, so we are well equipped to deal with the pandemic. In line with the World Health Organization’s advice, the UK Government will not impose any domestic or international travel restrictions, and they will keep UK borders open.

In Northern Ireland, as in the rest of the UK, we are following a containment strategy, supplying antivirals to people who develop the disease and, as a preventative measure, to their close contacts. The strategy has been effective to date in delaying widespread transmission. However, it will not work indefinitely if there is a rapid rise in cases. Therefore, preparations are in hand to move to a mitigation strategy. Such a strategy will mean that, when the number of cases increases beyond a certain level, we will have to keep under review the extent to which we supply antivirals to contacts. In the first instance, we will supply them only to immediate, close contacts rather than to all contacts. The mitigation strategy may also require the use of clinical diagnosis rather than laboratory testing where there is a high probability that people will test positive for the virus. A reduction in the numbers of follow-up contacts may also be necessary so that we target only people who are most at risk.

The move to phase 6 means that vaccine manufacturers will need to meet the contractual obligations of advance purchase agreements for vaccines that were made with the UK and some other countries. Such agreements were made in the event of a pandemic being declared and enable the UK to purchase up to 132 million doses of pandemic-specific vaccine when it becomes available, which means that we will have access to two doses of pandemic-specific vaccine for everyone in Northern Ireland if needed. Northern Ireland has a stock of antiviral drugs that covers half the population, and I have ensured that steps are in place to increase that stock so that antiviral drugs will be available to treat up to 80% of the population.

Last Friday, I called a meeting of the chief executives of the various health and social care bodies and the Fire and Rescue Service to assure myself that their organisations are in an advanced state of preparedness and ready to respond to the increased number of cases expected in the near future. The meeting was positive, and I am pleased that extensive plans are in place to ensure that the population will be protected.

I also continue to meet my counterparts throughout the UK. Along with Health Ministers from Wales and Scotland, I take part in regular COBRA meetings that are now chaired by the new Secretary of State for Health, Andy Burnham. My Department continues to work closely with the Department of Health and Children in the Republic of Ireland on North/South preparedness. Last week, on the fringes of the North/South Ministerial Council meeting, I met Mary Harney to discuss swine flu preparations and planning.

As we have been doing to date, my Department and I will ensure that the public are kept fully informed and are given the necessary advice. I remind Members and the public that we cannot do this alone: everyone must continue to play their part in helping to reduce the impact of the pandemic. My key message to everyone is to carry on as normal but to ensure that they follow the public health advice that has been widely publicised in leaflets, on television and radio, and in newspapers. The simple but effective measures that the public can take to protect themselves include covering their noses and mouths when coughing or sneezing, putting tissues in the bin and washing their hands with soap and water or sanitising gel as soon as possible. The message is simple: ‘Catch it, Bin it, Kill it.’

The Public Health Agency will continue to carry out rigorous surveillance to identify cases and arrange antiviral treatment for those affected and their close contacts. My Department is monitoring the situation in Northern Ireland and will take the necessary action to respond to the emerging situation. My officials are working closely with those from other Departments, particularly OFMDFM, as necessary to ensure that the wider Northern Ireland response is appropriate. I will, of course, report again to the Assembly as the situation evolves.

Photo of Iris Robinson Iris Robinson DUP 12:15 pm, 15th June 2009

I welcome the Minister’s swift and measured response to the pandemic. He said that steps are in place to increase the amount of antiviral drugs to cover 80% of the population. How long will it take to achieve that benchmark of 80% availability? Will there be enough antiviral drugs for the autumn, when a major rise in the number of people presenting with this type of flu is expected?

I assume that when the Minister mentioned people who are most at risk he was referring to older people, particularly those diagnosed with clostridium difficile and MRSA. Given that their condition is considerably weakened, will they be given priority?

Photo of Michael McGimpsey Michael McGimpsey UUP

I have dealt with the matter of antiviral drugs in the House on a number of occasions. Stocks are in place to cover 50% of the population; no pandemic has yet affected over 30% of a population. However, I have placed an order that will increase the population coverage to 80%. I have no precise date for the arrival of those antiviral drugs, but they will certainly be ready for us by the autumn. By then, I expect to have enough to cover the population not only during the containment stage but through the mitigation stage.

Older people with clostridium difficile or MRSA will of course be prioritised when the vaccines are eventually available. However, that is some way off because the virus seed must be identified before they go into production. The vaccines will be shared among countries that have placed advance orders, including the UK. Northern Ireland will receive its share, and we will determine at that point who is most at risk.

For Mrs Robinson’s benefit, it is clear that the people most at risk are those aged 16 and under, not older people. In fact, the suggestion has been made that people who are aged over 65 have some element of immunity. However, those are clinical decisions, and I will leave it to the clinicians to advise me on them.

Photo of Claire McGill Claire McGill Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. I note and welcome the fact that he said that our plans are “robust and well rehearsed.”

Some media reports say that in some areas of Scotland diagnoses are not being made by either swab or laboratory testing. Is that the case here? What would the level of infection have to be for that to happen here? I understand that GPs are diagnosing swine flu in some areas of Scotland. Given that, what is our GPs’ situation? Can they diagnose? What level of infection must be reached here before that would be required of our GPs?

Photo of Michael McGimpsey Michael McGimpsey UUP

To some extent, that depends on the progress of the virus in Northern Ireland. Degrees of infection are being seen in Scotland and in England that differ from those in, for example, Wales, Northern Ireland or, indeed, the Irish Republic.

Widespread community transition is being experienced in parts of Scotland. In some places in Scotland, mitigation, as opposed to containment, is operating. Mrs McGill described one of the characteristics of a mitigation, as opposed to a containment, strategy. We continue with our containment strategy, which has worked well so far. We will reach the point where we move to mitigation, but none of us can predict when that will be; it very much depends on the behaviour of the virus.

Photo of John McCallister John McCallister UUP

I also welcome the Minister’s statement. We are reaping the rewards of having robust and well-rehearsed plans.

It has become clear that, in dealing with swine flu, we are in it for the long haul. I see two big challenges in that. First, the population can become complacent about some of the messages. We must keep reiterating and reinforcing those messages as we move forward so that people do not think that the pandemic is over. Secondly, finance is an issue. Will a financial burden be placed on the Health Service as the pandemic continues into the summer and autumn?

Photo of Michael McGimpsey Michael McGimpsey UUP

The money that we had set aside for a flu pandemic will not begin to deal with the cost burden as the disease works its way through. It is clear that it is not part of my budget and that it is a matter for others; I cannot allow for it in the health budget. At present, the costs that are involved are still estimates. However, it seems to me that we have no choice other than to treat swine flu seriously. As I keep saying, we prepare for the worst and hope for the best. There will be a bill to pay, but, if the situation becomes as serious as it could, that bill will be well worth paying.

Photo of Carmel Hanna Carmel Hanna Social Democratic and Labour Party

I welcome the Minister’s update, and I acknowledge that the Scottish patient who sadly died had an underlying health problem. However, we are aware that people in Scotland were hospitalised; indeed, some of them were admitted to intensive care units. Scotland is not in our jurisdiction, but it is a very close neighbour of ours.

Has the possibility been discussed that the strain in Scotland is a more virulent one?

Photo of Michael McGimpsey Michael McGimpsey UUP 12:30 pm, 15th June 2009

The strain that is being dealt with in Scotland is the same one that we all continue to deal with. It has had a severe affect on 10 individuals, who are in hospital, but scientists and medical experts are unable to say why those people have been affected in that way.

Photo of Kieran McCarthy Kieran McCarthy Alliance

I, too, thank the Minister for keeping the House and the Northern Ireland public abreast of what is happening with swine flu. Unfortunately, a patient in Scotland sadly died, and I am sure that the House offers its sympathy to the family of that person. We were told that that person had underlying health problems. Swine flu has affected a number of patients in Northern Ireland. Do any of those patients have underlying health problems, and, if so, will they be monitored and given every available treatment to ensure that they have a speedy recovery?

Furthermore, does the Minister have any evidence that, during this phase of the swine flu outbreak, the wise instructions that he and his Department issued have been adhered to throughout Northern Ireland?

Photo of Michael McGimpsey Michael McGimpsey UUP

With respect to the Member’s latter point, we provide advice through the Public Health Agency, and Members will have seen that advice, particularly in media adverts. We rely on the public to be sensible and to co-operate. Co-operation is a key part of containment, and the longer that we can contain the outbreak, the more time we can buy until a vaccine is ready and in place.

Everybody who has tested positive for swine flu in Northern Ireland has either recovered or is doing well. The situation in Scotland is different; some patients there have had a mild reaction, but others have had a severe reaction. It is early days with this new and novel virus, and no one is clear about its characteristics. No one can yet say whether one of its characteristics is that it is a mild strain.

Photo of Thomas Buchanan Thomas Buchanan DUP

I wish to express my sincere sympathy to the family in Scotland, whose loved one had the virus and, over the past weekend, tragically lost her fight for life. Although I appreciate that that person was suffering from an underlying medical problem, is the Minister able to say whether pregnant women are at a greater risk from the virus? How does that death impact on the arrangements for fighting the virus in Northern Ireland?

Photo of Michael McGimpsey Michael McGimpsey UUP

As I said in my statement, although the World Health Organization has declared pandemic level 6, nothing will change; we will carry on with the plans and preparations that we have in place.

Although it is early days, there are some indications that pregnant women are more susceptible to the virus than the rest of the population. With respect to fighting the virus, Tamiflu is not suitable for pregnant women; however, suitable antivirals exist and are available to be administered.

Photo of Jennifer McCann Jennifer McCann Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his statement. In addition, I apologise on behalf of my colleagues Sue Ramsey and Michelle O’Neill who are members of the Health Committee but who have another engagement in the Long Gallery.

As other Members said, our thoughts and prayers are with the family of the women who died in Scotland. Although it has been confirmed that she tested positive for, and died from, the H1N1 virus, the Scottish Government also confirmed that she had underlying health problems. Of the 164 deaths worldwide that were associated with swine flu, how many of those people had underlying health problems?

Photo of Michael McGimpsey Michael McGimpsey UUP

I do not readily have such a statistical answer, and I imagine that much of the evidence is still being collated.

However, as I informed the House before, there has been an alarming degree of under-reporting in other countries. We are not clear about how many of the people whose deaths were ascribed to swine flu had underlying conditions and how many did not, but it is clear that there have been instances worldwide of perfectly healthy individuals, with no underlying conditions, contracting the virus and dying. There are no lessons that have been learned that I can relate to the House. It is still very early days as far as the scientific investigation is concerned.

Photo of Alex Easton Alex Easton DUP

Will the Minister tell us what contact he has had with colleagues in the Republic of Ireland? What level have they reached as regards their treatment, analysis and policy? Will he also tell the House whether the eight people who have contracted swine flu in Northern Ireland have been treated at home or have been admitted to hospital? Will he indicate the earliest date at which he expects to receive vaccines to treat swine flu?

Photo of Michael McGimpsey Michael McGimpsey UUP

There are 12 patients in the Republic of Ireland who have tested positive. My discussions with the Republic of Ireland show that it has adequate supplies of antivirals and has orders in place for vaccines.

As far as Northern Ireland is concerned, I am not aware of any of our patients who have tested positive going to hospital. They have been able to fight the virus at home with the support of the Health Service and antiviral treatments. As I keep saying, I am not in a position to say when we will receive vaccines, but we will not get all of our vaccines in one delivery: it will be an extended delivery because of the capacity of factories that produce the vaccines and because of the number of countries that require the vaccines. However, we are top of the queue thanks to the UK response and to our being part of the UK. Northern Ireland will get its full share of the 132 million vaccines that have been ordered.

Once the virus seed has been isolated and vaccine production starts, we should be seeing the vaccines before the end of the year. We will then determine who receives them first. High-impact employees, for example those in the Health Service and vulnerable groups, will be key, but that is very much in the future.