To ask the Secretary of State for Health
(1) pursuant to the answer of 9 January 2008, Official Report, column 595W, on influenza, what non-scientific considerations are taken into account when deciding on the stockpile levels of treatments to be purchased;
(2) when he plans to produce guidance on the eligibility of staff for vaccination against A/H5N1 based on a clinical assessment of the staff groups which may be at risk, as stated in paragraph 3.28, page 28, of his Department's document "Pandemic influenza: human resources guidance for the NHS," published on 21 November 2007;
(3) who will receive antiviral treatment in the event of an influenza pandemic should its clinical attack rate be greater than the quantity of antivirals stockpiled; and in what order of priority.
The size, quantity and content of the stockpile is guided primarily by the policy objective of using antiviral medicines effectively in order to prevent hospitalization and deaths arising from pandemic influenza, and supporting our 'stay at home policy'. To achieve this we are planning to increase our antiviral stockpile from 25 per cent. to 50 per cent. This should be enough to ensure treatment for all those that become symptomatic, including in a 'worst case' scenario where the maximum predicted attack rate is reached.
Safety and patient acceptability is key. All Neuraminidase inhibitors are generally well tolerated by patients but the side effects from amantadine make it less suitable for stockpiling. The form in which the medicine comes is also important; while Oseltamivir is a capsule, Zanamivir has to be administered using an inhalator. The possible development of antiviral resistance also needs to be taken into account. Resistance is known to develop quickly to amantadine, making it unsuitable for stockpiling. We are currently considering stockpiling a second Neuraminidase inhibitor.
In principle, antiviral medicine treatment will be available for all symptomatic patients from the onset of a pandemic. A move to prioritisation of treatment would only be made if information became available to suggest that demand for antiviral treatment would outstrip supply.
If the clinical attack rate exceeds the quantity of antivirals stockpiled, access to countermeasures will be based on the need to:
Reduce serious illness and deaths; and
Reduce transmission and spread.
Final decisions can only be made once we know what the clinical impact of the pandemic is.
As for the use of our existing stock of pre-pandemic vaccine, the Government have a stockpile of 3.3 million doses of H5N1 pre-pandemic vaccine for health care workers. However, the Human Resources guidance for the national health service is still being consulted on. Final guidance detailing the eligibility of staff for A/H5N1 based upon clinical assessment of staff who may be at risk will not be available until after the responses received during the consultation are collated and analysed.