§ 12.23 a.m.
§ Mr. John Cronin (Loughborough)
I wish to draw the attention of the House to certain matters arising out of poliomyelitis vaccination which are causing some disquiet among the public and among the medical profession. I am very much obliged to the Parliamentary Secretary to the Ministry of Health for being in his place to consider what I have to say, and I am sorry to have to raise this subject at a time when the Minister of Health is away ill.
I am sure that I speak for all hon. Members in the House when I express great sympathy with the Minister, and the hope that he will soon be well. But I feel some sympathy this evening for the Parliamentary Secretary, because he is carrying a very heavy burden in the Minister's absence. If I may say so, he appears to be carrying it extremely well.
I would like to make four suggestions to the hon. Gentleman. First, that poliomyelitis vaccination is progressing rather too slowly. Secondly, that the Ministry of Health should use the imported Salk vaccine. Thirdly, that the public relations aspect of poliomyelitis vaccination is being handled rather unhappily at 1438 present. Fourthly, that the Parliamentary Secretary should remove the present virtual embargo on the importation of the foreign, Salk vaccine.
I do not propose to make this discussion in any way a technical one. I have considerable sympathy with the Parliamentary Secretary in that he does have to rely to a very large extent on medical advice. Medicine, even in these days, is a science of sometimes embarrassing inexactitude. Anyone who has to deal with it may find some very serious problems. This is a grave subject, and one which should not be used for any party advantage at all. We should discuss this matter purely on its merits.
There are some background considerations which I should like to put to the House before coming to the four points which I have mentioned, and, first, we should remember that there are three types of poliomyelitis. There is the non-paralytic type, which is comparatively unimportant, the paralytic type, and that which is fatal. The paralytic type varies from a transient paralysis to those unfortunate cases—those tragic cases—where practically the whole body becomes paralysed and the victim has to spend often the rest of his life in what we have come to know as the iron lung. Between these extremes, there is a wide variety of paralysis and deformity, with some people crippled and having the most grotesque limps and disabilities; there are many varieties of human misery between the two points.
Fatal cases are comparatively uncommon, and represent only about 5 per cent. of all cases, but the paralytic cases constitute probably nearly half the total of all cases. Last year, there were 1,700 paralytic cases; but last year was comparatively good, for in 1947, 1949, and 1950, there were no fewer than nearly 8,000 paralytic cases. The worst time for poliomyelitis is late summer and autumn, so it is too early to give a true picture, but it does appear that this year the number of cases is rising; there is evidence that this will be a fairly bad year so far as paralytic cases are concerned.
One can obtain a very large measure of protection by the use of vaccines, and the country which has the most experience of vaccines, and which also has the largest output of them, is the United States. Vaccines are being produced 1439 here, although it is too early to form any final opinion about them, but it is generally agreed that they are satisfactory and that they are safe. The most stringent precautions are being used, and this, of course, is very wise.
The Salk vaccine is freely available for import into this country, being produced now not only by the United States, but also by Canada and Australia. Importation of it is subject to the provisions of the Therapeutic Substances Act, 1946, which lays down that a licence must be obtained from the Minister of Health before any therapeutic substance is imported. I understand that no licences are being issued for the importation of foreign-produced vaccines, so that there is virtually a complete embargo.
Having dealt with these general considerations, I will pass to my four specific points. The first one is that the poliomyelitis programme is proceeding too slowly. As long ago as January of last year, the Minister of Health promised that enough vaccine would be available for 300,000 to 500,000 persons to be vaccinated by June, 1956. But it subsequently emerged that only about 200,000 children were vaccinated by the end of 1956, and I think that quite recently the Parliamentary Secretary said in the House that roughly half of the children actually registered for vaccination had been vaccinated. Enough vaccine had been issued in this country for only half of those who were registered.
However, of the children eligible for registration for vaccination, only about 30 per cent. have been registered. Of the age group for registration, which is for children from the ages of 3 to 10—although recently children from one to 2 have been accepted for registration—the registrations requested represent only about half the total number of potential cases of paralytic poliomyelitis. Therefore, so far, quite a small proportion of the possible future victims of poliomyelitis have had the opportunity to be vaccinated against it.
The Parliamentary Secretary said recently that the only firm which is at present producing poliomyelitis vaccine is to increase its production by 50 per cent. That firm is Glaxo Laboratories Ltd. He also said that Burroughs, 1440 Wellcome & Co. will be going into production next year. I think we would all like to know why it has only just recently been decided to increase production of the vaccine at Glaxo Laboratories by 50 per cent., and why only 50 per cent., when there is this urgent need, and why Burroughs Wellcome is only coming into production next year.
I am not suggesting that it is the fault of these firms. It is, after all, the Government's duty to place the contracts on such terms as will produce rapid fulfilment of the demand. But we have to accept the fact that with this probability of thousands of victims of paralytic poliomyelitis, unless production is greatly increased, thousands of people will be crippled or maimed as a result of illness this year and, certainly, hundreds may well die.
My second point is that the Minister should use the foreign-produced Salk vaccine. As I said, this is available for import from the United States, Canada and Australia. The Minister did announce at the annual conference of the National Association of Maternity and Child Welfare on 26th June that he accepted expert medical advice that Britain should not run the risk of importing poliomyelitis vaccine. I think that the Minister is to a certain extent justified in being cautious, because we know that in 1955 there were a couple of hundred cases in the United States which arose directly from the vaccine manufactured by a firm called Cutter, and some precaution was obviously desirable in view of that somewhat disastrous result.
However, I would like to know whether the Minister is being, overcautious, because after that Cutter incident, regulations in the United States were tightened up very considerably, and so far over 100 million injections have been given of the United States produced vaccine without any serious ill effects.
I should like to quote from a letter written by Professor Trueta, who is probably one of the greatest authorities on poliomyelitis in this country, to the British Medical Journal on 15th June:After nearly 100 million inoculations without mishap in America and Canada of the Salk vaccine since the Cutter incident, no one could object as to the safety of the American vaccine as prepared by the best drug firms. I do not see any other reason which could be adduced against the immediate use of the 1441 American Salk vaccine, as in matters such as these national pride is not involved, the virus being an international aggressor, and the vaccine being prepared with the same virus.That, I suggest, comes from a very formidable authority on the subject.
§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
The hon. Gentleman has quoted from a letter from a professor who is a very great authority. Is the professor in question a virologist or immunologist and, therefore, particularly expert in this aspect of the matter?
§ Mr. Cronin
The professor in question is the surgeon who deals almost exclusively with poliomyelitis cases in a special hospital, the Wingfield Morris Hospital.
One can deduce from the Minister's own action that he must himself be, to some extent, convinced of the safety of the foreign vaccine, because there is one exception to this embargo on imports. Unsolicited gifts of vaccine are permitted to enter the country. If the vaccine were in any way dangerous, surely no vaccine whatever should be imported. There seems to be no logical reason why the receivers of unsolicited gifts should be subjected to danger more than anyone else.
I think that the House would like to be reassured that the ban on the Salk vaccine being imported is not purely for research reasons. It has been suggested that the Medical Research Council is anxious to have the results of the English-produced vaccine assessed without the complication of a foreign imported vaccine to interfere with the figures. I do not think that that is the case, but it has been suggested and we should be grateful if the Minister would deny it.
Another possible reason for not importing the Salk vaccine is that there might be some variations in its potency. But I think that it is generally agreed, on medical grounds, that the American vaccine is entirely satisfactory in doing its job. As an example, the Board of Health of Chicago published figures showing that it had managed to have over 1 million children vaccinated. Later, there was an outbreak of poliomyelitis in Chicago, and among those children who had not been vaccinated the incidence of 1442 poliomyelitis was 358 per 100,000. For those who had received two injections, the incidence was 14 for every 100,000, and for those who had three injections the incidence was nil, there being no cases at all in that group. It seems, therefore, that the American vaccine certainly does the job.
I cannot imagine that the Minister is banning the foreign vaccine for financial reasons. In fact, the American vaccine is cheaper than the British produced vaccine. Of course, from the general financial point of view, using vaccines would be very much cheaper than paying the quite enormous cost of hospital treatment and appliances necessary for the victims. I cannot imagine that financial reasons would seriously influence the Minister in a matter like this.
It has also been suggested that the British vaccine is more suitable. I should like the Minister to tell us whether there is any real evidence of this, because the British vaccine is of comparatively recent origin. Is there any evidence at all to suggest that the American vaccine would not give just as much, or nearly as much, protection as the British vaccine? As the American vaccine has not been tried out here, are we sure that it is not better than the British? It is quite possible that it is much better.
The Minister may well be striving to get the perfect vaccine, but while he is trying to attain perfection there is this constant flow of victims. In this case the Minister is rather like a bystander who sees someone drowning, but will not throw him a serviceable lifebuoy because in a factory a better lifebuoy is being produced.
I now turn to the public relations aspect of poliomyelitis vaccination. When the scheme was first announced, in January, 1956, the Ministry of Health completely failed to give any of the facts to the medical Press although the facts were passed on to the national Press. It seems to me quite extraordinary that the medical profession should have been completely ignored when this information was available.
Why is it that only one-third of the age group chosen was actually registered? Why did two-thirds of parents for whose children vaccination was available not take advantage of the offer? It suggests 1443 that there was not much in the way of really favourable publicity. When one considers that in Denmark, for instance, four-fifths of the whole population under the age of 45 has been vaccinated——
§ Mr. Vaughan-Morgan
I am sorry to keep interrupting the hon. Gentleman, but when he is discussing Denmark will he tell the House the form which vaccination in that country takes?
§ Mr. Cronin
The Danish vaccination is substantially the same as ours, but perhaps the Parliamentary Secretary will elaborate the point when he replies.
One wonders why the Minister gave such optimistic figures last year when the actual result was rather poor in regard to the number of vaccinations performed.
Finally, why was this curt announcement recently given to the Association of Maternal and Child Welfare concerning the risk of importing vaccines? Why were no reasons given? Why is the medical profession in complete ignorance as to the reasons which made the Minister take this decision? If they are good and valid reasons, there is no reason at all why they should not be published and made available for the medical profession to study.
I now come to the last matter—the refusal of the Minister to allow the importation of the Salk vaccine for private use if anyone wishes to use it. The present position is that one can obtain the Salk vaccine from the United States or Canada provided it is sent as an unsolicited gift. Why should members of the general public be deprived of a means of protecting themselves and their children from poliomyelitis when there is available a vaccine of known value? Why is there this interference with a doctor's right to prescribe any drug he thinks fit when that drug has been used extensively all over the world with marked success?
Another aspect of the matter is that the privilege of unsolicited gifts must, in the nature of things, be confined to people who have either travelled in the United States or who have connections with it, and it tends to give a privilege to a very limited class. If unsolicited gifts are being allowed in there is obviously a tendency for a species of smuggling to develop, and this is happening on 1444 a large and increasing scale at the present time. One feels that the law is being brought into contempt.
This privileged traffic is now gradually approaching black market proportions and there are very real dangers. The vaccine requires special skill in handling and storing. If it is coming into the country furtively, in small quantities, one does not know whether it is retaining its potency and being properly handled. There is great danger of the development of a black market in which unscrupulous persons either import the drug or even manufacture what appears to be this drug and pass it on to the public. There is often great parental anxiety to protect children from this dreadful disease. There seems, therefore, to be a real danger of this unsolicited gift system developing into an extensive black market.
I have put these considerations to the Minister and I shall be very interested in what he has to say. He is in a difficult position and one feels considerable sympathy for him, because he is carrying a heavy responsibility. If he makes the wrong decision, it is likely that thousands of people will be maimed and crippled and a large number of people will die. He has a frightening responsibility and he carries, for this reason, I am sure, the sympathy of the whole House. I hope that the hon. Gentleman will give these matters very careful consideration. Quite properly, he may not wish to commit himself tonight, but if he assures us that he will look into the matter carefully he will be giving us some satisfaction.
§ 12.47 a.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)
I make no complaint about the manner in which the hon. Member for Loughborough (Mr. Cronin)has dealt with this difficult and delicate subject and I hope that my remarks may enable him and the House to see it in its right perspective.
The hon. Member ranged widely and gave a survey of all the problems. I am grateful to him for his sympathetic remarks, not only about the illness of my right hon. Friend but about the decision taken by my right hon. Friend—I do not envy him in having to take it—which, in my view, was entirely the right one. It was a decision which. I think, any man 1445 in my right hon. Friend's position, having had the advice which he had then and which I have now, would still take.
It is difficult for a layman such as myself to contend against a doctor such as the hon. Member for Loughborough, but I am not so much further away from being an expert than he is. This is not simply a question for doctors as such. It is one in which I or the Minister have to rely on the very best specialist opinion in the subject—that is, on virologists or immunologists, whose speciality this is and whose advice is given to the Minister by the Medical Research Council.
Let me give an idea of some of the difficulties with which we must deal in the way of technicalities. The hon. Member referred to Denmark and said that four-fifths of its population was covered. The simple answer is that the dosage and method of administration in Denmark are entirely different. The Danes have their own approach, which is quite different from that of any other country. They give two small injections, each of which is approximately one-tenth of a normal dose. In those circumstances, it becomes 'rather easier to cover the population. Who is right, is not for me to say.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
Is it not the case that in this country only two doses are given, whereas in America, for example, three is the normal number?
§ Mr. Vaughan-Morgan
That is exactly my point. That is why I say that these comparisons are irrelevant. It is true that the Americans give three doses as against our two, but we are using an entirely different type of vaccine. It is no good comparing Denmark with us and saying that the Danes have complete coverage, because it is not so: they have it on an entirely different basis from ours. I say that not to contradict the hon. Gentleman, but to point out the difficulties of the subject.
I come to the question of imports which are taking place of Salk vaccine by private citizens. The hon. Gentleman referred to smuggling. All I can say is that I should have been happier if he had produced more evidence before making such a statement. Smuggling, as such, is a matter for the Customs and Excise. No doubt, the hon. Gentleman will draw the attention of the Customs 1446 to any evidence he has. I am concerned with unsolicited free gifts which come into the country. It may be well that I should give fairly detailed attention to that.
As the hon. Gentleman said, under the Therapeutic Substances Act. 1956, the import of vaccine requires to be licensed. It is still not thought appropriate to make arrangements for the general import of Salk vaccine, and, therefore, no licence has been issued under the Act. This being so, import is prohibited, and any consignments which arrive are detained by the Customs.
We have not wished, however, to exercise a rigid control over individuals who have been sent gifts of small quantities of the vaccine for family use and, therefore, we have authorised the Customs to release such packages where it is clear that a doctor has taken responsibility for injection. In each case we follow that up by explaining to the doctor concerned that the vaccine does not necessarily conform to the standards of potency and purity required of the English vaccine.
A Board of Trade import licence, carrying with it authority to incur dollar expenditure, is not available for such purchases and no parcel has been reported to us which has not been a gift. It may be of interest to know that the numbers of such parcels for the last three months were 33 in May, 48 in June, and 53 in July. In addition, there may be parcels brought by travellers—small quantities of vaccine for their families. It has never been the practice of the Customs and Excise to prevent the import by travellers of small amounts of medicaments for their own use, and no change in this practice seems to be called for.
This escape clause was originally planned so as to ensure that a diabetic bringing sufficient insulin to tide him over a short period should not be deprived of the means of maintaining life. There seems to us absolutely no reason to alter the instruction that small amounts of poliomyelitis vaccine for travellers or their families may be permitted.
So far as we know, there is no evidence that larger quantities for other than personal use are being brought into this country. I am keeping the question of the entry of these small personal packages under review, but unless there is a radical change in the present pattern I should 1447 not feel justified in interfering with what is a personal decision of individual parents who have been sent gifts of Salk vaccine, or who bring small quantities in with them on their return to this country and whose doctors—I repeat—are prepared to take responsibility for injection. Our responsibility is to see that those who receive these gifts are made fully aware of the issue at stake.
I come to the wider question of the importing of Salk vaccine on what I may call the national basis. I do not know why the hon. Gentleman referred only to my right hon. Friend's speech to the Maternity and Child Welfare Conference. I should have thought he would have gone back to the statement which my right hon. Friend made in this House on 15th May.
I quote his words:I have seen suggestions that arrangements should be made to import vaccine from America. When drawing up our scheme we decided, on expert advice, that the vaccine to be used in this country should have a composition different in certain respects from that of American vaccine which is made from strains of virus including the virulent Mahoney strain. That advice still stands, and, while the situation will continue to be kept under close review in all its aspects, my right hon. Friend and I do not consider that any departure from this policy is warranted in existing circumstances."—[OFFICIAL REPORT, 15th May, 1957; Vol. 570, c. 411.]I have nothing to add to that statement of policy. The advice given to me by the Medical Research Council and others concerned has not changed. If, in the light of experience, other and different expert advice is given we shall, of course, be ready forthwith to reconsider our policy.
§ Mr. Cronin
Obviously, the hon. Gentleman cannot ignore his medical advisers, but he certainly has the right and the responsibility to point out to them the fact, which he will accept, that 100 million injections of the Salk vaccine have been given without any untoward incident at all. Therefore, how can there be any serious question of the vaccine being dangerous?
§ Mr. Vaughan-Morgan
How easy it is to make a remark like that! How easy it is to suggest that I should interfere in any way with advice given to me by the Medical Research Council, which, I am sure, is as well aware of these facts 1448 as we are. At what stage does it become safe? How many years after the Cutter incident is it safe? Is it for the hon. Member or for me to try to counter the advice of our experts? If that advice changes we must reconsider the matter, but we should not lightly bandy about the House the risk involved. The Cutter incident was very serious indeed. If one litre of the stuff goes wrong, and a litre is enough to vaccinate 500 children, we might have a repetition. Is it not clear that we should keep absolutely to the high standard we have already observed? We have never had anything go wrong with the British vaccine.
The advice that I have received still stands. The reason for it was the prevalence in the Salk vaccine of the Mahoney strain, which we do not have in our material and which is much more virulent than our own Brunenders strain. If any virus survives the manufacturing process and remains undetected by tests, the Mahoney strain is a paralysing virus and the Brunenders strain is not. That is something to which we should pay continuing regard. The hon. Member talks about the prevalence of polio in this season and what we could do by importing Salk vaccine, but it is surely quite inconceivable that we should import it on any scale without the very careful tests which the Medical Research Council applied.
Let us remember that these tests are very careful and that they take three months to apply. If we add to those three months the time for distribution we shall have made it pretty well impossible to distribute the vaccine so as to be of any help in the coming year. Quite apart from that fact, there is the fact not generally realised that the time taken to achieve immunisation, which varies with each individual, can be anything up to six weeks.
I turn to British production. I shall not make any prophecies. We have had far too many difficulties and dangers in the way and so many pitfalls in the course of achieving production. After all, this is a fairly new project. There was no such thing as a polio vaccine even three years ago. Therefore, I do not think that we can blame the manufacturers or ourselves too much.
§ Mr. Fenner Brockway (Eton and Slough)
Would the hon. Gentleman pay 1449 some tribute to the firm and the workers in Slough who produce this valuable vaccine?
§ Mr. Vaughan-Morgan
The hon. Gentleman should give me a chance. I have not got as far as that yet. I was about to announce that the firm in Slough is to be able to increase its production by 50 per cent. It is a little hard when the hon. Gentleman interrupts me, because I was going to give the firm a real pat on the back.
We hope that the other firm will come into production next month, but we have had so many disappointments that I really cannot commit myself too far to any kind of future programme, though I may say that I am beginning to be a little more hopeful that we may have a substantial increase in the course of time.
Finally, I should like to say a word about the incidence of the disease. I have provided myself with a mass of figures, and could detain the House for a long time, but I shall refrain from that. The hon. Member for Loughborough referred to the fact that this was the worst year for poliomyelitis since 1950. I wonder whether it will help the House to get it into proportion when I say that the worst year we have ever had, which was 1950, was less than the lowest year they have ever had, for example, in the United States of America.
Even despite everything, I am told—though I have not had absolute confirmation of these figures—that in this heavy year for us and this light year for the United States, the incidence is still very comparable. That is not in any way to minimise the grimness of this disease, but that is the total number of cases, and includes both the paralytic and non-paralytic, and among the paralytic the very large number who recover.
It is difficult when one is dealing with and seeing cases of this kind not to be shocked; indeed, none of us would be anything else. But we must try to get the incidence into a sense of proportion. As time goes on, and more protection is available, I pray that this will be yet another of the diseases which we shall have driven from our midst. I hope these few words will give some satisfaction to the hon. Member. We are always on the alert to any possible change in the situation which may affect what is still our current policy.
§ Mr. Blenkinsop
Could the hon. Gentleman explain why, if he has decided to allow the unsolicited gifts to come through and to be used, and, therefore, not destroy the individual decisions of parents provided that the doctor is willing, similar provision cannot be allowed for those parents who are willing to pay for the import of Salk vaccine—again provided that it is administered under proper medical supervision and with proper medical guarantees?
Secondly, could he say whether it is true that this year a higher proportion of adults are suffering from poliomyelitis, and that this may suggest some change in the strain of poliomyelitis in this country, and would he ensure that if that were so it would be taken into account in any future decisions he may make? Will he ask for some further examination of the fairly complete information that we now have about the Salk vaccine being used all over the world?
§ Mr. Vaughan-Morgan
I cannot give the hon. Member the information about the breakdown of the cases for which he asked. I will examine that point and see whether I can find out. As he knows, there has been an international congress on the subject when opportunity was taken to exchange views, but I have not yet had different advice—that is the point I was trying to get over to the House. His other comment was a little inconsistent with some of the remarks of his hon. Friend the Member for Loughborough about creating two classes, the privileged and unprivileged.
Our policy is perfectly consistent. If the vaccine is an unsolicited gift, it is allowed to come here. What we have been discussing is the Salk vaccine as opposed to the British vaccine. There is no change in our view about that.