Motion made, and Question proposed,
That a further sum, not exceeding £30, be granted to Her Majesty, towards defraying the charges for the year ending on the 31st day of March, 1959, for the following services connected with the Supply of Poliomyelitis Vaccine, namely:—
|Civil Estimates, 1958–59|
|Class V. Vote 4 (Ministry of Health)||10|
|Class V, Vote 5 (National Health Service, England and Wales)||10|
|Class V, Vote 11 (National Health Service, Scotland)||10|
§ 7.12 p.m.
§ Dr. Edith Summerskill (Warrington)
The reason why we have asked for this debate today is to focus attention on the failure of the Minister of Health to make the necessary provisions to safeguard certain sections of the population against poliomyelitis. I have no need to remind the Committee of the serious nature of this disease, which can have fatal consequences, but probably the attention of the ordinary person is drawn to the fact that it can cause permanent paralysis of a most crippling nature.
No one, I think, will charge me or hon. Members on this side with trying to make party capital—[An HON. MEMBER: "Oh."] I expected that. If the hon. Member listens to me, he will perhaps agree that I am right. Nobody can charge us on this side with trying to make party capital out of this problem.
If hon. Members look at the Questions on poliomyelitis which have been put over the weeks they will see that they have come from both sides of the House. They have been put to the Minister for the purpose of eliciting information. The situation has been aggravated by the Minister's persistent evasion, his dialectical replies to Questions and his persistent reluctance to clarify the matter, although, now, the facts are known by a large number of people who have investigated them.
If there are any hon. Members who dissent when I say that we have endeavoured always to try to elicit information in the fairest manner, I direct their attention to a newspaper which has always supported the Government. After 654 Question Time last Monday week, when the Minister failed to respond to Questions on the Order Paper—Questions which should have elicited a statement in the House—The Times, two days later said:The Minister of Health can scarcely be surprised at the criticism which has been aroused by his policy on poliomyelitis vaccine. Even the statement issued by his Department yesterday will hardly assuage the despondency—if not alarm—caused by the news of inadequate supplies made public during the past few days. Indeed, yesterday's statement is typical of that lack of candour which has succeeded vacillation as the main characteristic of ministerial statements on the subject.After that, no hon. Member can charge me with having spoken too strongly on the matter.
The Minister certainly cannot plead ignorance of the position, or argue that he has had insufficient warning. There were serious outbreaks of poliomyelitis last summer which should have stimulated his Department to take action. Months ago, hon. Members on both sides—and I am very pleased to see present hon. Members opposite who put Questions over the months on this subject—asked Questions about the availability of vaccine and the programme of inoculation. Let me take two examples. It is, of course, possible to go all over the country and to cite cases in which the medical officer of health, the doctors and, indeed, people generally, feel very strongly about this.
Last summer, in the Borough of Maidstone and surrounding district, there were 116 confirmed cases of the disease, and six deaths, in four months. Is it surprising, therefore, that the people and the medical officer of health have protested that after last year's serious outbreak, they are still in a state of relative unpreparedness? There was a recent protest. As a result, the Ministry sent enough vaccine for 5,000 children, although there are 100,000 in the County of Kent waiting for their course of injections.
Let us consider another place, the congested area of Tottenham. In January this year, the medical officer of health had to write to doctors asking them not to request supplies of the limited amount of vaccine because 2,000 children who had been registered in 1956 and 1957 were still awaiting their first injection. It may be asked whether the Ministry 655 has undertaken too much. I would say that the scheme which the Minister of Health has failed to implement is the very minimum which Britain can introduce in the light of medical advance in this field.
What have we offered to do? We have offered to immunise children from 2 to 15 years of age and expectant mothers, while other countries have offered to immunise all people under the age of 40. It might be said that this is an extravagant offer, but what are the facts? Two-thirds of the deaths occur among old people, not children. It is clear from that, surely, that our approach can only be regarded as an initial effort. What else have we undertaken to do? Is this over-generous? We have undertaken to give two injections only, the very minimum, while in Canada and the United States three are given.
To make a success of this campaign, it could be argued that publicity and propaganda should be done. Hon. Members will be familiar with the posters on the hoardings when other public health campaigns were being conducted. I have not seen one poster on any hoarding, in any part of the country, drawing the attention of the people to the fact that certain categories should be immunised. The consequence is that only 40 per cent. of the 10 million who were eligible were registered up to the end of February. We should like to know why the Minister has dragged his feet in this respect. There are some doctors who believe that it is because he had not made adequate preparation for securing the vaccine and, therefore, the fewer that applied, the better for his Department's reputation.
While little positive propaganda of that kind has been done, the Minister has invited people to choose between the British vaccine and the Salk. Surely, this invitation to ordinary people, who know nothing about the technicalities of vaccine, can only sow seeds of distrust in their minds. Here again, this approach can limit the demand effectively. If it is true that one of these vaccines is unsafe no one should be injected with it. The fact is that doctors are giving children British or Salk vaccine, whichever is available. There is no question of the doctor saying to himself "I am sure one is safer than the other". If doctors adopt that course why is the vaccine 656 considered acceptable to the public? Despite all this, the Press has appreciated the serious position, with the result that there is a continuing demand for immunisation as the summer approaches. The Minister should now have in mind provision of enough vaccine to cover the 10 million who are eligible. That will call for at least 20 million doses.
The latest figures we have are those given at the end of last February. Then, of those registered, 571,000 had been given one injection and 2,688,000 were still waiting for the first injection. Thousands more are estimated to have registered in March and April. We still wait to hear the latest figures. Hon. Members on both sides have put Questions to the Minister and this debate is the culmination of a growing demand both here, among the public and the medical profession for the Minister to give top priority to this matter before the summer arrives. Today, one feels that the summer has already arrived.
I will remind the Committee of some of the Questions which have been put. I cannot read all of them, but those I read will show that hon. Members have been interested in this matter over a long period. In December, 1956, my hon. Friend the Member for Willesden, West (Mr. Viant) asked about the availability of the vaccine. He was told by the then Minister of Health simply that two firms were manufacturing it and output was limited. At that time, the end of December, there were already a large number of children registered.
On 18th February, 1957, my hon. Friend asked:how much poliomyelitis vaccine was sent to local authorities in December, 1956; and how much has been sent to local authorities so far this year.The Answer was:Approximately 31 litres; none."—[OFFICIAL REPORT, 18th February. 1957; Vol. 565, c. 13.]The Answer relating to the first part of the Question could not convey much to hon. Members not accustomed to think of litres, but of doses.
In March, 1957, my hon. Friend the Member for Barking (Mr. Hastings) asked:Can the Minister give any estimate of the number of children who will be vaccinated before the summer…with one vaccine or another.
657 The answer was:it might be unwise at this stage to give any estimate."—[OFFICIAL REPORT, 18th March, 1957; Vol. 567, c. 31.]On 15th May the then Minister of Health felt it was time to make a statement. He made a very long statement, in which he said:The number of notifications of poliomyelitis so far this year has been relatively high. This must be a cause for concern. I am, however, advised that on the basis of past experience it is not possible at this stage to draw any conclusions as to the probable incidence of the disease later in the year.He went on to say that he was not advised to import vaccine.
I began to feel apprehensive. I had listened to these Questions over the months and I had been persuaded that the Ministry of Health was doing everything in its power, but a year ago, on 15th May, I said to the Minister:In view of the high number of cases of poliomyelitis already registered in the first four months of the year, that is, before the start of those months which we consider of serious import, could the Minister say approximately when there will be enough vaccine available to vaccinate the 1 million children who were already registered before the extra number now mentioned?This was a year ago. The Minister said:As the right hon. Lady will have noticed, I am most anxious not to make forecasts which might prove inaccurate because of production difficulties, but if all goes well it should be possible to complete vaccination of those already registered by the end of this summer."—[OFFICIAL REPORT, 15th May, 1957; Vol. 570, c. 408–9.]Yet, in 1958 there are large numbers of children who were registered in 1956 who have not yet had their first injection.
How else could the Minister have been made aware of what was happening? In July, 1957, the International Poliomyelitis Conference was held in Geneva. There were some English medical officers of health there. The matter was thrashed out and attention was focused on the need to import vaccine. At that time there was a sharp outbreak of poliomyelitis in this country. Surely that should have focused the attention of the Minister on the need for importing some vaccine. It was clear then that Glaxo and Burroughs Wellcome could not meet the demand.
Despite all this, I believe—the Minister will confirm or deny whether this is accurate—that the initial arrangement for 658 the purchase from the United States of America was not made until September, 1957. It should be borne in mind that this vaccine takes six months to produce and test. The result of this vacillation, as we know, was that in February this year there were nearly 3 million children of those registered who had not received a single dose, and since then thousands more have been registered.
The administrative muddle has reached the Press. That in itself is significant, because most medical officers of health will endure a great deal before they talk to the Press. The Press often asks them to give what the Press considers human stories. That is quite understandable, but medical officers of health refrain from so doing. This time, because of the administrative muddle, medical officers all over the country have expressed themselves rather forcibly.
The vaccination has been done by local authorities and general practitioners. The arrangements with the parents of the child for two tests and the distribution of the vaccine, which must be kept at a certain temperature, is a very detailed process. The behind-the-scenes chaos in London owing to the failure of supply of vaccine resulted in arrangements being cancelled. On 15th April, the L.C.C. cancelled 15 poliomyelitis clinics, informed the doctors in charge that their services would not be required as there was no vaccine, but, nevertheless, they were to receive the usual fee. There was no mention as to when the vaccine would be available. On 22nd April, only seven days later, another letter was written to them sayingA small supply of vaccine has been received, sufficient to enable a limited number of sessions to be arranged for the week 28th April. The following sessions, which were provisionally cancelled on 15th April, will not take place.General practitioners have undertaken to do this vaccination during their busiest period, the winter. I think it an understatement to say that they were put to great inconvenience. The single-handed practitioner would have made all arrangements with the mother and child and, at the last moment, would have to cancel the arrangement because no vaccine was available. Very often he gave the first dose, made arrangements with the mother for the second a month hence, and then, because the vaccine was not available, that had to be cancelled.
659 Of course parents would be concerned as to the effectiveness of the first dose because of the delay. The clerical work for all this was undertaken by the doctor or his wife and it all had to be done by hand. This meant an enormous pressure on the household. I am told that one man in a busy practice in London because he had read that more vaccine was expected, last Monday asked for 14 doses for the second injection for some children. Last night he was informed that he could have seven. Therefore, whatever the Minister may say about the changed situation at the centre today, it has certainly not reached the periphery.
The Minister gave a Written Answer on 21st April. This was the statement which evoked such strong criticism from The Times. Having referred obscurely to the number of litres imported and so avoided the real question about the available supply in terms of doses for those already registered. The Minister went on to say:There has, however, been some interruption of supplies to local authorities, and consequently of the vaccination programme for a number of causes. These delays in the delivery of vaccine have occurred in each of the four original sources of supply, two British firms, one Canadian and one in the United States of America. In each of the four cases, the cause of delay was different, but in no case was it within the control of or due to the fault of the Government."—[OFFICIAL REPORT, 21st April, 1958; Vol. 586, c. 49.]That is completely inaccurate. I propose to go through each case and show why.
I have already shown that the Minister failed to order sufficient supplies from the United States soon enough. All advice on this important question was ignored. On 11th April, the United States Public Health Service reported that there was enough surplus vaccine for export to protect 15 million children and there was an abundance of vaccine available even after people up to 40 had to be given three injections. The National Foundation for Infantile Paralysis, in the United States, announced that there was a large exportable surplus of Salk vaccine. It is, therefore, very difficult to believe the Minister's contention that he and the Government were not at fault in their arrangements about the American supply. There was ample vaccine in the United States. The fault was that the Minister failed to arrange in time to have it sent here.
660 What had the Canadian supplier to say about the Minister's statement? Too often, Ministers make statements at the Box, forgetting that their words are conveyed very quickly to the country about which they are speaking. I turn again to The Times. When one is in opposition and does not have a great Department in which to make inquiries, one has to rely upon inquiries made by correspondents such as The Times correspondent who reported on this matter in the issue of 22nd April. He had made an inquiry from the supplier about whom the Minister was speaking when he said that it was not the Government's fault. If it was not the Government's fault, then it was the supplier's fault.
§ Dr. Summerskill
As the Minister has already said he is dealing with only one supplier in Canada, it is a little difficult to think of a third person who may be involved. However, we may hear of a third reason.
Under the dateline "Ottawa, 21st April, The Times published a report from its correspondent in Canada. The heading was "'Misunderstanding' over delivery". It will be noted that the word "misunderstanding" is in inverted commas. The report goes on:Commenting on a report from London that a million doses of poliomyelitis vaccine failed to arrive in England in March, Dr. Ferguson, director of the Connaught Laboratories (the Canadian supplies of the vaccine), today expressed the view that there was a misunderstanding in London on this matter. He said that there was a contract for four million doses to be supplied to the United Kingdom before the end of June.The orders given to suppliers by the Minister's Department are not given orally or over the telephone; there must be written instructions. Dr. Ferguson is quoting from the written instructions to supply before June. Also, presumably, the Minister has a copy of the letter. Instead of telling the House that he was not at fault when the vaccine did not arrive, he really should have said that the Canadian suppliers were given until June.
No doubt, during the last two or three months, the Minister has been sending S.O.S. after S.O.S. to Canada for more, but, of course, this vaccine takes months 661 to prepare and test. The Canadian suppliers could not respond immediately; they had their own domestic needs to consider. All this led to the evasive replies we received on Monday. If the Minister thinks that I am being too strong in my condemnation, I would direct his attention to the Manchester Guardian of 29th April, which condemned his attitude.
Were the British firms given all the facilities necessary to produce the maximum amount of vaccine in the required time? Producing this vaccine is not easy. It takes six months. Facilities are necessary. Here was something of an exceptional character, and apparently, there were two firms prepared to produce it. We should like to know the details.
§ Mr. Walker-Smith
To help me answer the right hon. Lady's question, will she be good enough to particularise a little more precisely what sort of facilities she thinks the Government ought to have given to these companies, or either of them?
§ Dr. Summerskill
The Minister is head of a big Health Department. His Department has all kinds of advisers who can give help on technical matters. He should have said, "My advisers are available. Any equipment you will want, we will try to help you obtain". He should have offered his Department's assistance. My hon. Friend the Member for Barking, very pertinently, asked the Minister, two weeks ago, whether it would not be a good idea for the State to produce this vaccine. The Minister treated my hon. Friend, who has some knowledge of this matter, as though he was making a ridiculous suggestion. He had already come to the House and said that these private suppliers had failed him. Why is it a ridiculous suggestion to put, in this special kind of matter, that the vaccine should be produced by the State?
§ Mr. Walker-Smith
Because these two companies have as good scientists, technicians, facilities and equipment as can be found anywhere.
§ Mr. Philip Goodhart (Beckenham)
Does the right hon. Lady really suggest that the Government could teach Burroughs Wellcome how to produce this vaccine?
§ Dr. Summerskill
I find that hon. Members opposite are on the defensive, trying to find an excuse. They ask why we should help firms to produce something which is needed quite desperately by the country. What an astonishing, negative attitude! The Government, through the Ministry of Health, are responsible for immunising children and expectant mothers against the horrible disease of poliomyelitis. I have produced evidence to show that they have failed to do it. They should be the first to say, "If we can help in any way, we are at your disposal." I do not accept the suggestion that each private drug house in this country needs no help or advice at all from any of those who advise the Minister.
The Minister has told the House that some batches of vaccine failed to reach a certain standard. Surely this is a very weak excuse. Everybody with the slightest knowledge of the subject—and the Minister and the drug houses are surrounded with technical advisers—knows that this can be expected. It has happened in other countries, and that is precisely why stringent tests are applied after production—because it is known that these hazards have to be faced. The Wellcome Foundation may have had sickness among the test monkeys, but, as I say, these hazards have to be anticipated. The fact is that, in any case, the initial order given was only large enough to protect 2 million people a year. That was the order given to the Wellcome Foundation—4 million doses, enough to protect 2 million people a year.
The position today is that the Minister is sending out urgent messages to suppliers in an attempt to retrieve the situation. Unfortunately, whatever the amount of vaccine flown here, it will take many weeks before the children are immunised. Even after the detailed arrangements are made, and the first does given, there should be an interval of a month, the optimum period, before the second injection is given and any immunity conferred.
Whatever the nature of the improvised scheme that the Minister may offer us tonight—a scheme that the Minister has had to contrive to cover his neglect—it appears that there will be many thousands of those registered still waiting for immunisation at mid-summer. Indeed, 663 summer has begun today, and summer is the season for poliomyelitis. There is no time to protect these children before mid-summer. Not only will these children be unprotected, but millions who are eligible but unregistered will be completely unprotected.
I have condemned the Minister, but I feel that I was justified. Furthermore, I feel that my condemnation was supported by facts which cannot be disputed.
§ 7.43 p.m.
§ The Minister of Health (Mr. Derek Walker-Smith)
I welcome the debate unreservedly. I welcome it in particular because it gives an opportunity to deploy the facts about what is inevitably a somewhat technical and complex problem, and I hope to remove some of the misunderstandings on this subject which published comments in various quarters show to be very considerable.
I wish I could say that the speech of the right hon. Lady the Member for Warrington (Dr. Summerskill) had been effective in dispelling some of these misunderstandings. Courtesy and good will prompt me to say so, but honesty, alas, forbids. My only regret is that the Opposition should have deemed this subject, important as it is and much as it is in people's minds, worth half a day's debate instead of a whole day. I regret it all the more because, owing to the complexity of this subject, I shall have necessarily to take up a little time to do justice to the problems involved.
This is a debate about polio and the efforts to combat it. As the Committee will know, in the post-war years the incidence of polio has varied, ranging between a peak of 5,565 paralytic cases in 1950 with 755 deaths to 1,319 cases in 1954, the lowest post-war figure, with only 134 deaths. Last year there were 3,175 cases with 255 deaths. In the first sixteen weeks of this year, there were 331 cases compared with 633 cases last year and 418 in 1956.
The history of the efforts to combat polio by immunisation is very short, starting no further back than 1949. In that year laboratory discoveries made possible the development of a vaccine containing all three types of polio virus grown in tissue culture and killed by formalin. It was not until 1954 that 664 enough vaccine had been manufactured for field trials to be carried out in the United States. I have quoted those dates to show not only how recent is the development of polio vaccine, but to show that it took nearly five years after the basic laboratory discoveries to manufacture enough vaccine for trials. That surely illustrates very clearly and factually the extreme complexity and difficulty of the manufacturing processes involved.
It is clear from many of the comments made in some quarters that there is a tendency to gross over-simplification. To read some newspaper comments, one would think that making this vaccine was no different from making toothpaste or ice cream, or any other commodity in daily use. With the successful production of the vaccine, it has been possible to introduce a process of inoculation, and I think it would be helpful if I gave a short and, I hope, objective explanation of the factors of immunisation and the risk involved.
Poliomyelitis vaccine does not, of course, give a total or guaranteed immunity in any particular case. It does, however, give a substantial degree of protection, as field trials have shown both here and in the United States. Unhappily, there are some who may develop polio although they have been vaccinated. There are a number of reasons for this. It is hardly ever possible to establish the cause of individual cases. This is not, of course, peculiar to polio vaccination.
There are several possible causes of failure which apply in all forms of preventive inoculation. Perhaps I could mention two. First, the vaccine may be given to the individual when he is already infected and is in the process of incubating the disease. Secondly, the person vaccinated may be constitutionally incapable of reacting to vaccination in the right way to give protection against natural infection.
There is, however, in polio vaccine another consideration that I should mention. A person vaccinated against polio could get the disease if some living virus survived in the particular dose of vaccine given to him. This should, of course, all be killed in the course of manufacture, and the special testing procedures which have been evolved and applied to polio vaccine are designed to eliminate this risk to the maximum possible extent.
665 I shall describe these tests in more detail in a moment, but I ought to make it clear that all tests of polio vaccine are sample tests, because of necessity only samples of each batch of vaccine can be tested. The possibility, therefore, must inevitably remain that in the untested part of the batch a few particles of living virus may still be present. This means that, whatever the test and however and wherever applied, no vaccine can be guaranteed to be wholly free from risk, because it is possible, although not at all probable, that the testing procedures could fail on occasion to detect survival. If this were to happen it would not be possible to distinguish the individual case of post-inoculation paralysis which might be due to this cause from cases due to the other general causes that I have described to the Committee. Therefore, though risk cannot be altogether excluded, it may be, and indeed is, immensely reduced and minimised by the testing procedures introduced for this purpose. So, though we cannot talk in terms of absolute safety, the risk is very slight indeed, whereas the degree of protection is very substantial. That is the basic factor we should have in mind.
With these considerations in mind, the Government decided last September to offer vaccination this year to certain priority groups, mainly children up to 15 and expectant mothers, and this constituted a considerable step forward. I should say that vaccination for this purpose is not compulsory. In the light of what I have said, it is right that people should make their own decision with, of course, the benefit of medical guidance. To ascertain which members of the priority groups desired vaccination, it was necessary to evolve a process of registration. In effect, therefore, there were three requisites for the Government programme: registration, the appropriate mechanics for vaccination, and the supply of vaccine, with which we are mainly concerned today.
At that time the Government could look to two main sources of supply—British vaccine and Salk vaccine—and, in turn, to two sources of Salk vaccine, Canada and the United States. The Committee knows that British and Salk vaccines have two common strains of virus, but the third differs. The British vaccine contains Brunenders Type 1 666 strain, whereas the Salk contains the Mahoney strain.
If any particles of live virus escaped inactivation and contained the Mahoney strain, they would be more dangerous than particles containing the Brunenders strain, and this is the essential difference between the two vaccines. With this in mind the Medical Research Council, which is an independent body advising the Government, as the Committee knows, advised last year on the following lines. First, that Salk should be regarded as a temporary supplement of supplies to bridge the gap until enough British supplies were available to meet full requirements; secondly, that such vaccines should be check-tested by the Medical Research Council; and thirdly, that people should be given the right to refuse, Salk vaccine if they preferred to wait for the British. In the placing of their orders, the Government naturally had this advice in mind, and placed orders for 5,000 litres—that is 5 million doses, if it helps the right hon. Lady—of Salk, 4,000 Canadian and 1,000 from the United States, all to be check-tested by the Medical Research Council.
I said a moment ago, and it is important in this context, that I would say a word or two about the subject of tests. Tests of polio vaccine are for three main purposes—first, the antigenicity tests for potency; secondly, the safety tests to negative the survival of live virus; and. thirdly, the sterility tests to establish freedom from bacteria. The safety tests are themselves comprised of three main types applied at different stages of production. For convenience, I will describe them as tests A, B and C.
Test A is carried out on separate pools of the individual strains of virus used. The first stage in vaccine preparation consists of the cultivation of these relatively small pools which, after inactivation, are later blended together. Before blending the separate pools are tested, at two stages at least, in the process of inactivation of the virus. If a positive result is obtained at either stage, the pool is discarded. Test B is the post-blending test. Like Test A it is carried out by a tissue culture but it is carried out on samples of the blended strain, and is sensitive in detecting very small amounts of residual live virus in the vaccine. Test C is a different type of test because it is not a tissue culture test 667 during the process of manufacture but a test applied by way of injection of monkeys from samples taken from the final containers of the finished vaccine.
Those are the three safety tests. Test A is applied and its results recorded only by the manufacturers, because of course it is not practicable for this test to be applied by outside agencies. Tests B and C are carried out by the manufacturer with, in the case of American Salk, additional tests at the National Institute of Health at Bethesda, who are the licensing authority of the United States. It has also been the practice for the Medical Research Council, in the process of check-testing, to apply tests B and C to Salk vaccine. I reiterate that all these tests are sample tests, and clearly only sample tests are possible with polio vaccine. So, although tests cannot altogether exclude risk and guarantee safety, they can and do minimise it to relatively small proportions.
I must say a word about the implications of testing on the time factor. Polio vaccine is a perishable commodity; that is to say, it loses its potency with time. In the United States, Government regulations require polio vaccine to be labelled with a life of not more than six months from the date of issue by the manufacturer. It follows that if we are to have check-testing, the most appropriate method is to run the tests concurrently on different samples from the same batches on both sides of the Atlantic. This ensures the maximum potency period for distribution and use.
What I would like to indicate to the Committee is that concurrent testing implies long-term contracts; that is to say, forward orders are placed for delivery at a future date, subject to satisfactory testing. The orders for the 5,000 litres of Salk were placed on this basis. It is true, of course, that long-term contracts and check-testing impose a certain inflexibility compared with the purchase of Salk vaccine "off the shelf" and the acceptance of the American tests as sufficient.
The right hon. Lady suggested that not enough was purchased originally. On Monday, I made some reference to the reasons for this, and they are really four. First, the advice from the Medical Research Council was that the import should be a temporary measure only, to bridge the gap 668 until adequate supplies of British vaccine became available, and then should stop. Secondly, there was no reason to foresee at that time the almost total interruption of British supplies that has occurred. Thirdly, parents were given a right of refusal of Salk vaccine and so no estimate could be made of the degree to which it would be acceptable—[HON. MEMBERS: "Why not?"] Of course it could not be made. If one gives a right of refusal one cannot estimate, until one has some experience, how much that right will be exercised and therefore what demand, in the circumstances anticipated at that time, would be likely to come about.
§ Mr. Barnett Janner (Leicester, North-West)
May I ask the Minister a question? First, will he answer the simple question why he did not order sufficient of the vaccine from the United States and Canada to cover the contingencies to which he has referred, so that he would have an opportunity of providing all that was necessary? Secondly, on the question of the right of individuals to choose whether they would have Salk vaccine or the British vaccine, surely it would have been simple to ask on registration whether the individual would choose or refuse one or the other?
§ Mr. Walker-Smith
That is precisely what we did, as the hon. Member ought to know. We are now talking about September, before the registration procedures had been evolved and put into operation. The hon. Member also overlooks the potency factor which I have just mentioned.
§ Dr. Summerskill
Is it not a fact that the right hon. and learned Gentleman made no order for Salk vaccine from the United States until last September?
§ Mr. Walker-Smith
It was known last September that that was the initial order for Salk vaccine, the 5,000 litres referred to. This was ordered against the background of the advice given by the Medical Research Council to which I have referred and also against the expectation of British supplies at that time. Our expert advice was then and still is that British vaccine, when available, is the best and constitutes the best long-term basis for our use. As I have explained the Salk was purchased against the background of that advice as a bridging operation until the other became available.
§ Mr. Maurice Edelman (Coventry, North)
The right hon. and learned Gentleman has said something which is very important and which is now being said for the first time. Is he now saying that the advice of the Government, acting on the advice of the Medical Research Council, is that if a parent has a choice he should choose British vaccine rather than the imported Salk vaccine.
§ Mr. Walker-Smith
The Medical Research Council regards the British as the best vaccine, if available, because of the presence of Brunenders Type 1 strain instead of the Mahoney strain. I have dealt with that in the earlier and necessarily slightly technical part of my speech.
In September last year, there was every reasonable expectation that 1958 would see mounting supplies of the British vaccine from at least two large and independent sources. Indeed, having started production in 1956, one of these companies had a steady record of substantial production in 1957 from the spring onwards and substantial consignments were received up to December and January and, indeed, into February of this year. Nobody could have foreseen at that time that British production would be almost at a standstill for several months in 1958, and it would have been a quite unreasonable hypothesis on which to work.
§ Mrs. Barbara Castle (Blackburn)
Before the right hon. Gentleman deals with the interruptions in the British supply, will he say whether it is not a fact that the target which Burroughs Wellcome set itself as a maximum production, when it was in production, was 4 million doses a year, enough for 2 million people, and, therefore, that if 12 million people were eligible there was an obvious gap which could have been foreseen from the beginning and which ought to have been met by imports?
§ Mr. Walker-Smith
I do not intend to go into the individual circumstances of the companies concerned, but the figures show that that firm was substantially the minor contributor. The company to which I have referred was not Burroughs Wellcome.
§ Mrs. Castlerose——670
§ Mr. Walker-Smith
The hon. Lady will have a chance to speak in this debate—perhaps; it is not for me to say.
I want shortly to deal with the difficulties that struck these two major companies. They were not difficulties involving just this or that batch, but were difficulties involving a wide range of their facilities for polio vaccine and their present production potential. In view of what the right hon. Lady has said, I want to make it clear that I say this by way of explanation and certainly not by way of blame. I feel regret at these events, as I am sure we all do, but I do not and will not utter a single syllable of reproach, and I will certainly not follow the ignoble example set in some quarters of preferring uninformed recrimination to understanding of the difficulties.
I repeat: no blame can be or should be attached to these companies. They are fine companies of great and deserved reputation. They have made a notable contribution to our requirements in the wide and varied field of contemporary pharmaceutical products, and we should sympathise with them in their difficulties in this context and have confidence that here too they will have a great contribution to make in the future.
§ Mrs. Castlerose——
§ Mr. Walker-Smith
I have given way several times and I warned the Committee that, unfortunately, to do justice to this difficult theme I should necessarily have to trespass on the patience of hon. Members for some little time. I think it is fairer to other hon. Members who wish to speak and who have great expert knowledge of this subject if I do not give way more than I need so that I do not take up too much time.
As I indicated to the House on 21st April, we took immediate steps to remedy the deficiencies arising in the British vaccine, and in January, 2,800 litres of Salk were ordered subject to check testing. That meant that the 2,800 litres could not be immediately available because of the concurrent testing procedures. That amount, as it were, was put into the pipeline with the expectation of emerging from the tests, if successful, in the course of April and May. This would have been the main, but not the 671 sole, source of supply for the present period.
I have been dealing so far with the supply of vaccine and the problems presented by the difficulties inherent in this complex process, but meanwhile registration and vaccination are progressing. The latest returns, as the right hon. Lady said, are not complete, because they are two-monthly returns in order not to burden local health authorities and divert their energies from the practical business in hand.
The right hon. Lady quoted the figures I gave for the end of February, which I stated in the House a week or two ago. Registration at the end of February was a little under 50 per cent. for children and a good deal below that for adults, but we did not and do not take the view that registration is likely to be less than 50 per cent., and, of course, it will not be. I am sure that the figures for April, which we will have within a week or so, will show a material advance upon those registration figures. I repeat that registration is a continuous process and the local health authorities will certainly continue to accept registrations as made. We have set no closing date and do not intend to do so.
As registration is a continuing process, so is vaccination and consequently there is no question of a precise closing date for the programme. Our intention briefly but. I hope, sufficiently stated is to proceed, as fast as supplies and the mechanics of vaccination allow, to vaccinate all who register.
To come to the transatlantic supplies to which the right hon. Lady referred, it is a fact that difficulties also came in this sphere, and although the major set-back to our programme was the considerable and almost total postponement of British supplies, we have encountered difficulties with the Salk. The right hon. Lady quoted what I said in the House on 21st April about the four cases being all different, but none of them is the fault of the Government.
The right hon. Lady referred to the Canadian case. The facts were that one batch of Canadian Salk was withdrawn by the manufacturers because it was not up to standard, and two batches were pre-empted for Canadian use with a consequential postponement of our expecta- 672 tion of delivery. I want to make it quite clear that there is no question of any breach of contract or faulty delivery by our Canadian suppliers. On the contrary, we are expecting the balance of their deliveries by June. Half a million doses arrived on Tuesday and are in the process of very rapid distribution.
A thousand litres of the American Salk originally ordered were duly received in February, check tested and in good order. The order for the additional 2,800 litres in January to replace the deferred supplies of British vaccine was placed with the same American firm who enjoy a deservedly high reputation for care and safety.
Unfortunately, the result of Test A on one strain pool component of the first large batch of 1,500 litres showed a minute contamination of live virus. I pointed out in my description of the test a few moments ago that this discovery by the American manufacturers, microscopic as it was, led to the immediate and unquestioned discarding of the whole batch of the vaccine. It also meant that the American authorities would require a successive run of negative tests on five batches from this firm before allowing one further batch to be issued. I say this, not in any sense of regret, but in one of unqualified approval of and praise for the thoroughness of this testing procedure. Of course, I regret the inevitable delays, as we all do, but I should certainly regret it very much more if any contaminated vaccine had been issued, even though contaminated only in the most minute degree.
These events together had both an immediate consequence on anticipated deliveries and a more long-term consequence on supplies in the pipeline, which is less capable of precise assessment. The immediate consequence was the loss of the 1,500 litres expected shortly after Easter. This was the largest item expected for delivery and issue in April, though, as I have already told the House, we have been able to distribute three batches of fair size in April, together totalling over 1 million doses.
The further consequence is that some large items in the pipeline must be considered to be at risk, because of the very proper requirements of the United States testing procedures, to which I have referred. In effect, therefore, our 2,800 litres of replacement for British vaccine, 673 instead of being available in part already and in part in the next few weeks, will not be available at the earliest for some weeks, and in any event, not at any date precisely definable now.
The combined effects of these events therefore presented us with a dual problem, or rather a problem with two facets; first, the acquisition of further vaccine, and secondly, the time factor in its use. The first problem was a physical problem, within the sole competence of Parliament. On the second problem, it was right that the Government should seek expert advice from the Medical Research Council as to whether, in view of the shortfall of vaccine which had arisen from all these varying causes in these difficult and unpredictable processes, American and Canadian Salk vaccine which had satisfactorily passed safety tests and had been licensed for issue in the country of origin, should be made available for use in this country, without first being subjected to the further safety tests of the Medical Research Council.
The Medical Research Council have sent a reasoned opinion to the Lord President of the Council. After rehearsing the factors, it reiterates its view that tested British vaccine is the best, and lists its order of priority or order of safety. First, the vaccine made according to the British formula which has successfully passed the British safety tests; then, imported vaccine from America and Canada, which has successfully passed the safety tests in the country of origin and also the British safety tests; and, thirdly, imported vaccine from the same sources which has successfully passed safety tests and been licensed for issue in the country of origin.
The Council then continues, and I quote:After carefully weighing all the available evidence bearing on this complex problem, the Council are satisfied that the risk of producing paralytic poliomyelitis by injecting any one of these three vaccines is very slight and that a person inoculated with any one of them is substantially less likely to contract paralytic poliomyelitis than if he is left uninoculated. Nevertheless, no vaccine can be guaranteed to be wholly free from risk, and the preference should always be for the safest known vaccine.The Council goes on, after referring to the present shortfall of the vaccine, with the reasons for which they are not concerned, 674 but which I have just given to the Committee, to express this opinion:After carefully examining the present situation, the Medical Research Council have concluded that, as it would appear to be impossible to overcome by any other means the deficit which will otherwise by inevitable during the summer months, it would be advisable as a temporary measure to issue American or Canadian vaccine which has not been submitted to British tests, provided that it has been tested and licensed for use in the country of origin.The Government accept that advice and will act at once upon it. Full information about the new arrangements will be circulated next week to the local health authorities. Their medical officers of health and all family doctors received detailed guidance about Salk vaccine last autumn, and they will now receive copies of the Medical Research Council's advice to enable them to deal with questions by parents and others who apply to them for advice on what they should do. Full details will, of course, also be made available to the medical Press. When the circular and guidance have been issued we propose to start distributing the new Salk vaccine. As I told the House on Monday, a million doses, part-British, part-Canadian, have been issued last week and this week to local health authorities, and substantial new supplies will follow hot-foot upon them.
This involves the supply of the full requirements of local health authorities, not only for those already registered, but those who continue to register in the coming weeks and months. As registrations will continue there is inevitably a fairly heavy programme of vaccination ahead, but, given the good will and cooperation of local health authorities and general practitioners—and both have cooperated magnificiently, and will, I know, continue to do so—I am confident that there is no insuperable task laid upon them. We shall, with their help, vaccinate every man, woman and child, within the priority groups who registers for vaccination.
The Medical Research Council have advised this as a temporary measure. I want to make it clear that its opinion in no way derogates from its general view that British vaccine is best, and that in general the greater the sizes and number of samples tested the better. I have, I hope, given a faithful paraphrase of the main content of the Council's advice, but, 675 as hon. Members may wish to study in detail, not only the conclusion but the reasoning of this important statement on this complex and technical problem, I have arranged for it to be available in the Vote Office.
I need only add that the Government accept also the longer term advice of the Medical Research Council, and propose to restore check testing in all cases by the Council at the earliest possible moment, and like the Council, we look forward to the possibility that one day we can dispense with the need to use any vaccine containing the Mahoney strain, but I must tell the House that this day is not yet, because of the present uncertainty surrounding the British supply position.
Meanwhile, we shall proceed with the work in hand on the basis of the Council's immediate advice. We shall go to it with a will, and we shall invite and expect the co-operation of all concerned. There is and always has been a right to reject the Salk vaccine if people prefer to wait for the British vaccine. This is logical, since there is, in any event, no obligation on anybody to register for vaccination at all. People will still have this right of refusal if they prefer to wait, either for the British vaccine or for Salk vaccine check tested by the Medical Research Council. This is a decision which the individual may find hard. But he can take his doctor's advice in individual cases.
Perhaps, from the point of view of the layman, I may conclude with a few words designed to help on the generality of the subject. I know that this is a sensitive and emotional subject. The fact that some may have sought to exploit these feelings does not alter the fact that there are deep feelings and genuine apprehensions. What people want is a guarantee of safety—an absolute exclusion of risk to the uttermost iota. What they particularly want is such a guarantee in respect of their children, for whom they make the decision, and this is certainly not an ignoble wish.
But this is precisely what they cannot have—not quite, that is to say. They cannot have it, either in this country or anywhere else in the world; not with any vaccine or with any testing. But in how many cases, and in how many activi- 676 ties of life, can such an absolute guarantee be given? It certainly cannot be given in the most everyday activities of life—in travelling by train, or even crossing the road. We must learn to look at this as we look at the other risks and chances of life. We must weigh the balance—in this case the risk which is tiny, against the gain which is great.
We should have in mind the following considerations: first, that we are acting in this matter upon expert advice; secondly, that the medical profession will be getting expert guidance and advice; thirdly, that our own tests to date have detected no flaw in the Salk vaccine which we have received; fourthly, that this is a fast-moving new technique, and great progress and improvements have been made in the technique of manufacture and testing since the disturbing Cutter episode of 1955 and, fifthly, that we have the experience of the world, and especially of the great North American Continent, particularly in the course of last year. Over 200 million doses of Salk vaccine have been administered in the United States in the last three years, and over 100 million in 1957 alone—besides millions more doses in many lands and diverse climes.
Let us not, then, in this matter, take counsel of our fears. Let us rather take confidence from the experience of our friends and the advancing skill and mounting ingenuity of science. I have described—I hope as fully and faithfully as time and the complexities of the subject allow—our present position and our future prospects. Let us now press forward—I hope together—to the task ahead. In this, I invite the co-operation of all men and women of good will, and I ask the House to set them the example.
§ 8.23 p.m.
§ Mr. Maurice Edelman (Coventry, North)
We have just listened to a long statement by the Minister which has been disappointing in substance and discouraging in presentation. I cannot help feeling that tomorrow morning millions of mothers will be confused and anxious about the choice between the Salk vaccine, which will be the major vaccine available, and the British vaccine, which will not be forthcoming in anything like the desired quantities.
Although I listened to the Minister with mounting concern I was most concerned 677 of all when, at the end, he said that in this matter he was being guided by the experts. Although I do not deny the value of expert advice, he must know that in this issue of anti-polio vaccine there has been a conflict of evidence among the experts, and that the very advice that he was rejecting last year, at the instigation of his own expert advisers, is advice which he has been taking ever since last September, when he was finally persuaded to import Salk vaccine.
As the Minister has rightly said, the object of the debate is to see what we can do to reduce the threat and danger of the poliomyelitis epidemic which we saw last year in all its ugly proportions and, by a joint examination of the problem, to see whether we can achieve a situation where no child will ever again have to walk about with irons on its legs or pant for life in an iron lung. That is what we seek to do, and we hope that in future summers parents may look forward to the months of July, August and September with hope and happiness instead of the apprehensions which they have suffered in the years following the war.
As a layman, I became personally concerned in this matter when, last year, Coventry had a most severe outbreak of this epidemic in which, by the end of August, over 100 people had been attacked by the disease, among whom 66 had the paralytic form. At that time the warnings which had previously been given, and which up till then had seemed to be of merely academic and purely medical concern, became the real thing to hundreds of thousands of people in my constituency, and as the epidemic spread throughout the country it became a matter of vital concern to many millions of parents.
My charge against the Minister and the Ministry is that poliomyelitis is a disease capable of control in precisely the same way as smallpox has been controlled. It is a disease which may be controlled by immunisation, and which is in process of being effectively controlled in America, where it was once a paralysing and killing disease of epidemic proportions which agitated the whole country year after year in the summer months. Had the Minister and his predecessors engaged in an energetic attack on the disease with the knowledge and resources at the disposal of our country, instead of the 678 anxieties with which we are now facing the summer months of 1958, we could have faced them with the certainty that there would not be the epidemic which we fear may occur.
Last summer, the Minister was warned by various sources that the potential supply of anti-polio vaccine from domestic producers would be inadequate, and that the only way in which he would be able to deal with the epidemic of last summer and autumn, and the possible epidemic of this year, was by importing Salk vaccine on a massive scale. When the epidemic struck in Coventry I went to see his predecessor's deputy and urged upon him the need to import Salk vaccine from America or any other source, especially France, which might be prepared to sell it to us.
The Parliamentary Secretary dismissed the proposal out of hand. He repeated the case, which the Minister has very properly put forward tonight on the advice of the Medical Research Council, that as the Mahoney strain was the dominant one in the Salk vaccine, and was more virulent than the strain used in British vaccine, it was thought undesirable to import Salk vaccine from the United States or Canada.
What were the facts? They were facts which only now are filtering through to the general public. At the end of August last year the Americans had issued 140 million doses of the Salk vaccine and, apart from the Cutter incident there had been only minor occurrences of failure The argument that the Minister has put forward only tonight—weighing up all the advantages and disadvantages of the vaccine and taking into account the reservations of the Medical Research Council—is based on considerations which were operative last summer Finally, under the pressure of public opinion, sustained by a responsible Press—and I want to say that, contrary to the Minister's innuendo, I believe that the Press has behaved very responsibly in this matter, and has, by its agitation, awakened not only the country but even himself and his predecessor to the urgency of the matter—the Prime Minister himself ultimately over-rode the Departmental haverings, and, as a result of a Cabinet decision, required the importation of the Salk vaccine.
679 Since the Minister invokes expert evidence, perhaps I can call in aid some of his own medical officers of health, who, last year, were writing and speaking on the subject of the importation of vaccine, and who, very courageously—and they deserve the thanks of the whole British public for their courage in speaking up, although they were the servants of the Ministry of Health—urged, clearly and conclusively, that Salk vaccine should be imported. Perhaps I can quote from one Minister of Health who attended the International Conference on Poliomyelitis in Geneva, last July, and who, on his return, wrote:I am of the opinion, in face of the possibility, even the probability, of an epidemic of grave proportions this year"—that is, in 1957—that had we bought the American vaccine six months ago we might have saved, not one single mishap but some lives and much crippling.I must say that was an understatement, because in a personal letter to me he said:Every time I see four cases of poliomyelitis I cannot help feeling that three might have been prevented by early action.What h meant by "early action" was importation of the Salk vaccine.
Now let me quote Dr. Geffen, the Medical Officer of Health for St. Pancras, who, again with great courage, has spoken on this subject. He said, in relation to the present year:If we want to prevent the possibility of an epidemic in 1958"—he was writing in August, 1957—then I believe we should import the American vaccine as soon as possible, using it to the maximum extent that we can, and, if necessary, replace it or add to it by the English vaccine as and when it becomes freely available.I refer to this statement by a medical officer of health who is in daily touch with cases of poliomyelitis, and whose concern is the health of his borough. He said last year that the only way in which there could be mass inoculation against poliomyelitis was by the importation of Salk vaccine.
What happened? Although the Prime Minister did, last year, decide that Salk vaccine should be imported, it is quite clear from what the Minister has said that his expert advisers were really a ball and chain on his activities; they were 680 clearly opposed to the importation of Salk vaccine. They wanted to import it, yes, but they wanted to import it slowly; they wanted to make sure—and the Minister stated this quite clearly—that Burroughs Wellcome and Glaxo should have the maximum opportunity of developing and producing the vaccine, for which, I believe I am right in saying, they were receiving a substantial subvention on the initiative of the General Medical Council.
When my hon. Friend the Member for Barking (Mr. Hastings) suggested that the production of this vaccine should be made a national concern, I do not think that the Minister, in his reply, referred to the fact that hundreds of thousands of pounds have been paid to Glaxo and to Burroughs Wellcome so that they should have the facilities for producing this vaccine. I want to know of the Minister, repeating a question I put to him the other day, whether, in fact, any undertakings, written or verbal, have been given to these two firms that they will have priority in contracts for the vaccine from the Minister. In other words I am asking whether there are any considerations, not medical but commercial which have resulted in giving these priorities and preferences to these two pharmaceutical firms. I hope that the Minister will answer that question.
I would now quote from another letter—this will be my last quotation—which I have received from a doctor who was actively engaged in the fight against polio. He says:There is no excuse for the Ministry to fail to import the American or Canadian vaccine. Their excuses simply do not hold water. The American vaccine has been used in 150 million cases.He wrote this letter last September.Except for the early Cutter incident the number of complications recorded are 25. These are all of a very minor variety. Surely no vaccine anywhere in the world has been tried on such an enormous scale.… I think it is the height of impertinence for the Ministry of Health to say that it is not proven, particularly when all we have managed to produce is enough to vaccinate a paltry two to three million.At this point my correspondent goes on to make a very serious charge against the Ministry, one which I repeat with all responsibility because I feel that there are many points, not only of maladministration, but of some commercial preference in the allocation of contracts. I 681 cannot help feeling, whatever the medical rationalisation, that there may have been commercial factors involved in the allocating of contracts and which deserve the closest scrutiny.
§ Mr. Edelman
I propose to develop the point. I am talking about inferences, and if the inferences are wrong, then the Minister or the Parliamentary Secretary will reply to them.
§ Mr. Edelman
I am going to quote again from the letter from the doctor. It contains points which the hon. Member who said "smear" so loudly might prefer to hear before he makes another comment. The letter says:I can only believe that there is some black agreement between the Ministry and the commercial firms in England not to import American or Canadian vaccine. If this is so, a manslaughter charge should be brought … every time a British child dies from acute anterior poliomyelitis.I repeat that because there are reasons to believe that there are strong resistances at work within the Minister's own colleagues against the importation into this country of the vaccine from abroad, or even the encouragement of importation of such vaccine. All those to whom I have spoken about the International Conference on Poliomyelitis, in Geneva, were unanimous—though, of course, they differed about the efficacy of the individual vaccines produced by different firms—in saying that this conference, so far from laying its whole weight on the study of poliomyelitis, resembled a commercial jamboree in which spokesmen for the vaccine interests were each plugging his own vaccine to try to ensure that the vaccine was adopted by particular Governments.
I have to record that, because I shall say something now which is within my own personal knowledge and experience. I apologise to the Committee for making public matters in which I was personally evolved. At the height of the polio epidemic in France last year I went to France, where I saw members of the French Ministry of Health. I asked them whether the Pasteur Institute had any anti-polio vaccine available which could be sent to Britain. Although there was 682 an epidemic of poliomyelitis in France at the time the Pasteur Institute generously said that it was willing to send immediately enough vaccine to inoculate 50,000 British children.
The essential thing about this Lepine vaccine, as it is called, is that it is made from dead virus. A layman myself, like the Minister of Health, I can only call in evidence expert opinion. The distinguished French specialist, Dr. Escoffier-Lambiotte, said that the security factor of the French strain in relation to the Mahoney strain is about 10,000. In fact, the French vaccine has been used widely in France, in Roumania, and, happily, there has never been a single adverse incident affecting its use.
Let it be remembered that the Pasteur Institute is not just a third-rate local laboratory. It is the laboratory which developed the B.C.G. vaccine. It is a laboratory which has a great tradition behind it. When I communicated the offer of the Pasteur Institute to the Minister's predecessor he treated the offer, which was not an offer from me but an offer from the Institute, with great churlishness, and at a later stage the Minister of Health himself was obliged to send a letter which was, in fact, a letter of apology to the Pasteur Institute for the way in which its offer had been treated.
§ Mr. Walker-Smith
The hon. Member says I was obliged to send a letter. I was very happy to send the letter to the French Department pointing out the circumstances, and that though there might be differences of method and tests that involved no slight upon them. People are not obliged to do these things of courtesy. Some people do them because they want to, and feel them to be appropriate.
§ Mr. Edelman
The right hon. and Learned Gentleman seems to have forgotten, perhaps forgotten for the occasion of tonight, the tremendous resentment which was felt in France and which was expressed in the Press, in Le Figaro, for instance, and by the directors of the institute about the manner—I absolve the right hon. and learned Gentleman personally—the manner in which his predecessor treated that offer.
I mention this not to dwell on history but to dwell on the fact that there was an organisation of the highest repute which was prepared to make an immediate 683 application of enough vaccine for 50,000 children, and, more than that, was prepared to go on mounting the supply of vaccine so that we in this country, who lack adequate domestic vaccine, could have a safe vaccine with which to inoculate our children.
§ Mr. Edelman
No, I cannot answer that question. All I do know, on the authority of distinguished French virologists, is that the French vaccine is regarded as probably being the safest vaccine in the whole world.
When I returned from France I asked the Prime Minister himself whether he would not over-ride the decision of the Minister of Health not to import the vaccine. A few days later an announcement was made that the Salk vaccine was to be imported and that, therefore, it would not be necessary to import the French vaccine. More than that—and this is an important point I want to put to the Minister—the Prime Minister at that time wrote to me and said that there would be continuing conversations between the Ministry of Health and the French authorities with a view to examining the possibility of supplying the French vaccine. When I asked him about that the other day, all he could say was that the decision to import the Transatlantic vaccine made it no longer necessary. In other words, what I am asking him is whether the Prime Minister's promise has been fulfilled.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
Can my hon. Friend tell the Committee what the French declare the immunity capacity of their vaccine is as compared with that of the Salk vaccine?
§ Mr. Edelman
I believe that the immunity of the Salk vaccine is 75 per cent. I think that the immunity, or the claim, at any rate, within the limits of French experiments, of the French vaccine is somewhat higher than that.
I want to turn now to the immediate problem. The immediate problem, despite everything the Minister has said, 684 is that even if the summer programme for the vaccination of children up to 15 were fulfilled it might well leave many people unprotected. We have been talking about this programme as if it would mean immunity for the whole of British youth and freedom from anxiety for every parent by the end of the summer. But, in fact, only children up to 15 were involved, and even out of those I doubt whether more than half will have been successfully vaccinated by the end of the summer.
I say that for this reason, despite the Minister's promise—and we are now both on record in this matter. A medical officer of health of my acquaintance whom I asked about the mechanics of inoculation has told me that under the most favourable existing circumstances, even if the vaccine were made available, it would be extremely difficult for him and his assistants to inoculate more than 3,000 children per week. If this rate were maintained, and even if the vaccine were available, I am certain that it would still mean that by the end of the summer at least half of the children in this country up to the age of 16 would not have had a second inoculation. That is a matter for great concern.
We who have been politically forbearing in not having raised the matter earlier, who now raise it under the pressure of events because we cannot contemplate the possibility that we are to get those anguished cries from mothers asking, "Where is the vaccine for our children?"—we who are faced with this possibility this summer have now, as a political duty, to urge the Minister to make decisions which, even at this late stage, may save the situation. What is quoted from the Medical Research Council merely shows that now, at the beginning of the summer of 1958, he is desperately trying to improvise in a matter which for long has been bad.
I am appalled at the dilatoriness with which the Minister of Health has considered the claims of this very disabling disease. We know that there are extremely conservative elements within the Ministry. There are bureaucrats of medicine, as there are bureaucrats in every other sphere of activity. I believe that what the Ministry needs now is a good shake-up. I believe that one of the first things to be done should be for the Ministry to get a new spokesman 685 upon whose word the country can rely, because the whole record on the subject of poliomyelitis ever since last summer is a record of promise followed by disappointment. Those who have been responsible for neglect in obtaining the vaccine should be dismissed. The Minister himself, who has defended the damaging ineptitudes of his Department, should resign.
I believe that what we need now is a committee of inquiry to go into the whole dark record of the Ministry's failure to defend the country against poliomyelitis. Let us pray that this summer the cycle of the disease will be such that there will not be a major epidemic, and that it will be possible for the damage done by the Minister's neglect to be repaired in time for next year. Let us hope that that will happen. In the meantime, the Minister must bear responsibility and the weight of our condemnation.
§ 8.49 p.m.
§ Mr. Philip Goodhart (Beckenham)
We in Beckenham have two reasons for taking an interest in this debate. First, we use the vaccine and, secondly, we produce the vaccine. Burroughs Wellcome and Company have their laboratory and production centre in my constituency.
During the last year the Minister has had to face the most extraordinary record of accidents. We in Beckenham know how difficult it is to produce this vaccine. We know that it is not like producing a toothpaste or a television set. We know that just as it is complicated to make, so there are additional problems, because once there is a breakdown in the production line one cannot merely stop and hope that it will be put right. It is often necessary to go right back to the beginning. One breakdown can mean a delay of six months or more in the whole programme.
While recognising that this is a difficult process, the Minister has also had to deal with some improbabilities. It was highly improbable that all four sources of supply would fail one after the other. The two British sources of supply, the American source and the Canadian source have all fallen down on us. It is an extraordinary state of affairs and is certainly unprecedented, because, as we know, although it is difficult to produce this vaccine, vast quantities have been 686 produced satisfactorily in the United States.
Could the Minister have been expected to do more? In the circumstances, I do not think he could. I congratulate him on the steps which he has already taken and I welcome the statement which he has made this evening.
We must also consider this evening whether the Opposition are trying to make party capital out of this unfortunate series of events. The hon. Member for Coventry, North (Mr. Edelman) has at least a consistent record on this matter because he has been opposed to the Medical Research Council from the word "go". In part, his criticism of the advice of the Council has been correct, although I was sorry to hear the smear tactics which he used against the firms which have done so much to produce this life-saving substance. It was a disgraceful performance.
On the other hand, at least he has been consistent. I do not think the same can be said for the right hon. Lady the Member for Warrington (Dr. Summer-skill). Only once in a speech of 30 minutes did she refer to the accidents which have interfered with the supply of vaccine. She spent the rest of the time blaming administrative blunders, as she called them. Never once did we gather from her whether she would have rejected the advice of the Medical Research Council on which my right hon. Friend has relied. I ask her now, would she have gone against the advice of the Medical Research Council, which was to use the Salk vaccine only as a temporary stopgap? Would she have gone against that advice?
§ Dr. Summerskill
The hon. Member was at least honest when he said that he was speaking for Burroughs Wellcome and Company who work in his constituency. Surely he should be logical in this matter. There was no importation of this vaccine until last September, although we are informed tonight that it will be imported immediately. [HON. MEMBERS: "Answer the Question."] I am answering the question. Would not the hon. Member agree that if the vaccine were not imported the firm of Burroughs Wellcome and Company should have been given an order for an amount equivalent to the dosage for 2 million children? That is the question before us.
§ Mr. Goodhart
We have had not reply at all.
In reply to the right hon. Lady's question, I do not know of any complaint on the part of Burroughs Wellcome or any feeling by the firm that it could have done more or got into production earlier than it did had it received any additional contract. Indeed, I have it on the authority of the firm to which reference has been made that on no account, whatever the Government had done in the way of contracts or stimulation, could it have got into production a moment earlier than it did.
§ Dr. Summerskill
Does the hon. Member realise that he is giving me my case? He is saying that the Minister has left the production of this most important vaccine simply to a firm which is unfitted in all ways to produce it.
§ Mr. Goodhart
Who is it in the Government service who is fitted to teach the experts in this firm their own job in the production of this vaccine? Who are these Government experts that the right hon. Lady wishes to send down to teach the firm its own job? I certainly know of none, and I do not think that my right hon. and learned Friend the Minister knows any. Even if the right hon. Lady were Minister, I do not think she would be able to find these experts in the Government service. It is, of course, this firm and its colleagues who would have to train the Government officials.
§ Mr. Edelman
Will the hon. Member answer me on a question of fact? Would he say whether the independent consultants to the Ministry of Health are also consultants to Burroughs Wellcome and Glaxo?
§ Mr. Goodhart
I have no idea who those independent consultants are, but no doubt my hon. Friend the Parliamentary Secretary, in replying to the debate, can deal with that point.
To move on to perhaps calmer but not entirely uncontentious ground, while congratulating my right hon. and learned 688 Friend on his performance so far, I should like to express a word of disquiet about the future, particularly about the importation of monkeys. Surely, it is the supply of monkeys that represents the Achilles heel in the supply of vaccine, not only here but throughout the world.
During the last two months, there have been two forms of restriction on the export of monkeys from India. First, the limitation on the weight of the monkeys allowed to be exported has been increased from 4 lb. to 6 lb., and secondly, there have been restrictions on the number of monkeys placed in a single cage. The transport difficulties can be easily overcome, but I am told by the Ministry—and this is confirmed by others outside—that the raising of the weight limit means that instead of getting 30 monkeys suitable for medical research from every 100 caught in India, only ten out of every 100 monkeys will now be suitable for research. As India is far and away the largest supplier of the monkeys, this must inevitably give rise to concern for the future.
The firm that operates in my constituency, apart from the present spread of sickness among the monkeys in its laboratories, has had two monkey crises to contend with, and it has not had a particularly helpful reaction from the Ministry of Health when it has gone there to ask for help. I am told it has had more rapid co-operation from rival firms across the Atlantic. I ask the Minister to use all the power at his elbow to persuade the Indians to relax these restrictions and to supplement the efforts of individual firms to find alternative sources of supply of monkeys.
This is essentially an international problem. I hope the Minister will also take the lead in stimulating an international conference on the whole problem of the supply of monkeys, in which, of course, India and other supplying nations would take part as well as nations which are importers of monkeys. If that were to be a result of this debate, and if another result were to be an increasing registration of children for vaccination, an otherwise disreputable affair might well after all be of value to the country.
§ 9.3 p.m.
§ Mr. Barnett Janner (Leicester, North-West)
I think that the Minister and those who have spoken from the other side of 689 the Committee have endeavoured to sidestep the real issue in this debate.
The Minister made a long and very interesting statement, which contained a considerable amount of fact, but I hope that he will not believe that it answers the charge of a lack of foresight and excuses the grave responsibility which rests upon his shoulders. The Minister is a very fine advocate. I have heard him in other places besides this Committee. Tonight, I fear, he has done what often occurs in other places when one has a bad case—used the opportunity to place facts before the Committee with a view to hiding the defects.
This is a very simple question. The question at issue is: did the Minister, or his predecessor, have sufficient acumen to be able to provide for the contingencies which must needs arise in respect of this serious disease? He knew that precautions had to be taken against poliomyelitis. He knew that there was a vaccine, or vaccines, available.
It is no use dithering whether one vaccine is better than another—[HON. MEMBERS: "Oh."] It really is not. It would be different if we had sufficient of all types. If we had sufficient of the best, the Minister would be justified in saying, "Why take something which is inferior when we have a sufficiency of what is best for this purpose?"
But that is not the case. At this very late hour, the Minister produces most damning evidence against himself. The very document he has produced says:After carefully weighing all the available evidence bearing on this complex problem, the Council are satisfied that the risk of producing paralytic poliomyelitis by injecting any one of these three vaccines"—any one of them, be it noted—is very slight, and that a person inoculated with any one of them is substantially less likely to contract paralytic poliomyelitis than if he is left uninoculated.That is the accusation against the Minister. He knew that. He must have known months and months ago. He was warned of the difficulties. Questions were asked. It is not really fair to say that this is being made a political issue. It is perfectly fair for an Opposition, or even for hon. Members on the same side as himself, to call attention to the fact that the Minister has been negligent in a certain matter. Though I do not say it 690 about the Minister himself, he must take responsibility, naturally, for those who advise him, and there is no doubt at all in my mind that there has been a very grave dereliction of duty here. It did not matter which of the vaccines was used. The danger was slight.
Instead of ordering vaccine which was available, much of which was sent to Europe and other countries from America, the Minister failed miserably in his duty, and had not the necessary quantity available to meet a contingency which arose when certain supplies failed. It is no good coming to the Committee and saying, "Supplies have failed." The The Minister did not give orders sufficient to cover the amount needed in the event of the supplies failing. Knowing that there must be a considerable quantity which would have to be rejected, he should have carefully calculated the quantity which ought to have been ordered. What nonsense it is to say at this stage, "We have not sufficient at this time to supply the needs of the community, because the supplies which we ordered have failed", when the Minister did not order sufficient to meet a contingency which might arise.
It was not an unknown contingency. The fact is that he knew these things very well. The Minister made his long statement about the need to examine and reexamine the vaccine before coming to a conclusion as to whether it is usable. That is the kernel of the situation. I do not say it personally of the Minister; I have a very great respect for the right hon. and learned Gentleman, but he should have come to us and said, "We have made a mistake. We are doing our best to remedy it. We are proceeding, as fast as we possibly can, to make the effect of the mistake as small as possible". If he had done that, he might have had the sympathy of the Committee. Instead, he has come here with a long story, telling us all about the technical difficulties and complexities of the situation.
We have been told by the Americans themselves that the Salk vaccine, which could and should have been used, has been available all the time, even if it had been tested only by the Americans. Really, it is a very cynical position, because what the Minister is saying is that what is good enough for the community in America, with all those tests, 691 is not good enough for us even in an emergency. I agree, as does the report of the Medical Research Council, that, were it possible to have the other, that would have been so much the better. But it was not possible.
Thus, we have it that millions of Americans who have been inoculated have been inoculated against the advice or contrary to the deep understanding of the Minister of Health in this country. What utter rubbish! I am sure that the Minister will, when he thinks about it, come to the conclusion that it is illogical to put forward an argument like that.
What is the position? I shall not quote a lot of figures, but there are one or two that face us in such a way that we cannot avoid them. We are told that 20 million doses are necessary, or that 10 million children are to be inoculated, together with 700,000 expectant mothers. We have not got the vaccine for them. It just will not be available. It is no good saying that anyone is trying to frighten people. Nobody is doing that. The fact is that even for two doses there will not be enough, whereas three are required.
That is not the end of the story. What will the Minister do in similar cases to that which I brought to his notice months and months ago, the case of an individual who is put in danger of being contaminated. I received a copy of a letter from a constituent of mine, which he sent to the Press. This is what he said:The Minister states that the Ministry is to offer vaccination to all children up to the age of 15 and to expectant mothers. I would urge that all who come into contact with polio cases should have at least equal priority. My son, aged 33 years was a public health inspector with a Borough Council in Kent and had occasion in the course of his duties to be in touch with polio contacts. Although he requested to be vaccinated against this disease many months ago no action was taken. In October he was taken ill and died within four days of polio-encephalitis leaving a wife and three young children. He had also requested his children should be vaccinated, but up to now nothing has been done. I contend that had my son been vaccinated he would still be alive. I am, therefore, writing this in the hope that something will be done quickly to give to those in contact with the disease, namely, public health inspectors, nurses, etc., as much priority for preventive action as expectant mothers and children.This is a human story. It is not something that can be just brushed aside. 692 These men and women who are nobly doing their duty towards the polio cases are putting themselves and, what is even worse, their families into the danger of getting the disease.
What is the use of talking about priorities? The fact is that those classes which have already been described as priorities are not enough by any means to meet the real needs of the community. We are faced at a critical time with a very unhappy position. Britain is 7 million inoculations of vaccine short even allowing for only two jabs per person.
I do not want to make a political matter of this in the sense that was suggested tonight; but I cannot help thinking that in their heart of hearts the Government supporters themselves must be feeling sick at the situation that has been created. We cannot play with the lives of men and women in that way. The necessary vaccine was available, and it should have been bought. The rejects should have been taken out of the total and the balance should have been sufficient for the purpose of vaccinating every person up to the age of at least 40 and also others who came in contact with the disease.
The danger is known and the position is serious. Questions were asked and the Minister was not unaware of the anxiety throughout the country. It was ignored, and it is no use the Minister coming to us today and saying, "I am sorry about this decision. Now I am going to put it right," knowing that we were right. In these circumstances, the Minister ought to offer a full apology, on behalf of those concerned, not only to this Committee but to the community.
The other day I said here that the position was scandalous, and it is. In fairness, the Minister ought to admit openly that a mistake has been made. He should now buy as much as he can of the vaccine available, wherever it may be obtainable. If he wishes, let him test it as quickly as he can, but do not leave the country in its present perilous state, largely uncared for in this matter.
I hope that the Minister will take note of what has been said tonight. It is unfair to say that my right hon. Friend or any hon. Member on this side of the Committee has raised the issue merely for the sake of attacking anyone. It is 693 because we are concerned with the health and happiness of people whom we do not want to see crippled or paralysed that we arranged this debate today. Would to heaven we were in a position to be able to see that the mistake could be put right in time in full; but at least let as much as possible be put right as quickly as possible.
§ 9.16 p.m.
§ Mr. Richard Fort (Clitheroe)
The hon. Member for Leicester, North-West (Mr. Janner) showed, as did the hon. Member for Coventry, North (Mr. Edelman), a willingness to make scientific decisions which I as a layman who has heard many of the discussions of my professional colleagues would feel reluctant and, indeed, entirely unentitled to make.
§ Mr. Janner
Would the hon. Gentleman agree with the decision of the Medical Research Council, and is there any difference between the present decision and the one taken six or nine months ago?
§ Mr. Fort
If the hon. Gentleman will wait a minute, he will have it made clear to him. I say this not only as a member of the Medical Research Council but also as a father who has had four sons at risk in this disease, that I shall always have some nervousness about the Salk vaccine, which contains the more virulent Mahoney strain. However, after I had listened to my professional colleagues discussing the problem of whether or not this vaccine should be used—and, of course, I am in no position to give a decision in the way the two hon. Gentlemen opposite have done—I could but concur with what they advised.
If, as no doubt it is, the full statement is now before the hon. Gentleman, he will see that it was made on a balance of risks which are exceedingly difficult to determine, in view of the merciful fact that this disease, horrible as it is, is rare, and therefore the scientific evidence on it is difficult to collect in a form which is susceptible to ordered analysis—
§ Mr. Janner
I am obliged to the hon. Gentleman for giving way, but he must either say whether he agrees with his 694 colleagues on the Medical Research Council or not. The statement says categorically that anyone inoculated with any one of these three vaccines—… is substantially less likely to contract paralytic poliomyelitis than if he is left uninoculated.There is no answer to that statement.
§ Mr. Fort
If the hon. Gentleman would turn to other parts of the document and also let me continue my argument, he would find that the decision was made on a very nice balance of arguments in view of the difficulty or interpreting the scientific information which is available to us.
I want now to turn, and turn sharply, on the hon. Member for Coventry, North. He made a smearing attack on manufacturers in this country, with which others can deal. However, I feel passionately about the way he attacked my colleagues on the Medical Research Council; not only my professional colleagues, who may well he able to defend themselves in the technical press against his unsupported allegations, but those who are not able to defend themselves, those who work for us day by day carrying out some of the most difficult scientific testing done anywhere in the world; and not only the directors of those departments but the skilled technicians upon whose experience and ability we have to rely for the safety of the vaccine which is put into our children. The hon. Member for Coventry, North wishes to intervene; let him come on.
§ Mr. Edelman
The hon. Member is working himself into a synthetic rage. I am obliged to repeat what I said previously, namely, that the Medical Research Council is certainly not infallible and that in the case of anti-poliomyelitis vaccine it has come to two conclusions, one last summer and one in the autumn. The one in the summer was not to import Salk vaccine, and the other was to import Salk vaccine. In view of that, the Medical Research Council stands established as a body of fallible people, and I regret that the hon. Member claims for it—and, therefore, for himself—an infallibility which I certainly would not attribute to it.
§ Mr. Fort
As to the hon. Member's last barb, in the company of professional people I do not make such shock 695 judgments as he and other hon. Members opposite have continuously done during the debate. Like all human organisations, the Medical Research Council is, of course, fallible, but if the hon. Member would take the trouble to read the evidence in the document published this evening as well as in the Press statements issued by the Medical Research Council last year, he would see that the decisions made previously have now been made on a balance of scientific information which is exceedingly difficult to strike.
To deal with the question of fact which the hon. Member threw at my hon. Friend the Member for Beckenham (Mr. Goodhart), in order to pursue the campaign which he has been conducting against part of the medical profession, he asked whether any of my colleagues on the Medical Research Council are consultants to Burroughs Wellcome. No doubt Glaxo is also at the back of his mind, just to extend the smear. I do not know; I do not inquire what my colleagues' activities are other than in their professions.
§ Mr. Fort
Because it is no part of my business to promote smears for the other side. If the hon. Member for Wolverhampton, North-East (Mr. Baird), with his medical background, is so concerned about this, he might have come here earlier to listen.
What I can tell the hon. Member for Coventry, North is that the safety tests which the Medical Research Council carries out have been discussed with the manufacturers in this country as well as with the United States Public Health Service, which is responsible for the corresponding tests in the United States, and with the manufacturers of Salk vaccine in the United States, and in the case of Canada the Medical Research Council carries out the tests for them because the Canadian Government do not do so. That is the factual answer to his question, and I hope that it does not add to the campaign to smear anybody connected with this subject who does not support his view.
I should like to address my last few remarks to the Minister and to say that we now have three vaccines in this coun- 696 try with the specifications outlined in the Medical Research Council's paper, to which he referred. All of them have very small risk. May I ask him if he will reaffirm what he has already said once—that the use of the two vaccines, the British tested Salk vaccine and the Salk vaccine not tested by the M.R.C., is a temporary measure to be terminated as soon as we have sufficient quantities of the British vaccine with the less virulent Brunenders strain in it? Following upon that, will he state that he will make quite sure that no financial or contractual difficulties will hold up the expansion of the British manufacturing capacity making the British type vaccine?
The last point I want to put to him is this. In conformity with the three categories of vaccine which the Medical Research Council has laid down, may I ask him if he will take no action to do what, in my experience, is sometimes done in an entirely different field, that of the engineering industry, and that is to take out from the pipeline material which is just going through? Will he not take supplies of Salk vaccine which are in or going into the testing pipeline in order to boost immediate supplies? I hope my right hon. Friend will recognise that, not only on this side of the Committee but far outside this Chamber, there will be many who will support him in the arguments he has put forward and utterly repudiate the political arguments raised particularly by the hon. Member for Coventry, North.
§ 9.28 p.m.
§ Mr. Somerville Hastings (Barking)
I do not propose to refer to the political side of this question at all but to deal with it purely from the medical aspect. I cannot say that I have had practical experience of the Salk vaccine or of any other sort of polio vaccine, but I have assisted in making vaccines, as well as administering them. Therefore, I do know something of the complexities, particularly in the manufacturing of such vaccines as we are considering today.
The first thing I want to say to the Minister, and I hope he will not misunderstand me, is that I regret that he is introducing the potentially more dangerous Salk vaccine which is being tested in America and not in this country. It is quite true that he has been advised by authoritative advisers about this, but I cannot but feel that two tests are better 697 than one. I cannot help thinking that this would not have been necessary except that the Minister has failed to think ahead. He told us, and I am quoting his words, that there had been unexpected delays in each of the four sources of vaccine. We know that unexpected troubles have happened, but these have not only happened in the last few months. The Cutter incident in America, in which case the Salk vaccine proved so dangerous, was in 1955. Therefore, he should have realised that some of the vaccines which he ordered might not have reached delivery point in time and therefore that he should have ordered more.
There are other reasons why I say that he has failed us in not ordering sufficient vaccines. One is that in other countries—as well as this, to a lesser extent—a third dose is being administered. Older people are getting the disease. Parents are catching it from their children. In our present state of knowledge, we feel that in many cases a third dose is necessary. Again, this was recommended by Salk in the United States in 1956. Since then the Medical Research Council has also recommended it—last November.
But the great reason why the Minister has failed is that he has not realised the type of disease with which he is dealing. It is a disease which in my view—and I think that it is generally accepted—can be eliminated only when a very high percentage of the population has been vaccinated. In primitive communities practically all the children get the disease early in life. When I was in Yugoslavia, five years ago, I found that they had no problem with poliomyelitis, because all the children got it. In the poorer parts of towns in the United States, where overcrowding exists, as many as 50 per cent. of the children have the antibodies in their blood. We want to have all people vaccinated twice and probably three times—certainly all children. This is not my idea; it the general scientific view. Surely the Minister ought to have known that many people would have come forward to be vaccinated, and he should have been ready for it.
The Minister should have taken more steps to provide us with a British vaccine. In spite of all that has been said by hon. Members on both sides of the Committee tonight, I feel that safer than the Salk vaccine, with the Mahony type of 698 virus, is the British vaccine, with the Brunender type, which is a less virulent organism. If by any chance some of the virus particles should escape destruction and get into the inoculated individual in the live form, there is less danger of serious results than there is in the case of the Salk vaccine.
Why did not the Minister take steps to have more vaccine produced in this country? Why did not he ask other firms to produce it, besides the two he has mentioned? I have seen the Glaxo film and I know the facilities they have provided and the excellence of their laboratory, but there must surely be other laboratories in this country. He has laboratories of his own, connected with his Ministry. Would it not have been possible to obtain a larger supply of the British vaccine from other laboratories, if not from those of Glaxo and the Wellcome Foundation? I very much regret having to say this, but I feel that in dealing with this important question the Minister has failed to look ahead.
§ 9.35 p.m.
§ Sir Hugh Linstead (Putney)
I have promised the Minister that I will sit down in time to allow him to make his reply. I will, therefore, be as brief as I possibly can.
I feel that I ought to make a reference to the speech of the hon. Member for Coventry, North (Mr. Edelman), because it did contain an innuendo which I thought ought to be dealt with in Committee, although I hope that I misunderstood what he said. If I heard him correctly, what he said amounted to this: that because the Minister had had some financial dealings with the two companies concerned there was a sort of unholy alliance between the Minister and the two companies whereby it was understood that to their advantage there would be no importation of foreign vaccine, or, at any rate, that the importation of foreign vaccine would be delayed.
That seems to me to be a most serious innuendo to launch publicly. We here have a responsibility personally for satisfying ourselves of the truth of statements of that kind that we make, and I wonder whether the hon. Gentleman, having that suggestion in his mind, took the ordinary precaution of finding out, by inquiry of the Minister or of the firms, whether 699 or hot there was, in fact, any such financial arrangement, or that any such undertaking was given, because if he did not it seems to me grossly improper for him to have launched that suggestion here tonight.
§ Mr. Edelman
The hon. Gentleman will no doubt read my speech tomorrow, when he will find that I addressed a question to the Minister, which I hope he will answer before the debate is over. In the meantime, may I ask the hon. Gentleman whether, in this matter, he should not declare his own connection with and interest in the Pharmaceutical Society?
§ Sir H. Linstead
May I say that I have no sort of financial or other connection with the production of poliomyelitis vaccine in any way whatsoever.
If I might continue to deal with the two points upon which the Minister has been criticised, they are, quite clearly, these: first, that he did not encourage the rapid enough production of polio vaccine in this country; and, secondly, that he did not early enough import Salk vaccine from America. Those are two quite simple issues. It is very easy to have what is called hindsight about these things, and most of the attacks on the Minister have been based on being wise after the event, which is far too easy a thing to be.
What we have to remember is that we are short at the moment, because of a mishap in production, of about 2,500 litres of this vaccine. We must also remember that the vaccine was coming off the production line steadily and satisfactorily until quite recently, and that there had been, from one firm, 188 batches, one after the other, coming through "Clear, clear, clear," without any sort of danger or failing in the tests.
There was no reason at all to suppose that suddenly, at the beginning of this year, there would be an unexpected slip in the production process. After 188 batches have been working satisfactorily, it seems unreasonable to criticise a Minister because the 189th or 190th should choose to fail for a reason which nobody could have foreseen.
As for the earlier importation of American vaccine, it is far too easy to be wise after the event. If any of us had 700 been asked, in 1955, whether a child of ours, or one for whom we had responsibility, ought to be vaccinated with Salk vaccine we would have said, "No". I had to advise in 1957 whether a child of someone I knew should be vaccinated with Salk vaccine, and it was only after weighing up the pros and cons with the greatest care, and with a very doubtful sense that I was giving the best advice, that I felt I could safely agree.
By 1958, I was certain that it was now safe to say that Salk vaccine could be used. The reason was that by that time the Salk vaccine had been tried on millions of people in America. What would have been a mistake in 1955 and a doubtful decision in 1957 is now a reasonable decision to take.
I have no doubt at all that in 1957 one would not have been right, if one had been responsible for the health of millions of children, to take the decision which, by looking back, hon. Members opposite are urging that the Minister should have taken.
§ Mr. Janner
Can the hon. Gentleman tell us atwhat time in 1957 he decided that the Salk vaccine was safe?
§ Sir H. Linstead
I do not remember precisely when it was, but it was probably in the summer. It is one thing to take a personal decision and another to take a decision which may affect millions of children.
There has been criticism of the Minister because he did not give larger orders. That is based upon a misunderstanding of the situation. As my right hon. Friend has said, this is not toothpaste or ice-cream, or something the manufacture of which is known and established. It is still in a stage of development. What the Minister has done is to say to the manufacturing firms, "I will take all your output." They have known that from the very beginning. The fact that it could have been put in another way, "Supply so many million doses", is neither here nor there as affecting the decision that was taken about laying down the plant.
I would answer the question: "Has my right hon. and learned Friend been right in the production methods that have been set on foot here?" Looking at the time when the decisions were taken, I say that they were right when they were taken. On the question whether or not 701 my right hon. and learned Friend should have imported American vaccine earlier, I am sure that he was wise to hold his hand until the very latest moment.
§ 9.44 p.m.
§ Mr. Walker-Smith
My hon. Friend the Member for Putney (Sir H. Linstead) has made a characteristically constructive speech in this field which he knows so well and to which he brings so much expert knowledge and experience.
Though, as I indicated in my earlier speech, the debate has been regrettably short, we have, with one deplorable exception to which I will return with a little more precision in a moment or two, had an interesting and useful debate. Let me deal first of all with one or two specific points.
My hon. Friend the Member for Beckenham (Mr. Goodhart), in his very interesting speech, put certain questions to me regarding the supply of monkeys which are indispensable for testing purposes. We are, in fact, urging the Government of India to reconsider their position in regard to the restriction on the export of monkeys, but there are other sources which might prove to be satisfactory, for example, Africa.
My hon. Friend the Member for Clitheroe (Mr. Fort) also made a very interesting speech, bringing his expert knowledge to bear as a member of the Medical Research Council. I can, of course, assure him that I shall bear very closely in mind what he said, and the suggestions which he was good enough to make.
The hon. Member for Barking (Mr. Hastings) also made an interesting contribution. He was very anxious, as were other hon. Members, that British supplies should come forward as much as possible. Though we have been concerned here tonight with two companies, those are not in fact the only companies. There is at least one other company which is contemplating production of this vaccine, though as it is not so far forward as those two which have been mentioned, and its potential has not figured in our calculations in this matter.
Now I think perhaps it would be appropriate to deal with the speech of the hon. Gentleman the Member for Coventry, North (Mr. Edelman), before coming to the more general questions 702 which have been raised. I did not understand the hon. Gentleman to make a personal attack upon me, but I did not resent what he said any the less for that, because he did seem to me to be breaching more than one tradition of this Committee, because he was attacking advisers or consultants and people who have not got the opportunity to answer for themselves.
§ Mr. Edelman
Let me be allowed to say to the right hon. and learned Gentleman at once that I was attacking advisers in his person, for he is responsible for them, and he, in accepting advice today which he rejected last summer, when he was equally great, has shown that he is relying on advisers who are themselves contradicting their advice.
§ Mr. Walker-Smith
The hon. Gentleman knows quite well that I was not Minister at the time he has referred to. I say to him that I am concerned more with the specific suggestions which he made which have aroused the indignation, very properly, of hon. Members on this side of the Committee, and he has breached, as I say, more than one tradition of this Committee. He has attacked people and specifically selected advisers and consultants not only of the Ministry of Health but also the Medical Research Council. The Council as the hon. Gentleman knows or ought to know, is not part of the Ministry of Health and is not responsible to it.
He put to me these questions. He asked, are there any undertakings to Glaxo and Burroughs Wellcome that they should have priority? He also asked, have hundreds of thousands of pounds of Government money been spent on them on the recommendation of the Medical Research Council? The answers are these. No undertakings whatsoever have been given to Glaxo and Burroughs Wellcome. The Medical Research Council prefers British vaccine on purely medical grounds. So far as money goes, no money whatever, apart from the purchase price of the vaccine, has been given to those companies. [HON. MEMBERS: "The hon. Member must withdraw."]
The Committee may wish to know what sort of inquiries the hon. Gentleman made before making that sort of slander in this Committee. [HON. MEMBERS: "Withdraw."]
§ Mr. Edelman rose——
§ Mr. Walker-Smith
Wait a minute. I want the hon. Gentleman to be quite clear first what I, and, I think, hon. Members on this side of the Committee, think about his intervention. In thirteen years in this Committee I consider that in the smears and unfounded allegations which he made against the Medical Research Council and against those companies he plumbed depths of squalor which I have not previously experienced.
§ Mr. Edelmanrose——
The Chairman (Sir Charles Mac-Andrew)
The hon. Member should resume his seat if the right hon. and learned Gentleman does not give way.
§ Mr. Walker-Smith
I shall give way when I have finished with the hon. Gentleman's conduct. Behind the cloak of Parliamentary privilege the hon. Gentleman has behaved in a disgraceful way to make those allegations, and we shall look forward with interest to see whether he has the courage to repeat them outside where he will be mulcted in heavy damages if he does so.
§ Mr. Edelman
The sole function of Parliamentary privilege is to protect the privileges of one's constituents who should defended against the ineptitude, to say no worse, of the Minister. The fact is that owing to his negligence, millions of children are going to be unprotected this summer, and I charge against him that he is working up a synthetic indignation as a cover for his failure to provide that protection.
§ Mr. Walker-Smith
The hon. Gentleman is now, of course, trying to get away from the indecent smear that he has made. I would remind the Committee of something else which the hon. Gentleman said without one tittle of evidence. He said that the independent consultants to the Ministry were the same as the consultants to Glaxo and Burroughs Wellcome.
§ Mr. Walker-Smith
I am told that no advisers of the Ministry are in any way connected with Burroughs Wellcome or Glaxo, nor is any member of the Medical Research Council, although the firms 704 may, of course, ask the Council, as may other firms, for advice. Once again the hon. Gentleman has abused his Parliamentary privilege in that way, and has made totally unsubstantiated and unfounded allegations and has disgraced his position in this House.
Now I turn, not without relief, to a more general and less disagreeable subject. As my hon. Friend the Member for Putney has said, there has been running through this debate the suggestion that we should have built up a stockpile last autumn of Salk vaccine. I have given in my earlier speech four reasons against this. Each one, taken by itself, is convincing, and the four together I believe to be overwhelming.
The Government acted on the advice of the Medical Research Council which I have read out. If we consider the position as it was then, the tide of British supplies was flowing strongly. I do not know by what superhuman exercise of foresight it is suggested that we should have anticipated the almost total interruption today. My hon. Friend the Member for Putney has pointed out how easy it is to make these criticisms with the advantage of hindsight.
Let us look at it the other way round. Suppose, in spite of the expert advice that we should limit the use of Salk vaccine to a temporary supplement awaiting British supplies, we had disregarded that advice, and large quantities had been ordered to make a stockpile of this perishable commodity; suppose that British production had continued to gain pace and gather strength and that nearly everybody had exercised his right to reject Salk; what would have been the position then? It does not require much imagination to see what the position would have been.
From Parliament, Press and platform we should have had scathing denunciations of the folly of the Government. The Public Accounts Committee would have wagged a sombre head. The Daily Herald and the Star would have gone into ecstasies of competitive vituperation. In Parliament Votes of Censure would have descended on the heads of the Government like thunderbolts, not just like speeches that we have heard tonight from the right hon. Lady the Member for Warrington (Dr. Summerskill). It would 705 even perhaps have brought in the old guard, the right hon. Member for Lewisham, South (Mr. H. Morrison), to do justice to the strength of the case. What a case it would have been.
We should have been asked: have not the Government disregarded the expert advice that they have been given? Have they not disregarded the clear probabilities of the case? Have they not extravagantly, foolishly and wantonly bought a perishable commodity which nobody wants, to build up a stockpile which cannot last? On second thoughts, perhaps the case would have been so strong that they could have left it to the right hon. Lady after all. The Government's case is that we have acted with proper foresight and energy and in accordance with expert advice. We have taken some hard knocks in this business at the hands of fortune but we have not wasted time in repining nor have we stooped to recrimination. We have kept our heads and we have acted with resolution and energy to prevent these hard knocks from harming the interests of the British people. If anybody thinks that a Labour Government would have done half as well then he has forgotten the history of the failures and frustrations of 1945–51.
I understand that the Opposition mean to divide the Committee. If I had wanted to gain a mere party advantage for the Government I should have made a provocative speech in opening to force them
§ to divide, because I believe that the decision to divide tonight will gravely harm the Opposition, especially if it is a decision prefabricated in advance and taken without full knowledge of the facts or waiting to hear them. I believe that such a decision will be recognised in the country as being a compound of factual ignorance and party calculation.
§ That is why, for mere party reasons, I could have wanted a Division tonight, but, as those who heard it know, my speech was not cast in that vein. It was factual, it was expository, it was technical. It may well have been dull, it was certainly long, but it most certainly was not provocative. I hoped that the Opposition would be open to reason on this matter. I hoped that there would be no Division on this great human issue. I hoped that we should be able to go forward together to resume the advance of which fortune had momentarily deprived us.
§ I was wrong. The Opposition are evidently determined to put faction first in this matter. I say this in conclusion: let them go into the Lobby, if go they must, but they should go with shame in their hearts and defeat for their portion.
§ Question put:—
§ The Committee divided: Ayes 220, Noes 286.709
|Division No. 105.]||AYES||[9.58 p.m.|
|Albu, A. H.||Champion, A. J.||Fletcher, Eric|
|Allen, Arthur (Bosworth)||Chapman, W. D.||Forman, J. C.|
|Allen, Scholefield (Crewe)||Chetwynd, G. R.||Fraser, Thomas (Hamilton)|
|Awbery, S. S.||Clunle, J.||Gaitskell, Rt. Hon. H. T. N.|
|Bacon, Miss Alice||Coldrick, W.||Gibson, C. W.|
|Baird, J.||Collick, p. H. (Birkenhead)||Gordon Walker, Rt. Hon. P. C.|
|Bellenger, Rt. Hon. F. J.||Collins, V.J.(Shoreditch & Finsbury)||Greenwood, Anthony|
|Bence, C. R. (Dunbartonshire, E.)||Corbet, Mrs. Freda||Grenfell, Rt. Hon. D. R.|
|Benn, Hn. Wedgwood (Bristol, S.E.)||Craddock, George (Bradford, S.)||Grey, C. F.|
|Benson, sir George||Cronin, J. D.||Griffiths, David (Rother Valley)|
|Beswick, Frank||Dalton, Rt. Hon. H.||Griffiths, William (Exchange)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Darling, George (Hillsborough)||Hall, Rt. Hn. Glenvil (Colne Valley)|
|Blackburn, P.||Davies, Ernest (Enfield, E.)||Hamilton, W. W.|
|Boardman, H.||Deer, G.||Hannan, W.|
|Bottomley, Rt. Hon. A, G.||de Freltas, Geoffrey||Harrison, J. (Nottingham, N.)|
|Bowdon, H. W. (Leicester, S.W.)||Delargy, H. J.||Hastings, S.|
|Boyd, T. C.||Diamond, John||Hayman, F. H.|
|Brockway, A. F.||Donnelly, D. L.||Healey, Denis|
|Broughton, Dr. A. D. D.||Dugdale, Rt. Hn. John (W. Brmwch)||Henderson, Rt. Hn. A. (Rwly Regis)|
|Brown, Rt. Hon. George (Belper)||Dye, S.||Herbison, Miss M.|
|Burke, W. A.||Ede, Rt. Hon. J. C.||Hewitson, Capt. M.|
|Burton, Miss F. E.||Edelman, M.||Hobson, C. R. (Keighley)|
|Butler, Herbert (Hackney, C.)||Edwards, Robert (Bilston)||Holman, P.|
|Butler, Mrs. Joyce (Wood Green)||Edwards, W. J. (Stepney)||Houghton, Douglas|
|Callaghan, L. J.||Evans, Albert (Islington, S.W.)||Howell, Charles (Perry Barr)|
|Carmichael, J.||Evans, Edward (Lowestoft)||Howell, Denis (All Saints)|
|Castle, Mrs. B. A.||Fernyhough, E,||Hughes, Cledwyn (Anglesey)|
|Hughes, Hector (Aberdeen, N.)||Messer, Sir F.||Simmons, C. J. (Brierley Hill)|
|Hunter, A. E.||Mikardo, Ian||Slater, Mrs. H. (Stoke, N.)|
|Hynd, H. (Accrington)||Mitchison, G. R.||Snow, J. W.|
|Hynd, J. B. (Attercliffe)||Moody, A. S.||Sorensen, R. W.|
|Irvine, A. J. (Edge Hill)||Morrison,Rt.Hn.Herbert(Lewis'm,S.)||Soskice, Rt. Hon. Sir Frank|
|Irving, Sydney (Dartford)||Mort, D. L.||Sparks, J. A.|
|Isaacs, Rt. Hon. G. A.||Moss, R.||Stewart, Michael (Fulham)|
|Janner, B.||Moyle, A.||Stonehouse, John|
|Jay, Rt. Hon. D. P. T.||Noel-Baker, Francis (Swindon)||Stones, W. (Consett)|
|Jeger, George (Goole)||Noel-Baker, Rt. Hon. P. (Derby, S.)||Strachey, Rt. Hon. J.|
|Jeger, Mrs. Lena(Holbn & St.Pncs.S.)||O'Brien, Sir Thomas||Strauss, Rt. Hon. George (Vauxhall)|
|Jenkins, Roy (Stechford)||Oliver, G. H.||Stross,Dr.Barnett(Stoke-on-Trent,C.)|
|Johnson, James (Rugby)||Oram, A. E.||Summerskill, Rt. Hon. E.|
|Johnston, Douglas (Paisley)||Orbach, M.||Swingler, S. T.|
|Jones, David (The Hartlepools)||Oswald, T.||Sylvester, G. O.|
|Jones, Elwyn (W. Ham, S.)||Owen, W. J.||Taylor, Bernard (Mansfield)|
|Jones, Jack (Rotherham)||Padley, W. E.||Taylor, John (West Lothian)|
|Jones, J. Idwal (Wrexham)||Paget, R. T.||Thomas, George (Cardiff)|
|Jones, T. W. (Merioneth)||Paling, Rt. Hon. W. (Dearne Valley)||Thomas, Iorwerth (Rhondda, W.)|
|Kenyon, C.||Palmer, A. M. F.||Thomson, George (Dundee, E.)|
|Key, Rt. Hon. C. W.||Pannell, Charles (Leeds, W.)||Thornton, E.|
|King, Dr. H. M.||Pargiter, G. A.||Timmons, J.|
|Lawson, G. M.||Parker, J.||Ungoed-Thomas, Sir Lynn|
|Ledger, R. J.||Parkin, B. T.||Usborne, H. C.|
|Lee, Frederick (Newton)||Paton, John||Viant, S. P.|
|Lee, Miss Jennie (Cannock)||Peart, T. F.||Weitzman, D.|
|Lever, Harold (Cheetham)||Pentland, N.||Wells, William (Walsall, N.)|
|Lewis, Arthur||Prentice, R. E.||West, D. G.|
|Lindgren, G. S.||Price, J. T. (Westhoughton)||Wheeldon, W. E.|
|Upton, Marcus||Price, Philips (Gloucestershire, W.)||White, Mrs. Eirene (E. Flint)|
|Logan, D. G.||Probert, A. R.||Wigg, George|
|McAlister, Mrs. Mary||Proctor, W. T.||Wilcock, Group Capt. C. A. B.|
|MacColl, J. E.||Pursey, Cmdr. H.||Willey, Frederick|
|MacDermot, Niall||Rankin, John||Williams, David (Neath)|
|McGhee, H. G.||Redhead, E. C.||Williams, Rev. Llywelyn (Ab'tillery)|
|McGovern, J.||Reeves, J.||Williams, Rt. Hon. T. (Don Valley)|
|McInnes, J.||Reid, William||Williams, W. T. (Barons Court)|
|McKay, John (Wallsend)||Rhodes, H.||Willis, Eustace (Edinburgh, E.)|
|McLeavy, Frank||Robens, Rt. Hon. A.||Wilson, Rt. Hon. Harold (Huyton)|
|MacMillan, M. K. (Western Isles)||Roberts, Albert (Normanton)||Woodburn, Rt. Hon. A.|
|MacPherson, Malcolm (Stirling)||Roberts, Goronwy (Caernarvon)||Woof, R. E,|
|Mahon, Simon||Robinson, Kenneth (St. Pancras, N.)||Yates, V. (Ladywood)|
|Mallalieu, E. L. (Brigg)||Rogers, George (Kensington, N.)||younger, Rt. Hon. K.|
|Mallalieu, J. P. W. (Huddersfd, E.)||Ross, William||Zilliacus, K.|
|Mann, Mrs. Jean||Shinwell, Rt. Hon. E.|
|Mason, Roy||Short, E. W.||TELLERS FOR THE AYES:|
|Mayhew, C. P.||Silverman, Julius (Aston)||Mr. Popplewell and Mr. Pearson.|
|Mellish, R. J.|
|Agnew, Sir Peter||Brooke, Rt. Hon. Henry||du Cann, E. D. L.|
|Aitken, W. T.||Brooman-White, R. C.||Duncan, Sir James|
|Allan, R. A. (Paddington, S.)||Browne, J. Nixon (Craigton)||Duthie, W. S.|
|Alport, C. J. M.||Bryan, P.||Eden, J. B. (Bournemouth, West)|
|Amory, Rt. Hn. Heathcoat (Tiverton)||Bullus, Wing Commander E. E.||Elliott,R.W.(Ne'castle upon Tyne,N.)|
|Arbuthnot, John||Burden, F. F. A.||Emmet, Hon. Mrs. Evelyn|
|Astor, Hon. J. J.||Butcher, Sir Herbert||Errington, Sir Eric|
|Atkins, H. E,||Butler,Rt. Hn.R.A.(Saffron Walden)||Erroll, F. J.|
|Baldock, Lt.-Comdr. J. M.||Campbell, Sir David||Farey-Jones, F. W.|
|Baldwin, A. E.||Carr, Robert||Finlay, Graeme|
|Balniel, Lord||Channon, Sir Henry||Fisher, Nigel|
|Barlow, Sir John||Chichester-Clark, R.||Fletcher-Cooke, C.|
|Barter, John||Churchill, Rt. Hon. Sir Winston||Fort, R.|
|Baxter, Sir Beverley||Clarke, Brig, Terence (Portsmth, W.)||Fraser, Hon. Hugh (Stone)|
|Beamish, Col. Tufton||Cooke, Robert||Fraser, Sir Ian (M'cmbe & Lonsdale)|
|Bell, Philip (Bolton, E.)||Cooper, A. E.||Freeth, Denzil|
|Bell, Ronald (Bucks, S.)||Cooper-Key, E. M.||Galbraith, Hon. T. G. D.|
|Bevins, J. R. (Toxteth)||Cordeaux, Lt.-Col. J. K.||Gammans, Lady|
|Bidgood, J. C.||Corfield, Capt. F. V.||Garner-Evans, E. H.|
|Biggs-Davison, J. A.||Craddock, Beresford (Spelthorne)||George, J. C. (Pollok)|
|Bingham, R. M.||Crosthwaite-Eyre, Col. O. E.||Gibson-Watt, D.|
|Birch, Rt. Hon. Nigel||Crowder, Sir John (Finchley)||Glover, D.|
|Bishop, F. P.||Crowder,Petre (Ruislip—Northwoot)||Glyn, Col. Richard H.|
|Black, C. W.||Currie, G. B. H.||Godber, J. B.|
|Body, R. F.||Dance, J. C. G.||Goodhart, Philip|
|Boothby, Sir Robert||Davidson, Viscountess||Gough, C. F. H.|
|Bossom, Sir Alfred||D'Avigdor-Goldsmid, Sir Henry||Gower, H. R.|
|Bowen, E. R. (Cardigan)||Deedes, W. F.||Graham, Sir Fergus|
|Boyd-Carpenter, Rt. Hon. J. A.||Digby, Simon Wingfield||Grant, W. (Woodside)|
|Boyle, Sir Edward||Dodds-Parker, A, D.||Grant-Ferris, Wg Cdr. R. (Nantwich)|
|Braine, B. R.||Doughty, C. J. A.||Green, A.|
|Bromley-Davenport, Lt.-Col, W. H.||Drayson, G. B.||Gresham Cooke, R.|
|Grimston, Hon. John (St. Albans)||Lindsay, Martin (Solihull)||Ramsden, J. E.|
|Grimston, Sir Robert (Westbury)||Linstead, Sir H. N.||Rawlinson, Peter|
|Grosvenor, Lt.-Col. R. G>||Llewellyn, D. T.||Redmayne, M.|
|Gurden, Harold||Lloyd, Rt. Hon. G.(Button Coldfield)||Remnant, Hon. P.|
|Hall, John (Wycombe)||Lloyd, Maj. Sir Guy (Renfrew, E.)||Renton, D. L. M.|
|Hare, Rt. Hon. J. H.||Lloyd, Rt. Hon. Selwyn (Wirral)||Ridsdale, J. E.|
|Harris, Frederic (Croydon, N.W.)||Longden, Gilbert||Rippon, A. G. F.|
|Harris, Reader (Heston)||Low, Rt. Hon. Sir Toby||Roberts, Sir Peter (Heeley)|
|Harrison, A. B. C. (Maldon)||Lucas, Sir Jocelyn (Portsmouth, S.)||Robinson, Sir Roland (Blackpool, S.)|
|Harrison, Col. J. H. (Eye)||Lucas, P. B. (Brentford & Chiswick)||Robson Brown, Sir William|
|Harvey, Sir Arthur Vere (Macclesf'd)||Lucas-Tooth, Sir Hugh||Rodgers, John (Sevenoaks)|
|Harvey, Ian (Harrow, E.)||McAdden, S. J.||Roper, Sir Harold|
|Harvey, John (Walthamstow, E.)||Macdonald, Sir Peter||Ropner, Col. Sir Leonard|
|Harvie-Watt, Sir George||Mackeson, Brig, Sir Harry||Sandys, Rt. Hon. D.|
|Heald, Rt. Hon. Sir Lionel||McKibbin, Alan||Scott-Miller, Cmdr. R.|
|Henderson, John (Cathcart)||Mackie, J. H. (Galloway)||Sharples, R. C.|
|Henderson-Stewart, Sir James||McLaughlin, Mrs. P.||Shepherd, William|
|Hesketh, R. F.||Maclay, Rt. Hon. John||Smithers, Peter (Winchester)|
|Hicks-Beach, Maj. W. W.||McLean, Neil (Inverness)||Smyth, Brig. Sir John (Norwood)|
|Hill, Rt. Hon. Charles (Luton)||Macleod, Rt. Hn. Iain (Enfield, w.)||Spearman, Sir Alexander|
|Hill, Mrs. E. (Wythenshawe)||MacLeod, John (Ross & Cromarty)||Speir, R. M.|
|Hinchingbrooke, Viscount||Macmillan, Rt. Hn. Harold(Bromley)||Spence, H. R. (Aberdeen, W.)|
|Hirst, Geoffray||Macmillan, Maurice (Halifax)||Spens, Rt. Hn. Sir p. (Kens'gt'n, S.)|
|Hobson, John (Warwick & Leam'gt'n)||Macpherson, Niall (Dumfries)||Stanley, Capt. Hon. Richard|
|Holland-Martin, C. J.||Maddan, Martin||Stevens, Geoffrey|
|Hope, Lord John||Manningham-Buller, Rt. Hn. Sir R.||Steward, Harold (Stockport, S.)|
|Hornby, R. P.||Marlowe, A. A. H.||Steward, Sir William (Woolwich, W.)|
|Hornsby-Smith, Miss M. P.||Marples, Rt. Hon. A. E.||Stoddart-Scott, Col. Sir Malcolm|
|Horobin, Sir Ian||Marshall, Douglas||Stuart, Rt. Hon. James (Moray)|
|Howard, Gerald (Cambridgeshire)||Mathew, R.||Studholme, sir Henry|
|Howard, Hon. Greville (St. Ives)||Mawby, R. L.||Summers, Sir Spencer|
|Howard, John (Test)||Maydon, Lt.-Comdr. S. L. C.||Taylor, Sir Charles (Eastbourne)|
|Hughes-Young, M. H. C.||Medlicott, Sir Frank||Taylor, William (Bradford, N.)|
|Hulbert, Sir Norman||Milligan, Rt. Hon. W. R.||Teeling, W.|
|Hurd, A. R.||Molson, Rt. Hon. Hugh||Temple, John M.|
|Hutchison, Michael Clark(E'b'gh, S.)||Moore, Sir Thomas||Thomas, Leslie (Canterbury)|
|Hutchison, Sir Ian Clark(E'b'gh, W.)||Morrison, John (Salisbury)||Thompson, Kenneth (Walton)|
|Hyde, Montgomery||Mott-Radclyffe, Sir Charles||Thompson, R. (Croydon, S.)|
|Hylton-Foster, Rt. Hon. Sir Harry||Nabarro, G. D. N.||Thorneycroft, Rt. Hon. P.|
|Iremonger, T. L.||Nairn, D. L. S.||Thornton-Kemsley, Sir Colin|
|Jenkins, Robert (Dulwich)||Neave, Airey||Tiley, A. (Bradford, W.)|
|Jennings, J. C. (Burton)||Nicholls, Harmar||Tilney, John (Wavertree)|
|Jennings, Sir Roland (Hallam)||Nicholson, Sir Godfrey (Farnham)||Turner, H. F. L.|
|Johnson, Dr. Donald (Carlisle)||Nicolson, N. (B'n'm'th, E. & Chr'ch)||Turton, Rt. Hon. R. H.|
|Johnson, Eric (Blackley)||Noble, comdr. Rt. Hon. Allan||Tweedsmuir, Lady|
|Johnson, Howard (Kemptown)||Nugent, G. R. H.||Vane, W. M. F.|
|Jones, Rt. Hon. Aubrey (Hall Green)||O'Neill, Hn. Phelim (Co. Antrim, N.)||Vaughan-Morgan, J. K.|
|Joseph, Sir Keith||Ormsby-Gore, Rt. Hon. W. D.||Vickers, Miss Joan|
|Joynson-Hicks, Hon. Sir Lancelot||Orr, Capt. L. P. S.||Wakefield, Edward (Derbyshire, W.)|
|Kaberry, D.||Orr-Ewing, Charles Ian (Hendon, N.)||Wakefield, Sir Wavell (St. M'lebone)|
|Kerby, Capt. H. B.||Osborne, C.||Walker-Smith, Rt. Hon. Derek|
|Kerr, Sir Hamilton||Page, R. G.||Wall, Patrick|
|Kershaw, J. A.||Pannell, N. A. (Kirkdale)||Ward, Dame Irene (Tynemouth)|
|Kimball, M.||Partridge, E.||Watkinson, Rt. Hon. Harold|
|Lagden, G. W.||Peel, W. J.||Webbe, Sir H.|
|Lancaster, Col. C. G.||Peyton, J. W. W.||Whitelaw, W. S. I.|
|Langford-Holt, J. A.||Pickthorn, K. W. M.||Willams, Paul (Sunderland, S.)|
|Leather, E. H. C.||Pike, Miss Mervyn||Wills, G. (Bridgwater)|
|Leavey, J. A.||Pilkington, Capt. R. A.||Wilson, Geoffrey (Truro)|
|Leburn, W. G.||Pitman, I. J.||Wood, Hon. R.|
|Legge-Bourke, Maj. E. A. H.||Pitt, Miss E. M.||Woollam, John Victor|
|Legh, Hon. Peter (Petersfield)||Powell, J. Enoch||Yates, William (The Wrexin)|
|Lennox-Boyd, Rt. Hon. A. T.||Price, Henry (Lewisham, W.)|
|Lindsay, Hon. James (Devon, N.)||Prior-Palmer, Brig. O. L.||TELLERS FOR THE NOES:|
|Mr. Heath and Mr. Oakshott.|
|Original Question again proposed.|
|It being after Ten o'clock, The CHAIRMAN left the Chair to report Progress and ask leave to sit again.|
|Committee report Progress; to sit again Tomorrow.|