§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Whitelaw.]
§ 10.11 p.m.
§ Mr. Arthur Tiley (Bradford, West)
I am grateful for the opportunity which the Adjournment debate gives to bring before the House some of the details of the smallpox epidemic. It has been a great ordeal for the City of Bradford. I am not speaking about this matter in order to apportion blame between those in favour of the Commonwealth Immigrants Bill and those who are not in favour, or between our country and Pakistan, or between white and coloured. There are essential lessons which have been learned in our city during this ordeal and we should be foolish if we did not take notice of them.
The adverse publicity during the Christmas Recess makes me fear that I may be sent a letter from you, Mr. Speaker, before the Easter Recess telling me not to turn up here. Instead of being asked, "Have you had a nice Christmas", people will be saying "Have you been vaccinated?" I am happy to say that on Monday last, 12th February, Dr. John Douglas, our Medical Officer of Health, concluded a statement to the Press by saying:I am confident that the present outbreak of smallpox in the City of Bradford can be considered at an end.1656 I am sure we all welcome that. It is a great pity that more publicity was not given to it because of the harm my city has endured during the last few weeks. A miracle has been achieved in Bradford in the quelling of this epidemic. Smallpox is difficult enough to contain when one knows that it is present, but the germ was virulently in our midst undetected.
I shall mention only two names in awarding praise, Dr. John Douglas our Medical Officer of Health and his Deputy, Dr. William Edgar. What they have achieved is beyond praise and beyond material reward. Of course they have been aided by an army of helpers in the medical services of our city, in the hospitals and outside the hospitals, and by many others outside medicine altogether. Bradford is grateful to neighbouring local authorities for the assistance they have given. We are grateful to the Minister of Health for immediately appointing an official to act as liaison between Bradford and London. We are grateful, too, that the vaccine flowed in and that the supply was not interrupted when the mass vaccinations took place.
That is the first lesson, for panic and hysteria begins if vaccine runs out. It is well to remember that. Happily in Bradford vaccine was supplied by the Ministry in huge quantities and for five days vaccinations went on uninterrupted. There was not the slightest panic. There was orderly queueing. It is not hysterical to seek vaccination because it is not a sign of hysteria to try to keep fire from one's home.
I will mention the staffs who volunteered to work in isolation hospitals and did tremendous work there. I see from Written Answers to Questions published in the OFFICIAL REPORT in the last few days that two domestic and ancillary staffs got overtime and bonus payments, 1657 but skilled medical staffs merely had their normal pay. Service of this type cannot be measured in terms of money. The people who volunteer for these jobs do so without thought of material reward. However, I hope that my hon. Friend the Parliamentary Secretary will look into the matter and see if something can be done to put it in its correct perspective.
I will give the figures of those who were concerned in the disease in Bradford. Perhaps my hon. Friend will supply the figures for the whole country. Bradford has a population of 300,000. The disease began when a Pakistani child died on 30th December. Unfortunately the death was returned as malaria. This is why the position was grave, because for many days smallpox was in cur midst but not detected.
The death is a sad story. I will tell it briefly. The father, a Pakistani, had worked happily and well in our city in the transport department for some years. He had saved up enough money to go out to Karachi to bring his wife and child home. Some days before Christmas he went out there to do so. Unfortunately, while they were in Karachi waiting for air transport his child evidently became infected. We are very sorry that his life in our city should have been shrouded, as it will be, with such tragedy.
I am instructed by our Medical Officer of Health to say that the Pakistanis co-operated in every way possible in the work he did in seeking out contacts and isolating them. There were fourteen definite cases in Bradford. There were six deaths. There was one death in addition to the six which was partly due to smallpox. Therefore, we were dealing with a very virulent type of germ. The death rate amongst those affected was very high.
Inside five days the authorities in my city vaccinated between 250,000 and 275,000 people. In addition, in the 24 hours following the first indication of the disease they sought out 900 direct contacts. That was the great danger. Normally, the contacts are few, but here hospitals, a slaughterhouse and visitors to hospitals were involved. In all, for about three weeks 900 people were visited daily and subject to medical check and watched for any sign of the 1658 disease. It was a great feat to find the 900 and vaccinate them quickly and curtain them off, and, in addition, curtain off the whole city.
The outbreak was greeted with these words on the front page of the Daily Express of 13th January—"The Frightened City". The headline is not true. It was offensive to all those who live in my city, and it was thoroughly irresponsible. It was harmful to our great export trade, because news travels fast. There was no panic in our city. I have lived in the city all my life, and I am not speaking from gossip or merely pipping up to constituents. This is my home. There was no panic, but it sent thousands in the next day or two to be vaccinated when our officers should have been dealing with the direct contacts. This interfered with the main work. Perhaps it is fair comment to say that the Beaverbrook Press may be just as wrong about the Common Market as it is about the City of Bradford. On Tuesday, 13th February, I searched through the Daily Express after Dr. Douglas had made his announcement that the epidemic was over, but there was not a word about that. The paper evidently thought that the people of Bradford had succumbed and were dead.
Happily, there were only a few cases, but in view of the situation, over which we were carefully watching, there could have been 50 or 100 cases. I want to examine what happens to the life of a great city if that should occur, because I can quite see that it would grind to a standstill—not with a bomb that drops, not with a strike, but with a germ which scientists have defeated but not destroyed. Look what happened to my city with the few cases there were. There is the sadness of the deaths, especially the young children involved. There is the cost of it all. There are slums and thousands of people living in squalor. I wonder how many houses we could have built with the money which has been used to fight this battle.
Our main hospitals were closed. Our shops were empty. The large stores tell me that their turnovers dropped by 50 per cent. The cafes had no business. The cinemas closed, and our famous Bradford pantomime is coming to an end a month before it should. Football 1659 came to an end—and that is not much of a tragedy for Bradford, although hon. Members must not say that I said that.
Our trade was injured. We have this world famous textile export trade, and people abroad, and especially in Italy, were refusing to receive our goods because of this epidemic. Bradford is famous, too, for its mail-order businesses, but catalogues were being refused. Indeed, the Secretary of the Chamber of Commerce told me of a parcel of knitting wool worth £1 which was sent to an address in Scotland. The woman received it, merely wrapped another paper around the parcel, enclosing £1 note, and a note saying, "Don't dare send me a receipt." That was Scotland, so the House can see how serious the position was.
We must not allow these things to happen again. Whatever may have been our regulations in the past, and whatever restrictions may have been imposed, we must make sure that this risk is not run again by our main industrial cities. We are told that the five persons who arrived here from Pakistan between 16th December and 11th January, all of whom were infected when they arrived, had valid international certificates of recent vaccination. We know that the members of the Pakistani family first involved in Bradford, including the child who died, all had vaccination certificates.
Those being the facts, I want to ask my hon. Friend whether we can be sure that the vaccination certificates are genuine, and not forged. Secondly, is the vaccine that is being used in Karachi and the rest of Pakistan an effective vaccine? Thirdly, should not certificates in future certify not only that the vaccination had been carried out but that it had taken effect?
My fourth point is this. After the epidemic started in Bradford, I was told—and it has since been confirmed—that a violent and virulent smallpox epidemic had been raging in Karachi since November. I should like to know how soon, if at all, the World Health Organisation advised us of that epidemic. Further, we have in Karachi a High Commissioner, and our officers there must know that thousands and thousands of Pakistanis come to our cities including Bradford. Without 1660 having to rely on outside sources, was not information received from those offices about the epidemic raging in Karachi?
It is certain that we must change our ideas on health checks at our ports and airports in the future, because the risks in our densely-populated cities are too great. Immigrants have brought great housing problems to our local authorities, and coloured immigrants are bringing great health problems, including T.B. and V.D. Those problems must be dealt with by this House. It is unfair to delegate that responsibility to our local people—it is our responsibility.
The danger of smallpox in epidemic form is greater now than it was, not only because of the masses of immigrants who are arriving and the housing conditions in which they live, but also because they now come by air. Our practice was satisfactory when people came by sea, because the spots came out on the voyage, and all we had to do was to isolate the boat or the few people involved at the end of the voyage. Air travel brings so many so quickly, and they mix in bad housing conditions with such large masses of people, that what we have done in the past is no good for the future.
There are bigger reasons involved than the material losses. The bad housing and health risk, more than anything else, causes tension between the races. The people of Bradford have a fine reputation with regard to immigrants and it is obvious that we should have, for Bradford is a great exporting city and we are outward-looking rather than inward, and that has been the case for centuries. As a result, many thousands of people have come in and have taken up life happily with us in Bradford.
During this period we behaved with great dignity and only two incidents occurred. Most places have more incidents than that without an epidemic raging in their midst. But the margin of safety is narrow and it is essential that if we have any knowledge of a smallpox epidemic in any part of the world we should know about it immediately—not within a fortnight or three weeks—and the Minister must then employ screening operations for all who arrive at the airports, not only in London but at the smaller airports throughout the country.
1661 It is very sad that the pathologist who died—a constituent of mine, a young man with a fine family and a great future—should have died in carrying out a post mortem. Life is too precious and it is bad enough to have to give one's life when saving a life, but to lose it when carrying out a post mortem is indeed a tragedy. We in Bradford are very sorry about this. However, this man, Dr. Ainley, was not vaccinated. I understand that the Medical Officer of Health for Tipton, who was called in to diagnose a case, was also not vaccinated.
Is it not possible for something other than a circular to be issued periodically by the Ministry throughout the country? So many documents are sent from London, from the various Ministries, on printed paper and many of these are not read as carefully as they should be. Is it not possible to originate a recording system within the Ministries so that the position of those vulnerable can be watched?
It is a great tragedy when things like this happen, but I hope that Bradford's ordeal will be examined and that a lesson will be drawn from it so that this dreadful anxiety and scourge and period of great disquiet shall not occur anywhere else.
§ 10.28 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I feel that if the resilience, the humour and the deep understanding displayed by my hon. Friend the Member for Bradford, West (Mr. Tiley) represents his native city, then no one should be surprised that the citizens brought such courage to the troubles which the smallpox outbreak in turn brought to them.
My hon. Friend asks me to give the figures. My right hon. Friend the Minister, in his statement to the House on 23rd January, gave the figures to that date and also explained the measures that had been taken to deal with the outbreak and to ensure that no new source of infection was imported. Since that date there have been no new imported cases. There have been, since my right hon. Friend spoke, five additional confirmed cases, three of which were in Bradford. There have been two additional deaths since the Minister made that statement and one of those was in Bradford. All the cases in that 1662 city stemmed from that one tragic case of the child of nine who died in Bradford hospital.
The normal health control measures taken in the case of travellers from infected areas consist of the issue of a warning card to all air passengers on arrival by direct flights. This tells them to call a doctor if they or anybody in the house feels sick within 21 days of their arrival and, with the card, the doctor is then alerted for signs of smallpox.
In the normal way it would not be practicable or internationally acceptable to impose very much more stringent health control measures—such as a clinical examination on arrival for all travellers from all areas where a case of smallpox had been notified.
At any time there are always a large number of so-called infected areas throughout the world and all are regularly notified to my Department and all port health authorities by the World Health Organisation. To hold up all travellers from all these places would nowadays be regarded as an intolerable hindrance to freedom of travel and quite out of line with internationally accepted practice for the control of smallpox. As my right hon. Friend said in the House on 23rd January… there is no reason in the history of recent years to believe that the normal safeguards which this country applies are inadequate or unsatisfactory."—[OFFICIAL REPORT, 23rd January, 1962; Vol. 652, c. 36.]We have powers under the Port Health Regulations to impose exceptionally stringent measures on suspects and these are now being applied to travellers who have been in Karachi within 14 days of their arrival in this country.
They include clinical examination for signs of recent successful vaccination, the offer of vaccination where necessary, and I repeat today what has been said earlier, and this is up to date, that no traveller has refused vaccination, and subsequent isolation for 14 days until the vaccination has taken. The names and addresses of all travellers from an infected area are also sent to medical officers of health at places of destination.
My hon. Friend ssked how soon the Ministry was advised by the World Health Organisation that the Karachi epidemic had begun in mid-November. 1663 There is no authoritative definition of an epidemic. Karachi was not free from smallpox during any quarter in 1961, but it was not until the week ending 16th December that a really significant increase in cases notified was registered. The World Health Organisation, in its regular weekly epidemiological bulletins informs the Ministry of Health and the port health authorities of the number of cases notified and of deaths.
The crux of the problem for our port health control is to decide when stringent measures should be applied to travellers from an area where there is a large-scale outbreak. In the present case they were generally applied, on the Ministry's advice, after confirmation of the third imported case of smallpox made it apparent that revaccination in Karachi was not taking effect in an appreciable number of cases. These measures, as my right hon. Friend told the House, are, we believe, more stringent than any applied anywhere else in the world.
My hon. Friend also asks if the High Commissioner in Karachi did not advise the Government direct of the epidemic there, but there is no cause for the High Commissioner to supply us direct with information as to the number of smallpox cases notified. He could obtain this information only from the local health authorities who in any case notify the World Health Organisation directly, and the Organisation passes on the information to all health administrations and port health authorities. Our High Commissioner in Karachi has, however, kept us informed of steps being taken by the Pakistan Government, and both he and the Government have been most cooperative in trying to deal with a situation which has been tragic both for Pakistan and for us.
My hon. Friend puts three more questions to me. Is the Pakistan vaccine reliable? We have no evidence on this matter, which is of course the concern of the Pakistani Government. There are always difficulties in ensuring the reliability of vaccine in tropical climates. My hon. Friend asks whether international certificates are any good, since they do not show that the vaccination has been successful. The certificates do give evidence of effective primary vaccination, but do not give this in respect 1664 of re-vaccination, and most travellers are cases of re-vaccination. In the case of re-vaccination, it is not by any means easy, and it may be impossible to get indisputable evidence of success, particularly from people who are regularly re-vaccinated.
The certificate devised by the W.H.O. reflects this fact and the belief that, even if there is not clinical evidence of success, re-vaccination is likely in any case to increase immunity. The fact that the international certificate does not and cannot give 100 per cent. guarantee of successful re-vaccination is one of the reasons why the United Kingdom has never formally required it from all passengers from so-called infected areas, although port medical officers do take it into account in the case of travellers from infected areas.
My hon. Friend also questioned the validity of the certificate produced by Pakistanis who came into the country. The inspection of international certificates of vaccination produced at the ports by Pakistani immigrants has revealed that some of these certificates, although on the correct form, have not been properly completed. The Pakistani authorties have shown great concern to ensure that all persons leaving their country should be in the possession of a valid, completed certificate, and have taken strict measures to enforce this. I must add, although my hon. Friend also said it, that all of the five cases had valid certificates.
However, since the emergency measures which I have described were introduced, all travellers arriving from Karachi about whose vaccinations there is doubt, either because of their international certificates or as a result of their medical examination, have been offered vaccination and have been subsequently isolated in hospital. Now I come to Bradford itself. After the death of this child and what followed, immediately the possibility was recognised that smallpox cases were in their midst, steps were taken by the public health authorities in Bradford, in consultation with medical officers of my Ministry, to contain the outbreak. The method followed was to block off all possible lines of infection by identifying, vaccinating and keeping under medical supervision 1665 anyone who could possibly have been in contact with an infected person or his contact.
We used the same method in other towns where there were contacts. In Bradford, this was a very big undertaking, particularly in view of the time which had elapsed since the first exposure to infection occurred. It could have been successfully accomplished, as it has been, only by the determined and unflagging efforts on the part of the medical officer of health and his staff, and I am glad to join with my hon. Friend in the tribute he has paid to them. I would also like to extend it to the public health services generally for all that has been done in the areas with smallpox cases.
A quarter of a million people were vaccinated in about five days in Bradford, with the willing aid of the medical and nursing staffs of other authorities in the area at the clinics established and with the aid of the general practitioners in their surgeries. Inevitably, during the crucial days after the first cases were confirmed, some disturbance of daily life occurred.
I appreciate the natural anxieties aroused and would like to express sympathy wish those who have lost a relative, with the suffering and distress of those now happily recovered, and with the others who for a time were believed to be infected. There is no question of the city being in quarantine, and once all contacts had been identified, vaccin- 1666 ated and placed under medical supervision, there was good ground for hoping that the outbreak could be kept under control. We know now that this was done, and I was glad to note the medical officer of health's statement on 12th February that the outbreak could be considered at an end.
My hon. Friend also asked me about the pathologist who died. He was not vaccinated. But the Medical Officer of Health at Tipton was vaccinated—the last time in 1951—and he is recovering. It is the duty of hospital and local authorities to make available, and to remind their staffs of the importance of, vaccination, for all who, because of the nature of their work, may be at risk.
Perhaps that is the right note on which to end the debate: I cannot over-emphasise the importance of taking advantage of the protection of vaccination in infancy. I hope that all parents will give the most careful thought to the question whether they have done all they can to secure protection for their children against this and other killer diseases, such as diphtheria and poliomyelitis.
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty minutes to Eleven o'clock.