§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]
11.41 pm§ Mr. Robert Litherland (Manchester, Central)I welcome the opportunity to raise in this Adjournment debate an extremely serious subject relating to the hepatitis virus. My purpose is to attempt to exercise the minds of Ministers and, hopefully, to draw public attention to the need for vaccination for high-risk groups who come into contact with hepatitis carriers in their normal work.
The word "hepatitis" is well known, but we usually relate it to yellow jaundice and assume that it is the fancy medical term for that condition. Hepatitis is often a short illness leading to jaundice, and most patients recover within a few weeks or months. That hepatitis virus comes under category A. Regrettably, there is more than one type of the virus. Hepatitis A never produces permanent disease, but hepatitis B and C do, and they do not respond to antibiotics. Like hepatitis B, the C virus is transmitted through contact with infected blood and body fluids. Little is known of the C virus, there is no vaccination to protect against it and no established cure.
However, the hepatitis B virus, with which I am concerned in this short debate, can be prevented if resources, education and intention by the Government are brought into operation. My concern about the seriousness of hepatitis B was stimulated by a pamphlet produced by the Russell Harty hepatitis and liver research fund. Normally, we pay scant attention to the volumes of circulars that come in our mail, and this pamphlet was almost doomed for the waste-paper bin burial ground, but on the front was a challenge—"Dare you read on?" I took the challenge and read on.
The pamphlet outlined how the fund began, its aims and the startling information which made me sit up and think. Two hundred and eighty-five million people are carriers of this virus. Hepatitis B can live outside the body of the carrier, which makes it easier to catch than the virus that causes AIDS. It can be caught simply by coming into close contact with a carrier and unknowingly absorbing the virus from contaminated blood, from saliva, from tears, from semen, from vaginal secretions and even from perspiration through small cracks in the skin. It can be caught by kissing an infected person or by sharing a toothbrush, a razor blade or needles. The most chilling fact was that hepatitis B kills more people worldwide in one day than AIDS does in a whole year. Who can catch the virus? The answer is, every one of us.
Hepatitis B can be prevented by vaccination, and that is why I want to raise the problem of the low take-up of the hepatitis B vaccine among high-risk groups, which demonstrates a miserable lack of action by the Government. Despite Government advice that members of high-risk groups should be vaccinated, we have no Department of Health figures or studies on the current level of vaccine take-up. I call on the Government radically to increase their responsibilities in this area.
Hepatitis B is a potentially fatal viral condition which affects the liver. The virus is more than 100 times more infectious than HIV. About 2 million people worldwide die each year of hepatitis B infection. In the United Kingdom, the annual reported incidence of acute hepatitis B has been about 1,000. The exact number of carriers is not known, 286 but it is estimated to be more than 50,000. There is no effective treatment for hepatitis B, and the best prevention of infection is vaccination.
The hepatitis B vaccine is available on national health service prescription to all high-risk groups, although many general practitioners appear still to be confused about who is entitled to receive it. In line with the World Health Organisation, the British Medical Association recommends that active immunisation is provided for health care staff in frequent contact with blood, needles or other sharp instruments in the community, in hospital or in dental departments. The Royal College of Nursing also supports the recommendations of the World Health Organisation and stresses that all nurses, including junior nurses, should be vaccinated. The RCN also recognises that there is a special risk to student nurses who regularly change their area of specialty and whose lack of experience makes them especially vulnerable to needlestick injuries.
The British Dental Association also supports the WHO guidelines and has issued a set of guidelines of its own on the prevention of infection and cross-infection for all dental health workers. The guidelines call for all clinical dental professionals to be immunised against the virus as soon as possible. Many other organisations and trade unions follow and recommend the WHO guidelines.
The incidence of hepatitis B in institutions, especially those for the mentally ill, has been significantly higher than in the general population. One recent survey found evidence of past infection in almost half the patients in a large mental hospital. Nursing and administrative staff who come into contact with highly unpredictable patients are inevitably at risk of infection. One tragic example is that of a psychiatric nurse, Thomas Rowe, who died from hepatitis B after being bitten by a patient at the Turner Village hospital in Colchester.
Accidental needlestick injuries from syringes infected with hepatitis B or HIV have become increasingly common. A number of cases have occurred among staff working in needle and syringe exchange schemes. The growing number of arbitrary cases is especially worrying, ranging from the reported cases of refuse collectors and road sweepers receiving pricks from discarded needles, to a young girl in Rhos-on-Sea receiving a needlestick injury after pricking her finger on a discarded syringe in a pub beer garden. I have also received many complaints from parents and grandparents about syringes and needles being found in school playgrounds. Vaccination to cover all such eventualities would be a massive operation, but high-risk groups at least should have the opportunity of vaccination.
Vaccination is usually given in three separate doses—an initial vaccination, followed by further doses one and six months later. A booster vaccination is recommended every three years. A course of treatment costs £30—not a great deal of money when compared with the cost of treatment once the virus is contracted and with the pain and misery suffered by the patient.
Sadly, because the hepatitis B virus is not new and has not captured public concern in the way that the AIDS virus has, it lacks a comparably high profile, and its virulence and potential danger are generally unknown among the public at large. Although incidence of acute hepatitis B is falling, due to more effective measures of protection, the absence of any official statistics and a 287 general apathy towards monitoring vaccination of staff and reporting incidents within health authorities have resulted in a confused and ill-informed picture.
To illustrate this point, I would point out that a young nurse recently contracted hepatitis B at Stoke Mandeville hospital after she was exposed to a contagious patient. During prosecution of Aylesbury Vale health authority, it transpired that a policy change in vaccinating staff had resulted in nurses having to wait six months before receiving vaccination. There are all too many cases of nurses and other health care workers contracting the virus through inefficient hospital management.
Particularly worrying in the United Kingdom is the significant number of people who get hepatitis B because of the kind of work they do. Hepatitis B has long been identified as an occupational risk to those whose work brings them into contact with blood and body fluids—such as doctors, nurses, dentists, laboratory workers, the emergency services, prison staff, and those who work with the mentally handicapped. Intravenous drug abusers and practising homosexuals are also vulnerable. There is therefore a real risk of infection for those whose work or life style brings them into contact with blood and other body fluids and who have not yet received vaccination.
Last year, the Russell Harty hepatitis and liver research fund was set up to promote awareness of the risks of hepatitis B, following the death of Russell Harty from the virus. The chairman of the fund, Alan Tomlinson, lost his nine-year-old son in 1982 as a result of his contracting hepatitis B. Both were treated at the liver disease unit of the St. James's hospital, Leeds, which is providing a focal point for the fund's activities.
In 1988, the Joint Committee on Vaccination and Immunisation recommended that named high-risk groups and their families should be vaccinated against hepatitis B. However, no new money was provided, no programme of vaccinations was set up and no follow-up monitoring was established.
From independent research undertaken in the last year, the fund believes that there is widespread ignorance among at-risk groups about the dangers of contracting the virus. It also believes that many GPs lack adequate information about the at-risk groups and that health authorities are treating the management and monitoring of vaccination programmes for own staff as a low priority. As a result of that inefficient state of affairs, people are dying needlessly.
The critical need for better management and application of the JCVI recommendations is clear and has been ignored by the Government. The inadequate provision of educational information about the dangers of hepatitis B to high-risk groups is a scandal.
Because of the lack of awareness and widespread ignorance of the dangers of hepatitis B, plus the inadequate funding of the health service, the regional health authority gives no lead and has a blinkered approach to this serious subject. The cost of immunising health service personnel and other high risk groups must be weighed against the financial demands for routine health care; so I urge the Minister to commit himself to a number of actions to redress the appalling threat to human suffering.
The Government should give an assurance that no member of a high-risk group will be denied vaccination against hepatitis B. The Government should institute their own monitoring programme to ensure comprehensive vaccination uptake according to JCVI guidelines. They 288 should add hepatitis B to the screen study that is currently in progress on the incidence of AIDS and HIV. The Health Education Authority should conduct an education campaign targeted at identified high-risk groups, their families and prescribing physicians. Hepatitis B is no respecter of persons. That is why I ask the Government to act now and save lives.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)I hope that the hon. Member for Manchester, Central (Mr. Litherland) will not take it amiss if I express regret at the outset that he alleged that there was a division between the action that he wants taken and the stance that the Government have adopted. There is no substantial difference, and any attempt to establish a difference between his position and ours is, as I shall argue, not soundly based.
The hon. Gentleman began by emphasising the terrible nature of hepatitis B as a disease, and there is no dispute about that. It can often be fatal. Whenever the opportunity exists to prevent or impede the spread of a potentially fatal disease, we shall take what action we can to achieve that result.
The hon. Gentleman stressed that the disease was widespread elsewhere in the world. That threat we must recognise and take seriously, although we are entitled to look at the scale of the threat that the disease represents in this country, because it is to this country's resident population that our principal effort in terms of prevention must be directed.
The welcome news in the context of hepatitis B is the fact, as the hon. Gentleman emphasised, that a vaccination has been available for some years which immunises the vaccinated individual against contracting the disease. The cornerstone of his case, and the cornerstone of the Government's position, is that that vaccination should be available to anyone who is at any serious, identifiable risk of contracting hepatitis B.
That is why, to take up the first of the three objectives that the hon. Gentleman set in his concluding remarks, the Government have no difficulty in giving the assurance that no member of a high-risk group should be denied vaccination against hepatitis B. Indeed, that is our policy. We are entitled to say that that policy has been carried through in the past few years with a degree of success.
The figures on the development of the disease in Britain in the past five years are startling. The number of individuals who have been vaccinated—both the hon. Gentleman and the Government want the vaccine to be made available to high-risk people—has increased from under 19,000 in 1985 to an average of more than 300,000 in 1988 and 1989. The figure for 1988 was 325,000 and the figure for 1989 was 294,000. The vaccination programme has run at a rate of 300,000 individuals per year. We do not yet know the full life of the protection provided by the vaccine, but we are advised that we can expect that vaccination will be effective for a minimum of five years. If one adds up the figures in the past five years, roughly 850,000 individuals have received protection as a result of the vaccination programme that the Government set in place.
The effect of the vaccination programme on the development of the disease is remarkable. In 1985, a total of 1,785 cases of hepatitis B were reported. By last year, on 289 the provisional figures available to us, the incidence had fallen to 560 cases. We have cut the incidence of the disease by more than two thirds in five years by adopting precisely the commitment to vaccination that the hon. Gentleman espoused. That is not a sound foundation for the party political attack that the hon. Gentleman directed at the Government.
Other figures on the development of the disease show that in 1985 545 cases of hepatitis B were directly attributable to drug abuse. By 1988, that figure had dropped to 108 cases—a fall of almost 80 per cent. The incidence of hepatitis B among homosexual men had fallen from 128 reported cases in 1985 to 52 in 1988. The incidence among health service staff fell from 47 cases in 1985 to 24 in 1988.
The end result of the vaccination programme is to reduce the number of deaths caused by hepatitis B. I can report to the House that the number of deaths attributable to hepatitis B has been effectively stable throughout the whole period from 1985 to 1989. The highest number of deaths was in 1987, when the total was 69. The total reported in 1989 was 58.
I simply do not accept that it is a fair representation of the record of the past few years to say that vaccination has not been available to those who need it. On the contrary, the evidence is that the vaccination programme has grown considerably. The effect of the programme is there for all to see in the number of reported cases of development of the disease.
We have stressed, as the hon. Gentleman stressed, that vaccination must be available to high-risk groups. There is no constituency for the argument that immunisation should be available to all adults. The vast majority of adults are not at any appreciable risk of contracting the disease. The Government therefore accept the proposition that the vaccination should be available to high-risk groups. The broad categories that the hon. Gentleman described are not a cause for contention between us.
We do not accept, however, that every policeman should be vaccinated against hepatitis B. There are some individuals within the police force who should be vaccinated because they are at risk, but a policeman on duty in the House does not face an appreciable risk of contracting hepatitis B. Resources will always be scarce and I do not think that it would be sensible to spend more than £30 vaccinating a policeman in the House against hepatitis B when he cannot by any stretch of imagination be judged to be in a high-risk group.
The hon. Gentleman repeated several times that high-risk groups should have access to the vaccination. That is not disputed by the Government. The hon. Gentleman also argued that the Government should provide better information on the rate of take-up of the vaccine. I have given the figures relating to the number of vaccinations against the disease and the number of reported cases. Information is not in short supply, as hepatitis B is a notifiable disease and proper laboratory tests are carried out, when appropriate, as a result of that notification process. In that respect, the disease is unlike AIDS, where the same disciplines do not apply, for reasons familar to the House.
290 The Government have access to information as to the spread of the disease and the rate of vaccination against that spread. If the hon. Gentleman wishes us to publish the take-up as a percentage of the target group, there is a difficulty. As the policy is to ensure that vaccination is available to high-risk groups, it is difficult to produce an accepted denominator to work out the percentage represented by the number of vaccinations given, because we cannot accurately identify every person in the community who is a member of a high-risk group. We have sought to ensure that every individual who is in such a group is made aware of that risk and of the fact that vaccination is available to prevent the spread of the disease. I do not accept the argument that there is a shortage of information about the spread of the disease. I accept that we have been unable to produce a percentage breakdown of target group, but I do not believe that that is achievable in practice.
Bearing in mind the fact that the disease is a notifiable one and that a reporting regime is available through the public health laboratory service and that information is available to general practitioners through any number of channels, I do not accept that there is a paucity of information about the dangers of the spread of the disease among the high-risk groups or about the availability of vaccination to prevent that spread.
The hon. Gentleman also alleged that no funding was available for vaccination, but I suppose that that is ritual comment on any subject to do with the national health service. It is true that there is not special central funding, and nor should there be. We are talking about relatively small sums of money in the £29 billion budget of the Department of Health. It is an entirely proper obligation for health authorities, on behalf of their populations, to make such protection available to high-risk groups, and there is no serious evidence to support the view that vaccination has not been available to any high-risk individual on the grounds of a local lack of funding.
In conclusion, I return to the factual background to the successful control of this terrible disease in Britain. I do not dispute for one moment that it is a substantial killer elsewhere in the world and that it is far from being under control on the earth's surface, but we in Britain can claim that we have successfully made information available so that those who are at risk of contracting it have that fact drawn to their attention, and that effective arrangements have been made to ensure that those who are at risk, and to whom the education programme that the hon. Gentleman espoused and which we have sought to put in place is directed, understand that vaccination is available. The effectiveness of that policy is shown by the fact that, in five years, we have reduced the number of reported cases of the disease by two thirds.
The hon. Gentleman has raised the serious problem of the control of the spread of a terrible disease. We want to continue to do better, so that its further spread is inhibited altogether, but cutting the incidence of the diseases by two thirds in the past five years cannot be said to be anything other than one of the successes of the NHS.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes past Twelve o'clock.