New Variant CJD

HC Deb 12 November 1998 vol 319 cc493-501 4.16 pm

Mr. Alan Duncan (Rutland and Melton)

(by private notice): To ask the Secretary of State for Health to make a statement on the Government's reaction to new findings about the risks associated with new variant CJD.

The Secretary of State for Health (Mr. Frank Dobson)

First, I apologise to the House for the delay in responding to this private notice question, which was caused by the fact that the computers in the Department went down when the young woman concerned was trying to type from my manuscript so that I could provide a decent copy for everyone.

Since I became Secretary of State, I have ensured that any recommendations from the experts who advise me on ways to reduce any risk of transmission of new variant CJD are implemented promptly and made public.

As far as I am aware, there are no new findings to report to the House about new variant CJD, but I can bring the House up to date on developments this year and the action that I have taken.

Following the development of BSE in the national herd and the identification of new variant CJD, the previous Government were advised that the human disease was probably linked to exposure to BSE. Since new variant CJD was identified, 31 cases have been notified to the Department of Health—three in 1995, 10 in 1996, 10 in 1997 and eight cases so far this year. Whenever there have been any new developments, I have sought expert advice on what I should do. I have taken that advice, instigated prompt action, found the necessary funds and made public what I have done.

In November 1997 I was advised that there was a possibility, however small, that new variant CJD could be transmitted through blood. I sought the expert advice of the Spongiform Encephalopathy Advisory Committee, and warned the National Blood Authority that it should be prepared to take all necessary steps to introduce the removal of white blood cells from the blood supply—a process called leucodepletion—should that be necessary. I made that information public and said at the time that it was better to be safe than sorry.

In February, I was advised by the Committee on Safety of Medicines that, as a precautionary measure, the use of United Kingdom-sourced plasma in the manufacture of blood products should be phased out. The committee went on to review each individual blood product licence, and on 13 May confirmed that all those products should be manufactured from plasma sourced from abroad. I have already authorised that action, at an estimated cost of about £30 million. At the same time, the committee emphasised that until safe new supplies made from non-UK sources were available, it was essential to maintain sufficient supplies of UK products for the national health service.

Anti-D immunoglobulin is used on mothers who are rhesus negative to prevent the serious condition of haemolytic disease in newborn babies, which can lead to fatalities or the babies being seriously handicapped by cerebral palsy or deafness.

There has always been a worldwide shortage of anti-D immunoglobulin. It has therefore taken longer to obtain sources of plasma to use for anti-D from non-UK sources than in the case of other blood products. That was known to the Committee on Safety of Medicines when it gave its advice. The scarcity arises because the donors are rare and must be specially immunised before they can produce anti-D blood. That obviously takes time. Sources have now been identified and those products should be available in a few months.

In July, SEAC advised me that Leucodepletion for blood transfusions might reduce the theoretical possibility of the transmission of nvCJD through blood, and the blood service has been instructed to introduce leucodepletion as soon as possible. I made that public; the estimated cost is £70 million.

One of the difficulties in handling this issue is that there is no known test for nvCJD and no certainty about the size of the epidemic. No one yet knows whether we face a small number of cases or a large number. Experts have been looking into that since cases were first identified.

Following the recent identification of prions in the appendix that had been removed from a patient who later died of nvCJD, I have asked scientists to draw up arrangements for a survey of human tissue held by hospitals throughout the country, in an effort to help to determine the extent of nvCJD in the general population. In line with our usual policies, that was announced on 27 August.

That discovery also raised the possibility of the transmission of nvCJD by surgical instruments during commonplace operations. SEAC advised that the risk was minimal, and to date I have not been advised to take any action on that aspect. The expert committees are reviewing the issue, and I will take any further action should they so advise. In the meantime, I have authorised work to identify measures that could be taken to reduce the risk of infection being transmitted by surgical instruments, should that be deemed necessary.

New variant CJD is a new disease which poses new problems. As I said, we have no idea of the extent of the disease or how it is transmitted. The advice that I receive tries to balance the risks of CJD, which are at present unquantifiable, with the certainty of death or injury if blood products and transfusions were not available or if surgery were restricted.

At all times, I have sought expert advice, acted promptly on that advice, made the advice public and found the necessary extra funds. Today, the Medicines Control Agency, following consultation with the chairman of the Committee on Safety of Medicines, stated: This is not a new story. The issues have been considered in depth by the Committee on the Safety of Medicines which has given its advice to the Government which has been fully followed. The Committee on the Safety of Medicines has kept the matter under continuous review and is satisfied with all the actions that have been taken.

Mr. Duncan

I accept the Secretary of State's apology for the delay, and I am grateful for his statement, but on this issue the devil is in the detail and there is still much more to learn.

Will the right hon. Gentleman now widen the scope of the national BSE-CJD inquiry to cover the handling of events since 1997? In particular, why did the Government choose to consider beef on the bone a much greater risk than that posed by surgical instruments, bearing in mind the fact that SEAC and the Advisory Committee on Dangerous Pathogens assessed the risks respectively as "minimal" and "very small"? Is it not the case that, in April, the right hon. Gentleman promised the House, as he sacked the head of the national blood service, that all British-derived blood products would be banned by September this year? Can he confirm that the Department of Health now privately concedes, as he appears now to have confirmed, that many of the potential sources of nvCJD transmission will continue to be used on NHS patients until next summer?

The right hon. Gentleman, in his response to my written question on autoclave sterilisation, recognised the expert guidance that routine sterilisation procedures are insufficient to destroy the infective agent of nvCJD. What action is his Department taking to modify autoclave practices to ensure the proper destruction of the prion protein in the light of this finding? His earlier written answer was brilliantly obtuse.

If the Department is aware that four of those who have so far died from nvCJD were also blood donors, what efforts has it made to trace and destroy this potentially infectious blood and all the associated products? Such action has already been taken in the United States; why not here as well?

We now also have two clusters of nvCJD infection, one near Ashford and one near Leicester. What assessment has the Department made of those clusters; and what efforts has it made to identify whether there is a common source for the infection?

Will the right hon. Gentleman today issue a list of all products that are at risk of contamination with nvCJD, and will he immediately ensure that alternatives to British-derived anti-D and gamma globulin are made available as soon as possible? Patients need to know the risks and they need to exercise an informed choice. We are dealing here with people, not cattle.

What happens if the risk is not theoretical and is proven? That is the very risk which has now been identified. In the meantime, thousands of women and others are being put at risk.

The right hon. Gentleman must not tell the House that, for a price, he can acquire anti-D. He must acquire it—will he now do so? And if there is no shortage of gamma globulin, why has he not already acquired it?

My recent written questions to the Department and work done by the Daily Express have, I detect, flushed out some reluctance to make a clear statement to the House, and has shown a Department that is near paralysed in deciding what to do.

Will the right hon. Gentleman confirm that funds will be specially available and that no NHS trust will be financially burdened as a result of tackling the problem?

There are clearly problems of which the general public has, until now, been unaware, and which have caused profound consternation within the Department. As the right hon. Gentleman knows, I have been asking parliamentary questions now for more than a fortnight, and it is only the Opposition's questions which have induced him to make this long overdue statement.

I have already written to the right hon. Gentleman and today the issue has been raised in the House. We will co-operate with him fully, but today we want answers to these questions. Will he give a personal undertaking to keep Britain fully informed at all stages?

Mr. Dobson

The hon. Gentleman started off on the right lines when he said that we have much more to learn. I made that clear in my statement. We do not know how many people are suffering from nvCJD and it is unlikely that we will know for several years, despite the efforts of scientists who were put on to the job by my predecessors. That is no criticism of either the scientists or my predecessors. It is a difficult task. Furthermore, we do not know how new variant CJD arises or is transmitted, so it is extremely difficult to deal with.

However, it is simply not true that any truthful information that has appeared recently in the newspapers is new. All the information that I have given today, and all the information that has appeared in the newspapers, has come from information that I have deliberately placed on the public record since November last year when this issue first arose, because I am determined to ensure that everyone knows as much as the Department of Health about new variant CJD and how we may or may not be able to deal with it.

Thus, no new information is available. Information has been made available by me or my Department at every stage in the proceedings. On receiving advice, we have acted on it and, with the help of my right hon. Friend the Chancellor of the Exchequer, have found the money to do everything that we have been advised to do. There is no question of not finding the money or of anything being held back because of lack of funds; but there are practical problems in getting from abroad plasma that can be used in blood products. I freely admit that that has proved to be more difficult than I was advised it would be when I told the House that I hoped that everything would be done by September this year. I regret that everything was not done by September, but I accept the practical problems and delays that have arisen.

On the sterilisation of equipment, as I said in my statement, which the hon. Member for Rutland and Melton (Mr. Duncan) appeared to ignore, I have already asked my officials to get on as best they can with looking at ways of preventing or reducing the likely spread of new variant CJD through medical instruments, in case the experts advise me to do that. That includes looking not just at autoclaves but at other methods of sterilisation and, in some cases, possibly changing the design and structure of instruments used during operations. Some of them, however, are immensely complex and would be difficult to make any safer or less liable to carry infections.

As for the 31 people who have died from new variant CJD, the latest figure that I have is that four of them had donated blood. That blood has been tracked down and, where it was not used, it has been destroyed. We are therefore not remiss compared with other countries: we got on with that.

SEAC is looking into the Ashford and Leicestershire clusters to see whether there appears to be a pattern or an explanation for them. To date, it has been unable to come up with an explanation. One of the problems with new variant CJD is that explanations are thin on the ground because no one has yet formulated them. In trying to ensure that the public know the risks, I have made every bit of information that has been available to me available to them. The problem is that I cannot assess the risks, and nor can the public, because we do not know the incidence of new variant CJD. We do not know whether the risk is high or low. No one can make any sort of formulation. When I arrived in the Department I asked whether there were any estimates and was told that computer modelling had been done by scientists. The figures ranged from 30 to several hundred thousand cases. My view was that those were not computer models but guesses. They may have been sophisticated guesses, but that is what we are reduced to.

We have no way of identifying the risks. I emphasise again that people who have suffered serious injury and need major surgery, or are in a condition that requires the replacement of their blood or the use of a blood product, face immediate death or injury if they do not get treatment using blood products or a blood transfusion.

We are doing our best to make sure that blood products and blood used in transfusions are as safe as possible. The experts who advise me are trying to balance out the unquantifiable risk of transmitting new variant CJD against the certainty that people who need a massive blood transfusion will die if they do not get it. We are cleaning up blood products and the blood supply as quickly as possible, and the only restraint is the practicalities—it is nothing to do with finance, and it has been nothing to do with Government delays.

Jacqui Smith (Redditch)

I declare both a personal and a constituency interest: first, a family in my constituency tragically lost one of its members to new variant CJD; secondly, like many women in my constituency, I have recently had an anti-D injection.

Although I recognise the hard work that has undoubtedly been carried out in the Department of Health by my right hon. and hon. Friends, does my right hon. Friend accept that uncertainty surrounding the safety of anti-D injections will result in some women refusing them, thereby putting future pregnancies at risk? Can he assure me that swift action will be taken to ensure the safety of the anti-D injection, to protect women and babies?

Mr. Dobson

I can give my hon. Friend that assurance—the swiftest possible action is being taken. Women who are faced with the choice should seek the advice of the clinicians who are dealing with them and, if they feel so inclined, take that advice. I cannot give general advice from the Dispatch Box, because it will be dependent in part on the needs and circumstances of each woman, and it is up to her and her clinician to decide what is best. I wish that they did not face that dilemma, but they do, and we are trying to deal with it as fast as humanly possible.

Dr. Peter Brand (Isle of Wight)

Creutzfeldt-Jakob disease, or the new variant, is a ghastly disease, and I welcome the Government's response to today's question.

It is important that people realise that science does not have the answer to every question, and that there is uncertainty, but it is also important that people be given facts. They should be given facts in a balanced way, however, and I despair at headlines such as "230,000 at risk from CJD jab". Apparently, that was published at the instigation of the hon. Member for Rutland and Melton (Mr. Duncan). It is disgraceful to use such a serious issue purely for party political purposes—especially for a party that denies that there is any risk whatever.

There is just as much uncertainty over eating beef on the bone. Conservative Members were right when they said that the Government were overreacting on beef on the bone, but they cannot have it both ways. They cannot, on the one hand, say, "We've got to do everything to be as sure as possible"—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. I must remind the hon. Gentleman that he should be putting a question to the Secretary of State.

Dr. Brand

Thank you, Mr. Deputy Speaker.

Does the Secretary of State agree that the way this issue has been presented is not in the interest of the public health of this nation? There may be uncertainty over some blood products, but there is absolute certainty about the risk of hepatitis acquired abroad and about the handicapping and death of rhesus babies. It is frightfully important that we get this absolutely right, and I welcome the way the right hon. Gentleman is treating that particular concern.

Mr. Dobson

I thank the doctor for a question based on his professional knowledge and concern. What I do not like is the challenge which some of the coverage represents to the integrity of a substantial number of hard-working people who are trying their level best to identify the level of risk and how we deal with it—not to mention a substantial number of public officials who have rightly been used to the idea that our blood supplies were generally better and safer than any supplies elsewhere in the world.

These people have been forced by circumstances for which neither they nor we are responsible to seek alternative sources for plasma from abroad, in some cases from countries that we would not normally have associated with particularly high standards of blood supplies. But they have been determined—and I have backed them up—that, when plasma is sought from, in particular, the United States, both premises and processes must be vetted in advance by experts from the Medicines Control Agency to ensure that the supplies meet our standards. All that takes time, but it is time well spent if we can ensure that alternative supplies are as safe as it is possible to make them, in the face of a problem which—as I have said—has arisen through the fault of no one in the Chamber, and which is, at the moment, literally unquantifiable.

Mr. Dennis Skinner (Bolsover)

My right hon. Friend is dealing with a subject that we all well understand will be difficult to explain fully. There will be a lot of uncertainty about putting out messages when perhaps they should be held back. Does my right hon. Friend agree, however, that one thing is certain? When the hon. Member for Rutland and Melton (Mr. Duncan) talked of putting down a few questions, it crossed my mind that it would have been very handy if a few Tory Back Benchers had put down a few questions in the past, when certain things were happening under a Tory Government who allowed this scandal to continue. Does my right hon. Friend recall that we had not just one ministerial statement on that fateful day, but two? Such was the enormity of the problem—the Tories had covered it up for so long—that the Minister of Agriculture, Fisheries and Food and the Secretary of State for Health had to answer questions on the same day. I have never seen that happen before, in all the 28 years I have been a Member of Parliament. Now the Tories are coming along and trying to give the impression that a Labour Government are at fault.

Does my right hon. Friend agree that the British people will consider the issue to be a question of trust? They did not trust the Tories in this regard; they kicked them out. They will agree with my right hon. Friend in that, as long as Ministers are straight and transparent and make statements to the House, they will believe what those Ministers say.

Mr. Dobson

I can tell my good and hon. Friend that, ever since I began my current job, I have tried to ensure that all information on matters such as this is made public as soon as reasonably possible. I have followed that to the letter. I have been so anxious to ensure that written questions receive accurate answers that I have insisted on their being vetted by the Chief Medical Officer himself, so that the answers are accurate, professionally sound and based on information that has been checked by someone whose integrity is unchallengeable.

Mr. Edward Leigh (Gainsborough)

I note that the Minister of Agriculture, Fisheries and Food is sitting on the Front Bench near the Secretary of State. Will the Secretary of State confirm that his statement has no implications for British farmers, and will he reaffirm his confidence in British beef?

Mr. Dobson

Yes, indeed. I think that my good, close and right hon. Friend the Minister of Agriculture is sitting here because he is a friend of mine—and I am glad that he is.

Mr. Alan W. Williams (East Carmarthen and Dinefwr)

What are the prospects of developing a test for CJD in blood donations? I know that a prion is different from a virus, but I understand that blood donations are screened for HIV and hepatitis. Given the history of BSE, should not the former Government, 10 years ago, have put 10 times as much effort into developing a test for BSE in live animals?

Mr. Dobson

I am here to answer questions on behalf of the present Government, and in relation to my stewardship. I can only say that substantial scientific efforts are being put into identifying a biopsy test for CJD. At present, it is only possible to be sure that someone died of new variant CJD by examining the brain after death; so any steps that can be taken to develop a test are very welcome.

As I said, all this has been going on since before we came to office. I hope that the scientists will come up with something, but it is proving very difficult, just as it has proved very difficult to come up with a live test for BSE. The sooner we can discover such a test, the better: it would transform the situation, because it would enable blood supplies and so forth to be made a good deal safer. We have provided funds. I believe, for instance, that we are providing funds for Dr. Dealler, who is occasionally quoted in the newspapers. He is looking for a test, but as yet he has not found one.

Mr. Christopher Gill (Ludlow)

The House will have noted the Secretary of State's comments about the need to advise the public about the degrees of risk associated with CJD. In answer to a question about beef on the bone, the Minister for Public Health told me that the Spongiform Encephalopathy Advisory Committee had said—in relation to the inadvisability of beef on the bone continuing to be sold— that there was a 95 per cent. chance of no cases of new variant Creutzfeldt-Jakob Disease and a 5 per cent. chance of one case arising from this exposure in 1998."—[Official Report, 13 July 1998; Vol. 316, c. 84.]

The next day, 14 July 1998, the Minister said that, reporting on peanut allergy, the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment had said that it was "potentially life-threatening", and advised that families with a history of allergic disease should avoid peanuts as a "sensible precautionary measure".

Is the Secretary of State satisfied that his Department is being entirely consistent and evenhanded in taking measures to deal with risks to human health across the board?

Mr. Dobson

Yes.

Mr. Mark Todd (South Derbyshire)

Does not this sorry episode demonstrate the frailty of human knowledge? Does it not show that scientists do not know the answers to many of the questions that trouble us, including the question of the interaction of animal and human health?

I listened carefully to my right hon. Friend's statement. I note that he has been meticulous in taking measures to deal with public health, that he has been open about the process and that he has consulted, and then followed medical advice to the letter. Does that not contrast with the behaviour of Opposition Members who were in charge at the beginning of the affair?

Mr. Dobson

I do not really want to go into that. Let me just say that I think officials in my Department are better pleased to be operating under a regime that tells the truth and tells it quickly, acts on the advice that it receives and finds the funds to make that possible. They do seem, from time to time, to contrast that regime with what they had to put up with before.

Mr. John Randall (Uxbridge)

Has the Department of Health been able to establish how many of the 31 known victims of new variant CJD had had operations or invasive surgery on the national health service? If so, has the Secretary of State taken any action to trace other people who may be at risk after such surgery?

Mr. Dobson

The hon. Gentleman asks a perfectly sensible question. The CJD surveillance unit in Edinburgh is carrying out minute examinations of the medical history of all the 31 people who have died—the 31st was announced today. One person—the one from Torbay—had an appendix removed prior to developing any symptoms of new variant CJD as it was understood at the time. Prions that could be related to new variant CJD were identified in material from that appendix, which, in line with the practice of every hospital, was preserved for precisely such survey purposes.

The unit is now examining the histories of the 30 other people, but I do not have the latest information on whether those people had had operations immediately before it was noticed that they may have been suffering from CJD or new variant CJD.