Tuberculosis: Schools Vaccination Programme (Hansard, 31 January 1990)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, the routine schools BCG vaccination programme has not been discontinued permanently. Because of supply problems and the need to conserve existing stocks of vaccine in order to protect high risk groups, a postponement of one year has been made for the group of children due to be vaccinated in the autumn of 1989. The programme is due to resume this autumn.

§ Baroness Masham of Ilton
My Lords, I thank the noble Baroness for that Answer. Is she aware that there has been an increase in tuberculosis in many countries with the emergence of the HIV infection? That includes America. Does she not agree that it is very important to protect our children against the infection of tuberculosis?

§ Baroness Hooper
My Lords, I can reassure the noble Baroness that there has been no increase in the incidence of tuberculosis in this country. Nevertheless we recognise that people with AIDS are vulnerable to tuberculosis. It can be the first manifestation of the problem. However, they themselves should not be given BCG because it may cause widespread disease in those who are immunosuppressed. A high level of protection from the BCG vaccination in young people in the community is therefore all the more important now because of the higher incidence of HIV-positive people.

§ Baroness Ewart-Biggs
My Lords, can the noble Baroness say what caused the shortage of the vaccine?

§ Baroness Hooper
Yes, my Lords. The UK suppliers, Evans Pharmaceuticals, had production problems because of a change of location.

§ Lord Ennals
My Lords, is the Minister saying that we are totally dependent upon one supplier for this vitally important programme for the health of children? Do we in Britain supply other countries from that supplier? Is it wise to be dependent upon one supplier for a programme as important as this, whether or not other countries are also dependent upon us? Our own schoolchildren depend upon this vaccine. The noble Baroness herself knows the importance of the programme. I am glad that she gave us the date for the autumn. But is it not very unwise to be dependent upon one producer?

§ Baroness Hooper
My Lords, no problems have arisen in the past over the BCG vaccine. The UK manufacturer is now resuming production. This is a good product which is exported to other parts of the world. No other UK manufacturer has sought a licence to manufacture it. If overseas suppliers sought to do so, the necessary licensing arrangements exist in order to make sure that clinical trials support the application.

§ Lord Ennals
My Lords, does that mean not only that there was a delay of a year in availability of supplies in Britain, but also, as a consequence, a similar delay in other countries where the incidence of tuberculosis is very much higher than here?

§ Baroness Hooper
My Lords, there are other world suppliers.

§ Lord Auckland
My Lords, can the Minister give figures showing the extent of tuberculosis in this country in comparison with similar countries?

§ Baroness Hooper
My Lords, I cannot supply my noble friend with the comparative figures, but I can say that notifications in England and Wales have declined from 14,600 in 1966 to 5,085 in 1987, 5,161 in 1988 and approximately 5,157 in 1989.

§ Lord Cledwyn of Penrhos
My Lords, is the noble Baroness aware that her reply will allay the concern which exists in Wales as a result of the announcement 301 that the vaccination was to be discontinued in schools? Is the noble Baroness also aware that before the war tuberculosis was the scourge of Wales as the Clement Davies report of 1937 showed very clearly? Will the noble Baroness give some indication of what the notifications are in respect of Wales alone as compared to England and Wales?

§ Baroness Hooper
My Lords, I do not have the separate figures but if they are available I shall write to the noble Lord.

Baroness Darcy (de Knayth)
My Lords, will the Minister tell us the cost of the programme? Has she any information on the best age to vaccinate a child?

§ Baroness Hooper
My Lords, the average total cost of BCG vaccine for 1986 to 1988 was £241,800. I understand that the programme that is applied to schoolchildren comes within the age range of nine to 14.

§ Baroness Robson of Kiddington
My Lords, is the Minister telling us that the stoppage of supplies from the one manufacturer in this country came out of the blue and that we were not given any warning to enable us to plan imports from alternative sources?

§ Baroness Hooper
My Lords, I believe that the department was first notified of the problems in early May 1989. The first reaction was to ensure that there were adequate supplies for high risk groups. That was done. We were confident that the high risk groups were fully catered for and that there would only be a short postponement of the schools programme.

§ Lord Ennals
My Lords, as there are other world suppliers why did we not turn to them immediately?

§ Baroness Hooper
My Lords, we did not do that because, as I mentioned, there are considerable importing and licensing procedures involved. Any non-UK supplier would have to apply for a product licence and might have to conduct the necessary clinical trials to support the application. We were confident that we were covered for the high risk groups and that only a short postponement of the schools programme was involved.

Lord Winstanley
My Lords, to try to put things in perspective does the noble Baroness accept that the really sensational reduction in the incidence of pulmonary tuberculosis during this century has not been greatly due to the BCG vaccine but to other factors altogether such as improved housing, improved nutrition and a vast improvement in therapy? Therefore, the vaccine itself is becoming gradually less important and one hopes that fairly soon it will not be needed at all.

§ Baroness Hooper
My Lords, we are always grateful to the noble Lord for giving us the benefit of his expert advice. The fact that the incidence of the disease is continuing to decrease proves his point.

§ Baroness Masham of Ilton
My Lords, is the noble Baroness not aware that nowadays travel has become very much more widespread and that people go abroad, especially to Asian countries, for holidays with their families, much more than previously was the case? Therefore they can bring the disease back to this country.

§ Baroness Hooper
My Lords, I am aware that as communications have improved the incidence of travel has increased. Recently arrived immigrants from developing countries for example are considered to come within the high risk groups I mentioned because of the high prevalence of tuberculosis in those countries.