§ 4 pm
§ Mr. David Heath (Somerton and Frome)
I am grateful for the opportunity to raise this issue in this Chamber. The debate has a somewhat off-putting title, but I hope that its content is a little more accessible. The concept of viral pandemic is well known among scientific and medical communities but less well known among the general public, although they should, perhaps, be more aware of it. One of the problems is trivialisation, because some of the prime suspects for a viral pandemic are bugs with which we think that we are familiar and which we think we understand.
The classic example is influenza. The danger is that everyone who ever has a sniffle nowadays and who does not want to go to work claims to have flu, whereas in fact, as we know, influenza is potentially a killer, especially those strains of it against which we have no protection. Indeed, three times in the past century there has been a genuine pandemic based on influenza: in 1918, 1957 and 1968–69.
It is worth noting just how serious was the disease condition associated with the biggest pandemic yet recorded, which occurred in 1918. That was the so-called Spanish influenza, although it had little to do with Spain and there was at least a suspicion that it was introduced by American servicemen from Kansas during the first world war. It caused acute illness in 25 to 30 per cent. of the world's population. The number of people who died from it is a matter of dispute. I have seen figures ranging from 20 million to 70 million, and I think that a figure of 40 million is probably about right. That is greatly in excess of the number of people who died as a consequence of the conflict in the first world war. Sadly, virologists have been predicting that we are due another pandemic, and they have been saying as much with increasing clamour since 1998.
Some of the issues associated with our defences against pandemic are the same as those that apply to our defences against bioterrorism, so the matter is currently even more salient. One of the problems with the deliberate introduction of infectious diseases, such as smallpox or anthrax, is that our population no longer has natural immunity or defences to them. Therefore, the capacity for contagion is much greater.
The world's attention at the moment is on severe acute respiratory syndrome. Whether it will turn out to be the risk that some people fear is still a contentious matter. The Minister might be able to help by giving us his Department's assessment of the situation. My figures, as of yesterday, from the World Health Organisation show that there are 487 recorded cases in 12 countries. Perhaps the Minister will update us on the precautions that he believes are appropriate. Perhaps he will also inform us of the incidence, or potential incidence, of the illness in this country and say what the implications are for air travel, which it has been suggested might be part of the background to the spread of infection.
That observation highlights one of the problems that we face as a world community. We live in a different world—one with many methods of communication. We live in a world of high mobility in which people use both air and land travel to a much greater extent than in the 133WH past. That is coupled with food chains that condense supply routes and encourage the maximum infection, if food is the medium for infection, and we can also add bugs' increased resistance to the normal antiviral and antimicrobial agents because of overuse of those agents in health or agriculture. We live in a world in which more members of the population have impaired immune systems, either because they are living longer due to surgical or medical interventions or for other reasons. From recent experience in this country of epizootics such as foot and mouth, we also know how limited our defences can be to the rapid spread of disease.
I do not want to talk about what are rightly described as pandemics. For example, I do not want to talk about AIDS, although it is undoubtedly a huge problem across the world and would repay a great deal more attention. I do not want to talk about iatrogenic or hospital-acquired infections. The Minister knows that they are a serious problem, but that is not my main point. I do not want to talk about the several tropical diseases that have surpassed epidemic and approached pandemic proportions but are not a direct threat in this country. That is not to underestimate their importance; we are talking simply about our domestic situation. I do not want to talk about the diseases that seem to be appearing with renewed vigour, but for which treatments exist, that are a matter of containment and early diagnosis rather than an overwhelming problem, such as tuberculosis.
Science has undoubtedly changed massively since 1918, as have the precautions that we can take and the advice that we are given. The prescribed advice of the News of the World from 3 November 1918 was:Wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply; do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge.Those may all be sound items of advice, but I suspect that we would not recommend them as an answer today to a new strain of influenza.
The problem is that we are dealing with a mutated form of the virus, and as we know, such mutations happen regularly. They usually represent a limited quantum leap from the previous infection, which means that there is scope for developing new vaccines to deal with them. Occasionally, there is a substantial leap in the antigenic qualities of the virus, which gives us a real problem. One problem is that the vaccines that we use to fight infection are normally produced using fertilised eggs. We do not yet have an adequate tissue culture method of production, so there is a serious time lag between identification and production of appropriate remedies.
We have some remedies, such as amantadine and rimantadine, but they are limited in their effectiveness against influenza. They are effective, but resistance is quickly developed. There is a new breed of drugs—neuraminidase inhibitors, including relenza and that family of drugs—which seem to be effective in their selective inhibition of the viral enzyme nuraminidase. They are not diminished by an antigenic shift, but they are sparingly available and still in their infancy.
How do we address effectively a major new epidemic or pandemic? If influenza is the enemy, we need research into new neuraminidase inhibitors that will be effective 134WH across a wide spectrum of mutation. We need enhanced diagnostic techniques so that we can not only identify a new infection at an early stage, identify the infectivity displayed and track the progress of the disease, but ensure that treatment begins at the earliest opportunity. We should also begin to develop appropriate preventive remedies and remedies for individual patients.
One remedy on which there has been work is intranasal live attenuated vaccine. Can the Minister tell me what progress has been made on that? I have mentioned the antivirals amantadine and rimantadine. I understand why those are not broadly available. It would be absurd to introduce resistance by selling them over the counter, and that is not what I am suggesting. However, given that they have a clear effect in retarding the spread of infection, I wonder whether there is sufficient availability in reserve, as a contingency across the country, to deal with a serious outbreak. We need a step change in what is available for strain identification and in the time that it takes to move from strain identification to vaccine availability.
Therefore we need to take the threat much more seriously than it has, perhaps, been taken historically. I give credit to the Government because I know that they have been examining it seriously. I looked with care at the publication by the chief medical officer last January, "Getting Ahead of the Curve". That sets out for the first time a strategy for dealing with infectious diseases in this country, which is a very important step.
I want to put some questions to the Minister on that document's recommendations. My main query is over the proposal to establish the Health Protection Agency and the absorption of the Public Health Laboratory Service, the Centre for Applied Microbiology and Research, the National Radiological Protection Board and the national focus for chemical incidents. I do not argue that there is no need for a co-ordinated and seamless approach to such issues, but I question whether a time of enhanced risk—I think that we all accept that we are in such a period—is the right time to make massive structural changes to the organisations on which we rely to provide us with protection against such threats. I will produce evidence to support my contention.
§ Mr. Paul Burstow (Sutton and Cheam)
My hon. Friend is making some very important points. Does he share my concern that in the consultation that the Department of Health undertook on establishing the Health Protection Agency, a theme that ran through the responses was concern over possible fragmentation, particularly with the transfer of the microbiological laboratories from the Public Health Laboratory Service to individual NHS trusts? There might be some loss of ability to put the pieces together and understand when a problem is arising that has more than merely local significance.
§ Mr. Heath
My hon. Friend is absolutely right. We need only look at some of the responses to the consultation exercise to see that. I quote the response from the Carmarthenshire Public Health Laboratory Service:Outbreaks of infection are no respecters of political niceties, and can progress with truly terrifying speed, unless vigorous, co-ordinated, and timely action is taken to stop them in their tracks. If I were the bearer of malevolent intent to the UK, I would seek to do harm from April 2003.135WH April 2003 is the date for implementation of the changes that the Minister has in mind.
Cornwall health community says:We are increasingly concerned that this has not been thought through at all well, and there is a considerable danger of local health protection arrangements deteriorating rather than improving.Serious doubts have been expressed that whatever the merits of having a comprehensive service, the process of getting from here to there is difficult. There will be uncertainty, threats of redundancy and, I suspect, resignations from the service of people whom we desperately need to do the work. A consequence, at least temporarily, may be to weaken rather than strengthen the service. There may be confusion about accountability at a time when we need the maximum accountability.
The proposals rely heavily on PCTs as the first line of defence. Much as I admire those who work in those trusts, I am not convinced that PCTs throughout the country will be equally prepared to take on that task. There may be holes in the protective services that we expect at a time when we can least afford them. I am not convinced that we have yet developed the necessary routes of public communication, or the internal communication that enables professionals to exchange information with one another. Professional education is a key task in providing a comprehensive and effective system. We need much more emphasis on working with the biopharmaceutical companies in this country on vaccine development, reducing delays and ensuring that vaccines are available where they are needed and in the quantities in which they are needed in those circumstances.
I hope that the Minister will reassure me on those points and that he has taken into account the disruption that the proposals will cause at a critical time. As I said, I do not disagree with what I believe will be the end result, or with the view that a protection organisation of this sort should have the widest possible remit. However, this is not the time to make such a structural reorganisation when the possibility of a viral pandemic is ever present and there is the distinct possibility of biological threat from terrorist activity. I am not criticising the Government when I say that we are still unprepared. That state of unpreparedness has existed for some time, and this country is better prepared than many others. However, we should recognise and deal with it. The paradox is that our defences may be at their weakest when the threat is greatest.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)
I congratulate the hon. Member for Somerton and Frome (Mr. Heath) on securing this debate on a subject that is without doubt very topical. In the short time that I have to reply, it is unlikely that I will be able to address all the questions that he asked, but I shall endeavour to follow up in a letter the points that I cannot answer.
As the hon. Gentleman rightly suggested, the recent emergence in east and south-east Asia of what appears to be a new disease—severe acute respiratory syndrome, or SARS—has raised the concern that this could become a major international public health threat 136WH similar to an influenza pandemic. There are increasing reports of possibly linked cases in other parts of the world. Those cases are being investigated, but the cause is still unknown.
A pandemic is a description for a situation in which a disease—usually infectious—reaches epidemic proportions in many regions of the world. Pandemics therefore have the potential to cause widespread disruption with regard to not only health but the general conduct of society.
As the hon. Gentleman outlined, pandemics have been few, although they have occurred throughout the centuries. There were three in the last century: the Spanish flu in 1918–19, the Asian flu in 1957–58, and the Hong Kong flu in 1968–69. It is now 35 years since the last pandemic started, but it is generally agreed that the conditions exist for a new pandemic to occur. As the chief medical officer noted in his infectious disease strategy for England, "Getting Ahead of the Curve", which was published in January 2002 and to which the hon. Gentleman referred, influenza viruses are the chameleons of the microbial world. They are constantly changing, which enables them to remain in circulation and cause outbreaks of illness each winter. Influenza viruses can also swap genetic material. Every so often that produces a new strain that has the potential to cause widespread infection in a population that has not met that virus before. Such new viruses are especially likely to emerge where animal and human influenza viruses can mix—for instance, in the far east. There are many unknowns, such as how long the virus will take to spread, how many people will fall ill, how severe the infection might be, which part of the population might be most susceptible to, or affected by, the pandemic, and how long the epidemic will last.
It is fortunate that we can get some indication of what to expect from previous pandemics. Modelling work also helps us get a clearer idea of the likely range of impact, and the critical parameters in planning an effective response.
What we can say is that should a new virus emerge and the right conditions exist for its spread—which can be rapid—the speed and volume of modern travel mean that it would also quickly hop from continent to continent. Previous pandemics have affected up to a quarter of the population. Flu normally causes most serious illness in the very young and the very old, although the ages most severely affected might be different, and the illness might be much more severe than the normal seasonal influenza that we see every winter. The emerging findings concerning the new illness suggest that it is due to a respiratory virus, but not flu. The spread of the new disease—SARS—suggests a highly transmissible infectious agent. Some 90 per cent. of the cases have been in health care workers directly involved in caring for a known case, or in close family members. The disease does not appear to spread through casual contact.
The hon. Gentleman is right that as of yesterday 487 suspected cases had been reported from 12 countries. We shall not know how many of those cases will be confirmed as part of the outbreak until we know the cause, but the situation is a timely reminder of the need to be prepared for such an international infectious disease threat, be it an influenza pandemic or a major epidemic of any other infectious disease—or, indeed, the 137WH deliberate release of a biological agent. The threat to the UK from SARS appears to be small, but since the cause is as yet unconfirmed the UK has taken a precautionary stance.
The Department of Health and the Public Health Laboratory Service issued information and advice on management and reporting of suspected cases to all general practitioners, trusts and public health professionals through the rapid public health link system on 13 March 2003. We also issued advice about SARS to the public and to travellers to south-east Asia. Full information and advice has been kept up to date on the Public Health Laboratory Service website. The Department of Health and the Public Health Laboratory Service continue to monitor the situation.
The UK was one of the first countries to publish a national pandemic influenza contingency plan in 1997. The basic elements of that plan still apply. However, it is important that plans are kept up to date and the plan is now being updated to take account of new developments in science and medicine, organisational changes and experience gained in planning for other emergencies since the events of 11 September 2001.
The UK has a strong public health infrastructure for the control of infectious diseases. The Public Health Laboratory Service is pivotal, providing expertise, the national communicable disease surveillance centre and laboratory services. The hon. Gentleman indicated that, as of 1 April 2003, those services will become part of the new Health Protection Agency, which has been created further to strengthen our arrangements. There should be no disruption to those services during the transition. At local level, services are provided by health protection teams.
I stress that there will be no transition phase from the Public Health Laboratory Service to the Health Protection Agency. Most of the core Public Health Laboratory Service staff required to respond to such an emergency will transfer into the new Health Protection Agency, along with many of the staff who deliver the local infectious disease control functions, such as the consultants in the communicable disease control centre and their staff.
138WH I hear what the hon. Gentleman says when he suggests that this is the right direction of travel but raises anxieties about the change taking place at this time. It is, however, an ends and means case, and it is right that we should manage that transition as we are doing. In the current environment it is right that we progress on the journey. We cannot will the means but not the ends.
A pandemic or global epidemic of a serious and easily transmitted respiratory viral infection, (such as the 1919 Spanish flu pandemic), would be both a national and international emergency. For the UK, the Department of Health would lead under the Cobra mechanism with the Health Protection Agency playing an essential supporting role.
A pandemic of a less pathogenic and/or easily transmissible virus could still be a major threat. Under its remit of responding to new or emerging threats, the Health Protection Agency would perform the main co-ordinating role for the national and local response to the threat, with the Department of Health taking the policy lead.
Specifically, the Health Protection Agency would work with the NHS and local authorities to provide a national and local health protection and infection control service. Through its communicable disease surveillance centre it would co-ordinate all relevant systems of surveillance relevant to the prevention and control of infectious diseases in order to provide, with the local and regional services division of the Health Protection Agency, up-to-date national and local situation reports. It would also draw on the best information available to provide up-to-date specialist guidance for professionals and the public, which would appear on the Health Protection Agency website.
There is already a joint generic Department of Health and Health Protection Agency plan for dealing with all national outbreaks, which leads to specific plans like the one for influenza.
The hon. Gentleman read out the plan for 1918. We are taking the issue seriously in the UK, and I am glad that he acknowledges that. We have travelled a long way since the beginning of the last century. The Department of Health takes the matter seriously because of the threats around. I believe that the new arrangements will equip us well to deal with any pandemic, should one emerge.
§ It being half-past four o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.