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Miss Julie Kirkbride (Bromsgrove): The right hon. Gentleman has to understand that he can quote as many organisations as he likes, but some parents will still strongly believe that they should not give their child the MMR vaccine. For those parents, the Government have closed the door on the option of single vaccines. If we want to increase immunisation rates, surely it would be sensible to allow those who wish to have single vaccines to have them.

Mr. Milburn: I shall address the issue of parental choice in a moment or two if the hon. Lady--who I know has concerns of her own--will bear with me.

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The hon. Member for Woodspring asked about coverage. As he knows, the coverage situation is not static at all. Rates of MMR vaccination started to fall in 1996, I think, and certainly they have fallen since. As he knows, coverage at age five is 93 per cent, but coverage at age 2 is 88 per cent. We know that those rates are not high enough and that action must be taken to increase them, to avoid precisely the type of measles outbreak that occurred very recently in Ireland, most notably in Dublin.

There is barely a country in the world that prescribes single vaccines. Japan is the only country that I know of that prescribes them. As the hon. Gentleman is well aware, between 1992 and 1997, Japan had, I think, 79 deaths from measles. In that period the United Kingdom had no deaths from measles. That is a salutary lesson for us all on the issue.

Miss Kirkbride: Will the right hon. Gentleman give way?

Mr. Milburn: I am coming to the hon. Lady's point, if she will be patient just one moment longer.

The hon. Member for Woodspring asked what the Government have been doing in the past year or so, since he wrote to me on the matter and I replied to him commending his approach. In the past year, we have placed advertisements on television. Posters and leaflets on MMR have been sent to every GP practice. Additionally, parents have received direct mailshots on the MMR vaccination. As he knows, there will also be a major public information campaign to inform parents of the facts about MMR so that they can make the best choices for their children. That campaign is supported by all the organisations that I mentioned earlier.

The policy that some people advocate--to put the health of children at risk by use of single vaccines--is fundamentally not about choice, but about chance. Parents always have the choice about whether to have their children vaccinated. However, I should make it clear that where licensed single jabs exist, or where unlicensed single jabs are legally provided, we have not prevented their use. What the Government cannot do, however, is to endorse a choice that the experts clearly believe will put children's health and children's lives at greater risk. It would be irresponsible of us to promote an alternative on the NHS that leaves children's lives to chance.

I am grateful to the hon. Member for Woodspring for the tone of his remarks this evening, which stands in some contrast to much of what he was saying only last week. I believe fundamentally that the position that his party has adopted has not allayed concerns but has, frankly, risked adding to them. If he wants to avoid damaging the case for MMR, I suggest that he gives unfettered support for the vaccine, without qualification.

This is a point not only for the hon. Gentleman but for some sections of the media to bear in mind. This is not a bandwagon for anyone in politics or outside to leap on. It is a serious public health issue that demands responsibility, not irresponsibility, on the part of every politician who is committed to improving the health of our children.

The same is true for some of the other issues that the hon. Gentleman raised. He raised serious issues concerning TB, sexual health and CJD. On TB, yes, it is true that cases have been rising. They have been rising

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since the early 1990s. They are rising throughout the world. He asked what we have done in response. The Government have responded with a firm programme of action, including more surveillance, better screening, and now the development of more rapid diagnostic and drug susceptibility tests.

The hon. Gentleman asked about the availability of the BCG vaccine, which is indeed a serious issue. He knows that we hit production problems with the one company producing the vaccine. Sadly, that was outside our control. He might not know that we have now been able to resume vaccinating schoolchildren in London, which is the area of highest risk. We are pursuing the matter actively. There are, sadly, not many manufacturers of the vaccine around, but we are doing all we can, and I hope that we will be able to make progress before too long.

Dr. Fox: When?

Mr. Milburn: I cannot say as yet, because we are still pursuing the matter. If I could give the hon. Gentleman an answer, I would.

The hon. Gentleman asked about sexually transmitted infections. They have been increasing since 1995. For 16 to 19-year-olds, there was a 53 per cent. increase in cases of gonorrhoea and a 45 per cent. increase in cases of chlamydia between 1995 and 1997. That is why we are now piloting chlamydia screening for the first time, with a view to rolling it out across the country as a whole. That is also is why we have introduced a policy to offer all pregnant women an HIV test, to reduce maternal transmission. The early results are very encouraging, and I hope that we will be able to build on them. Those are the reasons why the Government's health promotion campaigns are so important.

The hon. Gentleman asked about the publication of our sexual health strategy. I very much hope that we will be able to publish it within the next couple of months. What we cannot have, in the House or elsewhere, is a situation whereby people rail against high levels of unwanted pregnancy and then oppose making contraception more accessible. To do so begins to fall off the Richter scale of cant and hypocrisy.

The hon. Gentleman also asked about recombinant factor 8. My ministerial colleague, Lord Hunt, is considering precisely the issues that he raised, and had a meeting with the Haemophilia Society today to discuss that, among other matters.

The hon. Gentleman asked about the publication of relative risk in relation to transmission of vCJD, particularly in surgery. The Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), has already given a commitment that we will seek to get that information into the public domain, and that is the right thing to do. Relative risk is always a difficult issue, but it must be right to make the public aware. We must get away from a situation whereby politicians pronounce things 100 per cent. safe. We have to talk the language of safest, and assess what the risk is. [Interruption.] The hon. Member for Mid-Dorset and North Poole (Mr. Fraser) is laughing--

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Mr. Christopher Fraser (Mid-Dorset and North Poole): Not at what the right hon. Gentleman was saying.

Mr. Milburn: If it was a private joke between the hon. Gentleman and the hon. Member for New Forest, East (Dr. Lewis), perhaps they will share it with me.

Dr. Julian Lewis (New Forest, East): I am delighted to share the joke. When the Secretary of State said that nothing was 100 per cent. safe, I observed to my hon. Friend that that included the job of the Secretary of State for Northern Ireland.

Mr. Milburn: That was an extremely amusing joke. [Hon. Members: "You asked for it."] I suppose I did--and I got it, as did the whole House.

Fiona Mactaggart (Slough): Does my right hon. Friend share my frustration at the fact that, 45 minutes into this debate, we have not even discussed the greatest threats to public health: coronary heart disease and cancer? Does he share my anger that, when the Conservatives were in power, death rates from those diseases among poorer people went up, so that someone in Slough is twice as likely to die from coronary heart disease as someone in the rest of the county, which is much more prosperous?

Mr. Milburn: My hon. Friend makes a cogent and important point.

I think that I have answered the questions that the hon. Member for Woodspring asked.

Dr. Fox: There was one little point that the Secretary of State missed out. I am sure that the medical profession, as well as parents, would be interested in the possible availability, perhaps as soon as the end of this year, of pneumococcal vaccine. What are the Government's plans for rolling out that vaccine, given the success in controlling meningitis C?

Mr. Milburn: My hon. Friend the Minister for Public Health advises me that our position on new vaccines is that we will roll them out as quickly as we can, but we need first to check their effectiveness to ensure that the programmes that we institute have the impact that we want.

Improving public health is about getting the vaccination programmes right and ensuring that immunisation programmes are relevant. It is also about assuring the public that those programmes produce the right result. We all have a part to play in that. There is, however, a wider issue. As my hon. Friend the Member for Slough (Fiona Mactaggart) rightly said, improving public health is also about tackling our country's biggest killers: cancer and coronary heart disease. It is about improving the health services that prevent illness as well as those that treat it. Fundamentally, it is about addressing the single most significant underlying cause of ill health and health inequality: the poverty that afflicts and divides our nation.

On cancer and heart disease, after decades of, frankly, shameful neglect, services are finally getting the investment that they need. This year, these life-saving services will get more investment than ever before: an extra £450 million. There will be more money for new

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drugs, for new equipment, for more staff and for more operations. There will be new national standards for heart disease and cancer care. Over the next few years, patients will see in the NHS the fastest improving cancer services anywhere in Europe.

The hon. Member for Woodspring asked about preventive services. For the very youngest to the very oldest, such services are being expanded. They are receiving new investment. For the first time, newborn children are receiving hearing tests. Primary school children are being given free fruit as part of the biggest programme to support child nutrition since Mrs. Thatcher scrapped free school milk in the 1980s. Women aged over 65 will, for the first time, be screened for breast cancer. New screening programmes are planned for colorectal cancer and, when the technology is developed to make it effective, for prostate cancer too. Already in this country we now have the most comprehensive smoking cessation services anywhere in the world, available to the seven in 10 smokers who say that they want to give up smoking.

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