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The noble Baroness said: My Lords, it is proposed that this draft order should be made under Section 1(3) of the European Communities Act 1972. This provides that a treaty entered into by the United Kingdom after 22nd January 1972 shall not be regarded as a Community treaty unless it is specified as such by order in council. The draft order specifies the WTO agreement as a Community treaty from the time the agreement is in force for the United Kingdom. The principal effect of declaring the agreement to be a Community treaty is to bring into play the provisions of Section 2 of the Act which provides for the implementation of treaties specified as Community treaties.
Lord Rea: My Lords, perhaps the noble Baroness will correct me if I am wrong, but I do not believe that either House has had an opportunity to debate the actual setting up and accountability of this new organisation which will oversee GATT. Can the noble Baroness say whether an opportunity to do that will arise or is it too late? Has it all been done? Whether that is so or not, can she say how Parliament can or will be informed of the deliberations of the World Trade Organisation and how accountable our representative in that organisation will be to Parliament? Will that be through the Foreign and Commonwealth Office or through the DTI? I shall be grateful for a few words from the noble Baroness on that topic.
Baroness Chalker of Wallasey: My Lords, I understand that the other place debated the Uruguay Round Agreement on 14th June of this year. I can tell the noble Lord that the Foreign and Commonwealth Office, together with the DTI, obviously has responsibility for representing our interests at the World Trade Organisation in Geneva. I can further tell the noble Lord that this order before us tonight does not do anything other than what I have explained. There is no inwardness and no secretiveness. I sincerely hope that, after a long and difficult debate, we have secured the completion of the Uruguay Round and opened trading which will do so much to help all nations of the world and that that will now be very much the order of the day. I hope that the World Trade Organisation will not have to chase up too many people who fail to be open traders.
Lord Kennet: My Lords, the noble Baroness did not actually answer my noble friend's question about whether there will be a reporting arrangement to Parliament through the Foreign and Commonwealth Office from our representative in the new organisation. It will be interesting to know that. Do the Government intend or hope to do anything, even if it is only a hope?
Baroness Chalker of Wallasey: My Lords, there is no reason why there could not be a regular report if that was judged to be right. There is an annual reporting system by all representatives of international bodies. That is not a secret matter. We have not been required or asked before to have regular debates on these matters, but I shall bring the noble Lord's remarks to the attention of the Lord Privy Seal and the business managers. I do not think that noble Lords will find a
Baroness Robson of Kiddington rose to ask Her Majesty's Government whether, in the light of medical opinion that it is necessary, they will establish a large-scale, multi-centre study into toxoplasmosis in pregnancy.
"The strategic role of the Department of Health is ... to monitor and assess the health of the nation and take the action necessary ... to improve and protect health".
Toxoplasmosis in pregnancy is a clear example of how the Department of Health might implement the role that it has set itself. Toxoplasmosis is a common infection. It is caused by a parasite living in soil, on unwashed fruit and vegetables and in infected cat faeces. The infection is usually mild, giving flu-like symptoms which can often go unnoticed. An amazing statistic is that 70 per cent. of women in France are immune against toxoplasmosis because they have had it earlier in life, whereas only 30 per cent. of women in Britain are immune. I do not know whether that has something to do with how we handle soil and wash vegetables. I do not think that anyone knows the reason, but it is an interesting fact. The statistic proves that the danger is greater for pregnant women in this country than for those in France.
When a pregnant woman catches the infection, she may pass it to her unborn child, who may suffer from blindness, hydrocephalus and brain damage. A large number of the babies will have no symptoms at birth, but they will need to be clearly and closely monitored for six to nine months. Some may develop blindness as late as in their teens. Estimates of the scale of the problem in the UK broadly agree that two women per thousand will contract toxoplasmosis for the first time in pregnancy. With an average of 700,000 births each year, that means that 14,000 pregnant women will have new toxoplasma infections each year. The research indicates that 40 per cent. will pass the infection to their foetus. That could amount to as many as 600 babies per year.
However, it is known that toxoplasmosis in pregnancy is preventable, testable and treatable. Pregnant women should be routinely made aware of how to avoid the infection. Work on that has been carried out largely by the Toxoplasmosis Trust in this country. It has distributed over 1 million leaflets in the past five years, trying to inform women what to avoid
Spiramycin is the orthodox treatment that is used to prevent the transmission of toxoplasmosis from an infected mother to her foetus. It has been used and studied in France and Austria, where the incidence of congenital toxoplasmosis has dropped dramatically. In Austria, for example, following treatment, the incidence of affected babies has fallen from between five and seven per 1,000 births to as low as one in 10,000 births. Surely such a reduction is worth achieving.
What action is necessary in this country? I believe that it is for the Department of Health to regularise the situation on toxoplasmosis in pregnancy. A number of steps are appropriate. In the short term, all pregnant women should be informed about toxoplasmosis and how to avoid it. Such a crucial task cannot be left to a small charity to undertake. As I have said, that charity has done a magnificent job, but it is up to the Department of Health to see that that information is given to pregnant mothers.
I also believe that the Department of Health should bring together all the relevant professional groups to discuss clinical guidelines. That would at least standardise the treatment of pregnant women who are identified as being infected with toxoplasmosis. One of the problems is that there is no standard system for dealing with the infection across the different centres. Some centres are very good and provide very good treatment; others are not so good. We cannot afford to allow mothers who unfortunately happen to be infected to have their babies in centres that do not provide the best service.
The most important role for the Department of Health is to obtain epidemiological information, as proposed by the Royal College of Obstetricians and Gynaecologists in its working group in 1992. It emphasised the need for further research. It is not alone in that, because in 1991 the Select Committee on Health also stated that more research was required. We recommend that the Government should commission the appropriate epidemiological research to establish the incidence of toxoplasmosis. The problem is that real information on the number of pregnant women who contract the disease and infect their babies is clearly lacking. It is inappropriate to take a decision for or against screening without that information. I hope that the noble Baroness realises that I am not asking for a national screening programme. We would not dream of asking for that until all the relevant information is available on which we can base a decision about screening.
Over the past five years, numerous requests have been made for that crucial research to be undertaken. I believe that in October this year the Toxoplasmosis Trust wrote to the noble Baroness, Lady Cumberlege. I am not aware of whether it has received a reply or whether the Government are prepared to undertake that very important research programme. Such research needs to be carried out on a multi-centre basis, covering the country. Various small research programmes have taken place but, because they are small and do not cover large
I urge the Government to undertake that research as a matter of urgency. We all want all babies to be born healthy. To me, the results of this infection are frightening because it can manifest itself so much later in life. I hope that the Government will accede to this request.
Lord Rea: My Lords, the Unstarred Question asked by the noble Baroness deals with a parasitic disease of which few of us will have heard, and, yet, surprisingly, as she pointed out, many of us may have acquired it. Our immune system will have dealt with it with no more than minor, flu-like symptoms. The organism is a single-celled protozoan (or, strictly speaking, sporozoan). It is in the same group as some tropical parasitic diseases. It affects animals as well as man, so technically speaking it is a zoonosis. Domestic cats are known to harbour the organism, as are some farm animals, sheep in particular.
I am pleased that the noble Baroness, Lady Trumpington, is to answer the debate because she has had experience as a Minister in the Ministry of Agriculture, Fisheries and Food and the Department of Health. I am sure that she was chosen to answer the Question for that reason.
While adults, if infected, can suffer mild and occasionally prolonged glandular fever-like symptoms, the disease can, as the noble Baroness pointed out, cause much more severe damage to the unborn foetus if the organism crosses the placental barrier in pregnancy. It is newly acquired infections by mothers during, or shortly before, pregnancy, that concern us.
As the noble Baroness said, the rate of infection of pregnant women by the organism is about two per thousand (0.2 per cent.); that is, 1,200 to 1,400 (not thousands) per annum in the country. In 40 per cent. of those cases, according to several studies, the foetus also acquires the infection. It crosses the placental barrier and leads to some 500 to 600 affected foetuses. It is thought that about 10 per cent. of those (50 to 60 or so) are harmed seriously by the infection. Some are infected seriously with blindness and brain damage.
During a professional lifetime, I can remember treating only one adult case of toxoplasmosis. I had one sad infant case, nearly 40 years ago now. The child had hydrocephalous and blindness due to choroido retinitis, which fits the bill of toxoplasmosis. That child did not survive long. That diagnosis was not established, but it sounds exactly like the type of problem that arises, not commonly but enough to cause concern in this country. Most doctors will not have met a known case of toxoplasmosis during a whole professional lifetime. However, the infection is not so rare that it never gets into the news. The publication Rolling Stone on 24th March 1971 reported:
The disease is rare but as perinatal and infant mortality rates from all other causes decrease, further progress in reducing the risk to babies depends upon rooting out rare causes of death and disability so that they can be identified and eliminated. In most cases, that means prevented rather than cured, because treatment is too late.
In France, again as the noble Baroness said, there is the same percentage of new infections in pregnancy, but a much higher prevalence in the country as a whole. In France, all mothers are screened when they book for pregnancy and again later in pregnancy. All women in France have to have a toxoplasmosis tests before they can obtain a marriage licence. Several other European countries routinely screen all pregnant women for toxoplasmosis. The noble Baroness mentioned Austria, but Finland and Denmark do so also, and I gather that Germany is planning to do so.
I have not seen the details of the multi-centre research programme mentioned in the Question, but it would seem to fall properly within the province of direct Department of Health-funded research through the Public Health Laboratory Service. Its reference laboratories are equipped properly to do the accurate Sabin-Feldman dye test which identifies the infection. It has the expertise. Blood is taken routinely from pregnant women during pregnancy. It is merely a question of sending it to the correct laboratory.
Unfortunately, with a fairly rare disease, large numbers of blood samples have to be examined to detect significant differences in rates which may vary around the country. For instance, 100,000 samples would be needed to detect 200 cases. That is probably the number needed to show any statistical significance. However, there are cheaper, less sensitive screening methods than the dye test. For instance, there is a skin test which might be used initially to screen for possible infected women, which would reduce the cost of the whole exercise.
It is not appropriate to discuss research methodology across the Floor of the House. But it is appropriate that the risks to the next generation of a disease which is known to cause blindness and mental retardation, and which is largely preventable but not so easily curable, should be known as precisely as possible. As the noble Baroness said, we are not asking for a full-scale screening programme, as in France, to be initiated without further consideration. We are asking that the Government should allow the evidence to be collected upon which to base a balanced decision as to whether we should start having a routine toxoplasmosis screening policy in pregnancy. Surely that is a reasonable request.
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