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7 Dec 2009 : Column 916

Freud, L.
Garden of Frognal, B.
Gardner of Parkes, B.
Geddes, L.
Glenarthur, L.
Glentoran, L.
Goodhart, L.
Goodlad, L.
Greenway, L.
Griffiths of Fforestfach, L.
Hamilton of Epsom, L.
Hamwee, B.
Hannay of Chiswick, L.
Harries of Pentregarth, L.
Harris of Richmond, B.
Hayhoe, L.
Henley, L.
Hodgson of Astley Abbotts, L.
Howarth of Breckland, B.
Howe, E.
Howe of Aberavon, L.
Howe of Idlicote, B.
Hunt of Wirral, L.
James of Blackheath, L.
Jay of Ewelme, L.
Jenkin of Roding, L.
Jones of Cheltenham, L.
Jopling, L.
Kirkwood of Kirkhope, L.
Knight of Collingtree, B.
Laird, L.
Lamont of Lerwick, L.
Lawson of Blaby, L.
Lee of Trafford, L.
Lester of Herne Hill, L.
Lindsay, E.
Lloyd of Berwick, L.
Low of Dalston, L.
Lucas, L.
Luke, L.
Lyell, L.
McColl of Dulwich, L.
MacGregor of Pulham Market, L.
Mackay of Clashfern, L.
Maclennan of Rogart, L.
Maddock, B.
Mancroft, L.
Mar, C.
Mar and Kellie, E.
Marland, L.
Martin of Springburn, L.
Masham of Ilton, B.
Mawhinney, L.
Mayhew of Twysden, L.
Miller of Chilthorne Domer, B.
Morris of Bolton, B.
Murphy, B.
Naseby, L.
Neill of Bladen, L.
Neuberger, B.
Neville-Jones, B.
Newby, L.
Noakes, B.
O'Cathain, B.
O'Neill of Bengarve, B.
Onslow, E. [Teller]
Oppenheim-Barnes, B.
Palumbo, L.
Parkinson, L.
Patel, L.
Perry of Southwark, B.
Plumb, L.
Rawlings, B.
Redesdale, L.
Rennard, L.
Rix, L.
Roberts of Conwy, L.
Roberts of Llandudno, L.
Rodgers of Quarry Bank, L.
Rogan, L.
Rooker, L.
Rotherwick, L.
Ryder of Wensum, L.
St John of Fawsley, L.
Salisbury, Bp.
Scott of Foscote, L.
Seccombe, B. [Teller]
Selborne, E.
Selsdon, L.
Sharp of Guildford, B.
Shephard of Northwold, B.
Shutt of Greetland, L.
Simon, V.
Skelmersdale, L.
Slim, V.
Steel of Aikwood, L.
Stern, B.
Stewartby, L.
Stoddart of Swindon, L.
Strathclyde, L.
Sutherland of Houndwood, L.
Swinfen, L.
Taverne, L.
Taylor of Holbeach, L.
Tenby, V.
Thomas of Gresford, L.
Thomas of Walliswood, B.
Thomas of Winchester, B.
Tonge, B.
Tope, L.
Trefgarne, L.
Trimble, L.
Tyler, L.
Ullswater, V.
Verma, B.
Waddington, L.
Wakeham, L.
Wallace of Saltaire, L.
Walmsley, B.
Walpole, L.
Warnock, B.
Warsi, B.
Wilcox, B.
Williams of Crosby, B.
Williamson of Horton, L.
Young of Hornsey, B.

NOT CONTENTS

Ahmed, L.
Andrews, B.
Archer of Sandwell, L.
Bach, L.
Barnett, L.
Bassam of Brighton, L. [Teller]
Bernstein of Craigweil, L.
Bhattacharyya, L.
Billingham, B.
Bilston, L.
Blood, B.
Borrie, L.
Brett, L.
Brooke of Alverthorpe, L.
Brookman, L.
Brooks of Tremorfa, L.
Campbell-Savours, L.
Christopher, L.
Clark of Windermere, L.


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Clarke of Hampstead, L.
Clinton-Davis, L.
Cohen of Pimlico, B.
Corbett of Castle Vale, L.
Crawley, B.
Cunningham of Felling, L.
Davies of Coity, L.
Davies of Oldham, L. [Teller]
Dean of Thornton-le-Fylde, B.
Dubs, L.
Elder, L.
Elystan-Morgan, L.
Evans of Parkside, L.
Falkender, B.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Foster of Bishop Auckland, L.
Gale, B.
Gibson of Market Rasen, B.
Giddens, L.
Golding, B.
Gordon of Strathblane, L.
Goudie, B.
Gould of Potternewton, B.
Graham of Edmonton, L.
Grantchester, L.
Greengross, B.
Griffiths of Burry Port, L.
Grocott, L.
Harrison, L.
Hart of Chilton, L.
Haskel, L.
Haworth, L.
Henig, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Newport, L.
Howells of St. Davids, B.
Howie of Troon, L.
Hughes of Woodside, L.
Hunt of Chesterton, L.
Irvine of Lairg, L.
Jay of Paddington, B.
Jones of Whitchurch, B.
Jordan, L.
King of West Bromwich, L.
Kinnock, L.
Kinnock of Holyhead, B.
Kirkhill, L.
Lea of Crondall, L.
Leitch, L.
Lipsey, L.
McDonagh, B.
MacKenzie of Culkein, L.
McKenzie of Luton, L.
Mandelson, L.
Massey of Darwen, B.
Maxton, L.
May of Oxford, L.
Moonie, L.
Morgan, L.
Morgan of Drefelin, B.
Morris of Handsworth, L.
Morris of Manchester, L.
Morris of Yardley, B.
Myners, L.
O'Neill of Clackmannan, L.
Parekh, L.
Paul, L.
Peston, L.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Prys-Davies, L.
Quin, B.
Ramsay of Cartvale, B.
Rea, L.
Richard, L.
Rosser, L.
Rowlands, L.
Royall of Blaisdon, B.
Scotland of Asthal, B.
Sewel, L.
Sheldon, L.
Smith of Gilmorehill, B.
Soley, L.
Stone of Blackheath, L.
Strabolgi, L.
Taylor of Blackburn, L.
Thornton, B.
Tomlinson, L.
Tunnicliffe, L.
Turner of Camden, B.
Warwick of Undercliffe, B.
Wedderburn of Charlton, L.
Whitaker, B.
Whitty, L.
Williams of Elvel, L.
Woolmer of Leeds, L.
Young of Norwood Green, L.

Pandemic Influenza: S&T Committee Report

Science and Technology Committee

Motion to Take Note

4.34 pm

Moved By Lord Sutherland of Houndwood

Lord Sutherland of Houndwood: My Lords, I shall speak about the report of the Science and Technology Select Committee on pandemic flu and the Government's response to it. I propose to take the House through the main points, knowing that my colleagues will be eager to participate on specific issues. I thank the Government for a careful and, I have to say, at points a helpfully detailed response. That done, I of course immediately say "however", but I shall leave that for a moment or

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two because I also want to thank colleagues on the committee, including the co-optees-the noble Baronesses, Lady Finlay of Llandaff and Lady Whitaker, and the noble Lord, Lord Jenkin of Roding. With our excellent special adviser, Dr Sandra Mounier-Jack, and superb help from the Committee Office, they produced an important document that has provoked an important response from the Government.

The report was an update by the committee on a report of October 2005. The follow-up report was published on 28 July this year. We thought it necessary because the reaction to our 2005 report left us with a number of concerns about the adequacy of government preparedness for the possibility of a pandemic outbreak. We had expected it to be a short and fairly quick report; we had planned to do it in autumn 2008 and had a useful session with government and departmental spokesmen in November 2008. However, that evidence session did not convince us that all the questions that we thought ought to be publicly aired had been, so we decided to extend our report and prepare for two further sessions in spring 2009. The first was in February, when we had an excellent team of specialists from the appropriate areas of science and medicine to work with and advise us. For the second, on 17 March 2009-I stress the date, as it is important-we had departmental representatives and a ministerial presence.

One day later, on 18 March 2009, the virus H1N1 was identified in Mexico. That virus became known as possible "swine flu" because it could transmit from pigs to human beings and, as it turned out, from human beings to human beings. Therefore, the stage was set for some important and worrying consideration to be given to it. By 27 April, there was confirmation of cases in the USA, Canada and Spain, with suspected cases in several other countries including the UK. Within five or six weeks, we had moved from taking evidence on 17 March that was, in a sense, theoretical-for a table-based report-to a pandemic flu situation.

By 11 June, the World Health Organisation confirmed that we were at phase 6 alert in the pandemic period measurements, which was the first such alert for more than 40 years. Of course, that affected the nature of the Select Committee's work and the way in which it would go about its business. Quite properly, it also affected the nature of the government response to the Select Committee inquiries at that stage. So there were complications for the Government and complications for us. They were responding to a series of questions, some of which were originally asked in 2005, and the importance of the answers was becoming more evident day by day throughout the summer. It might be thought that the Select Committee showed some prescience in choosing this topic, but I have to say that we do not claim any special knowledge. Rather, the committee sees the continuing importance of these questions, so they must be kept alive. If they are not, that would be complacent and we would not be able to respond to a potential pandemic.

A pandemic is different from an epidemic in so far as a pandemic includes the possibility of risk to individuals worldwide. The virus that particularly concerns us at the moment is H1N1, which has the capacity to transfer from pigs to human beings and thence from some

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humans to others. One has learnt, not being an expert in these matters, that viruses are tricky customers. Evidence in Wales shows that this virus has already developed a resistance to Tamiflu, which is the first line of defence available to us. There are also major concerns about the evidence that the virus has already manifested itself in communities where avian flu virus is still present, perhaps because all the chickens were not killed. The possibility of mutation or a mixing of the different viruses is high and potentially very dangerous. We have to watch this because it is occurring in certain parts of the world, so the issue may not leave us in our current comparatively quiet state.

That is the context. The committee's response to the government reply is positive in terms of the way in which the current epidemic has been handled by the department and the Government. A number of good things have been done and, as we will hear later, international comparisons bear out the view that we have an alert and responsive Government and department. There is always a "but", however, which leads me on to two or three specific points.

First the "but", which is not carping in tone, but realistic. The virus and its effects in this country have, for most people so far, been comparatively mild in terms of the symptoms. Sadly, that is not true for everyone and there have been deaths, usually associated with other medical conditions. Nevertheless, it is a dangerous virus, as are they all. But so far, the symptoms of the virus have been mild. That has been a positive help to the Government and the department in their response; I shall come back to that in a few moments. However, there is a considerable possibility that a second and more virulent wave of the virus may come through, in which case the symptoms will be much more pressing and potentially more dangerous than they have been across the piece. Moreover, as I have suggested, there may be mutations which inevitably we are unaware of at this point and which produce a much more dangerous virus. We have dealt with the wave so far, for which congratulations are due to all concerned, but there is the possibility of further dangerous developments.

I now want to make one general and three specific points in the remaining time that I have available to speak. The general point is to ask whether, although we have been fortunate in that the virus has been comparatively mild and government systems have been able to respond, there are lessons to be learnt. Are there issues that we can pick up on and take forward into the future from the experience of the last five or six months? I am sure that there will be none of this in the Minister's speech, but the danger is that folks in the department might become a little complacent. They might ask, "Well, so far, so good-what were all those irritating questions about that we were getting a year ago? There has been a pandemic, we are dealing with it effectively and the number of cases is falling in this country, so what's the fuss about? We coped; why go on about it?". One sometimes had the impression that members of the department implied, "It'll be all right on the night", but was it? When we were pressing for system-wide review and testing, there was just a hint of that coming through.



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If that were the reply-that they had coped, that it was all right on the night, so what was the fuss about?-it would be wrong on two serious counts. The first, as I have suggested, is that it would be complacent. Fears of complacency are what stimulated the Select Committee to go back and produce an update after its 2005 report. There are risks of becoming complacent. More significantly, such a reply would ignore the most important contextual key point: this virus, I stress, has so far been only moderately virulent in its attacks and in the symptoms that it has produced. The systems that we have to deal with the symptoms have of course been tested under real enemy fire, so to speak. The department would be right to say, "Well, we have had pandemic here and we have coped", but the testing has not been comprehensive because there have been hot spots across the country where the virus has been claiming significantly more victims than it has elsewhere. A continuing concern for the committee is that the system testing has not been end to end, as we called it; it has not looked right down the chain to see that every stage is fit for purpose and will link up well and appropriately.

There has been system testing in the presence of a pandemic, but that has been of a comparatively mild one, whose impact has been patchy throughout the country. So far, the testing of systems has also been by and large desk-based. I am sure that the very strong recommendation from the committee would be that there are lessons to be learnt. We have been given a living laboratory; let us ensure that there is a proper report looking back to see what happened and how well or how ill it happened, as the case may be.

On my specific points, first, the evidence that we have on scientific infrastructure is that it has been good and has worked well. The World Health Organisation has labs in place throughout the world. It is functioning and has been able to bring reports on how the virus is spreading-some this very week. The UK lab system has, from the evidence that we have, been alert and ready to respond. UK scientists are currently trying to get ahead of the game. They are in jurisdictions where avian flu still exists and swine flu may be present and they are looking for the earliest dangerous signs of mutation-again, all credit to them. A pandemic brings out-this one has brought it out as well as any-how we are dependent on other jurisdictions. This is an international risk that we run and it might be worth asking the World Health Organisation to think about the lessons learnt in terms of international preparedness and co-operation.

The second specific issue that I want to take up is the provision of acute facilities. We were concerned about this from the earliest evidence taking, when we had some important evidence from those who work in the provision of acute beds in hospitals. Again, I am pleased that the Government plan-this emerged after our report was published-to double the readiness of intensive care beds. That is a better response than we had from them in oral evidence in July this year. However, they have moved from there and their response is important. It is a significant improvement on July and on a meeting that I had on behalf of the committee in May with the then Secretary of State and his advisers. The reaction from the advisers showed that

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they had not been thinking carefully or systematically about this matter at that stage; there was, I have to say, evidence of complacency. However, the Government have moved enough to be commended.

Equally, a recent Cambridge study casts doubt on whether even that preparedness will in fact deal with the situation. It says that some regions could come under particular pressure-patchiness again, but a different form of it. For example, the south-east coast region, which has only one relevant intensive care unit in Brighton, could see five times as many patients as it has beds for. That is a serious question being raised by a serious research team and there ought to be answers, even if they are not available today. We ask the Government to look at their improved policy and, in the light of what this study is giving to us, at whether further strengthening of the provision of intensive care beds would be sensible.

My final point is about communications. There have been good developments; we pressed this quite hard early on. There is good progress on the Department of Health website. The Government have sponsored the preparation of a leaflet on the most-asked questions to be distributed to key workers, which is good, as is the way in which private sector or professional groups have been involved-for example, the BMA's General Practitioners Committee and the Royal College of General Practitioners. I commend the latter body particularly because it was kind and gave me an honorary fellowship, so I have access to its website and its weekly bulletins, which have been first-class, and GPs have benefited from them immensely.

However, there are dangers with multiple sources. Having a lot of sources is good, but to which source does the worried individual go? Should that be looked at? I commend that to the Government. Are all the sources singing from the same hymn sheet? The answer is so far, so good.

The phone line has coped. The demands on it have not been as great as was predicted because of the nature of the pandemic, but there are still questions in the committee's mind about whether separating the number from NHS Direct was helpful. I gather that this was not done in Scotland. I understand the Government's reasons for wanting to do it here, but the number that a patient confronting the situation thinks of first will be NHS Direct, not a separate phone line whose number may be printed on a scrap of paper that came through the letterbox.

If the communications have gone really well, the impact will be great. However, a recent survey of 2,000 people suggested that almost half of them doubted whether they would be happy to accept a vaccination. There is a communication issue still to be faced there. Fewer than 10 per cent of the children coming into hospital had had antivirals and, of the whole population going into hospital, fewer than 15 per cent had done so, which suggests that there is a gap. Of the 10 million vaccination doses that went out, we have evidence so far of 1 million being used. The numbers may have improved, but why the gap between 1 million vaccinations and 10 million doses?



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In conclusion, we have made some good moves and I commend the department for that, but there are lessons to be learnt. I commend all those on the front line who have been doing such marvellous work, but I also commend to the Government continuing vigilance. I beg to move.

4.55 pm

Lord Crickhowell: My Lords, I must first thank our chairman, our clerks and our advisers for all the work that they put into the preparation of our report. I shall make one general comment before I concentrate my remarks on a specific topic.

In the face of criticism that preparedness and testing had been too long delayed, it is hardly an adequate response to say that the H1N1 epidemic has effectively proved an end-to-end test of preparedness. If the epidemic had been more serious at this stage than it has proved to be, the Government would not have found that response acceptable, particularly by those who have suffered most from a worsening of the epidemic.

When the Minister, Gillian Merron, gave evidence to the committee in July, I suggested that there was a need for much clearer advice to be given to pregnant women about the steps that they should take to protect themselves and their unborn children from the effects of the pandemic. Based on the experience of one of my daughters, it seemed to me that even good hospitals and GP practices were not doing enough to remove the understandable fears of women or making clear exactly what they should or should not be doing. It was relevant in that context that the Royal College of General Practitioners reported:

"Concerned family doctors have also been in contact seeking the latest recommendations on the protection of pregnant healthcare workers that might come into contact with possible swine flu patients. It appears guidance on this issue is not very clear".

In response, the Minister referred to the detailed information available on the Department of Health's website and that of the Royal College of Obstetricians and Gynaecologists. I suggested that there was a need for clear leaflets on the subject to be available. Anticipating that the committee might pursue the point and urge clear guidance for this and other particularly vulnerable groups-the noble Lord our chairman has just referred to the importance of guidance-the Government announced positive action just before our report appeared. I shall have more to say about antivirals and vaccinations in a moment. Perhaps the strongest advice given to my two pregnant daughters has been to isolate themselves as much as possible before the birth, and to isolate their babies in the months after and to avoid crowds. That is clearly sensible advice, although not every mother will be able to do that.

We learnt in evidence from the Department of Health-I refer to page 37 of our report-that neither oseltamivir, which is Tamiflu, nor zanamivir, also known as Relenza, is licensed for use in pregnant or lactating women, but that Tamiflu is licensed for use in children over one year old and that solutions of very-low-dose oseltamivir were being prepared by hospital pharmacy units for use with children under one. Zanamivir is not licensed for children under five years old and is not

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available in a suitable paediatric presentation. Rather confusingly-it is the very same paragraph-we were told that zanamivir was the preferred drug for pregnant and lactating women. We were later told in a supplementary paper-I refer to page 66 of our report-that, in general, Tamiflu may have additional benefits over zanamivir by being more systematically available against a wider spread of infection in the body and, again, that it can be given to younger children over one. However, zanamivir, more commonly known as Relenza, has fewer side effects. Trials have supported the effectiveness of both in alleviating and reducing the duration of symptoms. On the advice of the Scientific Pandemic Influenza Advisory Committee, Tamiflu has been selected as the main antiviral, except in the specific instances where it is unsuitable, which include pregnant and lactating women who are treated with Relenza. The Minister, Gillian Merron, confirmed this in response to a question from me in her evidence on 2 July, adding,

I asked about possible allergic reactions and was told by Professor Sir Gordon Duff that the indications were that Tamiflu is as safe as any drug ever is, but that up to 10 per cent of people report nausea. He did not say anything about the side effects of Relenza, and I do not think I ever got an answer about allergic reactions to flu injections. I referred to the case reported of a child at a Dulwich school, who had a very mild attack of swine flu and a very violent reaction to Tamiflu. The Daily Telegraph reported on Saturday that European regulators had said that children receiving their second dose of the swine flu jab may develop a high fever. We have also heard reports of the development of some resistance by the virus to Tamiflu and the transmission of a Tamiflu-resistant strain in south Wales. Again, this was referred to by the noble Lord, Lord Sutherland.

Perhaps more serious questions arise about the effect of vaccines on pregnant and lactating women and young children. The committee had completed its work by the time that swine flu vaccines were made available and approved as safe. Because of the brevity of the testing period and the relative lack of experience worldwide of the effects of having the vaccine, it is hardly surprising that there is quite widespread anxiety, particularly among pregnant women and the parents of young children, who feel that as the effects of swine flu seem to be relatively mild in the great majority of cases, they would rather not risk any as yet undisclosed hazards arising from the vaccination. They tend to point to past disasters with new products that were initially said to be safe but were later the cause of tragedies.


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