(2) what further consideration his Department has given to a policy of using antivirals for (a) household and (b) other prophylaxis;
(3) which antibiotics will be needed to treat the bacterial complications of pandemic influenza; when he intends to begin to stockpile those antibiotics; and if he will make a statement.
Suppliers have responded to the Invitation To Tender for antiviral medicines to increase the stockpile which was published in the Official Journal in August 2008, and these have now been evaluated. Orders have not yet been placed. For reasons of commercial confidentiality, it is not yet possible to make any announcements on the speed of the stockpile build. I will arrange for a copy of the tender documents to be placed in the Library when public procurement procedures allow.
There is ongoing discussion at scientific and policy level of antiviral household prophylaxis. For example, the Department has completed modelling which indicates that this is an effective strategy. We have also sought scientific advice on the issue from the Scientific Advisory Group on Pandemic Influenza (SPI), our external scientific advisory committee. This has concentrated on issues such as the size of the stockpile needed and the strategic approach to prophylaxis when the stockpile contains more than one type of antiviral. We are currently considering the delivery implications of a policy based on household prophylaxis, and the procurement approach to be followed. We are not currently considering other forms of prophylaxis.
Experts from the British Thoracic Society, British Infection Society and Health Protection Agency developed Clinical Management Guidelines for patients with pandemic influenza. These include proposals for antibiotics to be used for the treatment of bacterial complications. The guideline suggests antibiotics active against Heamophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus the bacteria, which most commonly cause respiratory infections. These include penicillin based products such as co-amoxiclav or a tetracycline such as doxycycline. For those allergic to penicillin, a macrolide such as erythromycin or clarithromycin is recommended. Complications requiring antibiotic therapy would be treated with a cephalosporin such as cefuroxime, which are administered with IV fluids.
Suppliers of antibiotics have responded to the Invitation To Tender published in the Official Journal in August 2008. These bids are currently being evaluated.
(2) what proportion of the antiviral stockpile for use in the event of an influenza pandemic is for use by (a) adults and (b) children;
(3) what the mass in milligrammes of oseltamivir stockpiled for use in the event of an influenza pandemic is; what the assumed dose in milligrammes of an individual course of treatment for (a) an adult and (b) children is; and if he will make a statement;
(4) how many doses of A/H5N1 vaccine are held by his Department; what proportion of the stockpile is reserved for the (a) armed forces, (b) healthcare workers and (c) other groups; and if he will make a statement;
(5) with reference to the answer of 13 December 2007, Official Report, columns 873-4W, on influenza disease control, when his Department's stockpile of Tamiflu will pass its shelf-life.
At the time of purchasing the current stockpile of antivirals, adult dosages were applied from age seven upwards. The relative proportions are 7.6 per cent., and 92.4 per cent., for children under seven and adults respectively.
The total mass of the current stockpile of Oseltamivir (Tamiflu) for the UK is 11 billion mg. The dosages per treatment course are 750 mg and 200-600 mg for adults and children respectively.
The bulk of the current stockpile of Tamiflu is due to reach the end of its shelf life in financial year 2010-11, the remainder is due to expire in financial years 2011-12 and 2012-13.
Approximately 275,000 courses of zanamivir have been stockpiled to protect pregnant women in the UK.
The UK holds 3.3 million doses of H5N1. The relative proportions are 2.9 per cent., 86.2 per cent., and 10.9 per cent., for the armed forces, health care workers and other groups respectively.
The Department continues to work in collaboration with a number of modelling and analytical groups both nationally and internationally to take forward both operational and epidemiological modelling work to assist preparedness for a possible pandemic. The main topics considered over the past 12 months have been the appropriate use of clinical countermeasures, the potential effectiveness of social distancing measures and the arrangements for real time modelling during the pandemic.
Where the consideration of these issues has led to a modification of the advice to policy makers the new advice has been recorded in the SPI-M modelling summary at:
The membership of the Committee on Ethical Aspects of Pandemic Influenza (CEAPI) is as follows:
Chair: Very Reverend Graham Forbes, Provost of St. Mary's Cathedral, Edinburgh
Mrs. Julie Acred, Chief Executive, Derby Hospitals NHS Foundation Trust
Mr. Chris Chaloner, Ethics Adviser, Royal College of Nursing
Mr. John Colvin, Consultant and Honorary Senior Lecturer in Anaesthesia and Intensive Care Medicine, Ninewells Hospital and Medical School, Dundee
Mr. Jane Cowan, Medicolegal Adviser, MPS Risk Consulting
Mr. Jean Jacques de Gorter, Director of Clinical Services, BUPA Hospitals Ltd.
Professor Robert Dingwall, Director of the Institute for the Study of Genetics, Biorisks and Society, University of Nottingham
Mr. Eugene Gallagher, Head of Primary Care and Family Practitioner Services in the Western Health and Social Services Board, Belfast
Professor Trisha Greenhalgh, Professor of Primary Health Care at University College London
Professor John Harris, Professor of Bioethics, School of Law, University of Manchester
Dr. Victor Larcher, Consultant in General Paediatrics and Clinical Ethics, Great Ormond Street Hospital, London
Professor Jonathan Montgomery, Professor of Health Care Law, University of Southampton; Chair, Hampshire Primary Care Trust
Professor Vivienne Nathanson, Director of Professional Activities, British Medical Association
Ms Jane O'Brien, Head of Standards and Ethics, General Medical Council
Professor Michael Parker, Professor of Bioethics and Director of the Ethox Centre at the University of Oxford
Dr. Clive Richards, Consultant in public health medicine, Nottinghamshire
Mr. Hugh Robertson, Senior Policy Officer with responsibility for Prevention, Rehabilitation and Compensation, Trades Union Congress
Mrs. Shahwar Sadeque, Educational and ICT Consultant and Chief Executive of TriEs Ltd.
Professor John Saunders, Consultant Physician, Nevill Hall Hospital, Abergavenny; Chairman of the Committee for ethical issues in medicine, Royal College of Physicians
Mr. Roy Taylor, Director of Community Services, Kingston upon Thames
Mr. Geoff Watts, freelance journalist
Professor Richard Williams, Professor of Mental Health Strategy, University of Glamorgan; Consultant Child and Adolescent Psychiatrist, Gwent Healthcare NHS Trust
Dr. Patricia Wilkie, Chair, Academy of Medical Royal Colleges patient/lay committee.
Representatives of the devolved Administrations attend as observers.
Our guidance document entitled “Pandemic influenza: surge capacity and prioritisation in health services - provisional guidance”, which has been issued to primary care trusts and other stakeholders for consultation and is due to be published in the new year, included an assessment tool for admitting individuals to secondary or critical care. We also plan to further refine assessment criteria, in consultation with key stakeholders, over the course of the year.
The Scientific Pandemic Influenza Advisory Committee’s Behaviour and Communication sub-group has met twice since its establishment in June 2008. These meetings were held on 19 August 2008 and 1 October 2008.
At these meetings, the group identified behavioural science-related research gaps relevant to pandemic influenza preparedness. The group has also assessed the feasibility of undertaking research to address any gaps.
The documents the sub-group considered were excerpts relevant to behavioural science from documents SPI/01/09a and SPI/01/09b, which were presented at the main SPI meeting in April 2008 and available on the SPI website. A copy of these papers has been placed in the Library.
The conclusions of the Behaviour and Communication sub-group meetings were recorded in the submission to the main SPI on the pandemic influenza research gap analysis discussed on 11 November 2008. A copy of this paper has been placed in the Library. It is also available to download on the Department’s Scientific Pandemic Influenza Advisory Committee (SPI) website at:
My previous answer highlighted the importance of gloves and aprons in supporting good hygiene practices in an influenza pandemic. The quantities and type of gloves and aprons, based on the number and type of patient interactions, are currently being investigated. The large numbers required and the need to ensure availability at point of use strongly favours the creation of a pandemic stockpile (without impacting on the Business As Usual requirement for these products). We are currently considering the most appropriate commercial options for building this stockpile.