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Health: Influenza Vaccination

Volume 724: debated on Thursday 20 January 2011


Asked by

To ask Her Majesty’s Government what plans they have to review the advice on the availability of the flu vaccination.

My Lords, the Government’s policy on flu vaccination is informed by the expert advice of the Joint Committee on Vaccination and Immunisation. The JCVI last met on 30 December to review the latest evidence. The committee decided that there were no grounds to change the risk groups that are offered vaccination and recommended that efforts be focused on maximising vaccine uptake among all those in the risk groups. As with all vaccination programmes, the JCVI will keep this matter under review.

I thank the noble Earl for his response. The latest figures show that approximately 780 people are in critical care, and there is still a long winter ahead of us. What steps are the Government taking in case the numbers continue to rise? Secondly, what steps have been taken to address the reported shortages of flu vaccines in some areas, with GPs and pharmacies running out of stocks?

My Lords, the noble Lord’s figures are slightly historic. Figures due to be published today will give a better picture. I spoke yesterday to the Chief Medical Officer, who told me that the rates to be published at 2 pm today will show a decrease from the figure that he mentioned. There has also been a further decrease since the new figure and it appears that the worst is over as regards the incidence of flu. On the second question, there have been reports of vaccine shortages. We have taken steps to address that by releasing stocks of the monovalent H1N1 vaccine from our national stock. That system is working well. There is an online ordering system, which GPs are using. They are also ordering stock directly from the manufacturers and we understand that that system is working well, too. The reports of shortages are, I hope, a matter of history.

My Lords, is my noble friend aware—I am sure that he is not—that over Christmas I presented myself at my GP’s for a flu vaccination? There was no vaccine in the surgery. He gave me a prescription, but there was no vaccine in the pharmacy, where I was informed that the general flu vaccine in this country had run out because the suppliers had run out of stock. I am delighted that the swine flu vaccine is still available, but surely that does not help any attempt to be vaccinated against general flu.

My Lords, we are very clear that the amount of vaccine produced for this season’s flu to address the probable need for vaccination was more than adequate. It is up to GPs to order the quantity of vaccine that they see as appropriate for their patients. That is what has happened over the past couple of years. Supplies are also ordered independently by private pharmacies. As regards my noble friend’s point on the H1N1 monovalent vaccine, I am afraid that 90 per cent of deaths have been from what is called swine flu, so that is a very appropriate vaccine to use in these circumstances.

Will the Minister comment on reports in today’s press that the Department of Health is intending to take back in house the ordering of flu vaccines because GPs have not done it properly?

My Lords, almost all vaccines, except the seasonal flu vaccines, are procured centrally because central procurement provides a cost-effective arrangement that can take account of the variation in supply and demand. It also gives us the ability to track where the batches of vaccine have gone. We are therefore looking at taking into the department the procurement of the seasonal flu vaccine.

Last time we discussed this subject, I asked the Minister why the advice given by the Centers for Disease Control and Prevention in the United States was so different from the advice from our committee on vaccination. My question this time is: is the Minister sure that the advice that he gets from our committee takes into account evidence that other countries gather and on which they base their advice? The CDC’s advice in the United States is to vaccinate everybody over the age of six months.

Yes, I am satisfied. The expert advice provided by the JCVI takes into consideration first and foremost the epidemiology of the disease in the UK, which may well differ from that in other countries. The noble Lord may be interested to know that, while the UK is experiencing H1N1 as the most prevalent flu strain, the prevalent flu strains in the United States are H3N2 and influenza B, so a very different situation applies in that country.

My Lords, I declare an interest as a member of an at-risk group who got vaccinated fairly early at the request of his doctor, which I acknowledge was based on expert advice. To follow on from the previous question, the plain fact is that that expert advice proved, in effect, to be politically unsustainable in one way or another. I think that that needs to be taken into account when we look at what we do next year.

I can reassure my noble friend that the advice that the JCVI gives is subject to regular review. Clearly, before the next flu season, it will be looking again at the experience of the current flu season.

What lessons have Ministers learnt from the management of the vaccine programme over the past six months? Is there anything that they may be prepared to do differently next year?

My Lords, the main lesson is one to which I referred a minute ago. We are considering bringing back into central procurement the purchasing of the seasonal flu vaccine, which is an exception to the normal rule. We purchase most vaccines centrally, apart from that one. There is a lot to be said for changing the ordering system so that we can keep better track of supplies and, perhaps, have more cost-effective procurement at the same time.

My Lords, I read a report in the media last week saying that, in light of the high incidence of children under five contracting flu, the Government are preparing to examine new evidence from the advisory group that could allow for all under-fives to be vaccinated. Have the Government reached a view on this?

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

My Lords, during the H1N1 pandemic, two organisations stood out as being essential to delivering a pandemic strategy: the Health Protection Agency, for its science, strategic planning and advice; and the PCTs, for their support and co-ordination on the ground. Both are due to be abolished in the next two years. Can the Minister inform the House about the Government’s pandemic plans, including, for example, the ordering of sufficient vaccine, both after the abolition and during the transition?

The noble Baroness asks an important question. The Government’s plans are to create what we are calling Public Health England, which will be the new public health service based centrally, linked closely to public health efforts in local authorities with local directors of public health. A pandemic vaccination campaign would be mobilised through those channels. I am clear that we have proper plans for the transition, which the noble Baroness rightly mentions as being a time when we need to have a specific focus on public health protection. The present plan, as she knows, is to bring the Health Protection Agency functions within the Department of Health so that there is a clear line of accountability from the Secretary of State downwards. I am clear that that is right. We will still have the expert advice that we do now from the people who are currently employed in the Health Protection Agency. That is an additional safeguard.