Private Notice Question
My Lords, the challenge we have is uncertainty. Genomic sequencing data links the Brazilian variant to the South African variant, the so-called E484K mutation. We also acknowledge that there are anecdotes from Manaus on transmissibility, but none of this is clear cut. We are working towards getting the concrete data necessary to make a confident assessment of this mutation. Therefore, we are taking a precautionary approach and we are committed to limiting its spread by all means at our disposal.
I thank the Minister. According to a report by the World Health Organization, the P1 variant that originated in Brazil has been found in at least 15 countries which are not on the Government’s red list, meaning that arrivals from those countries are currently exempt from the hotel quarantine policy. Virologists have warned that the Government’s red list is at risk of becoming out of date at any time because of the time it takes to sequence coronavirus cases. Indeed, these six cases date back to 11 and 12 February. In the light of these facts, and given concerns that the Brazilian variant may be more transmissible and might be resistant to existing vaccines, will the Government review the red list and take urgent action to introduce a comprehensive hotel quarantine system that applies to all UK arrivals?
The noble Baroness is entirely right: this is not the first case of P1 in Europe. As of 11 February, P1 has been identified in 17 countries, with 200 cases reported globally. In the EU, 30 cases have been identified in five countries and areas. We keep the red list under permanent review and have an ongoing process of keeping it up to date. The fact that we have a red list and a managed quarantine programme makes further expansion of the red list possible. It puts our borders and our vaccine under a programme where we can control things, which is to be applauded.
How confident are the Government that our vaccines will cope with the Brazilian variant of the Covid virus and that the passenger from Brazil, who is somewhere in south Gloucestershire, will be traced? What measures are now in place to ensure that an incoming passenger is not lost again?
We are uncertain on the vaccine. There is a huge amount of speculation, but I would recommend that noble Lords take it with a pinch of salt because we cannot know for sure how the virus will behave with those who have been vaccinated until we have much better and clearer data. Regarding the current managed quarantine arrangements, I pay tribute to the teams which have stood up the system extremely quickly and well. The south Gloucestershire and Aberdeen arrangements have been incredibly impressive. It is extremely frustrating to all concerned that one person did not fill in the form and slipped through the net. But overall, the programme has shown itself to be extremely robust and we have an enormous amount of confidence in it.
My Lords, we seem to be devoting a huge amount of state resources to chasing one person with a mutating virus at a time when the National Health Service is on the point of collapse. Waiting lists are going up and we are in a terrible mess. Will the Government accept that viruses mutate and that we need a strategy to deal with that? Constantly locking people up and extending the list of countries so that you can put more and more people into hotels is a self-defeating policy.
The vaccine is absolutely central to our strategy. It is an approach that has proved enormously popular, and I think I speak for a large number of people when I say that defending the vaccine has to be our number one priority. If there were a highly transmissible vaccine-escaping mutation, it would take us back to the beginning of this whole pandemic. That is why we have put in place red list countries and managed quarantine. That is why we are committed to Operation Eagle and the efforts to track down those bringing variants of concern into this country.
My Lords, the scientists are concerned about the P1 Brazilian variant because of three mutations, one of which is common to other variants, making it more transmissible. One of the others is referred to as the “escape mutation”, which may bypass some vaccine-induced immunity. Does the Minister agree that, apart from the measures the Government are taking of trace, track and isolate and surge testing—which I thoroughly approve of—it is important to continue genomic sequencing, at scale, of Covid cases to detect variants that may arise and to monitor and study post-vaccine immune response? That would enable us to modify the vaccines to boost the immune response and deal with the variants.
The noble Lord is entirely right. Our commitment to genomic sequencing, which has lasted for years, has put Britain in great shape to be able to do the sequencing necessary to track these variants. We are doing more sequencing than any other country. But as the noble Lord knows, this is detective work, and it is extremely complex. While the 484K mutation might be the significant change in both the Brazil and South African variants, it might be one of a great many other mutations in its genomic characteristics. This is the detective work we are doing. I am afraid that it will take some time to get to the bottom of it, and it needs to be complemented by field studies into how the mutation reacts in real life, as well as with antibodies. The combination of immunology, virology, biology and real-world clinical study will give us the insight that we need.
My Lords, with due respect to the Minister, I wonder if a pinch of salt is quite the right treatment for some of these variants of the Covid virus. It is not just the Brazilian and other different variants. For example, in addition to Siqueira’s paper, which has just been published from Brazil in the last couple of weeks, the paper from Bogota shows numerous variants which are not quite the same. Some of these may be rather more virulent, and it is possible that they may even cause reinfection—it is certainly not very clear. The point is this: surely we need to be very cautious indeed about our airports and whether the list we have is sufficient. At what stage do we decide that we need to take much firmer action with all incoming passengers to the United Kingdom, making certain that they are properly tracked and traced?
The noble Lord is entirely right. Things are happening around the world which are causing a great deal of anxiety. Stories of possible reinfection in South Africa are extremely concerning and the huge spike in infections in South America has not been properly explained. It is possible that there are a number of mutations, and mutations of mutations, there. The truth is that we do not have the genomic or immunological data that we need to fully understand what is going on. That is why we have taken a precautionary approach, as the noble Lord recommends. We have instituted both managed quarantine and a red list which we keep under review. If we feel it necessary to extend that list, we will do so.
My Lords, tracing new variants will be key in the next phase of this public health challenge. So why does the £22 billion test and trace system not have an individual identifier on each test posted to homes, along with an integrated database? This way, every test could be traced back to an individual, regardless of where the test was sent from, or even if a person incorrectly filled in a form.
I endorse the noble Lord’s observation that tracing is important. I pay tribute to the Operation Eagle team. The noble Lord will note that the South African variant, which made landfall in the UK, is currently being contained through the immense work of this team. They are throwing a blanket over communities and doing a huge amount of forensic, detective work in tracing variants. As to his specific point, it is possible for someone to walk up to a testing station, take the test, be handed a form and not fill it in. We are trying to understand if those were the circumstances in this case.
My Lords, are there risks that the Brazilian variant may not provide adequate protection against reinfection and that vaccinations are less effective against this strain? It carries the same mutation as the Kent variation, which is rated 70% more transmissible than previous strains.
My noble friend is stretching my immunological skills to the limit. The Brazilian variant has a number of mutations. It is not clear to us whether those are mutations of transmissibility, vaccine-escape mutations or reinfection mutations, and therefore which we should focus on. All are possible and we are keeping a careful eye on this. An enormous amount of investment and research is going into understanding this more carefully.
My Lords, is my noble friend aware that Brazilian companies have a significant footprint in both parts of the island of Ireland? Given that there is a common travel area between the two, what discussions has he had with the Government of Ireland about this? How is it proposed to deal with inflows of people from Brazil who might be able to travel freely throughout these islands?
I am grateful to the noble Lord for flagging the Brazilian connection with Ireland, which I did not know about. I reassure him that there is an enormous amount of collaboration between Whitehall and Dublin on this matter. There are strong links on the managed quarantine programme within Ireland in order to close the “Dublin backdoor”, as it is sometimes called. I pay tribute to colleagues in Dublin for their collaborative approach. We do not currently have a five nations unified approach, but it is of interest. We are definitely keen to ensure that there is no backdoor entrance for VOCs through Dublin, or in the other direction.
My Lords, given the inevitability of variants and that some will evade antibody responses, what plans do the Government have for unified messaging, across the whole of the UK, that long-term distancing, mask-wearing and other measures are essential, and to tell the public that this is not like flu and we need to live differently?
The noble Baroness is entirely right, which is why the Prime Minister struck such a cautious tone when he unveiled the road map. We are not through this yet. A substantial proportion of the country is vaccinated, but we have to protect the vaccine. For those who have not been vaccinated, there are risks, and that is why we still have in force a “do not travel” alert and why we are maintaining marketing and communications at every level on the restrictions that are still in place.
My Lords, to come back to my noble friend Lady Thornton’s Question, the Minister will know that, at the SAGE meeting on 21 January, there were warnings that geographically targeted bans cannot be relied upon to stop the importation of new variants, partly because of indirect travel. He has just said that he does not want a backdoor entrance through Ireland. But what are the Government going to do about indirect travel, which is a clear route into this country to avoid the current quarantine rules?
Those who travel to the UK must fill in a passenger locator form. On the PLF they have to state whether they have been in a red list country. We also share an enormous amount of information with the aviation industry to cover people’s previous travel, and therefore it is not as easy as the noble Lord might think to take a hop and a skip into Britain through a third country, as has been proved by those who have travelled from Brazil and been caught by the red list. However, his point is well made, which is I why I reinforce what I said earlier: we keep the red list under review and, if it proves necessary to extend the countries on that list, we shall do so to protect the vaccine.
My Lords, at the outset, my noble friend said that the Government wanted to use all means at their disposal to combat the spread of all the variants and mutations. I refer to a point I made last week. One means at the Government’s disposal is to ensure that all those who work in care homes are vaccinated. It is quite wrong that they can refuse it and then attend to the most intimate needs of their patients
My Lords, I remind my noble friend that we have some mandatory vaccination already in place in the health service; those who perform operations and other intimate health interventions are required to have hepatitis and other vaccinations, for instance, so there is a precedent for what he talks about. However, it is a huge step, which impacts people’s personal liberty and choices, to make vaccination mandatory for more than a million social care workers. My noble friend makes a persuasive argument, which is why the Cabinet Office is looking at exactly this sort of matter; there is a strong public health argument for mandatory vaccination. Given that we have not rolled out vaccination across the whole population yet, it is premature to make that decision today, but we are considering it carefully.