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Covid-19 Update

Volume 810: debated on Thursday 4 March 2021


The following Statement was made in the House of Commons on Tuesday 2 March.

“Today marks 12 weeks since Margaret Keenan became the first person in the world to receive a clinically approved vaccine for Covid-19. She has since been joined by over 20 million other citizens of this country in the biggest and fastest vaccination effort the world has ever seen.

This is a phenomenal achievement. Our vaccination programme is a national success story for the whole United Kingdom, and the reason it matters is that it allows us to replace the protection currently given by restrictions on our freedoms with the protection from science.

The data confirms that this strategy is working because the vaccines work. The number of hospital admissions is falling faster than the number of new cases, whereas in the first peak it fell more slowly, and the fall in hospitalisations is faster among the age groups vaccinated first than in younger age groups yet to get a jab.

I can tell the House about some further analysis that backs up this excellent news. The halving time of hospital admissions is now every 18 days. Over the past fortnight, it has fallen for those aged over 85 from 18 days to 15. This morning, the Office for National Statistics published data showing the number of deaths falling by over a quarter a week in mid-February. More than that, the number of deaths each day is not only falling faster than after the first peak, but it is falling faster in the over-80s, who got the jab first, compared with the under-80s. The number of daily deaths is halving every 12 days, but among the over-80s it is now halving every 10, so while the fall in cases is decelerating, the fall in the number of deaths is accelerating. What all this shows is that the vaccine is working, reducing the number of deaths among those who were vaccinated first and preventing hospital admissions. This is real-world evidence that the vaccine is protecting the NHS and saving lives, that the 12-week dosing regime is saving lives, and that this country’s strategy is working.

As well as this real-world data, I would like to update the House on two new pieces of analytical research published over the last 24 hours. First, this morning the Office for National Statistics published new data on the levels of protection people have. They show that up to 11 February, one in four people is estimated to have antibodies against coronavirus in England, up from one in five. The levels are highest in the over-80s, the first group to be vaccinated, showing again the protection from the vaccine across the country. The second piece of research, published last night, shows that a single dose of either the Oxford or the Pfizer vaccine delivers protection against severe infection in the over-70s, with a more than 80% reduction in hospitalisations. It is great news that both vaccines work so effectively. In fact, the protection from catching Covid 35 days after the first jab is even slightly better for the Oxford jab than for the Pfizer, so people can have confidence that they will get protection, whichever jab they are offered.

I am grateful for the work of colleagues across the House in promoting vaccine take-up, which has helped to deliver some of the highest levels of enthusiasm for vaccination in the whole world, and I am pleased to inform the House that we are now inviting over-60s to be vaccinated too. Although the day-to-day figures for supply are lumpy, we have some bumper weeks ahead later this month. Given that our vaccination programme began 12 weeks ago today, from now we begin in earnest our programme of second vaccinations, which ramps up over the month of March. I can assure the House that we have factored these second jabs into our supply projections, and we are on track to meet our target of offering a vaccine to all priority groups 1 to 9 by 15 April and to all adults by the end of July.

Our vaccination programme means that we can set out our road map to freedom and put this pandemic behind us, but we must stay vigilant because Covid-19, like all viruses, mutates over time. Part of controlling any virus is responding to new variants as they arise, just as we do with flu each year. Knowing this, we invested in genomic sequencing right at the start of the pandemic, giving the UK one of the biggest genomic sequencing capabilities in the world. Thanks to that, we have been able to spot variants here at home and support others to detect variants in other parts of the world.

I would like to update the House on the six cases of the variant of concern that was first identified in Manaus in Brazil and that we have now identified here in the UK. We know that five of those six people quarantined at home, as they were legally required to do. We have been in contact with them, and I would like to put on record my gratitude to them for doing their duty and following the rules. Whenever we identify cases of a new variant, we respond fast and come down hard by bringing in enhanced sequencing and testing, so we are stepping up our testing and sequencing in South Gloucestershire as a precaution. We have no information to suggest that the variant has spread further.

Unfortunately, one of the six cases completed a test but did not successfully complete the contact details. Incidents like this are rare and occur only in around 0.1% of tests. I can update the House with the latest information on identifying this case. We have identified the batch of home test kits in question, and our search has narrowed from the whole country down to 379 households in the south-east of England. We are contacting each one. We are grateful that a number of potential cases have come forward following the call that we put out over the weekend, and I would like to thank colleagues from across the House who have helped us to get the message out there.

Our current vaccines have not yet been studied against this variant. We are working to understand what impact it might have, but we do know that the variant has caused significant challenges in Brazil, so we are doing all we can to stop the spread of this new variant in the UK, to analyse its effects, to develop an updated vaccine that works on all these variants of concern, and to protect the progress that we have made as a nation. This country is on the road to recovery and we have freedom on the horizon. We must proceed with caution because although we are moving quickly, the virus moves quickly too. Let us not waver; let us do whatever it takes to keep this virus under control.”

My Lords, I thank the Minister for this Statement. I agree with the Statement in congratulating the NHS on its rollout of the vaccine, which continues to be a huge cause for optimism and hope, as does the science and research, in which the UK has played a leading role. However, we are still the country that has the third highest number of deaths in the world, at 124,000. Given the success of the vaccine and the strength of our science base, that is dismal. It must at least in part be attributed to decisions that the Government have taken or not taken, the failure of test and trace to do the job that we need it to do and the porous nature of our borders, on which we have again seen decisions taken too little, too late.

The concern about new variants means that, if the UK does not get on top of them, the valiant efforts of our NHS, our scientists and the vaccine could be terribly undermined. In January and February, cases here were running at tens of thousands a day and we were in lockdown, as we still are, because of our home- grown, new infectious variant. Nevertheless, people were allowed to fly in from abroad, bringing the P1 Brazilian mutation with them. Throughout history, epidemic after epidemic has exploited international travel. Surely it is obvious that tougher border controls should have been in place sooner.

The Brazilian variant cases arrived a month ago. They showed the problems of delays as well as the limitations of the pre-travel tests that did not catch those cases. Even now, 99% of the 15,000 daily arrivals are not covered by hotel quarantine. Most people can still travel home from the airport by Tube, train or even plane, mixing with others, as some of these travellers did, without being tested on arrival in the UK. Why are the Government still refusing to introduce additional tests on arrival and still allowing international passengers to travel onward on UK public transport? Does the Minister recognise that those gaps in the system will let more new variant cases spread? Is it also the case that there is a risk of cross-infection at airports where congestion is occurring? I understand that yesterday there were queues that lasted for several hours at Heathrow. What are the Government going to do about this? It is shocking that people are mixing, having arrived from a list of countries at risk, instead of going straight into hotels for isolation.

Of course, I welcome the progress that the Government have made in identifying the batch of tests from which that of the missing infected person came, but how on earth can a test be processed that does not collect contact details? What mechanisms have been put in place to fix that for the future? Some £22 billion have been allocated to this system, but it feels as though someone has vanished into thin air. How is the hunt for this person proceeding? Can the Minister assure us that this will not happen again?

Is there any information suggesting why this variant is spreading? The Minister might recall that John Edmunds from SAGE told the Home Affairs Select Committee in January that for every identified South African variant case, there were probably another 30 that had not been identified. Can the Minister tell the House, therefore, whether he has received any estimates of the number of unidentified cases in the wider community?

We are in a race against the evolution of this virus, so we have a long way to go. To be frank, nowhere is Covid-safe until everywhere is Covid-safe. None of us wants to yo-yo in and out of lockdown, so will the Minister guarantee that the lockdown easing will, as promised, be absolutely based on data, not dates, and that the assessment time between each step will not be compromised?

I welcome the extra surge in testing, but what is the current timeframe for genetic sequencing? How can it be speeded up? What steps will be taken to ensure that areas such as Ashfield, Leicester, Watford, Worthing and Hyndburn are not left behind when the national lockdown restrictions begin to lift, or will those places be put in localised lockdowns? Will the local authorities there be given extra resources to do more door-to-door testing and retrospective tracing? Will workplaces in those areas be inspected by the Health and Safety Executive to ensure that they are Covid-secure? Will people finally be given decent sick pay and isolation support?

On the Budget, it beggars belief that it did not include any detailed plans for the NHS. Indeed, the OBR highlights this, saying:

“The Government’s spending plans make no explicit provision for virus-related costs beyond 2021-22, despite its Roadmap recognising that annual vaccination programmes and continued testing and tracing are likely to be required.”

We know that the last reorganisation of the NHS cost £3 billion and that does not seem to have been put into the Budget either. Can the Minister explain how the NHS will catch up with the enormous backlog that has been created, as well as the ongoing pandemic-related costs? This is an urgent question.

It has also emerged that the Government appear to have delayed social care reforms until 2022, with the Chief Secretary to the Treasury, Stephen Barclay, telling campaigners that plans for sustainable improvement will only come next year. In January, the Prime Minister told Parliament that the Government would bring forward plans later this year, so will the Minister confirm whether it is this year or next year or when they actually intend to launch reforms on social care?

My Lords, from these Benches we, too, congratulate everyone involved in the vaccination process, including our brilliant teams of scientists, both in this country and abroad, who have been working—and continue to work—tirelessly on safe and effective vaccines for the world. We also congratulate the teams who are organising and managing the supply chains and all of those on the front line delivering jabs in arms, or supporting them to make it possible to reach the target of 20 million doses achieved this week. We will also not forget everyone working on Covid at the moment, whether front-line staff in health and social care or back-office staff who may not be visible to us but who are making sure that all these processes are working. We thank them all.

It is reassuring to hear that the second jab supply chain has been factored in, but can the Minister please tell the House if the supply chain and vaccination dose capacity is also protected for the next priority groups due to receive their first dose? This is critical to lifting lockdown.

It is good news that the clinical trials under way since before Christmas are demonstrating that the over-80s are developing good antibodies to resist the coronavirus and that this is now evident in the data. It is fascinating to see the vaccine gap in graphs, showing that there is a much steeper decline in cases in the over- 75s than there is in the under-60s. It is also encouraging to see reports that there have been very few side effects to both the AZ and the Pfizer vaccines. Can the Minister say if this information will be used to encourage those who have so far refused their first dose?

The Octave trial, funded by the Medical Research Council, is now under way, assessing whether those people with compromised immune systems are able to make antibodies. It was reassuring to read the details of this trial from some participating universities and university hospitals and I am grateful that Professor Chris Whitty was able to outline this project in a briefing to parliamentarians recently. I had understood it to be well under way already, although the press release makes it sound as if it is much more recent and still recruiting. Can the Minister say when the Octave trials are likely to publish their results, given that many people currently shielding are anxiously waiting for them?

The Statement refers to the Brazilian P1 variant and to the case of the individual who had not completed their form correctly. There has been silence over the last couple of days, and I wondered whether the Minister could update the House on the search for this individual. As I raised earlier this week, can the Minister help the House to understand why such an issue was able to happen at all? Is it correct that there are no processes in place to ensure that, as people come into the UK, border agency staff check their passports against the online forms completed in advance, so that personal details, such as addresses, are visible? The noble Lord, Lord Balfe, made it plain—as have many others travelling into the UK—that these checks are rarely made, if at all.

Is it correct that local health and resilience forums are not given any details of people quarantining in their areas? This is important to ensure that care support teams would be able to check and provide help for those quarantining if they have any concerns. That might have helped with this particular case: a traveller from Brazil feeling unwell would have had a local contact to talk to about what to do.

Finally, as we wait to see if cases, hospitalisations and deaths have reduced enough to start lifting lockdown carefully in April, can the Minister respond to the report published today showing that test and trace has barely used the check-in app data from visitors to pubs, restaurants and hairdressers, resulting in thousands of people who have been checked in not being warned that they might be at risk of infection? The report states that the Department of Health and Social Care has noted that more than 100 million people have checked into venues since it went live in the autumn, but only 284 alerts have been sent to 274 venues—not 274,000 venues, just 274. Worse, the report says that the lack of guidance for local resilience forum trace teams on how to use the data has left businesses being asked to, or volunteering to, contact customers and visitors, which is technically a breach of GDPR and leaves those businesses and venues open to potential legal challenge.

After spending £40 million on the contact tracing app, encouraging the public to act responsibly, and the department saying today:

“The NHS COVID-19 App is an important tool in our pandemic response”,

can the Minister tell us which of these statements are true? Can he confirm that the guidance given to local authority health departments on how to use the data to notify people from the app is in full compliance with GDPR legislation? Is the figure of only 274 venues receiving alerts correct—yes or no? What steps are the Government taking to remedy this before pubs, restaurants, hairdressers and non-essential retail begin to open again?

My Lords, I am enormously grateful for the questions from both the noble Baronesses, Lady Thornton and Lady Brinton. I start by echoing both their tributes to those involved in the rollout of the vaccine. It is a remarkable national achievement and we should all be enormously proud. My own wife was vaccinated last week, and she told me that she cried as she left the GP’s surgery—so moved was she by the experience. That is something I have heard many times before.

The noble Baroness, Lady Thornton, paid tribute to all those involved in science and research, and I absolutely agree. This has been a remarkable moment for British science. We will start celebrating British Science Week tomorrow, and I cannot think of a more apt moment to do that.

The noble Baroness, Lady Thornton, asked about the highest number of deaths. There are a number of reasons. Before I move on, I mention that today is World Obesity Day, and one of the most telling pieces of research that has come out in recent weeks is the work of PHE. We must all reflect on the nation’s health and whether obesity has played a role in Britain’s higher incidence of mortality. I look forward to reflecting on this issue more in the future.

The noble Baroness, Lady Thornton, asked directly about the decisions that the Government have made, test and trace, and the borders. Let me tackle those head on. On the decisions that the Government have made, I share with the Chamber that the road map announced by the Prime Minister has landed extremely well. It is extremely conservative. It puts school openings first, which is undoubtedly the feedback we have had from both parents and the country at large. The easing of measures for the rest of the economy and civic activity is based entirely on the data that emerges from the infection rates and will be done in a way that contains the spread of the virus.

I reassure the noble Baroness that the test and trace operation has developed remarkable capacity, and both the turnaround times for the testing and the effectiveness of the tracing have now emerged as being fantastic. The tracing of the Brazilian variant pays tribute to the effectiveness of the test and trace operation, as does Project Eagle, which has been mainly focused on the South African variant. We believe that the spread of the South African variant has been largely contained by the tracing of the Project Eagle team working closely with local authorities and infection control teams around the world. It shows what we can do with this remarkable resource.

With regard to borders, the “red list” and managed quarantine system has been stood up in an extremely effective way. The families in south Gloucestershire and Aberdeen isolated themselves, as they should have done, and the handling of their variant of concern has been professional. I am led to believe that progress is being made on tracking down our Brazilian friend, the one stray person with the disease.

In answer to the question of how someone could have a test without filling in the form, we believe that there are two ways in which that could happen. Someone could walk up to a testing site, have their test but not fill in the form properly, or they could have had the test sent to them in the post and returned it without filling in the correct form. There are lessons to be learned from both potential models, and we are communicating with those who provide tests to ensure that barcodes are put on all tests.

We have to run a risk-based analysis on cross-infection at airports and infection control within airports. We could close all airports—that could be one way of doing it—but, under the circumstances, I applaud both the airlines and the airports for putting in mitigation and hygiene measures which the CMO’s office believes will be effective.

The noble Baroness, Lady Thornton, asked about sequencing. We have stood up an enormous amount of new sequencing—30,000 samples a week is our current capacity—and we have dramatically reduced the time it takes to do sequencing. The biggest problem with that is transporting the samples around the country, and therefore we are looking at distributing sequencing capacity to the Lighthouse laboratories so that once a sample tests positive, it can be automatically taken to a plate to be sequenced at the same location. We believe that that could make a big impact.

One lesson from Project Eagle I share with the House is that door-to-door tracing is quite effective, but by far the most effective means of tracing has been intelligence-led tracing. The noble Baroness, Lady Brinton, asked about the check-in data, and this has been its power: it has allowed us to trace those who may have bumped into others in, for instance, areas of hospitality. It is not the objective of that check-in data to send out alerts to large numbers of people who may have been present in a location; it is more about empowering the forensic contact tracing necessary to track down potential connections.

The noble Baroness, Lady Thornton, asked about NHS plans. I will focus on one particular area and one of the lessons we have had from recent weeks. We have done an enormous amount to contain the spread of disease and we have seen—partly because of the lockdown, partly because of the wearing of masks, partly because of hygiene—a dramatic reduction in the amount of flu and gastroenteritis across the country. It is not an unrealistic ambition to hope that NHS resources could and should be focused on reducing contagious diseases across the piece and use the lessons from testing, hygiene and diagnostics generally to massively reduce the impact of contagious diseases. That will have huge benefits to the capacity of the NHS to combat sickness and ill health generally.

I thank the noble Baroness, Lady Brinton, for her kind remarks on the contribution of those in the back office of the NHS. I am sometimes admonished by those who say that there is simply too much white-collar, managerial wastage in the NHS. I do not accept that criticism, and the rollout of the vaccine shows the immense management muscularity at the NHS which is able to organise such a huge national programme with such efficiency and courtesy.

The noble Baroness asked about clinical trials. I celebrate the fact that the large amount of really encouraging evidence that we have had has vindicated the decision by the JCVI, the MHRA and the CMO to prioritise the first dose over the distribution of second doses and to bring in the 12-week gap. That was a wise, pragmatic and impactful decision and we thank those involved.

The noble Baroness is entirely right that the large take-up among older people will have a big impact on younger people. The most influential people in anyone’s life are the people whom they love and live with. I cannot think of a better way of marketing it to younger people than the older people whom they love and live with taking the vaccine.

I also pay tribute to Professor Paul Moss and the team at Octave who are working extremely hard on the impact of the vaccine on those with immune deficiency. As the noble Baroness alluded to, the work at the University of Birmingham is at pace. It has been going on for some months, and its impact is already being shared among professionals. I am not sure whether there is an official report planned, but I reassure her that the insight and intelligence from their work is being shared across the system.

Finally, I give enormous praise to all those currently working on our borders. The situation in other countries remains extremely concerning. Variants of concern are rising in many countries, and in Europe infection rates remain extremely high. We have put in place measures on our borders that have the capacity to protect us from these variants of concern and I am enormously grateful to all those concerned who have strengthened those positions.

My Lords, we now come to the 30 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.

My Lords, the speed and scale of the vaccine rollout is indeed a remarkable achievement and reflects great credit to all involved. The House will have noted the publication this morning of the REACH study based on data from February. Among its findings was that there was some regional variation in prevalence, particularly in the later part of February. Will the Government on this basis consider regional variation in the pace at which restrictions are lifted, rather than necessarily assuming that it will be a uniform, national approach?

My noble friend is entirely right to raise the issue of regional variation. It had been our profound hope to be able to adjust and to focus lockdown arrangements on geographical locations so that national measures were not the only tool in our toolkit. The evidence from last year suggests that the amount of travel that individuals do makes regional and local lockdowns only partially effective. This has put a massive question mark over the way in which we can use regional and local lockdowns. There is more work to be done to understand exactly how that works but he is right to raise it as a considerable issue.

My Lords, it is a great pleasure to congratulate the Minister on behalf of the Government on what has been achieved in lockdown. It is absolutely fantastic. I want to ask two questions. First, bearing in mind that some 20 million people have now been vaccinated, do the Government have any assessment of the number of people who still contract the disease after having had the vaccination? Secondly, do the Government have any idea about the relative impact of side-effects of the different vaccines?

My Lords, I have nothing but good news on both those important issues. The number of people who have mild or profound sickness, need hospitalisation or die after having the vaccine is extremely small indeed. There is some differential when we come to the variants of concern. Certainly, mild disease has been observed with the South African variant by sources in South Africa and we are working to understand that. However, severe hospitalisation and death are massively reduced by all the vaccines. The side-effects from all the vaccines on all age groups and on people with almost all comorbidities are extremely small. The yellow list information published by the MHRA is extremely reassuring and so far it has been nothing but good news about the vaccines.

My Lords, the House should be very grateful to the noble Lord, Lord Bethell, who is constantly being bombarded with our questions. However, I point out that within six hours of entering a cell this virus will have replicated, leading to millions of copies. Some copies will be imperfect, the so-called variants. Time is of the essence. The risk of dangerous new variants to which we have no defence is eventually likely to be inevitable. Will the Government now answer the question that has been repeatedly asked both in this House and in the other place since Christmas: as the red list of presumed points of embarkation is ludicrous and ineffectual, why do the Government not ensure that all those tens of thousands we have heard about entering the UK daily are effectively separated, screened, tracked, traced and isolated where necessary before they are lost within minutes somewhere in a British city?

My Lords, I thank the noble Lord for his grim prognosis and I agree with his analysis. If there is one place in the world where a mutant variation is likely to happen, it will be in an area where you have high infection rates and a large amount of suppression of the virus by either a lockdown or a vaccine programme. If you look around the world, that country is most likely to be Britain. We must be on the balls of our feet to be prepared for unhelpful news on that front.

Can I reassure the noble Lord on the borders? The number of people travelling in and out of the UK has reduced dramatically and the traffic through our airports and seaports is down tremendously. The application of the red list programme is extremely effective and the use of quarantine hotels has been extremely rigorously enforced. The isolation, along with amber routes, has also had enormous resources and is much more effective than it once was. We are prepared to go further. We review the red list constantly and, should the threats mount up to being serious enough, we will extend the red list as far as necessary.

My Lords, vaccines are key to getting us to a position where we can live with the virus, but we really must listen to scientists telling us that we must control the virus everywhere. While our support for the COVAX initiative is to be applauded, it cannot work effectively without reliable supplies of the vaccine. The Covid-19 Technology Access Pool is designed to do just that. Are we fully engaged in C-TAP?

My Lords, we are taking a leadership role in COVAX, CEPI, ACT, Gavi and all the international, multilateral initiatives to roll out vaccine around the world. We are looking at what to do with our own stock of vaccines, and the Foreign Secretary has made it very clear that distribution of the vaccines we have bought is very much on the agenda. The AstraZeneca vaccine is being used as probably the default vaccine of choice around the world, as it is low- cost and easily distributed. Through our G7 chairmanship, we entirely support the agenda of preventing further pandemic by ensuring that vaccines are fairly and widely distributed around the world.

I join others in congratulating my noble friend and his colleagues on the brilliant success of the vaccine programme. However, why is everyone in the United Kingdom, on receiving the vaccine, not being issued with a card to show that they have had it?

My Lords, they are issued with a certificate. It is a digital certificate that is put in their patient record. In the modern day, that is by far the most effective way to ensure that people know that they have had the vaccine. A physical card has the potential for fraud. We have looked that extremely carefully, but we think the digital approach is the right one. Most people will receive a small card with their second dose appointment on it, but if my noble friend did not get one, I am sorry about that.

My Lords, following on from that question, the need for vaccination passports to travel abroad, discussed earlier, now looks very likely, including, of course, to the EU, which will have its own standard. All the talk is of a phone app, but will the Government ensure that a paper version will be provided which will be acceptable abroad? A significant minority of older people still do not have mobile phones, and why should OAPs have to buy one in order to travel?

My Lords, in this matter, we will be led by international standards, and collaboration with our neighbours is essential when it comes to matters of international travel. If a paper certificate is required for international travel, we will put in place arrangements for that. A huge amount of the work that goes on for foreign travel nowadays happens before you ever get anywhere near the airport to depart. Passenger locator forms, pre-testing and vaccination certificates are all necessary in order to book a ticket, and that is where, really, the responsibility of the individual lies.

My Lords, I add my congratulations to the NHS and the Minister for the rollout of the vaccine, but with continued concern about the mortality rates. Churches, clergy and chaplains have been very involved in pastoral care and in support of the dying and the bereaved, even when buildings have been closed. There is now big concern with Holy Week and Easter coming up. Can the Minister offer a roadmap for when singing by choirs and congregations will once again be allowed, with sufficient time to prepare?

I am entirely sympathetic to the question posed by the right reverend Prelate. I cannot think of anything nicer than spending Easter at Salisbury Cathedral listening to the beautiful singing of the choir there. We will be led, however, by the public health practicalities on that. It has been one of the most heartbreaking aspects of this pandemic that those who seek sanctuary through worship have not been able to join the rest of their community, but the practicalities of the spread of the virus are unavoidable, so we will be led by public health advice in this matter. I do not have a date for his roadmap, I fear, but his considerations are very much understood in the department.

I thank the Minister for his continuing patience on this subject, and I am sure he did not mean to sidestep the two questions from my noble friend Lady Thornton. One was about the cliff edge for the social care sector, where the special funding is due to come to an end in March, and the apparent delay before we solve our care sector problem until 2022. The second was about there being no mention of NHS funding in the Budget, despite the fact that the roadmap recognises that annual vaccination programmes and continued testing and tracing are likely to be required. Does he have anything to say about those two areas of social care and NHS funding?

My Lords, we would not ordinarily expect a big announcement on NHS funding at a Budget such as this, and the truth is that we are not through the woods yet. It is impossible to predict what funds the NHS will need this year or next until we are through this pandemic, and while we are spending time today taking pleasure in celebrating the vaccine, the honest truth is that danger is still around the corner and we do not yet know that we are truly through this. When we are able to say that for sure, it will be possible to take a moment to decide on NHS funding. In the meantime, we remain committed to our manifesto pledges on hospital building and on recruitment, and on both those matters, we have made an enormous amount of progress. The Prime Minister has been crystal clear about his commitment to social care funding reform, and he stands by that commitment.

My Lords, given the undoubted success in the UK of the rollout of the vaccination programme, on which all involved are to be congratulated, our attention must turn, as my noble friend Lady Sheehan said, to consider the global operation because this disease is a global issue, not a United Kingdom one. The United Kingdom cannot live normally without the security of knowing that it is being tackled successfully globally. Will the Government use their chairmanship of the G7 to put in place and publish a global response action plan that goes further than what we have seen already and certainly further than simply donating spare vaccines?

The noble Lord puts it extremely well. We have four key themes in the health track of the G7. The first is pandemic preparedness in the round; the second is clinical trial data—that is an essential building block for pandemic preparedness; the third is medical data transfer—one thing we have tripped over repeatedly in our international collaboration on pandemic reform is the difficulty of sharing data; and the fourth is AMR, which is the threat on the horizon. If we have learned one thing from this pandemic, it is not to underestimate the threat from anti-microbial resistance.

My Lords, with the potential need for a rolling programme of booster injections or vaccination against new variants, can my noble friend tell the House what infrastructure is being planned so that we can protect our entire population for as long as is necessary?

I am grateful to my noble friend for looking forward. She is entirely right: the experience of this vaccination programme cannot stop when we have finished the initial rollout and we have to look to the future. As I said in my opening remarks, I am extremely hopeful that this can be an inflection point where we double-up on our commitment to rid the country of as much contagious disease as we possibly can. That will include booster shots, to which my noble friend alluded. It will also include a greater commitment to flu shots, and we very much hope that we can increase dramatically the take-up of flu shots at all ages, to stop not only illness itself but transmission.

Following on from the noble Baroness’s question and the importance of overall and ongoing vaccination coverage, can the Minister say how many people living in the UK are not registered with an NHS GP and therefore cannot be contacted for vaccination? We know that socially excluded groups, such as rough sleepers, Gypsy, Roma and Traveller communities and vulnerable migrants, are less likely to be registered, and there will be people registered only with a private GP. What assessment have the Government made of the scale of this challenge—how many people are affected—and what efforts are under way to find them and offer them vaccination?

My Lords, the noble Baroness makes her point extremely well. It is an area that we have looked at extremely carefully. The proportion of people who are not registered is remarkably small, but the phenomenon does exist. For this particular vaccination round, we have put in procedures so that those who turn up at a GP or vaccination centre who are not registered can be registered on the spot, and I thank colleagues at NHS D, who have put the necessary arrangements into the NIMS programme to make that possible. There are also others who do not know their NHS number—well, an enormous number of them now do know it. That is one of the blessings of this vaccination programme. We are also working extremely hard to reach out to the people the noble Baroness alludes to—the homeless, the Roma community and those who are recent arrivals in the UK—to make sure that the vaccination is offered to absolutely everyone in the UK, whatever their immigration status, whatever their living arrangements and whatever their medical history.

My Lords, last month the High Court concluded that the Secretary of State acted unlawfully by failing to comply with the transparency policy. When did the Prime Minister become aware that the Government were failing to meet their policy, and will the Minister now provide this House with minutes of each Cabinet meeting at which the government failure was discussed?

It was a regrettable administrative oversight; it was one that the Secretary of State has made it clear he would do again if it meant saving lives. I am not aware of it having reached the Cabinet.

My Lords, we should all be enormously grateful to those who have made the vaccination programme such a success. In our thanks, we should not forget Kate Bingham and her team. However, there are still inconsistencies. During the last lockdown, pre-vaccine, we could have services properly distanced in Lincoln Cathedral with a choir and a congregation. Post-vaccine, we cannot. Post-vaccine, we are still—I am back to my old hobbyhorse—allowing care home workers to attend to the most intimate needs of their patients having refused a vaccine. Can we have some consistency, please? I am grateful to my noble friend.

I am grateful to my noble friend for his question and I echo his comments on Kate Bingham. However, my Lords, we are not post-vaccine; we are, at best, mid-vaccine. Vaccinating 20 million people is an enormous achievement but there is a hell of a long way to go. There is still an enormous amount of infection in this country; nearly half a million people, or thereabouts, have the disease. There are variants of concern being generated in this country, such as the Kent virus, and overseas, such as the Manaus virus. Until we are truly through this, we have to show restraint and make uncomfortable decisions, and we must ensure that the NHS is preserved and we save lives. That, I am afraid, remains our priority.

My Lords, British science is indeed to be celebrated, as is government support of it, in vaccine development, genome sequencing and disease-specific registries such as UK Biobank. Will the Government use that experience to establish a national Covid registry to bring together the four main groups of data referred to by the Minister in his reply to the noble Lord, Lord Taylor, to inform long-term planning to reveal links between new variants found on sequencing, different long-term complications, including long Covid, the risk factors behind it and other matters such as body-mass index, vaccine history and any associated other contagious diseases? Such a registry could act as a long-term public health research tool.

My Lords, I am grateful to the noble Baroness for her insightful question about the obscure but vital question of data architecture. If there is going to be one powerful legacy of this awful disease, it will be the way in which data helped drive medical research, medical insight and the treatment of individuals. I am not sure if we need a new registry, a national Covid registry; what we need is for our existing data to be able to talk to itself. I can tell the Chamber that we are making enormous progress on that. I pay tribute to the unsung heroes, the CTOs who meet weekly at the NHS data architecture meeting, an obscure but vital forum where an enormous amount of good work is done by NHSX, NHSD, test and trace and others in primary and secondary care who are working incredibly hard, so that if one takes a test today, it goes into one’s patient record tomorrow and can be used the day after by a researcher looking at long Covid, dexamethasone, recovery or whatever. This is how modern healthcare should work. We have not done it well enough to date. We are making great progress on it tomorrow and we must not stop.

My Lords, like everyone else, I could not agree more that the NHS rollout has been absolutely brilliant. I should also say that the Minister has been resilient, and we all appreciate that. However, I return to what is a more uncomfortable subject, I suspect, and follow up the question on airport testing. The Minister said that far fewer people are travelling and that the pursuit of quarantine conditions is more effective than it was. Given that fewer people are travelling, is it not possible to do what my noble friend Lord Winston suggested and pursue those people through test and trace and airport testing, as many other countries are doing successfully? How can the Minister say that quarantine testing of people in self-isolation is more effective? Can he give us more details on that?

My Lords, I thank the noble Baroness, Lady Andrews, for her questions. Perhaps I may tackle the specific question of airport testing, which has been raised a couple of times. The honest truth is that the arrival of families in south Gloucestershire and Aberdeen who had done a pre-flight test and subsequently developed symptoms demonstrates, I am afraid, that pre-flight and airport testing is not as effective as one would hope. If it were, we would not have to impose a 10-day testing regime with tests on the second and eighth days. That is the only rigorous way in which one can do it. It is estimated that airport testing catches perhaps between 10% and 20% of infection, and that is why managed quarantine is so important. The infection rate among those who arrive in the UK is high enough for us to be seriously concerned and to impose the kind of isolation that we have done. Until that infection rate is reduced, I am afraid that we have to look forward to managed quarantine and isolation being a part of the travel experience for some time.

My Lords, I add my congratulations to those offered to all those involved in a remarkable national achievement. It has also been a personal triumph for my noble friend and all his colleagues. However, perhaps I may pursue the question that my noble friend Lord Cormack raised a moment ago. An alarming proportion of Covid infections have been caught by patients in hospital and those inside care homes. Can the Minister elaborate on government plans to require those who work in the NHS and care homes to accept vaccination if they are to continue to work among such vulnerable people? Why are so many of them so reluctant? Does he agree that the trade unions have some nerve in describing any suggestion of that sort as bullying?

My Lords, I completely acknowledge the concerns of my noble friends Lord Dobbs and Lord Cormack about nosocomial infection. Undoubtedly, infections caught onsite in Britain last year and this year, and in every epidemic, are not only among the saddest forms of contagion but among the most dangerous. I want to reassure both my noble friends that we are absolutely focused on this point. It is, though, too early to make a call on professional mandatory vaccination. We have got through only the first 20 million people in the highest-risk and, therefore, the oldest age groups, and we have not moved through all the other age groups. The Cabinet Office is looking at this matter and has a review process in place. When that process has coughed up its findings, we will be in a position to debate the matter, and I look forward to that in due course.

My Lords, does the Minister agree that the success of the NHS vaccination programme is a tribute to the efficiency and success of the public sector, in contrast to some of the private organisations involved in other aspects of dealing with the pandemic? I want to put a specific question to the Minister. He used the phrase, “Until we are through this pandemic”. Would it not be more sensible to say that we may never be fully through this pandemic, so our planning must be based on the fact that we will have to continue with the vaccination programme as new mutations develop for many years to come? Would it not be better to look that far ahead?

My Lords, I disagree completely with the noble Lord’s first point. The vaccine would not have happened without AstraZeneca and the other private companies that have produced, manufactured and delivered it, so I do not know where the public sector would have got its vaccines from. I completely reject that point.

I agree with his second point. I should not have said, “When we are through this pandemic” because we are going to live with its consequences for many years to come, and if it is not this pandemic, there may be others in the future. We have all, I think, taken on board the fact that in the modern world, there is a new, 21st century cost for the kind of global lifestyle that we have got used to, and that is the international spread of viruses. We can, I think, win the battle, but we will have to adapt. Learning how to do that is the challenge of this year.

I too would like to offer my congratulations to the Government on the speed and efficiency of the vaccine rollout. Due credit must be given to all our health professionals for their dedication in risking their own health in care homes and when visiting private houses. The sight of an end to the pandemic should not lead to smugness. We were caught ill-prepared when it began and, with environmental and climate change, along with the increasing movement of people, there will always be new threats. Does the Minister agree, as he has already hinted, that we should plan to use this experience to combat these new threats more effectively?

My Lords, I am grateful to the noble Lord for teeing up what I hope can be an insight about the future. We will have to work much more closely with our international allies and colleagues on this matter. We must invest in vaccines, therapeutics and antivirals on a prophylactic basis to be ready for when the worst viruses, including coronaviruses, emerge. We will have to bring international flying standards up to a much higher level so that the spread of viruses when pandemics occur is kept under control. We will also have to put the necessary surgical capacity into our healthcare systems to ensure that they are much more resilient than they were in the past. These are just three examples of the kind of changes that are on the horizon. I am hungry to get on with them and I am sure we will have a fantastic impact in our battle against disease.

My Lords, did the Minister have time to watch the David Harewood documentary shown at prime time on BBC1 on Tuesday about the massive health inequalities in the UK, which of course the Marmot report and reviews have been documenting for a decade? Why have so many Covid deaths been among the poor and the BAME communities?

My Lords, I am not an epidemiologist who can totally nail that question, but I recognise and acknowledge completely the assumption. This disease has hit the least advantaged the hardest, but trying to understand the correlation and causation of that is extremely difficult. The evidence so far suggests that some of these causes are to do with the environment: the houses that people live in, the circumstances of their employment and their behaviour within that employment. But some of this is about comorbidities and healthy lifestyles, as well as weight, which I mentioned earlier. These are all matters of grave community concern. We have to take an interest in the public health of the whole nation and we are only as strong as the weakest part. I agree with the noble Lord’s implication: this is a wake-up call for the whole country and we have to address the health of absolutely everyone.