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The Countess of Mar: My Lords, I must apologise to noble Lords and to the noble Lord, Lord Hodgson, in particular for not having put my name down for this debate, and I am very grateful to have this opportunity to speak in the gap.
For many years, governments and scientists were trusted implicitly when it came to the matter of deciding what was best for public health. We are all used to having vaccinations against numerous diseases endemic in the UK and when we wish to travel abroad. That trust continued until the first cases of disability caused by whooping cough vaccines came to light. Parents fought a long and painful battle to win recognition, and then compensation, for their damaged children.
I propose to confine myself to the measles, mumps and rubella vaccine that is currently causing angst among parents. It is a fact that rates of diagnosed autism in pre-school and school children have increased exponentially. In Scotland, the past 10 years have seen a fourfold increase to 3,400 diagnosed cases.
Even before Dr Andrew Wakefield published his now notorious paper in 1998—which, incidentally, did not establish a link between autism and MMR vaccine but one between autism and inflammatory bowel disease—parents were making an association between vaccination and a change in their children's development. Their fears were dismissed. That is not an uncommon phenomenon in the medical or scientific professions. Perhaps I may say, cynically, that I speak from huge experience.
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When the pressure becomes too great, the Government and their advisers retreat behind the curtain of epidemiological studies. Without concurrent clinical studies, I have concluded that they are the medico-scientific equivalent of the parliamentary filibuster.
In the Lancet of 20 July 2002, Chi-Tai Fang and Wen-Yi Shau wrote that,
"the validity of observational research depends on the validity of existing knowledge about the cause of the studied disease. In other words, causal association cannot be established by data from observational research alone. Supportive evidence from experimental research, including basic science and randomised trials, is essential rather than optional for causal inference in medicine".
They have expressed concisely what I have been trying to convey for years.
The parents of autistic children are crying out for proper clinical studies to be conducted in order to underpin or disprove the epidemiological findings. Why have Ministers consistently refused to ask for such research to be commissioned? That is the very first action that Ministers should take to restore public confidence in infant vaccination unless, of course, they have a very good reason for not doing so. If there is a reason, the public should be told.
Will the Minister confirm that manufacturers of single measles, mumps and rubella vaccines have been instructed not to market within the UK and that, if any of their single vaccines are found here, they will lose their licences? If it is the Government's intention to eliminate these diseases, are they going to gain or lose public trust by taking such draconian measures?
Will the Minister also say how many of the combination of measles, mumps and rubella components in the live vaccine actually seroconvert at the first inoculation? I am aware that unpublished evidence shows that in more than 50 per cent of cases at least one component does not seroconvert. This is a serious failure and I cannot help feeling that somehow, so far as concerns MMR, we have all been betrayed. There are some parents with extremely sick children out in the world, and they need to be listened to and not swatted away like flies.
Lord Jopling: My Lords, I am grateful to have an opportunity to speak in the gap and I want briefly to raise one matter which is of great concern to me. I refer to the danger in the United Kingdom of a terrorist attack using smallpox as a biological weapon. During the Committee stage of the Civil Contingencies Bill, I moved an amendment in your Lordships' House in which I tried to strengthen the nation's preparation in the event of a situation as horrific as smallpox being used as a biological weapon. I am appalled at the very low level of preparation.
I asked a Written Question last July about how many people in the emergency services had been vaccinated to deal with a smallpox attack. I was told then that throughout the whole of the country only 141 doctors, 126 nurses, 19 scientists and six ambulance staff have been vaccinated to deal with
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that. I was told, and I have since told your Lordships, that in the United States 40,000 emergency service workers have been vaccinated.
In talking to the Department of Health, I was told that there is a reluctance among people in the emergency services to be vaccinated. They have a low level of trust. That is largely because of the side effects of smallpox vaccination. I am bound to say that I do not remember much concern about that when I was young.
I was told that the side effects of the smallpox vaccination can be significantly alleviated using what is called vaccinia immunoglobulin (VIG). That significantly reduces the side effects of smallpox vaccination. The Government have a large stock of smallpox vaccination shots, which are held in preparation for a terrorist attack using smallpox. The Minister will recall that I have asked questions over the past few weeks. On a rough calculation of how many people might need to be treated for the ill-effects of smallpox vaccination, it would be necessary for the Government, with the stock they already hold, to have 10,000 VIG shots available to deal with those side effects.
However, I find the Government have none or virtually none of these at the moment. In an Answer to my Question, it appeared that they were just starting a programme to acquire VIG stocks. I do not suggest for a minute that my Question caused that. However, I think that it is gross negligence that the Government in a complementary way with their basic vaccination shots have not acquired adequate numbers of VIG shots to deal with those side effects.
The Government are now in the process of getting bids to acquire those VIG shots. I ask the Minister: why have they not been acquired? Why, when they have been acquiring basic vaccination shots, have they not acquired the VIG shots? I think this is gross complacency by the Government and I should like an explanation from the Minister.
Baroness Barker: My Lords, I begin by thanking the noble Lord, Lord Hodgson of Astley Abbots, for intoducing the debate. I also want to thank him for very succinctly putting an end to a puzzle. Since I read the title of the debate I have tried to work out why he wanted to discuss the subject. He gave a very clear explanation.
I have chosen to address the topic in a slightly different way, but I shall come back to some of his arguments because I think they are very important.
I have to begin by declaring an interest. I am an employee of Age Concern England. That may not seem immediately relevant, but I assure noble Lords that it will be. I took this issue of public trust rather than the efficacy of the vaccination as being at the heart of the debate. That led to my finding some really fascinating and interesting publications on the Internet, as the noble Lord, Lord Hodgson, said.
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What are the factors that determine public trust in government policy? As the noble Lord pointed out, one of the key factors is access to information by the general public. The Guardian very helpfully this week listed 10 health websites one can go to to obtain health information, such as the National electronic Library for Health, the Hi Quality website, which was launched on March 2002 by the Centre for Health Information Quality, which is a division of the Help for Health Trust. That is designed to help raise standards of Internet health information and to give guidance and tips which enable people to make judgments about the credibility and quality of health information.
The Research Councils UK website was launched on 1 May to provide information on the work of the Research Councils, including the Medical Research Council, the SERC and the Biotechnology and Biological Sciences Research Council. There is an unparalleled wealth of information available. However, there are no means of enabling people to evaluate the quality of the information which is put before them. Therein lies one answer to restoring trust.
It seems—not least from listening to the "Today" programme and its seemingly weekly stories on yet another piece of health research—that the Government, and perhaps scientists too, have not yet fully woken up to the extent to which individual patients believe themselves to be far better informed than in the past and the extent to which that knowledge has undermined the assumed authority of government and, indeed, of healthcare workers to pass on information. We are a long way away from the time when doctors and scientists were seen to be the deliverers of authoritative information.
It therefore seems to me that we have gone past the point when it is acceptable for government to communicate merely the conclusions of research studies. We are now at a point where it is essential that the methodology of research is communicated. The noble Lord, Lord Hodgson of Astley Abbots, was absolutely right when he cited the announcement on 9 August of the move to the combination five-in-one vaccination. Against an unparalleled scepticism on the part of individuals about MMR, this simple announcement was made, smack in the middle of the school holidays when the people who should be its targets were away, that this would change.
From my reading of the literature, the work of the different agencies, for example the Medicine and Healthcare Products Regulatory Agency, which regulates vaccines and the Health Protection Agency, which monitors the incidence of infectious disease against vaccine take-up, is more widely available. Why do we have two separate bodies; how do they work together; and do they use the same epidemiological information? I accept that the Government have, to some extent, moved—not least in the yellow card system whereby a range of health professionals can report apparent adverse reactions to immunisation; and that is to be extended to individual patients and parents. How will patients—and I think for that read "parents"—be
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informed of their rights to be involved in making contributions to that important epidemiological information?
In the South East Thames Region of the NHS, a new system is in place to investigate vaccine safety. It is a system whereby hospital admission records are linked electronically to data about vaccination from child health and GP records. How will that system be evaluated and are there any plans to roll it out across the rest of the country?
In this country, vaccination take-up in general is high. That is a product of three factors. The first is years and years of public health information campaigns. The second is easy availability and low cost. There is perhaps something that the Government need to analyse in terms of generational difference. People of a certain age have a common experience of seeing people who had contracted polio. They had an immediate understanding of what vaccines were about. Small children grew up knowing about the work of Dr Salk. I suspect that there is now a generation of parents for whom that is not necessarily an immediate part of their experience. Their scepticism is therefore likely to be higher.
I do not want to repeat the statistics about the take-up of MMR given by the noble Lord, Lord Hodgson of Astley Abbotts, but launching the one-in-five vaccine against the backdrop of such deep scepticism seems almost inevitably to lead to the Government knowing that a large percentage of parents in some areas will opt out of vaccination altogether. That will result in children having less disposition to immunity.
In the face of that, do not the Government see that there may be a case for adopting single vaccine immunisations, while ensuring that they are tightly monitored and controlled? They could set up a control group to test the efficacy of that control group. As far as I understand it, at present, there are no data on the efficacy of single vaccines. Do the Government plan to carry out research about the prevalence of mumps among students? We now have a cohort of people who have not been immunised against that condition.
In the short time available to me, I want to respond to the points made by the noble Lord, Lord Hodgson of Astley Abbotts, about the independence of research. I find myself in some disagreement with him if he believes that taking research wholly out of the NHS will increase its credibility. I listened to what he said about the independence of research in the United States of America. I am not convinced that independence is necessarily any higher in the USA, because so much of the research is privately funded. We know from the work of the Health Select Committee in your Lordships' House in 2002 that that does not necessarily raise its credibility. Also, I would fear the lack of accountability that comes with taking research out of the NHS.
The noble Lord is right to stress to the Government the need for strict transparency. We need to push the Government on how they will engender trust by enabling individuals to evaluate the efficacy and quality of health information. Will that be an integral
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part of the legislation that will follow the publication of the public health White Paper? If we are to restore trust and confidence, that is key.
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