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Lord Warner: My Lords, this is an important issue, which the Government take very seriously. I am grateful to the noble Lord for giving us an opportunity to set the record straight on a number of areas, particularly where he was not altogether fair in his presentation of the Government's position—I hope that he will appreciate that later. I was grateful for the extremely balanced contribution of the noble Earl, Lord Howe, and that of the noble Baroness, Lady Barker. It is slightly surprising that two of the six speakers did not manage to put their names down to speak. I will certainly read the contribution of the noble Lord, Lord Jopling, with interest. I do not accept his criticism and I have nothing much to add to the full information given to him in our Written Answers. I will deal with the points made by the noble Countess, Lady Mar, in my remarks on MMR.
In the past 200 years the two most significant contributions to better health have been clean water supplies and vaccines; both have saved millions of lives throughout the world. That is why the immunisation programme in this country is key to the continued health of children. Parents' trust in immunisation is crucial for its success. Diseases such as smallpox and polio used to cause illness, disability and death. Because of vaccination, smallpox has been eradicated from the world. Polio has been eliminated from Europe and most other parts of the world. In my youth, polio was one of the scare concerns of many parents.
Even though smallpox and polio have been consigned to the history books, we accept that we cannot rest on our laurels. We continue to review our immunisation programme to see how it can be improved. Noble Lords will remember clearly the growing problem that we had
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with meningococcal C infection in the late 1990s. That terrible illness causes permanent disability and, all too frequently, death. Meningitis was the commonest infectious cause of death overall in children aged one to five in the UK.
The UK was the first country to introduce the meningitis C vaccine—in 1999. That was the result of collaborative research and work in this country. That research ensured that the vaccine was effective and had an excellent safety profile. It is worth bearing that bit of very recent history in mind. Parents all over the country welcomed the initiative, as it offered protection for their children against meningitis, the disease that, parents continued to tell us, they feared the most. As a result, cases of meningitis C have plummeted by over 90 per cent and continue to decline.
I accept totally that, if parents lose confidence in the safety of vaccines or underestimate the seriousness of the diseases, those diseases can and will return. In recent years, Ireland, the Netherlands and Italy have suffered from outbreaks of measles. In each outbreak, children have died. The UK has been more fortunate. There have been no childhood deaths in the UK from acute measles for over 10 years, but recently we have had to deal with inaccurate media-driven stories that have done much to make parents question whether to have their young children vaccinated.
It is not just Ministers who say this; it is worth reflecting on some of the independent research published by a number of groups on the MMR story. The King's Fund stated in its study on MMR and the media that,
"Arguably this is a case of media coverage affecting public behaviour in ways that may increase rather than reduce health risks".
A report from the University of Cardiff about the media coverage of the purported link between MMR and autism showed that the media coverage was,
"unintentionally misleading in creating the impression that the evidence for the link was as substantial as the evidence against it".
A study from the University of Birmingham found that,
particularly on MMR. That is not the Government's special pleading; those are the views of people who are independent of government and who have examined what we have had to contend with.
Given those quotations, it is hardly surprising that there is uncertainty in the mind of some parents. The decision to vaccinate a child should be straightforward. The benefits that vaccines bring to children enormously outweigh any risks. I was grateful to the noble Earl, Lord Howe, for his brisk dispatch of the idea that babies cannot cope with combined vaccines. That view is plain mistaken. Despite the anxieties that some parents have expressed recently, the vast majority choose to have their babies vaccinated. More than nine out of 10 infants complete all their immunisations by their first birthday. More than eight out of 10 children receive a dose of the combined MMR vaccine by their second birthday. Although the MMR figures are lower than the ideal,
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MMR uptake has risen in three of the past four quarters. That can be happening only because parental confidence in vaccine safety is returning—perhaps not as fast as we would like. We want to work hard to make sure that that trend continues.
I shall say something about what we are doing to improve patient confidence. In order better to understand parents' concerns about immunisation, the department commissions surveys every six months, involving about 1,000 parents of young children. The in-depth interviews with each parent help us to know the real concerns of parents and what they need to help them make decisions about vaccination. One clear message from parents is that they want clear, factual information. We are trying hard to meet that need by producing a wide range of resources, such as leaflets, factsheets, and websites. All of the material that we produce is tested first with parents to make sure that it meets their needs.
In all that work, parents have consistently told us that they have a high level of trust in primary care staff—the practice nurses, GPs and health visitors who are the frontline staff who play a crucial role in implementing any of our immunisation programmes. They are the professionals with whom parents can discuss their concerns and who provide advice on what is in the child's best interests.
We need to ensure that health professionals have the information resources that they need to carry out their work. Every year, the department carries out a survey of health professionals, just as we do with the parents. We give seminars to health professionals all over the country. I shall give the House some idea of the range of that work. The Department of Health has issued over 12 million leaflets and factsheets directly related to the immunisation programme. Our websites received over 20,000 hits and received 2,000 questions from concerned parents so far this year, all of which have all been answered. We have given presentations at nearly 50 seminars for health professionals and for parents. We have done a lot of work in that area.
We also want the public to be able to access the expert advice on which we base our work. Both the independent—I stress the word "independent"—Committee on Safety of Medicines and the independent Joint Committee on Vaccination and Immunisation do much to ensure that their work is available to all by publishing information about their activities on their websites. We are working all the time to see how we can bring more of that work into the public arena.
The noble Lord, Lord Hodgson of Astley Abbotts, suggested that decision making on vaccines should be transferred to an independent body similar to the Food Standards Agency. We do not accept that. I do not have time to go into all the arguments, but we have great confidence in the MHRA and the Committee on Safety of Medicines. It is independent and has served this country well. As noble Lords have acknowledged, we are doing much to improve the perception of transparency and the reality of that transparency. There are changes taking place in the regulatory environment that involve restructuring the Committee on Safety of Medicines and tightening up the approach, to ensure that its advice is
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seen much more to be impartial and entirely transparent. I am unconvinced, as a result of the work that we have been doing—it is one of my ministerial responsibilities—that setting up a further independent body would change the minds of concerned parents in the way that has been suggested.
The noble Lord, Lord Hodgson of Astley Abbotts, raised the subject of thiomersal. It is important to state clearly again the fact that the MMR vaccine does not contain thiomersal and never has. You cannot use thiomersal in live vaccines, and MMR is a live vaccine. Thiomersal is a preservative that has been widely used in vaccines for over 60 years. It is added in very small amounts to vaccines to prevent bacterial and fungal contamination, particularly in multi-dose vials where repeated doses are withdrawn, once the vial is opened.
There have been numerous studies. I do not have time to go through all of them, but I will give the House the references. I am happy to write to all noble Lords with the data. A major study in Denmark examined the question, and the Committee on Safety of Medicines has considered the available evidence. Work has been done by the European Medicines Agency. The United States has had a major review of all the evidence. The World Health Organisation is clear on the issue. The overwhelming finding of all that work by independent bodies is clear: all the evidence on the safety of thiomersal in vaccines has been thoroughly investigated, and the consistent message is reassuring.
However, from September this year, we accepted that the vaccines offered in the current routine childhood immunisation programme should not contain thiomersal. We switched to new vaccines in September because they contained a slightly safer form of the polio vaccine—an inactivated polio vaccine—which replaced the oral polio vaccine that had been used for many years. There is a very slight risk—about one in a million—of the oral polio vaccine causing a condition known as vaccine-associated paralytic polio. That slight risk does not occur with the inactivated polio vaccine that we have used since September.
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Despite all the remarks made by the noble Lord, Lord Hodgson of Astley Abbotts, about what we were up to in the summer, that is the straightforward explanation of the change. We had hoped to present it to health professionals in a more orderly way, but the story broke in a particular paper—very inaccurately. As happens in life, we had to deal with that as best we could. It happens sometimes. I recognise the helpful comments of the noble Earl, Lord Howe, about the contribution of Dr David Salisbury. It was a major contribution and it helped to settle matters down. Thankfully, parents do not believe everything that they read in the newspapers. The story died within a few days and all the information that we received from around the country is that the new vaccine has simply replaced the old one.
I do not have time to respond to all the points that were made. I shall briefly turn to MMR and autism. Experts from around the world, including the World Health Organisation, agree that there is no link between MMR and autism. It is true that there has been a steady increase, as the noble Countess, Lady Mar, mentioned, in the number of children diagnosed with autism since the mid-1980s. An MRC report on autism found that the increase was likely to be due to raised awareness of the condition, particularly among health professionals and parents, combined with a wider definition of autistic spectrum disorders.
The MRC has already supported a number of significant projects. In February 2002 the Government committed a further £2.5 million to the MRC for autism research. We are working on this particular area. It is also true that single vaccines in the MMR area can be imported from abroad unlicensed. It is the duty of the MHRA to assess the safety and efficacy of any applications for importing unlicensed vaccines into this country.
That is the best that I can do in the time available in responding to those issues. This has been a helpful debate in many ways. It has given me the chance to put the record straight on a number of issues. I shall certainly consider very carefully the points that I have been unable to deal with in responding to the debate and I shall write to all noble Lords on those points.
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