(10 years, 4 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Geoffrey Clifton-Brown (The Cotswolds) (Con)
Thank you, Mr Speaker, for giving me the opportunity to raise the important matter of meningococcal B—or MenB—vaccines in this short debate. I also thank the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), for kindly responding on behalf of the Government. I appreciate that I have dragged her to these green Benches at a time when she might well be negotiating with the drugs companies and it might be difficult for her to respond to every one of my points. Nevertheless, she will understand that I must make them on behalf of my constituents and other members of the public.
There will be a number of hon. Members in this House with constituents whose lives have been affected by meningitis B. I have constituents who have had to deal with the suffering and loss caused by meningitis B, which is why I am here today further to raise the need for a national roll-out of the vaccination. My constituents, Dr and Mrs Turner, who are here today, tragically lost their 19-year-old granddaughter on new year’s day this year. As you are aware, Mr Speaker, their granddaughter, Emily, and her parents are constituents of yours. Emily’s uncle is a constituent of my hon. Friend the Member for North Wiltshire (Mr Gray).
Meningitis B is a comparatively rare disease, with about 1,800 cases in the UK each year. According to the charity Meningitis UK, however, many thousands of people die as a result of contracting the illness. The infection progresses rapidly and can lead to permanent disability or death within 24 hours of the symptoms becoming evident. That is sadly what happened to Emily. One in 10 people who contract the infection will tragically die despite the treatment that is available today. Of those who survive, one in five will have devastating life-long disability such as brain damage, hearing loss or limb damage.
Infants under the age of one year are disproportionately affected by meningitis B, with the number of cases peaking at the age of about five to six months. However, there is unfortunately another peak during late adolescence when students mix at university. Those are the two age groups that are most likely to contract meningitis B and the fact that there is another peak later in life highlights the need for a vaccine during infancy to protect people from lifelong suffering from this potentially devastating disease.
Parents up and down the country were given a sense of hope when in January 2013 a vaccine was licensed in the UK as well as in Europe and the US. The Bexsero vaccine was developed by the drug company Novartis and protects against approximately 73% of the different strains of meningitis B with apparently limited side effects. That was obviously very welcome, but there have been extremely long and costly delays in implementing any vaccination programme. The vaccine was turned down by the NHS after being considered by the Joint Committee on Vaccination and Immunisation.
The passion felt by many members of the public that the vaccination should have been implemented straightaway has resulted in various petitions urging the Government to do so. The charity Meningitis Now, which I heartily and sincerely congratulate on its constant campaigning, delivered a petition of 36,000 signatures to Downing street. My constituents organised a petition of around 5,000 signatures and I had great pleasure in presenting that petition to Parliament earlier this evening.
Jim Shannon (Strangford) (DUP)
I thank the hon. Gentleman for giving way and for bringing this matter forward for consideration. Meningitis B numbers have halved in the past 25 years, but there is no room for complacency. Some of my constituents have experienced devastating effects from meningitis, so, as the MP for Strangford, my issue is whether the hon. Gentleman feels that the vaccine, when it becomes available, should be available to the whole of the United Kingdom of Great Britain and Northern Ireland.
Geoffrey Clifton-Brown
I am grateful to the hon. Gentleman for his intervention. As I shall discuss later, this is obviously a big and costly undertaking for the NHS. As I am sure the Minister will mention later, there are delicate negotiations to be had, but if we start with babies—preferably babies under the age of 12 months—and then roll it out to students, the whole population will eventually have been vaccinated. Perhaps that will take too long, and once we have vaccinated those cohorts of the population, we might be able to find the money later to vaccinate other cohorts, but let us start, for goodness’ sake. In particular, vaccinating young babies would be an important start.
In my view, and in the view of many others, the Bexsero vaccine should have been rolled out immediately. Doing so could have prevented around 600 cases of meningitis B, and the associated 200 deaths between January 2013 and now. Although there have been delays in rolling out this vaccine on a national scale in the UK, it has been available privately since December 2013 for parents able to pay the high price, and it has been used across several university campuses in the United States. I am sure the House would agree that it is unsatisfactory that where a vaccine has been licensed and is available for use, only those who can afford to pay can get it.
Ms Margaret Ritchie (South Down) (SDLP)
I congratulate the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) on achieving this debate on an extremely important subject that impacts on many of our constituents. I have been tabling questions to the Minister about this. Does the hon. Gentleman agree that the most important issue is the time scale for the roll-out of this vaccine? I agree that the important age cohort is infants, and that vaccination should be rolled out to other age groups later.
Geoffrey Clifton-Brown
I thank the hon. Lady for her intervention. The key thing that we want to hear from the Minister tonight is an honest assessment of when the roll-out of the vaccine is likely to happen. That information will be particularly important to parents of young babies.
Within the announcement that there would be vaccine as part of childhood immunisation, the Department for Health stated that the Bexsero vaccine would be made available—I quote from a letter dated 25 April 2014 to me from the Minister—
“subject to it being made available by the manufacturer at a cost-effective price”.
That is the crunch point, as that will be a very large cost to the national health service, and the Minister needs to negotiate a good low price so that immunisation does not become prohibitively expensive. If anyone would like to see a copy of that letter, they should email me at cliftonbrowng@parliament.uk and I will willingly send them a copy. I am told that I am not allowed to deposit it in the Library, otherwise I would do so.
There are three things that I would like to ask the Minister to do. First, what does her Department consider to be a “cost-effective price” for something that will save many lives in the future? Surely it is impossible to put a monetary value on young lives. I urge her not to base her decision solely on how much the vaccine will cost, but to look at the hugely positive effects that implementing a vaccine will have, especially when one considers the trauma that parents have to go through and the devastating pain of losing a young child suddenly within 24 hours. Indeed, there are large costs associated with not vaccinating, as it is estimated that every case of MenB which leads to a severe disability will cost the Government £2 million to £3 million during the life of that child.
Secondly, the announcement made in March confirmed that the vaccine would be introduced only for infants at two months old, with a limited catch-up period for babies up to four months. Given that, as I said earlier, cases peak at around five or six months and the illness remains most common in babies under one year, I urge the Minister to consider implementing the vaccine for all infants under one year old at the time of introduction, to ensure that we protect as many babies as possible. In her response tonight could the Minister inform me of the difference in cost between providing the vaccine for all two-month-old babies, with a catch-up for all four-month-old babies at the time of introducing the vaccine, and the cost of providing it for all 12-month-old infants? I appreciate that she might not have those figures this evening. If she does not know the figures, I would be grateful if she would undertake a cost-benefit analysis of vaccinating all 12-month-old babies and let me have the figures. That would be helpful.
Thirdly, as I said earlier, there is another peak of individuals contracting meningitis B during late adolescence, as my constituent’s granddaughter sadly did. At university, people’s lifestyle is totally different; they mix and get different germs, and unfortunately that seems to mean that they are more susceptible to this dreadful meningitis B. There is therefore a strong case for a roll-out of Bexsero to university students to prevent the spread among that age group. As I have said, some campuses in the US have already administered the vaccine to stop outbreaks of meningitis across the student body. When evaluating the costings, will the Minister please embark on a cost-benefit analysis of providing the vaccine to all 18-year-olds in full-time education?
The Joint Committee on Vaccination and Immunisation has recommended a study to inform its decision on whether to recommend a vaccine for adolescents as the second most at-risk group of people. In her letter to me of 25 April, the Minister told me that the Department is
“considering how best to proceed with this”.
I urge her to instigate the study as soon as possible to prevent any further delays. Once it has been decided how to develop the study, people must be recruited to it as soon as possible, and once the results are available, they should be presented to the JCVI without delay, so that a recommendation can be made quickly. Only with speedy action and decisions can we prevent any more unnecessary deaths and suffering as a result of meningitis B in this group.
I would like to end where I started. Thousands of families suffer from the devastating effects of meningitis B, but we now have a preventive vaccine, which is fantastic news. The vaccine has been licensed for 18 months without being rolled out by the NHS. That delay has had a devastating effect on families of individuals who have contracted the infection and died or become seriously disabled. Now that the JCVI has given a positive recommendation for roll-out of the vaccine, that should happen swiftly. I urge the Minister to conclude rapid negotiations with Novartis. I ask the drug company to enter those negotiations with the Government in a spirit of good will, so that we can get this vaccine rolled out as quickly as possible. I also urge the Minister to consider expanding the current proposal of vaccination to include children up to one year old and adolescents, so that we cover all high-risk groups.
It is now possible to prevent further tragedies similar to that of Emily and thousands of others. We have experienced too many delays already. Let us end those delays, make quick progress, and find ourselves in a situation in which parents are confident that their child will be safe from the devastating effects of this dreadful infection. Every day’s delay is a potential life lost. Please will the Minister act as quickly as she can?
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this debate on the meningococcal B—or MenB, as I think we will call it—vaccination. It is a hugely important topic to which he has done great justice. Obviously, this is a very topical public health issue. He is not alone in this House in having had constituents who have felt the devastating effects of MenB, and he put his case passionately; I certainly respect that. Of course, we recognise the devastating impact that MenB disease can have, and Members have described it. It is often known among clinicians and parents as a parent’s greatest fear.
Children aged less than five years are most affected by MenB. As my hon. Friend mentioned, the peak of the disease is in infants aged 6 to 12 months. MenB is fatal for about one in 10 of those who develop meningitis and/or septicaemia. With early diagnosis and treatment, most people can make a full recovery, but around a tenth of survivors have major physical or neurological disabilities, including amputation, deafness, epilepsy and learning difficulties, so it is truly devastating. It is, thankfully, relatively uncommon, with an average of about 1,000 cases per year in England and Wales over the last decade. Incidence has been decreasing in recent years, as was alluded to in an intervention, but it is unpredictable and it could rise again quickly. That is why the advent of a vaccine that could provide protection against MenB is so welcome.
If the House will indulge me, I will go over the history of the investigation into the vaccine and the work of the Joint Committee on Vaccination and Immunisation. It is worth noting for the record that the JCVI is an independent departmental expert committee that provides scientific advice to inform policy making. It is a statutory standing advisory committee for England and Wales under the National Health Service Act 1977. It has no statutory basis for providing advice to Ministers in Scotland or Northern Ireland, although Health Departments in those countries may choose to accept the committee’s advice or recommendations, and they generally do.
In anticipation of a MenB vaccine being developed and licensed, the JCVI began work to consider a possible MenB immunisation strategy in 2010. The MenB vaccine Bexsero, manufactured by Novartis, was licensed by the European Medicines Agency in January 2013. The JCVI’s work before that date enabled it to provide advice at the earliest opportunity, so it is not quite right to say that there has been a great delay. The work had begun in anticipation to try to get us ahead of the situation. The JCVI looked to base its recommendations on the best available evidence for efficacy and cost-effectiveness.
Following the licensing of the vaccine, my right hon. Friend, the Secretary of State for Health requested a recommendation from the JCVI on the use of a MenB vaccine under the provisions of the Health Protection (Vaccination) Regulations 2009, which provide the basis for the public’s right of access to national immunisation programmes in the NHS constitution. The Secretary of State has a statutory duty to implement a recommendation from the JCVI on a new immunisation programme, so far as reasonably practicable, where cost-effectiveness has been demonstrated.
The Secretary of State and my predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), subsequently met to discuss the MenB vaccine with the national meningitis charities Meningitis Now and the Meningitis Research Foundation. Like my hon. Friend the Member for The Cotswolds and other Members in previous debates, I pay tribute to those charities for their excellent work.
The JCVI published an interim position statement on the MenB vaccine for consultation in July 2013 to assist it in making a complete assessment of the available evidence. That interim statement did not recommend a national immunisation programme because of uncertainties about the vaccine’s effectiveness and cost-effectiveness. In response to its consultation, the JCVI received new and recently published evidence on the MenB vaccine. The JCVI also considered comments and queries received in response to its interim position statement. Many of those comments and queries followed similar lines to those raised by my hon. Friend and made the same points on the severity of the impact on children who survive MenB. All the evidence and submissions led to further detailed analysis of the cost-effectiveness of a MenB immunisation programme.
Having considered the outcome of the further analysis at its meeting in February 2014, the JCVI recommended on 21 March that there should be a carefully planned national MenB immunisation programme for infants, starting at the age of two months. The JCVI made it clear that that recommendation was subject to the vaccine being available at a cost-effective price lower than the list price of £75 a dose.
There was some rather inaccurate media reporting when the JCVI’s recommendation was published that suggested that external influences might have led the JCVI to change from the position in its interim statement. The JCVI is an independent committee that greatly values its independence, so I remind Members that, in response to its consultation, the JCVI received new and recently published evidence and relevant comments that led to further analysis and the recommendation that the programme should be cost-effective subject to vaccine price. That is why the JCVI’s position shifted; there was no question of external interference.
Geoffrey Clifton-Brown
I am grateful for the way in which my hon. Friend is presenting her reply. From what she has said so far, the only issue seems to be the cost-effectiveness of the vaccine. Will she give any indication of when the cost-effectiveness issue is likely to be resolved so that a roll-out can begin for two-month-old babies, with a catch up for four-month-old babies?
Jane Ellison
Rather frustratingly, for me and for my hon. Friend—he alluded to this in his speech—I am not in a position to answer that, because to do so would be to pre-empt the stage we have reached with the issue. What I can say is that this country has world-leading vaccination programmes and a great deal of experience in planning them and rolling them out very effectively. I can assure him that all our experience would be brought to bear in a positive way at that stage. I cannot pre-empt either the timing or the price, but he can be assured of the expertise that sits behind the UK’s vaccination programme.
The Government welcomed and accepted the JCVI’s recommendation and hope that the UK will be the first country in the world to launch a national immunisation programme for MenB. As I have just said, that would continue our successful track record in providing a world-leading national immunisation programme.
I acknowledge that some people might say—I would not blame them—that cost-effectiveness should not be an issue when talking about a vaccine to protect very young children from a potentially fatal disease. However, it is important to consider cost-effectiveness so that money spent on new immunisation programmes does not use finite NHS funds that would otherwise provide more overall benefit to the wider population if spent on other treatments or services. We all recognise that those decisions are not easy, which is why so much expert thought and careful consideration go into them.
My hon. Friend asked when immunisation would start, and I have explained that we are not in a position to comment on that, but we are in a position to draw on great expertise when we face that issue. As I have said, the JCVI recommended that a MenB vaccine be introduced but only at a cost-effective price, below the list price published by Novartis. Therefore, the first essential step is to agree a cost-effective price for the vaccine with the manufacturer. We want to agree that with Novartis as soon as possible so that children can benefit from the vaccine, but we need to ensure NHS funds are used effectively, as I have explained. We must also follow due process on spending approvals within the Government before launching any procurement. That is quite a complex process involving a detailed business case.
We see the onus as being on the manufacturer to respond positively to the JCVI’s recommendation so that we can purchase the vaccine at a price that represents good value for money for the NHS. If we can obtain the vaccine at a cost-effective price, the introduction of the new vaccination programme would need to be carefully planned with the manufacturer and the NHS so that parents can be confident of a sufficient and sustainable supply of vaccine, with arrangements in place in the NHS for it to be provided and for clear information to be given to parents to enable them to make an informed choice.
I hope that it will give my hon. Friend some reassurance to know that last year the NHS introduced three new vaccination programmes and another one was rescheduled, which demonstrates that that is something we can do. That large expansion in the national immunisation programme was unprecedented. We must ensure that the NHS is fully equipped to be able to deliver another programme safely before introducing it. We hope to be able to start the procurement process soon and to purchase the vaccine at a cost-effective price.
My hon. Friend asked about adolescents. The JCVI’s advice was that research was needed on the effectiveness in adolescents of preventing transmission of infection. I am aware of the cases on US campuses to which he alluded. The Department is considering how best to commission the necessary work. If I have any update on that situation, I will write to interested Members after the debate. In addition, I will give an update on where we are in the process as soon as I am in a position to do so. If the procurement is successful, we will be in a position to make firm plans for the introduction of the new MenB immunisation programme. At that point I will be able to say a lot more. I accept that it is frustrating that I cannot say as much as he would like.
I thank my hon. Friend for raising this incredibly important subject. All of us, as constituency MPs, and certainly those of us who are Health Ministers, are extremely aware of the importance that many parents place on this subject and the fear that MenB raises for some many people. He was right to ask me to come to the House and address the subject, even if I cannot do so in quite as much detail as he would like. I look forward to updating the House in due course and will do my very best to ensure that I keep all interested Members fully up to date as we progress with this important process.
Question put and agreed to.