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Meningitis B Vaccine
(8 years, 6 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Ben Howlett (Bath) (Con)
I beg to move,
That this House has considered e-petition 108072 relating to the meningitis B vaccine.
As ever, it is a great pleasure to serve under your chairmanship, Mr Pritchard, and it is also a pleasure to see such a high level of interest in this debate from colleagues from all parts of the House. The petition that sparked this debate gathered over 820,000 signatures and received widespread media attention. Someone from every one of our 650 constituencies signed this petition; that shows just how horrifying meningitis B is, and gives a very strong indication of the level of public support for efforts to eradicate this disease.
Before today’s debate, the Petitions Committee and the Health Committee undertook joint oral evidence sessions, during which we heard from families who have been affected by meningitis B, as well as from charities and experts in the field. Some of those families are here today; I thank them for taking the time to share their stories with us. I also thank the charities that came along to the evidence sessions. The evidence that we heard will undoubtedly inform today’s very important debate.
Meningitis B is an evil disease that kills or maims hundreds of children in the UK every year. Finding out that their child has contracted this dreadful disease is clearly one of the worst things that can ever happen to a parent. We need to eradicate it as soon as possible, and I hope that this debate and the attention that it brings to the topic will lead to a new action plan from the Government.
Nick Thomas-Symonds (Torfaen) (Lab)
The hon. Gentleman has talked about the need for action soon. I got a sense of urgency from the constituents who contacted me. Does he agree that that sense of urgency needs to be reflected by the Joint Committee on Vaccination and Immunisation when reviewing the position with regard to meningitis B?
Ben Howlett
I thank the hon. Gentleman for his intervention; as ever, he is fast off the mark in intervening. I agree that urgent action is needed and I will come on to give the reasons why. From the evidence that we heard, there is, in effect, a two-year window for a vaccine’s shelf life, so I hope that when the Minister sums up, she will make that case clear. Previous campaigns on this issue have brought about change, and I can only hope that this campaign has gathered enough momentum to follow in their path.
Before I turn to the evidence that we heard in the joint sessions, I will mention a constituent of mine from Bath. I am sure that many hon. Members here have seen for themselves, as I have, the effects of this awful disease and what it does to those who suffer from it. One case that has particularly moved me is that of my constituent, Harmonie-Rose. She contracted meningitis B when she was just 10 months old. Just a few days after she had taken her first steps, she was taken into hospital with one of the worst cases of the disease that her doctors had ever seen. As she battled to survive, the toxins in her body spread to her limbs. The disease attacked and destroyed the tissue in her arms and legs, meaning that they had to be amputated in order to save her life.
Although Harmonie-Rose eventually recovered, she now lives as a quadruple amputee. Harmonie-Rose is a lovely, bubbly young child, living her life to the absolute full. She is beginning to adapt to her prosthetics; one day, she will have the freedom to move around that we all enjoy.
Mr Jim Cunningham (Coventry South) (Lab)
I congratulate the hon. Gentleman on securing this debate, and I also congratulate all the people who signed the petition. While this debate in Parliament is very timely, meningitis has in fact been around for a very long time. A constituent wrote to me to say that they were having difficulty getting the vaccination. More importantly, if they had gone private, it could have cost them something like £700, which is very expensive for any family, for any treatment. I wonder what the hon. Gentleman thinks about that.
Ben Howlett
I thank the hon. Gentleman for his intervention. He is quite right to pick up on the fact that the long-term costs to families need to be taken into account when the JCVI makes its decision about whether to extend vaccinations; I will come on to that issue later. It is quite clear that without the support of many of our constituents—those who fundraise and do so much work to help support families in need—those families would be in a much more challenging situation.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
I commend the hon. Gentleman on leading this debate. He gave the very powerful constituency example of Harmonie-Rose. We heard evidence from the parents of Faye Burdett, who made it very clear how fast the disease can strike, and how vital it is that meningitis is treated as quickly as possible to minimise damage. Does the hon. Gentleman agree that, as we heard in evidence, children under the age of five have difficulty communicating the symptoms that they are experiencing, and that is one of the factors that should be taken into account very carefully when considering extending the vaccination programme to those in that age group? They cannot communicate, which delays the delivery of the medical treatment that they so vitally need.
Ben Howlett
I thank the hon. Lady for her intervention, and I agree. Without giving away what I am about to say, I think that the evidence is quite clear on that, and I hope that the JCVI will look at that in due course. The fact is that Harmonie-Rose and many other children see their lives dramatically changed, or even cut short, by this tragic and awful disease, and it is time that we did something about it, here and now.
The petition that led to the debate was started by Lee Booth, who was told that his eight-month-old child was too old to qualify for the meningitis B vaccine. Lee was quite rightly uneasy about that, as the group most susceptible to contracting the disease are babies under the age of one. I am sure that we were all pleased when the Government made the unprecedented announcement that from September 2015 all newborn babies would be given the vaccine, making the UK the first country in the world to make that provision.
Michael Dugher (Barnsley East) (Lab)
On behalf of colleagues from all parties in the House, I thank the hon. Gentleman for the eloquent and passionate way that he is leading this important debate. He is aware of the heartbreaking case of Mia Barton, who tragically passed away last month after contracting meningitis B. Her courageous parents, my constituents Rebecca Barton and Matthew Bright, are campaigning incredibly hard, even in the midst of such awful grief. Does the hon. Gentleman agree that, at the very least, the JCVI should be open to reviewing its recommendations to the Government, and that the tragic death of Mia Barton underlines the need to look again at the age requirement for the national vaccination programme?
Ben Howlett
I thank the hon. Gentleman for his intervention, and my condolences go to Mia’s family, because obviously anybody who is lost to this tragic disease is a loss overall, and it is horrendous what Mia’s family have had to go through; I have seen that with the family of my own constituent, and as MPs no doubt we have all seen that. There is a question around age, and I will come on to that shortly. Like Mia’s family, Lee Booth is calling for the Government to extend vaccinations up to the age of 11, and I think that we need to review some of the evidence today.
Geoffrey Clifton-Brown (The Cotswolds) (Con)
I congratulate my hon. Friend on leading this very important debate. I have been involved in this campaign for a considerable while. Does he agree that there is not an issue about the safety of the drug, because it is very safe—we know that because it has been used very safely on students in American universities—and that it is simply an issue of cost?
Ben Howlett
I thank my hon. Friend for his intervention; I am aware of his work in championing this cause, which he has done for a while. I very much hope that the Minister will consider that point when she makes her summation.
Although it is quite difficult for all of us as MPs to say this, throughout this debate we must of course keep at the back of our minds the fact that the NHS has finite resources. Everything that the NHS provides has an element of cost to it, and a life cost-benefit, too. However, along with many other Members, I worry that the long-term benefits of childhood vaccination and the life chances that vaccination can give to so many children are not being considered as much as they should be.
Mrs Helen Grant (Maidstone and The Weald) (Con)
I, too, congratulate my hon. Friend on leading this debate, and on speaking so passionately but in a measured way about this awful, awful disease. GlaxoSmithKline reported annual profits of £10.3 billion in 2013. Its website devotes several pages to corporate social responsibility. Does my hon. Friend agree that the company would show real leadership and great responsibility if it was prepared to relax further the price of the Bexsero vaccine?
Ben Howlett
I met GlaxoSmithKline and we had a conversation on the issue. There needs to be a long-term conversation in the here and now with GlaxoSmithKline about the pricing of a catch-up programme. We heard an awful lot of evidence about that, and JCVI needs to take it into consideration. As part of that, I lend my support to those campaigning for a full review of the cost-effectiveness methodology for immunisation programmes and procurements, or CEMIPP, its understanding of life benefit, and what it takes into consideration when making a judgment call on life benefit. That has a huge impact on how JCVI makes its decisions. I hope that a review would have a wider benefit for all those children who might be put at risk.
From September 2017, we will start to receive information from the current vaccination programme of babies under the age of one, and we can begin to assess the success of the new approach. In September 2016, we will get early preliminary data on the early introduction of the vaccine. That will hopefully help JCVI readdress its decision on extending the vaccine to those aged up to five. As the UK is the first country to use the meningitis B vaccine, it is understandably difficult to predict its effects when administered on a large scale. The data will be incredibly useful in helping to formulate a plan from September 2017, but it is important to remember that while we sit waiting for the data, children are contracting the disease, with life-changing consequences. Sadly, in some cases they are dying. Families going through that trauma will not be comforted by the fact that from 2017 we will have a better idea of what to do.
It is the opinion of many research organisations that while we wait for the data, we should prioritise protecting the most vulnerable from contracting the disease through a one-off catch-up programme for children under the age of five. They are the age group at the next highest risk of meningitis B infection. That one-off campaign would put many minds at ease and help the future eradication of the disease. The current vaccine only has a two-year shelf life, so it makes sense for the UK to use the vaccines while it can, to catch all those under the age of five. The evidence that we heard showed that the number of cases falls substantially after the age of five. While it is always uncomfortable to set a cut-off age, that would be a sensible one to introduce in the here and now.
At the heart of every successful immunisation campaign is uptake of the offer. Information shows that uptake for the under-ones is strong; that is unsurprising given what the papers are publishing, and the sad stories of families who have suffered the devastating effects of their child contracting the disease. We must ensure that uptake is continually high and does not negatively affect the uptake of any other vaccinations, especially if a one-off catch-up programme is undertaken.
Catherine McKinnell
This is an opportune moment to highlight one of the other points that came out of the evidence we took in Committee: while vaccination is vital, public awareness is a huge concern for everyone. It is not only parents who need the best possible awareness of the symptoms; medical staff need it, too. Perhaps that awareness is not high enough. It would be good to hear from the Minister what the Government will do to ensure that public awareness and awareness among medical personnel is the best it can be, to ensure that the disease can be treated as quickly as possible.
Ben Howlett
We both heard the evidence that we need to increase awareness of meningitis B. Just because someone has had the vaccination, it does not mean that they are 100% certain not to contract the virus. We have to ensure wider awareness, not just among clinicians, but in nurseries and schools. That will ensure that the issue is higher up their agenda. I have seen some of the highly successful campaigns run by the Department of Health, and I hope we can support the Department in pushing more of those campaigns in the future.
We heard evidence about the importance of vaccinating young children, but Meningitis Now and the Meningitis Research Foundation point out that vaccinating teenagers could be the key to protecting the whole population from meningitis B, knocking out the infection at source before it can spread. That is because teenagers may be responsible for a high proportion of disease carriage. During our evidence sessions, we discussed at length the evidence to back that up. Vinny Smith, the chief executive officer of the Meningitis Research Foundation, explained that the bug lives in the noses and throats of people, particularly teenagers, but it does not live in everybody. The idea is that the key carrier group is targeted with a vaccination campaign that would hopefully protect the most at risk groups.
That targeted immunisation programme could be the solution when it comes to eradicating the disease. However, in-depth research has not yet been done on how effective that would be. It is hoped that the programme would severely reduce contraction of the disease, but it is unclear. What is clear is that a better understanding is at least three years away. We need to get the research process started as quickly as possible. It could benefit those young children who have not been vaccinated by reducing the chances of exposure. It is clearly too soon to advocate the immunisation of all teenagers, given that evidence is still unclear about the effects of immunisation beyond prevention in adolescents. When the research process is under way—I repeat that I hope it starts sooner, rather than later—a short-term option would be to extend the vaccination programme to under-fives who are at a higher risk of contracting the disease.
GlaxoSmithKline, which produces the vaccine, has said that it is prepared to work with the Government to ensure that there are enough vaccines for the catch-up period. The company will be under pressure from other nations looking to focus on their vaccination programmes. The Government need to place an urgent and vocal emphasis on vaccinations, as well as prevention. They would be an important voice in encouraging vaccination producers to have greater confidence in investing in the UK. All the families in the UK who want the reassurance a vaccination would bring would much rather we had a stockpile of vaccinations used in a one-off catch-up programme than for our country to miss out because we were slower on the uptake than our competitors. I hope that the urgency of the discussion is at the forefront of the Minister’s mind.
Nick Thomas-Symonds
I think the hon. Gentleman spoke about the benefits of reassurance. Does he agree that it is important that peace of mind is taken into account in evaluating the spreading of the vaccination programme?
Ben Howlett
Yes. I do not think JCVI gives as much consideration to peace of mind as it should. From speaking to the parents of Harmonie-Rose and others, I know that that sense of reassurance is in many instances unquantifiable, which makes it difficult for the JCVI to base a decision on peace of mind, but at the end of the day, my opinion, from the evidence we heard in the Committee hearings, is that we need a review of these matters.
As was highlighted repeatedly during the evidence sessions, the exact effect of the vaccine is still unknown, and parents should not ignore any potential signs of the disease just because their child has been immunised. They may still contract the disease, although the chance is much smaller. As ever, early identification is key. The families and experts we heard from stressed the need for strengthened education campaigns highlighting the symptoms of meningitis B, which include a rash that spreads quickly across the body, a high temperature with ice-cold feet and hands, and babies who are agitated and refusing to feed. While it is important that all parents receive that information, it also needs to be targeted at all those with responsibility for children, including childminders, teachers and nurses.
Mr Jim Cunningham
One of the things that struck me was that there has always been difficulty negotiating the price of drugs with manufacturers. Has the hon. Gentleman come across any evidence that in this case that could contribute to any delays with progress?
Ben Howlett
I have not yet seen that evidence, because we are a couple of stages away from that point. Compared with some of the other long-term battles in this place to get access to particular drugs, the conversations that were had with GlaxoSmithKline when the immunisation programme went up to the age of one were particularly small. Longer term, there is obviously a wider conversation that we need to have around access to medicines, if we are going into a world where everybody will, effectively, have a rare disease. We know even more now about genetics and the genome. The system is not set up to help the 68 million people in our country to access medicines in a quick way. That system needs to be created, and the work that the Under-Secretary of State for Life Sciences is doing is leading the way on that. I call on all Members in the Chamber to help speed up that process, and to put pressure on the Government to come up with an accelerated access to medicines review as quickly as possible to help the people that the hon. Member for Coventry South (Mr Cunningham) identified.
While we decide what needs to be done, we need to be thankful to the public for raising so much money to support the families living with the reality of a child having meningitis B, and thankful to the charities that provide them with financial, emotional and practical support. Only yesterday, some of the London marathon runners, including seven Members of Parliament, raised thousands of pounds to support such families. Such efforts are vital to providing support, and I know that families are thankful for those efforts. I am tremendously proud to represent a constituency where thousands of pounds have been donated and fundraised for Harmonie-Rose. I know the family are immensely grateful for all the support.
In summary, I am honoured to have been able to open today’s debate on behalf of the Petitions Committee. It is unsurprising that this campaign has gathered so much attention following the sad stories in the media. I hope that the Government listen to the widespread calls for a change in policy, and I hope that they have a one-off catch-up vaccination programme for those up to the age of five to put parents’ minds at rest while research is conducted into the impact on adolescents and the spread of this horrendous disease.
Mr David Winnick (Walsall North) (Lab)
It is a pleasure to follow the hon. Member for Bath (Ben Howlett), who has given a comprehensive account of this important subject. The debate was initiated by those who signed the petition, which received more signatures than any other petition that has reached the House of Commons, so it is obviously right and proper that we should have this debate.
I rise to speak about one of my constituents. I want to briefly mention what happened in a tragedy experienced by my constituents Mr and Mrs Timmins, who lost their beloved son, Mason, at the age of seven. Mason had been vaccinated against meningitis C, but in 2013 he tragically contracted meningitis B. The red rashes that I understand are usually associated with this disease did not appear. Mrs Timmins said she heard her son coughing and then he started to be sick. He fell seriously ill that day and, tragically, by midnight he was brain dead.
That day, the parents had rushed their son to the doctor, who immediately recognised that he had meningitis B and gave injections accordingly, and then he was taken to hospital. I do not think there is any criticism of the health service, but Mr and Mrs Timmins, understandably, are of the very strong view that all children should have the meningitis B vaccination. Indeed, Mrs Timmins arranged for her three-year-old daughter to be vaccinated privately. The family are of the view that had Mason had the vaccination earlier, he would have survived. We do not know that—there is no guarantee about anything—but I am speaking because of their strong feeling that that would have been the case.
Afterwards, to publicise what had occurred and so that it would not be a one-off obscure case that no one knew about, the parents released pictures of their son in his final moments, which can be found online. In the circumstances, I believe they were right to do so.
I am not a medical person. I do not have the medical knowledge to know whether what is being urged by Mr and Mrs Timmins and so many other parents is right. I do not know whether the reluctance to give the vaccination is because of cost, so I shall listen carefully to the Minister. However, I do know—I do not think there is any disagreement among Members of Parliament —that if children can be saved from the fate suffered by Mr and Mrs Timmins’ son, action should be taken along the lines that they urge.
So I shall listen carefully to the arguments, but I—and I believe many hon. Members—cannot accept the view that no action should be taken for reasons of cost. The debate is very important. Children have lost their lives and parents are grieving. We want to know what can be done to avoid the situation so tragically faced by my constituents.
Helen Whately (Faversham and Mid Kent) (Con)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank the hon. Member for Walsall North (Mr Winnick) for his powerful contribution and my hon. Friend the Member for Bath (Ben Howlett) for his comprehensive opening speech.
I want to start by paying tribute to my constituents, Neil and Jenny Burdett, who are with us this afternoon. Their two-year-old daughter, Faye, died on Valentine’s day this year after an 11-day battle against meningitis B. It is their determination that something good should come of their loss that has brought us all here today. More than 800,000 people signed the petition after they published a picture of their daughter gravely ill in hospital. They have shown incredible courage over the past few weeks and months since her death. They did not expect to receive this much attention; they just wanted to prevent other families from suffering as they have. The scale of the response to the petition shows how strongly people in this country feel about meningitis and the level of fear and concern that there is out there among parents.
I am proud that Britain was the first country in the world to vaccinate the most at-risk group of babies against meningitis B. In this debate, we should not overlook the important fact that the rest of the world is watching our vaccination programme and seeing how it fares. In the evidence sessions prior to this debate, we heard Britain’s immunisation programme described by one expert as
“the envy of the world”,
but that does not mean we cannot do more.
It feels cold-hearted to talk about cost-effectiveness, but we have to introduce that to the debate because we know that NHS resources are limited, and we must recognise that money spent on meningitis cannot be used to fight other diseases. After extensive research and the work that was done to make the case for the vaccination to be introduced, costs were included that would not normally be included in such a case for vaccination. For instance, litigation costs and health losses to family members were included. The JCVI, which makes the recommendations, concluded that it would be cost-effective to vaccinate babies up to 12 months, but not older children. If I understand it correctly, the Government are legally bound by that decision. I am sure the Minister will confirm this, but I do not know whether we can simply call for that decision to be overturned and an instant change in the programme introduced. But questions can be asked, particularly as a group is looking at the moment into how the cost-effectiveness calculation is carried out.
Mrs Helen Grant
Does my hon. Friend agree that we should not ignore things simply because they are hard to measure, especially in a situation such as this? Issues that have already been mentioned such as peace of mind and public preference are really important.
Helen Whately
I completely agree with my hon. Friend and neighbour in Maidstone. I know she has been contacted by many of her constituents about this issue. We need to ensure that the formula used to calculate whether the vaccine should be introduced includes things such as peace of mind and the level of fear about meningitis. It should also take into account the public preference for protecting children from illness.
Catherine McKinnell
The hon. Lady is making an important point. My understanding—I would be grateful if the Minister would clarify this in her response—is that in calculating the cost-effectiveness of the meningitis B vaccination, the JCVI has not fully considered the potential outcome for those children who contract meningitis but survive and the long-term costs for them and their families for the rest of their lives. Such costs are often borne by the state, so, along with the factors that the hon. Lady is outlining, there are other financial costs that have perhaps not been considered fully.
Helen Whately
I thank the hon. Lady for that comment. We may well hear from the Minister that some of those extra costs have been taken into account, but when the Select Committee took evidence a few weeks ago we heard from the Meningitis Research Foundation and others that the cost-effectiveness model tends to privilege near-term costs over long-term costs and benefits. It does not look at the long-term lifetime health impacts, positive or negative, from a person having had or not had meningitis.
That brings me to something called the discount rate, which is applied at 3.5%. I have been told that, as a result of that discount rate, the benefits of a vaccine reach zero by the time somebody is 27. People clearly live for much longer than that, so is enough account being taken of the long-term benefits of a vaccination programme when cost-effectiveness is calculated? For instance, it has been calculated that if a 1.5% discount rate were used instead of the 3.5% rate, the answer would be different and a catch-up programme for under-fives would be cost-effective. The NICE guidance states that a 1.5% discount rate can be applied if health benefits would be attained over long periods and for public health interventions. Surely vaccinations should fall under those categories?
Mims Davies (Eastleigh) (Con)
Given my hon. Friend’s experience in the NHS and the clear point she is making, does she think we are missing a trick if we do not listen to that argument now?
Helen Whately
The arguments I am putting forward should certainly be looked into, and it is timely to consider them now, because a working group is currently looking at the cost-effectiveness calculation. We need a real sense of urgency about the report on the calculation and it should be published as soon as possible. According to the conversations I have had, there seems to be uncertainty about how it is progressing and when we will be able to discuss the findings.
In the meantime, ever greater awareness of meningitis is important, particularly as it strikes so quickly. Parents need to trust their instincts if a child seems unusually ill, and it is critical for health professionals to listen to them. We have heard many tragic cases of children getting meningitis in which the parents had suspicions that their child was really sick. They have gone to hospital and seen doctors, but they have been sent home with instructions to give the child Calpol or something similar. We know that meningitis is very difficult to diagnose, but it is worrying that there is such variability in how children are treated when they turn up with potential symptoms.
Mrs Helen Grant
During the Select Committee’s evidence sessions it was suggested that information about the disease could be put in babies’ red books to raise parents’ awareness. Does my hon. Friend think that that is a good idea that should be considered?
Helen Whately
It should most certainly be considered. The Government should look into all possible avenues for raising awareness. Charities such as Meningitis Now are working very hard and have some excellent leaflets, but parents are often still not aware. I have three young children and I have worried about meningitis. I would look out for a rash, but through being involved in this petition I now know that the rash comes so late in the process that it can be too late by the time it is seen. Parents have to be ready to spot a whole host of other symptoms and, when they speak to doctors, to be really confident that they think their child is more sick than usual and that it does not feel like a case for just Calpol. Parents have an instinct. We need to encourage them to trust it, and health professionals need to encourage them to speak up about it.
I know that other colleagues want to speak, so I shall conclude my remarks. We need a much greater sense of urgency about the work on the cost-effectiveness of vaccination. Bearing in mind the points I have made about the discount rate and the value that society attributes to the life of a child, a case could be made for extending the vaccination programme to more children. Work should be done on how health professionals deal with possible cases of meningitis B. Whether or not the NICE guidance is still right, it is certainly confusing. We also need more transparency about doctors’ reactions to possible cases of meningitis B, because it is hard to see the difference in the data—we only have anecdotes about how doctors and others respond when they see a possible case.
The Government must do all they can to raise awareness. Whatever the outcome of the debate, I thank Neil and Jenny very much for all that they have done. The petition and debate have surely raised awareness of meningitis B throughout the country, which in itself will have saved lives.
Several hon. Members rose—
Mark Pritchard (in the Chair)
Order. Before I call Mark Durkan, may I ask everybody to check that their mobile phones are on silent mode? It affects the broadcasting equipment—[Interruption.] I rest my case—somebody does have their phone on.
Secondly, I am aware that there was an important health statement in the House today. Some colleagues wrote to say that they would arrive late, and I thank them for that courtesy. If Members stand, they will be called, subject to the order of speakers given to me by the Speaker’s office.
Mark Durkan (Foyle) (SDLP)
It is a pleasure to serve under your chairmanship, Mr Pritchard, and to follow the hon. Member for Faversham and Mid Kent (Helen Whately). She spoke so strongly on behalf of the Burdett family, whom she represents, and about the tragedy they have faced, and she also spoke to the wider issues raised by the petition following Faye’s death.
I thank the hon. Member for Bath (Ben Howlett) for introducing the debate in the way he did, and I also thank the members of the Petitions Committee for the great service they provided to not only the House but the public by holding hearings in conjunction with the Health Committee. These petitions are a new way for Parliament to engage with the public on important issues, and I hope we will learn from this debate that there is also a new way for Members to engage with Ministers to deal with questions that are not always as easy to address as we might want them to be.
Over the past few years, ever since Bexsero was first licensed as a vaccine in Europe, I have tabled a number of early-day motions encouraging the Government and the Joint Committee on Vaccination and Immunisation to move more quickly. Like Meningitis Now and the original Meningitis UK “Beat it now” campaign, I wanted to ensure that we did not have to wait another five years, as we had to for the meningitis C vaccine, with all the accompanying loss of life and life-changing damage done to children in the meantime.
Peter Dowd (Bootle) (Lab)
I met Harmonie-Rose the other day, and what a beautiful little girl she is. I do not want to make inappropriate or spurious comparisons, but the swine flu vaccine cost £1 billion, which, despite the criticism, was money well spent. Does the hon. Gentleman agree that a vaccine catch-up programme would also be money well spent?
Mark Durkan
I believe that it would. I will come to that point shortly.
Many Government and Opposition MPs in the previous Parliament and this one have been aware of the issues and concerns involved. First, there was the issue of whether we would get the men B vaccine on to the immunisation schedule as soon as we should. Thankfully, steps were taken last spring, and it came on stream in the autumn. The decision that was made by the Department of Health here effectively became the predictive text for what happened in my devolved area, and I welcome the fact that the Health Minister in Northern Ireland followed suit. A similar issue has arisen here. If the Department responds to the evidence that the Petitions Committee and the Health Committee took, which was based on the issues that the petition raised, that will make a difference not only to NHS England, but to my devolved area.
Being based in Northern Ireland, I am conscious that the south of Ireland has taken the decision to follow the UK on the men B vaccine. It will take it up later this year, which may have an impact on the supply of the vaccine. That is why we need to ensure that, when we talk to Government Ministers here and the devolved Ministers, we also talk to the authorities in the south of Ireland. Between us, we have a very good instrument—the British-Irish Council—which brings together all the Administrations on these islands. They should collectively discuss these policy issues and challenges, and they should combine their muscle to improve their negotiating power with Glaxo on any price implications or sensitivities in relation to the drug.
We have been asked to address three main questions, and I hope that the Minister will do so. I know that some will sound like technocratic issues, and perhaps talking in those terms will make the Minister feel uncomfortable or insensitive. There are the issues that delayed the men B vaccine being put on the schedule in the first place and the issues that we face now, particularly the cost-effectiveness framework. As many hon. Members have said, the framework needs to be adjusted to take into account peace of mind factors and the lifelong impact on those who survive meningitis but suffer lasting damage and have difficulties with the economic and social costs that arise from that. The hon. Member for Bath addressed the issue of ensuring that there is a commitment to funding the adolescent intervention study. Rightly, he did not over-speculate about that, but we need to fully understand it and see what can come of it.
As the hon. Member for Bootle (Peter Dowd) said, there is the question of the under-fives catch-up. Most parents understand that that is a basic thing that should be done. People find it hard to believe that there is a significant case against it; they think it is just a question of how we manage and organise it. It is not enough to say, “If we reach the newborns, that will be enough.” The risk is significant.
Like the hon. Gentleman, I met Harmonie-Rose last week in Westminster Hall. I could not help but be conscious that I was talking to a beautiful, lovely child, and that perhaps, if the men B vaccine had been on stream earlier and in the immunisation schedule when it was licensed, she would not have had to use her great charm to lobby on this issue.
If we delay the under-fives catch-up, how many other people will be affected? How many other young, precious lives will be lost? How many families will be plunged into grief? How many young lives will be harmed? How many young people will lose limbs or suffer brain damage or facial disfiguration? We need a response and an intervention, which is why people have petitioned so strongly. The people who petitioned us want action, and I hope the Minister will address them in honest but hopeful terms.
Maggie Throup (Erewash) (Con)
Thank you for calling me to speak, Mr Pritchard, despite the fact that I was unable to be here at the start of the debate. It is a pleasure to serve under your chairmanship.
Decades of immunisation have provided protection from a wide range of diseases and have been crucial to improving the health of the nation—indeed, health worldwide. The United Kingdom benefits from a world-class immunisation programme, which, as other hon. Members have said, is envied by many other countries. Nevertheless, there is still variation in the take-up of some of the key vaccines in both the early and teenage years, and the take-up of the flu vaccine in the older and vulnerable population could be better, so there is a problem in every age group. That does not seem right, given that we are debating a petition calling for the men B immunisation cohort to be expanded.
I commend the UK for being the first country in the world to provide a men B vaccine. As we have heard, the Republic of Ireland is going to follow suit. We lead the way in many areas of medical research and healthcare, and I am delighted that we continue to do so for this important public health and disease prevention measure, which will tackle the devastating condition of meningitis B —and, indeed, all types of meningitis.
Having a wide-ranging immunisation programme can cause problems. During the pre-debate inquiry, we heard evidence from parents who knew that their child had been vaccinated against meningitis but did not know that there are numerous types of the disease and that one vaccine does not protect their child from all of them. That can cause parents to rule out the possibility that their child is suffering from meningitis, which can delay their seeking medical help.
Seema Kennedy (South Ribble) (Con)
Does my hon. Friend agree that the rapidity of meningitis B is terribly frightening for parents? I pay tribute to my constituent Emma Moore, who lost her first child, George, to meningitis in October 2013. She told me that she had a perfectly healthy little boy in the morning, and that by 11 pm at night she had to see his dead, lifeless body. She would not wish that nightmare upon anyone.
Maggie Throup
My hon. Friend is completely right that the speed of meningitis B is incredible. We heard various such stories in evidence. We must do everything we can to stop that.
The petition has already raised the profile of the disease, which will help to bust the myth that there is one meningitis and that vaccination against one strain makes a child immune to other strains. It is often difficult for parents to know what vaccines their children have had, when they had them, when their boosters are due, and what they are protected and not protected against. In evidence to the inquiry, we heard that irrespective of that confusion, medical professionals should and must trust parents’ instincts more. Despite the fact that the numerous vaccines for the different types of meningitis can be confusing, parents often have a sixth sense that tells them that something is really wrong. However, I understand that medical professionals are concerned that we are becoming more and more resistant to antibiotics, and that if a child is treated with antibiotics without clinical evidence, that resistance builds up even more. This is a complex subject with no easy answers.
The good news is that the vaccination programme has started and is almost one year in. This time next year, the majority of infants under two years old—the group that shows the greatest prevalence of meningitis B —will have been immunised. I am pleased that the Minister has asked the Joint Committee on Vaccination and Immunisation to reconsider the men B vaccination in the one to two-year-old age group. Given the potential community effect, I hope we will start to see the end of the disease.
There has been a lot of focus on meningitis B in recent months, but we must not lose sight of the impact of other types of meningitis or the fact that many other serious diseases can disproportionately affect infants, who cannot tell their parents or the doctor where they hurt or how poorly they feel. It was clear from the evidence that the Petitions Committee and the Health Committee took that a great deal of work still needs to be carried out to ensure that we get the best possible vaccines at the best possible price, and that they are as effective as possible. As is already happening, it is important to assess the outcomes of each and every infant who receives a men B vaccine. If possible, I would like to see data included from older children who have been immunised privately.
Mrs Helen Grant
In addition to vaccines, on which my hon. Friend is making a strong case, does she agree that we still need to do much more about prevention, and that the completion of the adolescent carriage study, which was recommended in June 2015, might be a good start? It would be helpful to hear from the Minister about progress on that.
Maggie Throup
My hon. Friend makes a good point, and I agree with her.
As we heard last week during the debate on funding for brain tumour research, no price can be put on anyone’s life, at any age. We must use all the evidence available and do whatever is necessary and appropriate to provide protection from meningitis and other potentially fatal conditions.
Mr David Nuttall (Bury North) (Con)
As always, it is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard.
I want to share the story of Charlie. Charlie Edmondson is a lively, boisterous four-year-old. I know him because he attends the Sunday school at St Anne’s church in Tottington in my constituency where, for the past seven years, I have been one of the church wardens.
Last year, at midnight on 15 December, just two days after Charlie took part in the Sunday school’s annual Christingle and nativity play, he woke up and complained to his mum, Rose, that he was not feeling very well. He had a high temperature, but his twin sister had been ill the previous week and his parents had not felt 100%, so his mum understandably thought Charlie was probably going down with a similar bug.
Rose tried to get Charlie’s temperature down with Calpol and some Nurofen, but the next morning he woke at 6 am looking extremely pale, with dark rings under his eyes, and his breathing seemed quite fast. His mother put the symptoms down to a viral infection and assumed he would start to feel better after he had been sick. Never in a million years did she think it could be meningitis.
Charlie went downstairs and, after some more Calpol and ibuprofen, he seemed to perk up and managed to eat some breakfast. At about 10 am, as he and his mum settled down to watch Tim Peake go up in a space rocket, something that would normally excite the imagination of any young boy, he started to chat less and became quieter. At that point, his mum became concerned about a pinprick rash that had appeared. It did not look like a typical viral rash, and doubts started to form in her mind.
After they had watched Tim Peake go into space, Rose noticed Charlie was staring vacantly at the television, but she put that down to him perhaps being a little sleepy. Shortly after that, Charlie was sick, and he fell asleep next to his mum on the couch. As his mum said:
“I don’t know what prevented me from putting him in his bed and to keep him on the couch—it would have been so easy to do that and he may not have been so lucky.”
While Charlie was napping, his mum noticed what she thought was a bruise on his upper leg, with one on his arm and another small one near his neck. Rose knew that was a potential sign of blood poisoning, and she started to piece together the other symptoms. She looked at the Meningitis Now website for the checklist of symptoms. She called her husband, who told her to call their GP. Unfortunately, the GP closed at lunchtime, but she was put through to an out-of-hours doctor, who told her to call 999 immediately. She decided to check the rash, to see if it disappeared with a glass— it did not.
Rose called 999 and was told that an ambulance would be sent straight away. When the fast-response car arrived, Charlie was lying on his side on the couch. He immediately had antibiotics administered to him. The ambulance arrived about five minutes later and took him to the Royal Bolton hospital, which, as his mum said, did “an absolutely amazing job”. The hospital staff explained everything they were doing, including when they decided to induce Charlie into a coma and he was transferred to the intensive care unit at Alder Hey children’s hospital. At that point, they told his mother that they were treating him for meningitis B.
Charlie stayed in Alder Hey until Christmas day, including eight days in intensive care. He received fantastic care and treatment, but his family were disappointed that they were not given more information about meningitis and its after-effects. At this point, however, I will place on the record the enormous help that the charity Meningitis Now gave to Charlie and his family. I know that they are all extremely grateful. The charity sent them lots of information and they found that reading others’ stories helped them to understand the impact that the disease can have. It helped them to cope.
Unfortunately, three days after Charlie’s initial discharge, he was readmitted to the Royal Bolton and then Alder Hey, as he was struggling to stand and walk. The doctors suspected he might have a bone infection. That meant another week in hospital, including over new year, but he was finally discharged, with much more mobility, as the doctors discovered that the problem was inflammation around his ankle and hip joints. As an MMR scan confirmed, the meningitis had scarred his bones. It was two months before Charlie could walk and stand properly.
Charlie will continue to be monitored by Alder Hey for the next few years, to keep an eye on his growth plates. As Charlie’s mum said:
“I will be forever grateful that Charlie can say he has survived meningitis and I want him to remember how lucky he is and we are that he is still here despite being hit with such an awful, awful disease.
The speed at which this disease acts is frightening and the symptoms can be so easily confused with other things. This is why it’s so very important to recognise the signs and symptoms quickly.”
I hope that one benefit of this afternoon’s debate will be that more people learn the signs and symptoms, and know what to do. Understandably, Charlie’s parents want to see the roll-out of an improved meningitis B vaccination programme, so that others will never have to go through what they had to go through. Mr and Mrs Edmondson did not know that they could have vaccinated their children privately until the consultant told them that he had vaccinated his children because he knew how important it was.
I appreciate that even with the increased resources being made available to our NHS, the advances in medical science, new treatments, new drugs and a growing and ageing population inevitably mean that difficult decisions have to be made. Of course it will be costly to vaccinate even up to only the five-year-old age group, but when one considers the loss of life, the cost of treating cases such as Charlie’s—which one healthcare professional put at £30,000 to £40,000—and the suffering of children such as Charlie, along with the heartache, anxiety and distress of the parents, the cost of the vaccination suddenly starts to look very cheap indeed.
As you know, Mr Pritchard, I am not one to present problems without trying to find a solution for Government, so let me suggest another source of funding: the millions of pounds spent on trying to persuade adults who, despite years and years of warnings about the dangers of smoking, nevertheless continue to do so. If they have not stopped by now, when will they? Those adults have a choice and they choose to continue to smoke. Some of the millions spent on increasingly ineffective stop-smoking campaigns could be spent on children, who have no choice.
Geoffrey Clifton-Brown (The Cotswolds) (Con)
I am delighted to serve under your chairmanship, Mr Pritchard. I echo a feeling of sympathy for my hon. Friend the Minister, because in a sense she is the meat in the sandwich. Time after time she has to answer such debates, but, as she and the House know—the hon. Member for Foyle (Mark Durkan) certainly knows this, because he had an Adjournment debate on 7 July 2014 on this subject—there has been an ongoing campaign on this for a long time in the House.
My hon. Friend the Member for Bath (Ben Howlett) is right that meningitis B is a terrible disease that—as other hon. Members have said—comes on suddenly and, at least in the early stages, is often not recognised by health professionals, let alone parents. More publicity should be given to the disease so that people are aware of what to look for. Given that only yesterday I heard a public health advertisement to encourage parents to get their babies vaccinated against MMR, I am not sure why we should not have such a publicity campaign for meningitis B.
The Bexsero vaccine was first licenced by the European Medicines Agency on 1 January 2013. The Minister wrote to me in April 2014 and said that it would be rolled out for children under two months, with a one-off catch-up programme for children born between 1 May 2015 and 30 June 2015. I use that illustratively, because at that stage we did not know when the vaccine was to be introduced. The Minister will say that by 2017 all children under two years will be covered, but if the vaccine had been rolled out at the time of my Adjournment debate, in which we were urging the Minister to do that for all children under one, more children would have been covered. In that debate she said:
“Children aged less than five years are most affected by MenB…the peak of the disease is in infants aged 6 to 12 months.”
She went on to say that
“MenB is fatal for about one in 10 of those who develop meningitis…With early diagnosis and treatment, most people can make a full recovery”.
That is true. She also said:
“Incidence has been decreasing in recent years…but it is unpredictable and it could rise again quickly.”—[Official Report, 7 July 2014; Vol. 584, c. 137.]
The disease has an unfortunate habit of falling and rising in incidence, so it could very well start rising again. The Joint Committee on Vaccination and Immunisation set up a working party in 2013—I think in June—to look at vaccinating all children under one year. What has happened to that working party? Have we got the results yet?
This is an unfortunate issue, because as many hon. Members will know—particularly those who have had young children more recently than when my two were youngsters—we often have to take young children to the surgery anyway, so the costs to the NHS of administering the vaccine would be minuscule: just the cost of the drug. There is also a unit cost issue—if GlaxoSmithKline had to make more of the vaccines, presumably the price would come down. I urge the Minister to consider the anxiety that the disease causes and the vast number of people who signed the petition. It was the largest petition ever for such a debate, and I pay great tribute to the House for changing its procedures to introduce such interactive debates so that we can consider the concerns of large numbers of constituents on such issues. I originally got involved in the meningitis B campaign after my constituents, Dr and Mrs Turner, contacted me about their granddaughter, who sadly died from the disease, but it obviously concerns large numbers of constituents.
We should not consider this vaccine as just an issue of cost. We know that the drug is safe. It has been licensed since 1 January 2013 and in the United States, the student cohort at many universities received the vaccine at least two years ago, and it was also trialled in adolescents at a university in this country. It therefore appears to be safe, although the JCVI wants to look at that issue. I say as gently as possible to the Minister that we should not let this be purely an issue of cost. If we have a drug that works—we know it is effective—and it is simply an issue of cost, we should at least consider rolling it out to all babies under one year old and preferably to all children under five.
Caroline Ansell (Eastbourne) (Con)
My hon. Friend makes a powerful case for the drug’s safety. We just heard an agonising story from my hon. Friend the Member for Bury North (Mr Nuttall) about Charlie and his experience, so does he agree that the cost and suffering of those who survive men B should be factored into the consideration of a catch-up scheme?
Geoffrey Clifton-Brown
I entirely agree. I will ask the Minister to clarify this, because when I sat down she said sotto voce that it is one year, but my information is that, from when it started, it was for all those under two months of age on 1 September 2015, with a one-off catch-up programme for babies born between 1 May 2015 and 30 June 2015—those who were three or four months of age when the programme was launched. Therefore, while by now it may have nearly spread to one year, that was not the case when it was introduced. We should consider rolling it out definitely to those who are one year old today and preferably to those a little older as well.
I turn to the Department of Health’s cost-effectiveness methodology for immunisation programmes and procurement—the so-called CEMIPP, which is a dreadful acronym. The Minister will tell us that that looks at the life-cost issues, but those who contract meningitis and suffer long-term effects face not just the £30,000 to £40,000 of costs my hon. Friend the Member for Bury North (Mr Nuttall) mentioned, but considerable lifelong costs afterwards. The discounting rates, as hon. Friends have said, are particularly mean in that respect, so to look at the issue in the round we must look seriously at the cost to the public purse of not vaccinating. That route could show us more clearly that a roll-out to a larger cohort would be cost-effective.
Neil Carmichael (Stroud) (Con)
Meningitis Now is headquartered in my constituency. To follow on from my hon. Friend’s point, should we not think that prevention is better than cure? That should be the overall strapline to the debate.
Geoffrey Clifton-Brown
My hon. Friend is right. I pay tribute to the charity based in his constituency and to the other meningitis charity, because they have been campaigning for many years on meningitis B and all the other strains.
The point about rolling out the vaccine to the cohorts—I urge the Minister to go further than that—is that my understanding is that once someone is vaccinated for meningitis B with Bexsero, they are covered for life. Therefore, if more cohorts are covered by the roll-out, more of the population will be covered and the entire population will become less susceptible.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
My question follows on nicely from the point made by the hon. Member for Stroud (Neil Carmichael) in his intervention about the long-term costs. I first came across this issue at a reception held by Meningitis Now. I commend that charity and the Meningitis Research Foundation for their excellent work. In terms of special educational needs, long-term costs can come in when a child reaches 12 or 13 and it becomes apparent that they are not developing at the same rate as other children. All sorts of educational implications should be factored into the long-term costs.
Geoffrey Clifton-Brown
I could not agree more. That is why the CEMIPP group study should look at not only the medical costs but the educational costs, the cost of carers and so on. There are considerable costs to the public purse. We tend, under our democratic system, to be quite short-termist in our view of such matters. I am involved at the moment in work on drugs for cystic fibrosis, to which exactly the same issues apply. After the considerable cost at the outset, there is a lifelong benefit to babies from getting such drugs. If we are going to carry out a cost-benefit analysis for the meningitisusb B vaccination, that is what we should consider.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I agree with the vast majority of what the hon. Gentleman says. In actual fact, it was not possible to trial Bexsero in humans because this is such a rare condition, and therefore we do not yet know whether the immunity will be for life.
Geoffrey Clifton-Brown
I am extremely grateful to the hon. Lady. The benefit of these debates is that we always have a professional on hand who can give us the last word on the subject. My sister is a GP and would no doubt have given me that same advice.
I am grateful for the chance to speak in this debate. This is a tragic disease with tragic consequences. I urge the Minister to go further, and faster in rolling out a good, safe vaccine that will give immunity to a larger section of the population.
Several hon. Members rose—
Mark Pritchard (in the Chair)
Order. Normally I would call a Member from the Opposition Benches at this point. It would be Hywel Williams in this case, but he has not been here for one hour of the debate, for reasons that he has explained to me. I have some discretion, but I think it is only fair that I call now Peter Heaton-Jones, who has been here for the whole debate, and then Dr Sarah Wollaston, who was in the main Chamber for the health statement and is Chair of the Select Committee on Health.
Peter Heaton-Jones (North Devon) (Con)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate my hon. Friend the Member for Bath (Ben Howlett) and the Petitions Committee on securing this incredibly important debate. I also pay tribute to the many families and charities whose tireless work has been instrumental in bringing us to this stage.
Two months ago, I was visited at my surgery in the village of Braunton in North Devon by my constituents Anthony and Jodie Cross. Mr and Mrs Cross told me about their daughters, Millie and Lydia, who both contracted meningitis B as young children. Millie was seven months old when she suffered from the disease. She went to hospital and was successfully treated, but on the day she returned home from hospital, her sister Lydia, who was nearly three, became ill. As the illness tragically developed, both of Lydia’s legs were badly damaged by septicaemia and had to be amputated below the knee.
That was nearly 12 years ago. Lydia has gone on to become a remarkable young woman and, with her family, a doughty and brave campaigner. Nothing illustrates that better than Lydia’s own words. She wrote an article for my local newspaper, the North Devon Journal, in May 2014, when she was just 13 years of age. Her words sum up better than I could what a remarkable young woman she is and how she has fought this disease so bravely. She says,
“I became a double below knee amputee when I was two due to meningitis and septicaemia. Sometimes having a disability is really hard but then other times it doesn’t really bother me. People may not realise how everyday things that they take for granted are much harder for me to do. I love all sports but I do get upset when I can’t participate because my legs really hurt, or I have sores where they’ve rubbed. I started to really enjoy blade running but due to infections and needing the bones trimmed in my legs, I haven’t been able to do it for months now. Hopefully, soon though, I can get back to training with the North Devon Athletics Club…I can then get my blades altered with new sockets and really train and focus on hopefully going to the next Paralympics in Rio, where I’d like to compete in the 100 metres (fingers crossed). I’m desperate to get back to doing it again. It’s really annoying when you have the determination to do something but your ‘disability’ stops you.
I’ve probably had about seven bone trimming operations and my most recent one was about seven weeks ago. It’s painful, but more annoying because I can’t wear my prosthetic legs for about six to eight weeks afterwards. I’m also unable to attend school—Braunton Academy—during this time so I do a lot of school work at home, but I really miss seeing all my friends. I’ve got an amazing group of friends. They treat me just as Lydia (their mad friend), not a girl who’s an amputee and I love that. I’m happier when people don’t treat me differently because I’m only missing the bottom part of my legs and I’m just the same as any other teenager (loud, annoying, always sleeping in and very untidy)…
Even though I’m only 13, I’ve been able to have the most amazing opportunities, that I’m sure I wouldn’t have had if I hadn’t become an amputee. But the one I’m most proud of is being the youngest patron for Help For Heroes, which is such a huge honour. I’ve met many of our wounded heroes who have lost far more than me… and…are my inspiration and friends. Even though I’m a teenager and an amputee which makes me ‘different’, I still consider myself very lucky and I am definitely very happy. I’ve got an amazing family and friends and I wouldn’t change anything about my life because that’s what makes me ‘me’.”
I thought it was worth reading that quite extraordinary article to the House at some length, because it sums up better than I could why we are here today.
Clearly, this is a matter of huge public interest and concern. When Mr and Mrs Cross came to see me, they told me about the growing petition seeking an extension of the men B vaccine to all children up to the age of 11. Today, that petition has in excess of 820,000 signatures—the most received by any petition since the new process was launched. I agree with hon. Members that it is good that we have changed our procedures in the House to allow such a petition to be debated in this way.
In considering the matter today, it is of course important to put the medical and scientific evidence front and centre. We should base our decision on that and that alone. Our decision must be evidence-based, which is why I agree wholeheartedly with my hon. Friend the Member for Bath that we should ask the JCVI to conduct a thorough review of the medical evidence. It is an important principle that Ministers should not make what amount to clinical decisions. Most Ministers—indeed, most MPs—are not scientists or doctors, although there are notable and extremely respected exceptions to that rule in the Chamber today, to whom we have listened very carefully indeed. We must take account of the expertise and advice of the JCVI, which is why the right approach is to thoroughly review the scientific and medical evidence.
This Government have shown that they are willing to act on this issue. As we have heard, a men B immunisation programme for infants under the age of one was introduced in September 2015, in line with the JCVI’s recommendations. In addition, the Government have requested that the JCVI research the evidence for extending the men B vaccination programme up to the age of two. Those are both welcome steps, and I hope they show that we are pushing on an at least partially open door and that the Government are willing to listen. I know that the Minister is listening today, and I look forward to hearing her summing-up.
The elephant in the room is the cost, which has been referred to, and it cannot be ignored. There is only so much money available in the Department of Health budget—I made that very point two weeks ago in a debate in the House on the need for compensation for those affected by the contaminated blood scandal.
Mrs Helen Grant
On cost, does my hon. Friend agree that the earliest possible safe introduction—“safe” being the important word—of a competing product to Bexsero could help patient access by reducing market prices and increasing availability?
Peter Heaton-Jones
I thank my hon. Friend for that intervention. I was much taken by comments that two of my hon. Friends made about cost. My hon. Friend the Member for Bury North (Mr Nuttall) made a powerful point in suggesting that we should be looking elsewhere for contributions towards the funding—it should come from those who, frankly, have decided to do harm to themselves rather than from small children who are in no way to blame for the position in which they find themselves. My hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) said—I wrote this down, because I thought it was telling—that we should consider very carefully the cost of not vaccinating, and I am sure the Minister will have taken that important point on board.
Cost is an issue to consider, which is why it is important that we look at the scientific evidence and carefully take on board what the experts from the JCVI and elsewhere say about this issue, as I know we will. We need to get this matter dealt with soon, because time is of the essence. Families are being affected as we speak, in the same tragic way as, in North Devon, Mr and Mrs Cross and their daughters Millie and Lydia have been. Their bravery, selflessness and hard work in pushing this issue forward, along with that of many other families and campaigners, is the reason why we are here today. I say to the Minister that we should listen to them, and we must not let them down.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow my hon. Friend the Member for North Devon (Peter Heaton-Jones), and I apologise to my hon. Friend the Member for Bath (Ben Howlett) for missing his opening statement, because of a statement in the main Chamber.
I start by thanking all the families who gave evidence to the Petitions Committee and the Health Committee. Through their very brave and dignified testimony, they have done more to raise awareness and save lives than any Government-led awareness campaign could possibly hope to achieve.
It is wonderful to be in a debate in which we are airing the positive benefits of vaccination, which has undoubtedly been one of the greatest achievements of modern science. We stand on the brink of eradicating polio from the world, and it is worth pausing to thank all those who have been involved in the development of vaccination over the years.
Neil Carmichael
At this point, I would like to salute Dr Edward Jenner, who worked on a smallpox vaccination and was based in my constituency. That underlines the importance of vaccination, and that work then is directly linked to the work of Meningitis Now.
Dr Wollaston
I thank my hon. Friend. In fact, I will take us back even further by mentioning Ben Franklin, who said that
“an Ounce of Prevention is worth a Pound of Cure.”
He was referring to fire services in Philadelphia, of course, but the principle still stands.
In paying tribute to all who have brought us to where we are today, we should remind ourselves that vaccination is becoming increasingly complex to develop. Bexsero is being developed through reverse antigen mining and is extraordinarily expensive. That is why we have to consider cost-effectiveness, because in a system where finances are limited, what might be displaced if a new intervention is funded? In other words, we in this House and beyond have a responsibility to ensure that the money we spend can save as many lives as possible, and to consider that in the round.
That is why it is important to take account of the work of the Joint Committee on Vaccination and Immunisation in making its incredibly difficult decisions and judgments. It is absolutely important that we allow the JCVI to carry out its work without undue political interference. The role of this House is, of course, to raise awareness and to hold the Government to account for the way in which—and the framework under which—the JCVI operates. However, our role must never be to lean directly on members of that committee in the very difficult decisions that they make. I pay tribute to the JCVI—to Professor Andrew Pollard and his team—for their work. Their decisions are extraordinarily difficult, and they need to apply the science with a combination of judgment and sensitivity. It is absolutely right that we regularly review the criteria that they are able to take into account.
I thank the Minister for her letter today confirming that the cost-effectiveness methodology for immunisation programmes and procurements working group, or CEMIPP—it may need a catchier title—is going to publish its work in full. Perhaps she will say whether she has now received that report. It is absolutely important that the principle of transparency applies, so that we can all be clear about the decision-making process.
I support Members who have said that we should review the so-called discounting rate if it means that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) has pointed out, by the time someone is in their 20s, effectively no account is taken of them. It clearly seems reasonable that we apply the same principle that is applied to public health decision making in the NICE methodology, with its lower discount rate, so that we can take full account of that situation. It is also right for the House to reflect on views beyond this place by thinking, for example, about the social costs. I do not wish to repeat the many important points that have been made about that today.
The JCVI’s independence is absolutely vital. We in this House are not in a position to make judgments about the effectiveness and safety of vaccination. We have to rely on experts, and we are very grateful to them for their work. However, one thing that we have to do is hold the Secretary of State to account for implementing the decisions of the JCVI in a timely manner and for the time that it takes to carry out the negotiations on the cost of vaccines.
I would like to make a further point, which I do not think Members have brought up today. The level of variation in the roll-out of existing vaccinations needs to be looked at. During the Health Committee’s current inquiry into public health, we have been hearing evidence about the difficulty that public health professionals and directors of public health have in being able to access the data and information that they need to tell them where the gaps are in the roll-out of vaccination. Perhaps the Minister will update the House on where we are in that regard, because it clearly cannot make sense that artificial barriers have sprung up between those who are responsible for implementing the programme and those who are delivering it on the ground. It would be helpful to have an update on that issue.
It is also absolutely right that the House holds the Minister to account on what is being done to follow up the work that is happening on sepsis. As she will know, early diagnosis is critical. Although we want to focus on the number of cases that we can prevent, we cannot prevent them all, so we must also focus on early diagnosis and intervention and on ensuring that we have the right pathways in hospitals, so that the time it takes from the moment someone enters a hospital until they receive life-saving antibiotic therapy is kept to a minimum. Perhaps the Minister will update us on that.
Geoffrey Clifton-Brown
I hesitate to intervene on my hon. Friend, especially as she is such an expert on this subject, but as I understand it, Bexsero was licensed by the European Medicines Agency on 1 January 2013. It was not introduced in this country until more than two and a half years later, and people will have died of the disease in the interim. Does my hon. Friend not think that is too long a process when the argument is not about the safety of the drug but purely about the price? Something needs to change. The negotiation with the drugs companies needs to be done in a different way.
Dr Wollaston
I agree that there needs to be a better and faster procedure for negotiating about cost, but we cannot get away from cost, because, as I mentioned, cost-effectiveness is not an abstract concept. It means asking, could we save more lives by spending the same amount of money differently? If the cost of the drug is exorbitantly high, would it be better to invest the money in, for example, early diagnosis and intervention? Those complex decisions should not be made by politicians. Politicians and the public should be part of the process that sets the guidelines and advises the committee, but it is not for this House to make those decisions, although I absolutely agree that of course it would be better if the negotiations could be done more quickly.
I end where I began, by paying tribute to the very brave families for the evidence that they gave. I hope that the Minister will do everything in her power to ensure that we reach decisions as quickly and as fairly as possible.
[Philip Davies in the Chair]
Hywel Williams (Arfon) (PC)
I am glad of the opportunity to speak in the debate, and I congratulate the hon. Member for Bath (Ben Howlett) on securing it. I am grateful for the somewhat unexpected opportunity to make a brief contribution. I should explain my late arrival: I was detained because I had another, long-standing engagement. I was able to leave because I was in the fortunate position of being the chairman and so could curtail discussion in order to attend this debate.
An overwhelming case has been made on this matter by the petitioners, but also, importantly for us as Members, by our constituents in the campaigns carried out locally. My constituent Janice Roberts has been instrumental in raising the issue locally and in raising awareness among other families. She has combined that with being a champion for local families. We are all very grateful to her for the work that she has done.
An hon. Member referred earlier to being a parent of some standing. I am a new parent, with a three-month-old daughter and a son of two and a half, and I think I can imagine the pain and anguish that parents face with this appalling and terrible illness. As a new parent, I live in fear of what might happen to my child. For me and other parents, cost is obviously not an issue where our own children are concerned, but in the real world, of course, cost is an issue. Inflation is higher in the health service than in the rest of the country, whether one wants to use the retail prices index or the consumer prices index, but in the face of the pain and anguish and the illness of little children, cost just has to take a back seat. From what we have heard, and from what I had already read, this drug is safe. The cost should not be an issue. Every child should have this vaccine, and I am very glad to add my voice to that call.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I apologise to the Chamber for being late; that was due to the health statement earlier. I, too, begin by paying tribute to the families who attended the combined Petitions and Health Committees last month. Their bravery in going through their experience again was incredible, and it was obviously very moving for us to listen to.
Funnily enough, this is World Immunisation Week, so the debate could not have been timed any better. Just think of the lethal diseases and conditions that we have tackled across the world because of immunisation. The hon. Member for Totnes (Dr Wollaston) referred to polio; we have not beaten that yet, but we are on the way.
Meningitis is an inflammation of the meninges, the covering of the brain, and that can happen with other diseases, not just meningitis B or any of the meningococcal diseases, but they are the most serious; they are the ones that result in the biggest harm. There is A, B, C, W and Y. When I was a younger doctor, which was a wee while ago, meningitis C was the big concern. It was very common in teenagers as well as in children, and there was always a big peak when people went off to university, but in 1999 the vaccine for that was introduced. It was given to those right up to the age of 18, and 90% of those cases are now prevented, which is a real transformation.
That leaves meningitis B, which is the most lethal type and affects people very quickly. We have heard that from the families and from hon. Members in the debate. There are not many conditions whereby someone will go from being slightly off-colour to either death or permanent disability in less than 12 hours. Having worked in a paediatric hospital and dealt with children with meningitis, I can tell hon. Members that for a doctor, it is terrifying. As was talked about in the Committee, it is not that doctors think, “Och, no, it won’t be that; I’ll ignore it.” It is simply that it is so hard to pick out that child. When they are a little bit hingy, as we would say in Scotland—a little bit off—it is not obvious, but there are signs that people should be looking for.
As the hon. Member for Faversham and Mid Kent (Helen Whately) said, do not wait for the rash. I was delighted to see in the Meningitis Now advice that that is written in big red letters: “Don’t wait for a rash”. Do not wait for the rash if the child is quiet, not reacting normally and very feverish. As a doctor, what I would say is of real concern is cold hands and feet. If a child has a fever, yet has cold hands and feet, that to me is a sign of septicaemia—a sign that the blood supply to the extremities is beginning to shut down. That should be a warning sign long before we get to the rash. Reading the testimony produced by the families and the petitions group is absolutely heartbreaking. In case after case, the first warning sign that the parents or the medical professionals recognised was that horrible rash.
It is important that we take account of the long-term disability. One in 10 of these children will not survive. One in three of them will be left with a severe disability. That includes brain damage, cognitive and sensory impairment and, as we have heard, limb amputation. That is horrific to think of in little children. I can tell hon. Members as a doctor that this impinges on doctors as well. If someone has seen a child and not spotted meningitis, or seen a child and watched them just slip through their fingers, that is absolutely horrific. Meningitis moves so fast that vaccination has always been the holy grail. We now have it, but we probably have not rolled it out widely enough, because of the cost-benefit analysis.
I will echo the hon. Member for Totnes: there is no question but that the decision should not be made in this House. It is not a political decision; it must be made in the cold light of evidence of benefit, but that is not just cost-benefit; it is also risk-benefit. We spend a lot of our time being lobbied by constituents who are against vaccination. Think of the saga we have been through with the measles, mumps and rubella vaccine in the last decade, and here we are with a movie reigniting all of that.
There was no trial with Bexsero, so we are still gathering the data through this year. I am talking about the efficacy, safety, side effects and, crucially, as I mentioned earlier, whether people have permanent protection. We do not know that yet, but questions on those points have to be answered, so it is crucial that the body responsible is the JCVI . On my reading, the key problem has been in the discounting. Of course if people invest money in any treatment, they want a quick return. That is what the City of London would look for as well. But we are talking about preventing things—preventing damage that will be with someone for their whole life. A child’s life is written off, before they are 28, as really not having any additional value in being saved. A discounting of 3.5% means that that value is gone at that age, even though we have perhaps saved 70 years of life. In particular, if the child never got ill in the first place, we would have saved a disabled life; we would have saved a life of suffering, and the cost to society and the family of looking after a child who perhaps faces incredible disabilities and suffering.
Every year, that life is discounted at 3.5% until we reach zero, yet we accept that public health measures, such as smoking cessation, take a long time to give us a return. Having seen the results of people smoking, I am not quite ready to say that we should give up on those public health measures. We need people to stop smoking as that will save us money in the long term. However, we should be using the same rate, because if we were discounting at 1.5% a year, the catch-up up to the age of five would have been considered cost-effective. It is not that the rate should not be down to the JCVI, or that it should not be based on proper medical evidence. The issue is the tool that was given by the National Institute for Health and Care Excellence, based on the Treasury figure of 3.5%, although appraisal committees can consider anything between zero and 6%. The key thing is to ask for that evidence to be looked at—specifically the long-term costs of major disability—and to look at the impact on the decisions of using that lower discount rate.
The other thing mentioned was a study of adolescents. In meningitis C, we were particularly after the adolescents. Babies do not carry meningococcal meningitis; teenagers do. When we vaccinate little children, it is for the individual protection of that child. The protection that is given by teenagers is herd immunity. When they stop carrying it, babies will catch it less. We do not know whether that will happen with Bexsero as it is such a different vaccine. As the hon. Member for Totnes mentioned, the whole structure is totally different. Normally, we are looking at the sugars on the surface of bacteria. Bexsero was done through genomics—identifying protein to create antigens and antibodies. It is so expensive because it has been done in a totally different and novel way.
We need to do a study on adolescents. There seem to have been a couple of years of talking about doing it, yet we have not even started or laid out the terms and parameters. It is really important that we answer the questions with evidence, not just by thinking that we would quite like to splash the vaccine around. The case for extending the catch-up to five years is stronger as half the cases will happen before the age of two and the majority will happen before the age of five. The cost burden for a child who requires 24/7 care for their entire life—particularly when they are older and their parents are no longer looking after them—including the burden on their family, friends and society, is enormous. I find it hard to believe that it would not be cost-effective to prevent that.
For me, as a doctor, vaccination is almost the only way. The one thing I do not recognise in the cost-effectiveness balance is the talk about peace of mind. As we explored with families in Committee hearings, peace of mind caused some of the problem, because some parents thought, “My child is vaccinated against meningitis.” We cannot cast that up. A simple change in the discounting method and the inclusion of long-term social care costs are the most important things.
Even if we roll the vaccination out, we must remember that there are other types of meningitis, and that there is more than one strain of meningitis B. We need to get that great little Meningitis Now card out to families and parents as widely as possible, but we also need to get this message to doctors: do not wait for the rash. Look at the child, listen to the parents, and, as I said earlier, think about cold hands and feet. We have the potential to stop the damage of this absolutely horrific disease, and I hope that we take the issue back to the JCVI.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to serve under your chairmanship, Mr Davies, as it was to serve under that of Mr Pritchard earlier. I pay tribute to the hon. Member for Bath (Ben Howlett) for opening the debate in such an eloquent and detailed fashion. The way he set out the terms of the debate is a credit to the petitioners, and we have heard a set of powerful contributions from right across the Chamber.
A week ago, I said that the Petitions Committee debate on brain tumour research was a credit to the way in which the House of Commons operates. That has followed through to this week’s debate. I thank my hon. Friend the Member for Walsall North (Mr Winnick) and the hon. Members for Foyle (Mark Durkan), for Faversham and Mid Kent (Helen Whately), for Erewash (Maggie Throup), for Bury North (Mr Nuttall), for The Cotswolds (Geoffrey Clifton-Brown), for North Devon (Peter Heaton-Jones), and for Arfon (Hywel Williams), as well as the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health for the Scottish National party. It is always a pleasure to follow her expertise on such matters. Mainly, I congratulate all 823,000 petitioners for the enormousness of their campaign, which led to the petition becoming, I think, the most popular e-petition so far. This is a huge issue for so many families affected by the disease.
The impact of meningitis B is felt long after initial contraction, and about one in 10 suffering from it will die. According to research published in The Lancet, one in three survivors will be left with lifelong disability. There is, necessarily, a huge cost to society and the individual when people are left without the ability to lead a normal life. Considering that there is a possibility of tackling the disease with just one vaccine, the issue deserves our undivided attention. Some hon. Members who are regulars in debates on health will know that I am always banging the drum for prevention, and I am not the only one. Simon Stevens, in his “Five Year Forward View”, identifies £5 billion of savings later in the review period that could be made as a direct consequence of prevention early on in that five-year forward view. Meningitis B is one instance where the case for prevention is very strong indeed. The ongoing cost to the NHS of a patient who survives meningitis can run into millions of pounds in the worst cases.
The UK is leading the world in the fight against meningitis. Our immunisation and surveillance programmes are world-class, and everybody involved in them should be proud of the lives that have been saved and the lifelong disabilities that have been prevented over the years. However, as I will explain, we still have a long way to go. The joint work of the Petitions Committee and the Health Committee has been instrumental in really getting to the bottom of an issue that has been trundling along for far too long.
The notion of Committees taking evidence on matters raised in e-petitions is quite new, and it is right that scrutiny work is guided by the public. That was recognised by my hon. Friend the Member for Warrington North (Helen Jones), who chairs the Petitions Committee. That the Petitions Committee is proactive with other Committees of the House will be of great importance for the future work of not just the Petitions Committee, but the other Select Committees of the House of Commons. I hope that in this instance, this work will be of some comfort to the many hundreds of thousands of people across the country who are signing petitions on a variety of issues. Indeed, I checked just before the debate and 1,240 people in my constituency signed the petition before it closed. Almost exactly the same number signed it in the constituency of the Chair of the Petitions Committee, and a similar number—1,311—signed it in the constituency of the hon. Member for Bath. I am sure that the Minister appreciates the depth of feeling on the matter right across the country.
I will get into the detail, because the debate is not as clearcut as many of us would like. Indeed, very few issues in health are simple. There is always more than one side to consider, and I appreciate the merits of the Government’s case. The Minister will argue that the Government are rightly following the recommendations of the JCVI, which the Opposition agree is correct in principle, but not, having looked at this in a bit more detail, necessarily in this instance. As we have already heard, the JCVI recommended an adolescent carriage study—this was more than two years ago—to determine what bacteria young people are carrying, and my understanding is that that study has not yet started. It takes a considerable amount of time for such a study to collect usable data, so will the Minister confirm that the funding needed to carry out the study will be made available? I have seen a reasonable timetable for the work set out by Meningitis Now and the Meningitis Research Foundation. If the Department of Health will not be following that timetable, will the Minister confirm when an adolescent carriage study will begin? Has she ensured that there are sufficient supplies of the vaccine to carry out the study?
Health economics, which other Members have mentioned, frustrates me a little because there is a bit of guess-ology, or a wet finger in the air, to it. Unless the lifetime cost and benefits of, and all the associated issues with, a particular drug can be assessed, it is difficult to assess the true costs and benefits of a particular treatment. I do not think that lifetime costs are adequately considered when looking at the cost-effectiveness of drugs and treatments. Indeed, that point was raised in the Procedure Committee’s final evidence session. Professor Andrew Pollard, chair of the JCVI, suggested that the JCVI was concerned that it “might be underestimating” the lifetime costs—that point was eloquently put today by the hon. Member for The Cotswolds. Dr Mary Ramsay, head of immunisation, hepatitis and blood safety at Public Health England, pointed out that social costs, such as out-of-pocket expenses, are excluded from the JCVI formula. Likewise, as we have heard from the hon. Member for Central Ayrshire, the peace-of-mind benefits are difficult to measure, but they are also left out of the formula.
Will the Minister assure Members here today that the working group has considered how to reform the JCVI framework so that some of the health gains for children are adequately represented, and so that prevention is prioritised in the formula? I understand that the JCVI agreed to review the impact of the vaccination programme within two years of its decision. I hope that, in light of the exceptionally strong public interest in this issue, the JCVI will, as part of that review, reassess the case for extending the vaccination to all children. The current cost-effectiveness framework used to assess vaccines tends to be a little unfair when it comes to relatively rare but severe diseases in children, and I accept that changes to those procedures do not come quickly, but that is no excuse for the unnecessary and bureaucratic delays that we saw in the introduction of the vaccine for the under-ones. I hope to see promising results this autumn, showing that the vaccine works in a mainstream programme.
Finally, if the JCVI were to make a recommendation to extend the reach of the meningitis B vaccine, I would not hesitate strongly to encourage Ministers to extend the vaccination’s coverage at the earliest opportunity. The principle of quasi-independence for the JCVI is important, and it should be defended, as we have heard from other hon. Members today, but that is not to say that its procedures and remit should not be continually re-evaluated to ensure that it takes the right factors into account. I hope the Minister will listen extremely carefully to all the arguments that have been raised on both sides of the Chamber in this debate and will see the strength of public opinion on this issue as genuine and real. Given that she has a considerable amount of time in which to respond, I am sure that we will get a thorough and full reply to all the questions put by hon. Members today. I am sure that the petitioners watching the debate, both here and through online forums, will be interested in what she has to say.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I thank all hon. Members who have spoken in this important debate. As others did, I start by offering my condolences to the family of Faye Burdett, whose tragic death sparked such interest in the e-petition that led to this debate, and to all the other parents. Their powerful testimony on their personal family tragedies has led us and their Members of Parliament here today, and they have helped to stimulate interest in the petition, which has huge support, with more than 820,000 signatures. The petition goes right to the heart of the concern that parents and the public have about meningitis.
I have listened to the many hon. Members who have spoken this afternoon and, like everyone in the Chamber, I have been moved by the stories we have heard of how both meningitis and septicaemia have affected families and, in some cases, have tragically changed their lives forever. As has been made clear, meningococcal meningitis—the infection and inflammation of the lining of the brain—and meningococcal septicaemia, or blood poisoning, which for simplicity I will refer to as meningitis, are very serious infections that can be severely disabling and even fatal, as has been movingly and, in some cases, starkly demonstrated by hon. Members today. It is right that we should have robust arrangements in place to protect against this disease. In fact, we are the only country in the world with a vaccination programme for all the major causes of meningitis, and it is clear from the strength of feeling today that hon. Members fully support the meningitis and other world-class vaccination programmes that we have in place to protect individuals, particularly children, and the community as a whole by vaccinating against preventable diseases.
For 35 years successive Governments have based decisions on vaccination programmes on independent expert advice from the Joint Committee on Vaccination and Immunisation, and it will help to answer one or two points that have been raised if I clarify the JCVI’s legal basis. Since 1 April 2009, the Health Protection (Vaccination) Regulations 2009 have placed a duty on the Secretary of State for Health in England
“to ensure, so far as is reasonably practicable, that the recommendation of the JCVI is implemented”
where certain conditions are met, including that the recommendation is
“in response to a question referred to the JCVI by the Secretary of State”
and that it is
“based on an assessment which demonstrates cost-effectiveness”.
That is the basis on which the JCVI was constructed and under which it operates.
At the recommendation of the JCVI, as the House knows, we introduced in September 2015 a men B programme, using the vaccine Bexsero, for babies born on or after 1 July 2015. The babies receive a dose of vaccine at two months, with a further dose at four months and a booster at 12 months. To ensure that we have protected as many infants born in 2015 as possible from men B before the usual winter peak in cases, we also offered the vaccine to babies born in May and June 2015 as part of a one-off catch-up programme, which was possible because the vaccinations could take place when the babies were due to attend their routine immunisation appointments at three and four months.
By May 2016, all infants under one will have become eligible for the men B vaccine, and by May 2017 all children under two will have become eligible for vaccination, which clarifies the points made by my hon. Friends the Members for Erewash (Maggie Throup) and, in particular, for The Cotswolds (Geoffrey Clifton-Brown). Obviously, much of today’s debate has focused on extending the men B vaccination programme, and hon. Members and those who signed the e-petition want us to go further, which I absolutely understand. The term “meningitis” strikes fear into the heart of any parent. Public Health England surveys parental attitudes, and its surveys regularly show that meningitis is the disease that parents fear the most. When we hear sad stories and see utterly heart-breaking pictures of children such as Faye, of course it adds to parents’ fear and worry. They want what is best for their children, which includes protecting them from meningitis if there is a means available to do so.
The Government feel the same, which is why we became the first country in the world to introduce a programme using Bexsero. However, although meningitis is a much-feared disease, it is now much rarer, thanks in large part to the success of this country’s immunisation programmes. Cases are currently at their lowest numbers in more than two decades. To give the House an example drawn on by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the Scottish National party, cases of meningitis C have dropped from a peak of around 900 in 1998-99 to about 30 cases in 2014-15. Very few children will get meningitis, and thankfully, deaths are uncommon, although no less tragic.
The hon. Member for Central Ayrshire also mentioned teenagers. As I have enough time, I will draw the House’s attention to the men ACWY programme that we have introduced. Men W is the strain of meningitis that has increased; cases have been increasing since 2009. There were about 50 cases in 2012-13, about 100 in 2013-14 and around 180 in 2014-15. We rapidly introduced a vaccination programme this year as part of an emergency response to control the national outbreak of group W meningococcal disease. Provisional data show men ACWY vaccine uptake at around 34% in the urgent catch-up cohort aged 17 to 18 in 2014-15. I say that to enlist the help of hon. Members when we try to increase awareness of the men W campaign again this year. We need any help that can be given in publicising it. As I remarked with one colleague before the debate, it is considerably harder to get teenagers to the GP than small infants. It is an important campaign involving a very dangerous strain of meningitis that we must continue to bear down on.
However, the petition is about men B. It calls for the men B programme to be extended to children up to 11 years, although several hon. Members have suggested that up to five years may be a compromise. I fully understand why parents and the public want the extension, but as we have begun to explore in this debate, it is not a simple matter; I hope that hon. Members agree. Some of the reasons for that have been teased out, and I will say a little more about them.
Any Government must make the best use of the resources that they have to ensure that they deliver the maximum health benefit to the population. The greatest burden of meningitis B falls on the under-ones, who have therefore been our focus, on expert advice. As we have heard, such judgments are based on NICE’s rules on cost-effectiveness, which have helped successive generations of Ministers to make difficult decisions that are none the less fair and justifiable and reflect, as the Chair of the Health Committee said, the many challenges across our healthcare system.
I have spoken in detail to Professor Andy Pollard, the chair of the JCVI, to understand what process the committee went through when considering the men B vaccination and to be assured that the committee’s recommendation is robust. I have been reassured that the programme we have is the right one, targeting the group of children at highest risk of disease and death. Professor Pollard confirmed that a catch-up programme for one to four-year-olds would not be cost-effective at a realistic vaccine price. Also, the disease is so rare in those aged five to 11 that a programme for that age group would not be cost-effective, and the JCVI could not recommend it.
Dr Whitford
Is it not the case that the JCVI did a cost-effectiveness analysis using a 1.5% discount, which is the same as in public health, and at that level a catch-up programme for one to five-year-olds would be cost-effective?
Jane Ellison
I am coming to that point, but I thank the hon. Lady for her intervention.
As it stands, on the evidence and advice that I have received, I cannot support extending the men B vaccination programme to older children, but I emphasise that the JCVI keeps under review the evidence relating to all vaccination programmes, and I know that it will consider all the points made in this important debate. If the committee’s advice changes, I will consider it as a priority. The JCVI also keeps the eligibility criteria under review. I wrote to the chair on 17 March this year, following the evidence session with parents, asking the committee to review the cost-effectiveness evidence for one to two-year-olds, which Professor Pollard mentioned in his evidence to the committees. I await formal advice on that. Again, if the JCVI’s advice changes, I will consider it as a priority.
Many of the contributions made by hon. Members in this debate have queried whether the cost-effectiveness methodology used by our experts is right for immunisation programmes. The shadow Minister drew out that point, as did others, including my hon. Friend the Member for Bath (Ben Howlett), who led the debate on behalf of the committees. As some hon. Members said, an independent expert group—the Chair of the Health Committee gave it its full title, but I will call it CEMIPP for ease—is considering the cost-effectiveness methodology for immunisation generally. It includes factors such as peace of mind, cost of long-term social care for surviving children and how prevention is taken into account, all of which have been mentioned in this debate, as well as the issue of discounting.
The CEMIPP review is considering whether current discount rates are appropriate for vaccination in general, and it will report in the summer. I will consider any recommendations on that, although obviously I cannot pre-empt decisions in this debate. As I indicated to the Chair of the Health Committee when she made her contribution, I look forward to receiving the report in the summer. I have committed to publishing the report, and I do so again. If it is of interest, I will also provide the Petitions and Health Committees with a written briefing summarising the report and the Government’s proposed next steps when we get it.
Several hon. Members have expressed concern about whether the research requested by JCVI into whether a men B vaccination programme for adolescents would be cost-effective will take place and how long it might take. I can confirm that a preliminary study of the meningococcal strains carried by teenagers is now under way and will report in February 2017. It will inform a larger study of the effect of men B vaccination in that group. As the Chair of the Health Committee said, it is about exactly how the impact of the larger group would bed down on the impact of the disease in smaller children. I commit to the House to commission the second, wider study following on from the preliminary study now under way on strains.
I recognise that Members have concerns—again, the hon. Member for Central Ayrshire mentioned this issue—about how long the research is taking. I have had extensive discussions about that, because like hon. Members, I want quick answers. However, things are sometimes difficult to weigh in the balance. Robust scientific studies on which long-lasting and important decisions can be taken take time. My scientific advisers have told me that this is a particularly complex study, and that a previous study had inconclusive findings. We want to get this one right and ensure that we have a definitive answer. I am hopeful that this study could start in December 2017. The House has my complete assurance that we will always go with as much speed as we can while maintaining important robustness, so that we reach answers on which evidence-based policies can be made.
Much has been made about the importance of raising awareness and ensuring quick treatment. As many have said, no matter what the nature of the vaccination programme, there will still be cases, and we need to bear that in mind. Many Members have spoken of the reassurance that vaccinations offer and how they set minds at rest; it came out particularly in some of the evidence sessions. Although it is important that it reassures parents, I take this opportunity to underline and stress that vaccination is not a silver bullet. Even with a vaccination programme up to the age of 11, there would still be men B cases in under-11s, as we think that the vaccine covers only about three quarters of all men B strains and no vaccine is 100% effective.
A number of people have made the point, including the hon. Member for Central Ayrshire in an earlier intervention, about understanding the impact of the programme. No other country has introduced a free vaccination programme.
There is as yet no evidence regarding the real-world effectiveness of Bexsero in preventing meningococcal disease in a population—that is different from the safety issue—because, as has been said, incidence is too low for clinical trials to provide a reliable measure of effectiveness.
In response to points made by my hon. Friend the Member for The Cotswolds, I will say that we should have some indication later in 2016 of how effective the vaccine has been. However, establishing an accurate measure of how effective the vaccine is, how long the protection lasts and what proportion of strains it will prevent will take many years of detailed observation by Public Health England, and that clearly will feed into the ongoing review and the important decision-making process that we have. It is worth making that point.
Mr Winnick
I go back to what the Minister said a few moments ago. Of course there is no guarantee with vaccination; everyone recognises that. However, my constituents—no doubt she listened when I spoke about my constituents who tragically lost their child—strongly feel that if Mason, their seven-year-old boy who died, had been vaccinated against this disease, he would have lived. To a large extent, that is the essence of the petition, the debate today and the rest of it. To repeat myself, everyone recognises that there is no guarantee, but there is a question of saving lives.
Jane Ellison
Of course, and I have tried to reflect on that important point. Nevertheless, raising awareness and ensuring the quick treatment of meningitis will always remain very important for that reason, so parents and healthcare professionals need to remain alert to the signs and symptoms of the disease, as was brought out in the moving speech by my hon. Friend the Member for Bury North (Mr Nuttall) when he talked about the attentiveness of Charlie’s mum as she monitored his symptoms.
Let me tell the House a little about what we are doing to raise awareness among healthcare professionals. Public Health England produces a range of training materials for immunisers, which includes information on the various programmes. It also collaborates with the charities in this area to support their work to improve healthcare worker knowledge, including through the development and distribution of resources aimed at each type of healthcare professional. It runs teaching and training events, and cascades briefing notes through networks. NHS England also does work to provide tools to help GPs to recognise meningitis. A great deal of work is going on in this area, but of course there is always a need to do more.
I turn to the issue of raising awareness among parents, because that is where we can do more. I announce to the House today that I have asked Public Health England to develop a national awareness campaign that will focus on the dangerous infections that parents worry about the most, including meningitis, septicaemia and sepsis. The campaign will focus on the symptoms that parents need to look out for. To get that right, we will work with the appropriate experts and charities, and of course more details will be available in due course. I will look to keep the relevant Committees up to date with that, but it is my intention that this information should be rolled out before the peak of cases in the winter.
Ben Howlett
Will the Minister also confirm that she will work with the Department for Education on helping those in the teaching professions and nurseries to identify the different conditions, so that we break down the silo type of response that sometimes prevents these sorts of conversations from being had more freely?
Jane Ellison
I have only had initial conversations with Public Health England about the shape of the campaign, but I can assure my hon. Friend that the officials and the other people working on this campaign will look very carefully at what has been said today, and at some of the ideas that hon. Friends and other Members have put forward, and of course they will take all those points into account.
Geoffrey Clifton-Brown
I fear that I am becoming the bane of the Minister’s life over this issue, so I apologise, but I am grateful to her for giving way. One of the issues that I raised in my speech was the unit cost. As I understand it from her reply today, she does not think that there is a case yet for rolling vaccination out to children under five. Would she undertake to keep this matter under review, and would she also undertake to ensure that the JCVI, or Department of Health officials, will continue to have discussions with GlaxoSmithKline on what the drop in the unit cost might be if all these extra vaccinations were given to under-fives?
Jane Ellison
I can assure the whole House that the JCVI keeps that under constant review. It is not something that is occasionally dusted off and looked at every four or five years. The committee looks at all the factors that go into making the relevant decisions. When the factors that contribute to its decision making change, it looks into them. I have already given the House the assurance that the JCVI will keep that under careful review. The Select Committees heard directly from Professor Pollard and had that assurance from him. However, I will draw the JCVI’s attention to the concerns raised in this debate and the huge level of interest in the matter in the House and among the wider public.
As came out in the evidence that the JCVI gave to the Health Committee and the Petitions Committee, under the current cost-effectiveness criteria, the men B vaccination programme was only just cost-effective even for infants on JCVI’s final analysis, but we did not shy away from introducing it because we know how devastating meningitis can be and how important protecting children from it is to parents. That is why we became the first country to have a programme of using Bexsero. Many other countries have asked experts to consider men B vaccine programmes, but because the cost-effectiveness is so borderline, to date only Ireland has recommended a programme. I understand that it will start in the autumn, using the same criteria as the UK’s programme. We are leading the way in protecting our children from men B.
As I draw my remarks to a close, I want to reiterate Members’ thanks. I appreciate the fact that so many Members have expressed their thanks to Professor Pollard and the JCVI for the complex and important work that they do. That also goes for the many clinical experts who give us their expertise on which to make these enormously difficult decisions.
Dr Wollaston
I am intervening because the Minister mentioned that she is drawing her remarks to a close. Can she comment on the issue I raised about the variation in roll-out and the communication issues for public health directors in being able to assess the variation in their areas?
Jane Ellison
I am not able to give my hon. Friend an answer today. If she does not mind, I will write to her about that. I have had a conversation about that with the public health director in my own borough, so I am aware of some of the frustrations that have been expressed. If my hon. Friend does not mind, I will write to her with more detail rather than give a response off the top of my head—her question deserves a better answer.
I want to put on the record my thanks to the meningitis charities that work tirelessly to support families affected by this terrible disease and have done so much to advance their cause. Many of them have circulated their 10-point action plan. I have touched on most of those points and indicated how the Government are responding.
Like other Members, I recognise the courage and dignity that, as has rightly been said, Mr and Mrs Burdett and the other families affected by meningitis in such a tragic way have shown over recent weeks. Nothing I can say today can make up for their loss, but I have listened very carefully to the evidence that they have bravely given to the Select Committees, and particularly the emphasis that they have put on raising awareness, which they have done so much about. I hope it is some comfort to them to know that not only their own efforts in bearing testimony but the new awareness campaign, alongside our vaccination programmes, will save lives in future.
Ben Howlett
I thank you, Mr Davies, and Mr Pritchard, who was here earlier, for chairing the debate. There have been incredibly powerful speeches today. I have seen this place at its best many times here in Westminster Hall during debates on petitions. I thank every Member here for contributing and for listening to the 820,000-plus people across the UK who care deeply about the issue. It shows that we as parliamentarians can really connect with our constituents on issues they care passionately about. I lend my thanks to the petitioners, the families, the charities and all those who gave evidence to the joint Health Committee and Petitions Committee sittings for their time, their passion, their work around our country and their fundraising for little children, including little girls like Harmonie-Rose in my constituency and many thousands of others in the rest of the UK.
I thank the Minister for her response. I was pleased to hear about the public awareness campaign that she has just announced to the House. It is absolutely right, as my hon. Friend the Member for Totnes (Dr Wollaston) said, that the decision-making process is clinically led. Sometimes it is rather irritating when politicians come in and say, “We know best.” Sometimes we do not know best, as my brother who is a doctor tells me many a time—although he is a junior doctor, but we will not get into that debate right now.
We rightly have a responsibility to hold the Government to account. Given what the Minister has just announced, I was pleased to hear her wish to report back to the Petitions Committee and the Health Committee on the reports that will be produced later in the summer. I look forward to seeing what reforms to CEMIPP will be discussed—as someone who is thoroughly dyslexic, with luck I will not end up having to spell that.
I thank all those who have taken part in the debate. This is not the end of the journey. Once we get to debate a particular subject in this Chamber, that is not the end of the road. There is no doubt that this is a long-term conversation that needs to be had. Any life lost is one too many. I thank you, Mr Davies, for chairing the debate.
Question put and agreed to.
Resolved,
That this House has considered e-petition 108072 relating to the meningitis B vaccine.