Meningitis B Vaccine

(Limited Text - Ministerial Extracts only)

Monday 25th April 2016 Westminster Hall

[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.