Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021
(Limited Text - Ministerial Extracts only)
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Lord Bethell
That the Regulations laid before the House on 15 June be approved.
Instrument not yet reported by the Joint Committee on Statutory Instruments
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we are making excellent progress along the spring 2021 road map, and we now have one of the most open economies and societies in this part of the world. But we all want to see restrictions lifted even further, and on that I am optimistic. However, we know we cannot be complacent. As the Prime Minister set out in his address to the nation on Monday, we do need to hold at step 3 of the road map for just a little longer. This is vital. The very latest scientific data and evidence show us that we must proceed with the utmost caution. By pausing at step 3, we are seeking to protect the progress we have made on infection rates and the vaccine rollout, and to make absolutely certain that we are on a stable footing before we go further.
Unfortunately, the prevalence of the highly transmittable vaccine escapee delta variant has shifted our assessment of the risks. It is now the dominant variant across England, accounting for 90% of cases, and it is set to spread around the world. Its R number is estimated to be 60% to 80% higher than the previously most widespread alpha variant. The overall R number in England has increased and is now between 1.2 and 1.4, meaning that we are in the age of doubling times. We need to be in an age of halving times. Early evidence suggests an increased risk of hospitalisations with the delta variant compared with the alpha. This pause will bring us more time in the race between the vaccine and the virus. It will ensure that we as a nation are equipped as well as we can be to take on the virus and the delta variant.
Can I say a word about the vaccine? Increasing the number of second jabs is absolutely crucial. The data that we have at the moment suggests that the vaccines are less effective against symptomatic disease cause by the delta variant, but that protection increases after two doses. Two doses of the vaccine has now been shown to be highly effective in reducing hospitalisation from the delta variant, with the latest PHE data suggesting that this could be 96% for the Pfizer vaccine and 92% for the Oxford/AstraZeneca vaccine after the second dose.
In this time, while we pause step 3, we will deliver many more first and second vaccine doses. There are currently 1.2 million over-50s and 4.3 million over-40s who have had their first jab but have not had their second. By 19 July all those over 50 and the clinically extremely vulnerable who have had their first doses by mid-May will have had their second dose—or will have been offered it. Second doses for all over-40s will be accelerated by reducing the dosing interval from 12 weeks to eight weeks. All over-40s who received a first dose by mid-May will be offered a second dose by 19 July. All adults aged 18 and over will be offered a first dose by 19 July, two weeks earlier than planned.
I am confident that we can hit those targets, not least because our vaccination programme has made great progress. A network of vaccination sites continues to operate brilliantly across the UK; there are now more than 1,990 vaccination sites in England, with more coming on line in the days and weeks ahead. Thanks to the tremendous efforts of all those involved, more than 41.8 million people in the UK have received their first dose and 30.2 million their second. From today, all adults over 21 can book their first dose.
Vaccine supplies are robust and delivering to forecast. For the Pfizer vaccine, we expect supply in June to be 30% more than in May, and July’s will be 80% more than in June. Supplies should be sustained at this level in August. So I thank everyone involved in the vaccination programme for their continued efforts to maintain this tremendous progress over the weeks ahead.
I would like to anticipate a couple of the questions that may arise in the debate ahead, and I will start with borders. A number of noble Lords have asked why, if the delta variant has changed our assessment so much, we did not act sooner, protect our borders more quickly and prevent the variant entering the country. I would say that we did act quickly to reduce the importation of the delta variant; we took the decision to add India to the red list immediately upon being advised that this lineage of variant was potentially higher risk than any other variants under investigation, and several days before the delta was considered a variant of concern. We acted quickly and with caution. The contribution of variants to the surge in cases in India was at that time unclear. We added India to the red list on 23 April, with arrivals having to quarantine for 10 days in a hotel. Before India was red listed, everyone had to quarantine on arrival for 10 days, take a pre-departure test and two further tests on days 2 and 8 of quarantine.
The decision to add and remove countries from the red list is made by Ministers, informed by the latest scientific data and public health advice from a world-leading range of experts. As with all our coronavirus measures, we keep the red list under constant review, and our priority remains to protect the health of the UK public. However, this does not change the fact that this virus is a formidable enemy and needs to be tackled on many fronts. Border measures are important, but that does not mean that we can be complacent elsewhere. We have learned that Covid likes to take advantage of complacency, which is one reason why we each need to take individual responsibility for tackling the virus. We all need to follow the public health advice to protect the progress that we have made.
I will now move on to a topic that I know many noble Lords are interested in: singing. We are aware that singing can increase the risk of Covid-19 transmission through the spread of aerosol droplets. It is particularly dangerous indoors, where the particles can build up and, as with any activity, the cumulative effect of aerosol transmission means that the more people are involved, the higher the risk of transmission. The guidance mirrors our approach elsewhere to be more cautious indoors than outdoors and to be mindful of the impact that our actions have on other people.
Finally, can I say a word about adult social care vaccination? An extensive six-week consultation on making the vaccine a condition of employment for care home staff concluded on 26 May. It saw a fantastic level of engagement; we see a clear public health rationale for driving vaccination uptake in care homes.
So I am confident that we will be in a stronger position by 19 July. This pause at step 3 will help us reduce the number of hospitalisations and deaths and will protect the NHS. I commend these regulations to the House.
Amendment to the Motion
Lord Bethell (Con)
My Lords, this delay comes with huge regret—no one likes to see step 4 delayed in this way. I start by acknowledging that it will have an impact on many people’s lives. We have talked a lot in this Chamber about singing. I do not think that it is necessarily the biggest impact, but it is iconic and important. I am disappointed that I have not been able to satisfy my noble friend with my comments on it. I have the guidance on singing here, and I make it clear that the Government are not banning singing or dancing. We know that people want to get back to normal activities, but they need to acknowledge that singing and dancing can increase the risk of catching and passing on the virus. We know that singing is risky; that is proven. Covid can spread from person to person through small droplets in aerosols, and singing increases the risk of transmission through these. It is particularly dangerous indoors.
I return to the question of singing because I want to convey a sense of the science basis on which we have made these decisions and because of the importance we put on individual responsibility. We advise on amateur singers, sports matches, bars and restaurants and audience participation—I should be glad to share with the House a copy of this advice—we allow outdoor singing for amateur singers, audience participation and at sports matches, and professional choirs and singers are permitted to rehearse and perform in any number. That is a way of trying to say that a huge amount of consideration has gone into the practical impact of this advice and these guidelines, and where we have made tough decisions, it has been done with consideration.
I can give some good news to the noble Baroness, Lady Thornton. BEIS estimates that there will be 50,000 weddings in the four weeks from 21 June. To give the Chamber a sense of scale, assuming an average reception size of 50 people, that means that 2.5 million people will be able to go to a wedding this summer, and I know that that will be a huge relief to many of them.
I shall take a moment, a long moment, to address my noble friend Lord Lilley’s point seriously, because it is an important one. I agree with him wholeheartedly that we will learn to live with Covid, with some people catching the disease and, sadly, a very small number of them succumbing to it. The nation will need to commit to public health measures to fight new variants and outbreaks, as we have done through history. But let me address his strongly held view that we are today ready to unlock.
Yes, the vaccine programme is going well—and I can confirm to the noble Baroness, Lady Thornton, that the supplies are in place to commit to the programme as advertised—but the supply is still limited only to the supplies we have booked, so we need another month to offer it to everyone. Despite the effect of the vaccine on infection, transmission, serious disease and death, to which my noble friend referred in his very persuasive speech, infection rates are rising, and they are rising dramatically. The noble Baroness, Lady Brinton, put the statistics extremely well. The doubling rate in many LAs is just six days. The infection rate in schools is bubbling up. Outbreaks in social care are becoming regular.
We have been here before. To give your Lordships a specific example, in a city such as London, which has a relatively young population, there is a huge reservoir of potential novel, unvaccinated people, so we are just not quite out of this yet. Even if the vaccine does prevent severe disease, I remind noble Lords that there are more than a million—nearer 2 million—people who are immunosuppressed for one reason or another and for whom the vaccine does not offer a way out at all.
I also remind my noble friend Lord Lilley that if the infection were to be rife, even if the consequences were not disease and severe illness, it would not be consequence-free. We do not know the incidence of long Covid, but we do know that many of the people who have long Covid are completely asymptomatic, and we know that high rates of infection increase the conditions of mutation. That is what happened in Kent, to very grave effect, in September. So I say to my noble friend that I think this delay is necessary; it is right.
I remind the noble Lord, Lord Scriven, that red-listing is not decided by some simple algorithmic relationship to infection rates. Red-listing is used principally to keep out variants of concern. During the period that he talked about, we were understandably focused on the South African variant, and it was the South African variant that was rife in Pakistan and Bangladesh and that led us to red-list those two countries. We did not have a copy of delta. We did not have the necessary sequencing data. The WHO had not attributed it as being a VOC. Let us look at what actually happened. The delta variant became a variant of concern on 7 May 2021. By this point, India had already been on the UK red list for a full two weeks.
I absolutely sympathise with the difficulties faced by individuals, families and businesses which my noble friend Lord Robathan reflected on. On his specific point, which was also raised by my noble friend Lady Neville-Rolfe, an impact assessment was not published for this instrument because it is a temporary measure extending the steps regulations for only a short period. But I completely understand their point, and I reassure them both that in making these decisions, we continually assess the economic and societal impact of restrictions, balancing these with risks to public health.
On my noble friend’s substantive point, I am always grateful for the challenge he brings. Over the last 18 months, he has expressed his scepticism. He is sceptical about the effectiveness of lockdowns. On both 9 October and 12 November, he questioned whether additional restrictions in Leicester were having any impact at all, yet we know that lockdowns work. In Leicester, we managed to reduce the daily incidence rate from 135 cases per 100,000 on 28 June to 25.3 cases per 100,000 on 3 September.
My noble friend is sceptical about the accuracy of tests. On 6 October, he claimed that a high proportion of tests bring back false positives, yet after 193 million Covid tests, we know that this is not true. Independent confirmatory testing of positive samples indicates a test specificity that exceeds 99.3%, meaning that the false positive rate is less than 1%.
My noble friend has been sceptical about the rate of deaths from Covid here in the UK, and he is sceptical that the Covid death rate is a cause for concern. On 24 July last year, he questioned whether the death rate was really that bad. On 23 September, he told us that the death rate is still
“only between 1% and 2% of the average daily death rate in this country.”—[Official Report, 23/9/20; col. 1889.]
My noble friend is sceptical that the NHS capacity has ever been at risk. On 29 July last year, he said that hospitals were “not particularly full” and that they had not been “swamped”.
My noble friend is sceptical that world leaders are right to consider and worry about this pandemic so much. In May 2020, he said:
“According to the figures, perhaps 316,000 deaths around the world so far have been linked to CV-19. This is awful—every one is tragic—but it is not callous to point out that some 60 million people will die anyway around the world this year.”—[Official Report, 18/5/20; col. 949.]
My noble friend is sceptical about the Government’s whole response to the pandemic. I remember that he told the House:
“A huge number of people, including me, are concerned that we will overreact—although the Minister has said that we will not—and cause panic in the country, where panic should not be seen.”—[Official Report, 3/3/20; col. 521.]
He said that in March 2020, and I did not agree with him then. With 128,000 deaths in the UK and around 4 million deaths around the world, with a million people in the UK reporting long Covid symptoms, and with the rise of this nasty, highly transmissible, vaccine-evading new variant which seems set to spread around the world, I do not agree with him now.
I do not believe in doing nothing in the face of the evidence. I do not believe in leaving the elderly and vulnerable to fend for themselves or hoping that the virus will somehow blow itself out. I do not expect the economy to rock and roll even as the death toll rises and public confidence collapses. We are prepared to take tough decisions to save lives, protect the NHS and get us out of this awful pandemic, and we will continue to do so. For that reason, I ask my noble friend to withdraw his amendment. I beg to move.