Covid: Vitamin D

(Limited Text - Ministerial Extracts only)

Thursday 17th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is an absolute pleasure to serve under your chairmanship, Mrs Murray, I think for the first time. I offer my warm congratulations to the hon. Member for Strangford (Jim Shannon) on securing the debate. I am sure if he had not secured it, he would have contributed to another debate in here this afternoon. I intended to say this yesterday, but I did not get the chance: I would like to send my warm and best wishes to the hon. Gentleman’s mother. He will know why I am saying that. It is a delight to be here today to respond to him.

I will try to respond directly to all the points that were made today, if not specifically then more broadly, but I am always here if hon. Members want to ask me for more specific details. We consistently review the data and the latest information as it emerges on covid-19. Our objectives are to ensure that people are not made adversely ill by covid-19 and that as many people as possible stay out of hospital, off ventilators and improve as quickly as possible.

That includes the progress we have seen in treatments for those suffering with the virus, including longer-term preventive measures, such as our strategy to reduce obesity, which we know is one of the few modifiable factors of covid-19, and the implementation of the vaccination programme.

Some 78.9% of adults in the UK have now received the first dose of the covid-19 vaccine, and 56.6% have received the second dose. Everyone who has spoken, including the shadow Minister, the hon. Member for Nottingham North (Alex Norris), and the SNP spokesman, the hon. Member for Glasgow East (David Linden), has congratulated volunteers and those who have run and operated the vaccine programme across the UK, and I add my congratulations. It has been phenomenal, and we have much to be thankful for. I am sure that everyone will join me in acknowledging the dedication of volunteers who have answered the clarion call and turned up. I think the hon. Member for Glasgow East said—it may have been yesterday—that they have donned the vest and got out there, and they are still doing those jobs. That is just amazing.

Since the start of the pandemic, there have been reports that vitamin D may reduce the risk of coronavirus. I have to sound a note of caution here because, when looking at the data and the evidence, we cannot cherry-pick the odd report here and there. I am not accusing anyone of doing that, but we have to take a more robust view of the data and look at it in the round.

I will pick up on the points that the hon. Member for Strangford made about BAME communities. To date, the UK Biobank’s most robust data on covid, vitamin D and ethnicity has not found a link between vitamin D concentration and ethnicity that could reduce covid-19 infections. There was no link, sadly. It would really be encouraging for us if the data showed that vitamin D prevented people from catching covid—that would be quite amazing—and we are certainly working on and searching for that data, but we do not have it yet.

On 14 January, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), responded to a debate on this matter, in which the hon. Member for Strangford also participated. I welcome the opportunity to debate it further and set out the measures that we are delivering. As my hon. Friend said:

“Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19.”—[Official Report, 14 January 2021; Vol. 687, c. 597.]

Last December, the National Institute for Health and Care Excellence, the Scientific Advisory Committee on Nutrition, and Public Health England published rapid guidance in response to the queries that the hon. Member for Strangford and others have raised on vitamin D in relation to covid-19. The data was reviewed by an expert panel and included the best available scientific evidence published to date, including both randomised controlled trials and observational studies. The expert panel supported existing Government advice and the recommendation for everyone to take 10 mcg of vitamin D supplement throughout the autumn and winter to protect their bone and muscle health. However, the panel concluded that there is currently not enough evidence available to support taking vitamin D to prevent or treat covid-19.

There are still significant gaps in the current evidence, as was the case in January. To date, studies have not reached the high level of data quality required to revise the guidance. The current evidence base is mixed and dominated by low-quality studies, with substantial concerns around bias and confounding evidence. There are lots of studies out there, but some of them do not have the quality and the robustness of data and evidence that are required.

Currently, studies are unable to demonstrate a causal relationship between vitamin D and covid-19 for anyone. That is because many of the risk factors for severe covid-19 outcomes are the same as the risk factors for low vitamin D status. Owing to the lack of reliable evidence, the NICE guidance recommends that more research be conducted on the subject. Government guidance continues to stress the use of high-quality randomised control trials in future studies.

At present, more than 90 trials that are looking at the efficacy of vitamin D as an intervention for covid-19 across all stages of the disease are either under way or due to publish, either in the UK or internationally. Given that 90 trials are currently under way, possibly—hopefully—the evidence and data that we require will come our way soon. I would be really disappointed if those 90 trials do not give us the evidence we want. Let us hope that they do.

Some of the trials are of the high quality that we require to produce the data, and will answer key questions. NICE, PHE and the Scientific Advisory Committee on Nutrition are monitoring new evidence from trials as it becomes available.

The long-standing Government advice is that, every year, between October and early March, everyone is advised to take a supplement containing 10 mcg—400 international units—of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body and to protect bone and muscle health. In April and autumn 2020, PHE reiterated the advice and also ran a public awareness campaign throughout December 2020. That had a specific focus on BAME communities, where vitamin D supplementation is important.

Vitamin D is made in the skin when exposed to sunlight during the spring and summer months and the PHE advice to continue taking vitamin D supplements is therefore particularly important for those who were shielding, care home residents and prisoners, as well as those who choose to cover most of their skin when outdoors, as these groups are likely to have reduced sunlight exposure. Importantly, individuals with dark skin are more at risk of not having enough vitamin D and are advised to take the 10 mcg of vitamin D supplements all year round.

We have actively supported the uptake of the PHE recommendations. Over winter 2020-21, the Government provided a free four-month supply of daily vitamin D supplements to adults on the clinically extremely vulnerable list who had opted to receive the supplements, all residents in residential and nursing care homes in England, and the prison population, where Her Majesty’s Prison and Probation Service made supplements available across England and Wales.

The Government prioritised groups that were asked to stay indoors more than usual over spring and summer 2020 due to national restrictions. The supplements were provided to help support their general health and, in particular, bone and muscle health.

Recipients of the Healthy Start scheme are also offered supplements containing vitamin D by the Government. Guidance on vitamin D can be found online, and we encourage individuals to buy 10 mcg vitamin D supplements from retailers such as supermarkets, chemists and health food shops.

As research continues on the impact of vitamin D on covid-19, we will continue to monitor evidence as it is published. We have committed to keeping this under review and, as I have said, we are committed to keeping the 90 trials that are under way under review, some of which are high quality, producing robust information.

[Jim Shannon]

Does the Minister have any indication of when the trials will be completed and when the evidence will be sought and got?

--- Later in debate ---

[Ms Dorries]

I do not believe all the trials start at the same time or aim to finish at the same time and there are 90 different trials, so I cannot give the hon. Gentleman a concise answer to that question. I reassure him that we are in the same place. If the trials proved that vitamin D had an effect on covid-19, we would be the first to shout about the results. As soon as they report, we will be delighted to receive the information.

Public Health England and the Scientific Advisory Committee on Nutrition and NICE will update further advice and the Government welcome any further studies into this emerging area. It may not just be 90 trials, as we may see even more.

We have been clear that our decisions are based on robust evidence. That position remains. I am sure hon. Members understand the importance of that and the reason why that has to be. We know that vaccines are the way out of this pandemic. Vaccines are the best way to protect people from covid-19 and they have saved many thousands of lives.

Looking to the future, we know that excess weight is one of the few modifiable factors for covid-19. It is a sad fact that obesity has played a large role in the impact on and outcomes for people who contract covid-19. Therefore, supporting people to achieve a healthier weight is crucial to keeping people fit and well as we move forward.

We launched “Tackling obesity: empowering adults and children to live healthier lives” in July 2020 and, as part of delivering the measures set out in our strategy, we confirmed in December 2020 our intention to legislate to stop the promotion of high fat, salt and sugar products by volume and prominent location, both online and in store, in England from April 2022. In the Queen’s Speech on 11 May, we confirmed our intention to introduce advertising restrictions for products high in fat, sugar and salt on TV before 9 pm and online. Currently, the House is debating legislation to introduce mandatory calorie labelling for large out-of-home food businesses such as restaurants, cafés and takeaways.

I hope that Members here today and Members from across the House will support the measures in their passage through Parliament, because we believe that they will be a key part of the tackling obesity campaign, which is so important in relation to covid-19. Helping people to achieve and maintain a healthy weight is one of the most important things that we can do to improve the nation’s health, and we are committed to meeting the challenge. My right hon. Friend the Prime Minister has been clear that

“we…must have a care for the health of our population and we will be happier and fitter and more resistant to diseases like Covid if we can tackle obesity.”

I will finish by saying that I think the objectives of everybody in the debate today are the same. I hope, along with other hon. Members, that we receive the robust data that we need; and if we do not, we continue with what we are doing, rolling out vaccines and dealing with the challenge of achieving a healthier nation via tackling obesity.

[Jim Shannon]

I want to thank all those who took part in the debate. First, I thank the hon. Member for Glasgow East (David Linden) for his contribution. Many things that the Scottish Parliament does on health issues interest me. He knows this, because I have said it to a health spokesperson for his party. I always listen intently to everyone, but in particular to the Scottish Members about how Scotland has done things, because it has done many things that I believe we could replicate across the whole United Kingdom.

One of the great things about these debates is that we can learn from one another and then, hopefully, take some of the good things from elsewhere and bring them in where we are, in the same way as we have done in Northern Ireland. The hon. Member for Glasgow East referred to what the Scottish Parliament is doing on vitamin D and to taking it all year round. It is perhaps a step ahead of us, so I thank him for describing that.

I am very pleased, as always, to have the hon. Member for Nottingham North (Alex Norris) here. My apologies to his wife; she can have him for the rest of the day—is that the way to put it? He has responsibilities here and has done well; I thank him for that. I also thank him for making, as always, an in-depth contribution, which lets us know where the Opposition, in the form of the Labour party, are and what they are doing.

We can probably all agree—I think the Minister is absolutely right, by the way—that we are here to support each other and the Minister. She outlined a very robust strategy for health—

[Ms Dorries]

I want to let the hon. Gentleman know that I have received a response on when the trials are due to conclude. Most are due to conclude this year.

[Jim Shannon]

Now, that was a quick answer! How many people get an answer to a question they asked 15 minutes ago? That is brilliant. That reinforces my comments about the strategy that the Minister referred to—the restrictions on adverts before 9 pm, the obesity and covid-19 death connection, and all the things the Minister referred to. Hopefully, some of the 90 trials—I never realised that there were that many trials going on—will produce high-quality data, which is what the Government needs to act upon.

I am hopeful, and I thank everyone for their participation. In particular, I thank the Minister for her excellent response and for reassuring me, the shadow Minister, the hon. Member for Glasgow East and those who were not able to come today but are watching the debate and would have wished to participate. Today, we have hope for the strategy. If the high-quality data is there, this can be a reality. I genuinely believe in my heart that this can benefit people, but we need the data to prove it. Our job, and the Minister’s job, is to receive that data and work on it. We have had that commitment. If the data is correct, we will have that.

Thank you for your chairmanship, Mrs Murray, as always. We do not always say that to the Chair, but thank you for chairing the debate well, as you always do. I also thank the staff, who work away in the background behind the screens. If we did not have them, this would not work at all.

Question put and agreed to.

Resolved,

That this House has considered the value of vitamin D as a defence against covid-19 infection.