New Covid Variants: Government Preparedness
(1 year, 4 months ago)
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Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)
I rise to address this Government’s preparedness for new covid-19 variants and other biological threats. Based on past experience, it is fair to say I am yet to be convinced that this Government are making the necessary progress in this regard. I will first address the Government’s culture before moving on to extant concerns specific to pandemic preparedness.
Hindsight is of value only if we are prepared to use the lessons it reveals to ensure that the same mistakes or misjudgments are not repeated. When it comes to calamity and loss, vindication brings only a bitter taste, not solace or comfort. For those of us in this place, and beyond, who voiced genuinely held concerns about the UK Government’s response to the pandemic, yesterday’s evidence to the covid inquiry from the former Health Secretary is unlikely to elicit any sense of schadenfreude—just a deep sense of despair and sadness.
The former Health Secretary’s testimony does not reflect well on those experts who allegedly gave him deeply flawed advice but, ultimately, he accepted that he alone carried ministerial responsibility for the “calamitous state of affairs” not only in his Department but in the agencies that reported to him, as Secretary of State. In short, he admitted that, when courage called, he failed to execute the responsibilities of his office. He is, of course, correct, but his apology rings hollow and does nothing to ameliorate the damage caused.
My abiding memory of the pandemic is the former Health Secretary’s all-too-frequent glib responses from the Dispatch Box to questions intended to be helpful and constructive. I could devote further commentary to his shocking testimony, but I suggest that might be better served by a Privileges Committee inquiry or other serious investigation.
The shutting down of dissenting voices was all too commonplace, and not just in this place. Innova, the beneficiary of lucrative lateral flow test contracts, put pressure on The Scotsman for daring to publish my valid criticism of the reliability of its tests. Despite scrupulously evidencing my assertions, with the support of esteemed academics, the editorial team could not withstand the very deep pockets that Innova had, on the back of billions of pounds of public money spent on its devices.
In addition, pressure was applied to academic and clinical staff who raised concerns about the adequacy of the UK Government’s pandemic response. Although I readily give my thanks to those staff for their ongoing encouragement and support, I am unable to name them, such is my concern that we are not yet out of the woods in terms of truth and reconciliation on these matters. That such a culture was allowed to flourish at a time of grave emergency is detestable.
Although it is clear that the UK Government must change, I see few earnest attempts to do so. I have asked too many questions on these matters to count, and I have led and contributed to multiple debates in this Chamber and in Westminster Hall, but much of that was for naught. Concerns went ignored and commitments were readily discarded, even by those few souls who maintained a position during the ministerial churn from Prime Minister to Prime Minister to Prime Minister. This may seem tangential to the matter at hand, but Government culture is central to organisational learning for future preparedness. In its basic form, the management of any infection is not rocket science, but each strand is necessarily interdependent and must be rigorous in both design and application. The continued failure to understand that fundamental relationship will fatally undermine any strategic future planning.
In essence, robust surveillance and detection should lead to prompt isolation of the threat, followed by the administration of safe and effective treatments, and supported measures, with further screening and surveillance repeated until the threat is managed. Get any step of that process wrong and the risk quickly spirals out of control. Relying on detection and isolation alone will not work. As we know only too well, an over-reliance on vaccination in the absence of robust surveillance is, similarly, a fool’s errand.
A recent briefing from the House of Commons Library set out the ambitions of the UK Health Security Agency and its Centre for Pandemic Preparedness. The CPP aims to ensure the UK’s future pandemic responses are effective and efficient, and that they reduce the negative impacts of health threats. The CCP aims to become the world-leading hub for all aspects of pandemic preparedness. In addition, the briefing notes that the HSA is working in partnership with the United States Centres for Disease Control and Prevention to turbocharge efforts to combat global pandemics and emerging health threats. Those are grand claims, grandiose perhaps, but the question remains: what does this mean in the practice of disease management and control?
In my Adjournment debate on the UK diagnostics industry in May last year, I voiced my concerns about the UK’s lack of preparedness for a future pandemic strategy, whereas economies the world over were developing 10-year strategies for the same. I applaud the efforts of the HSA in conceptualising a detailed report and a tentative timeline to execute a 10-year science strategy. It emphasises transforming surveillance through genomic identification and characterisation of new covid-19 variants, and promoting the use of innovative diagnostics, which are promising steps in the direction I indicated last year.
However, there are still clamant concerns to be addressed on the implementation of this plan and the efficacy of the HSA as an institution to deliver on those ambitions. First, the partnerships section on page 31 of the strategy report that a
“10-year strategic collaboration with Moderna will ensure we are better prepared against future pandemic threats, including through an onshore mRNA Innovation and Technology Centre.”
What is the basis of this “focused partnership” between the HSA and this single specific pharmaceutical company and a single specific vaccine technology? Recalling the Valneva vaccine production debacle and the adverse impact it had on the Scottish based company, may I ask what the rationale is behind such a partnership, as opposed to a more diffuse and cost-effective approach?
During a Westminster Hall debate in January 2022 I raised concerns about the UK Government’s overemphasis on vaccination as the sole plank of their policy, noting that even with the vaccine success delivered by Dame Kate Bingham, they had placed all their eggs in the mRNA basket. That was, and still is, short-sighted. The Valneva vaccine was the only adjuvanted, inactivated, whole-virus vaccine technology, yet the UK Government pulled the contract just before the phase 3 results were published. They demonstrated that the vaccine was highly effective and safe. That makes it abundantly clear that Scotland does have the potential to lead the way for the world in the domain of innovation and vaccine strategy for pandemic preparedness, yet we are continually and systematically impeded by the UK Government in that ambition.
Sir Christopher Chope (Christchurch) (Con)
I congratulate the hon. Gentleman on his persistence in trying to hold the Government to account on this subject. He refers to the culture, particularly in the Department of Health and Social Care, of keeping things to themselves, playing cards close to their chest, not having regulatory impact assessments and, in effect, as he says, imposing good ideas on the basis of heroic assumptions that are not being tested. May I encourage him to carry on his good work?
Neale Hanvey
I thank the hon. Gentleman for his kind intervention and warm words. I take them in good grace. He makes an important point. Assertations were made throughout the pandemic that things were one way and, despite interrogation, any understanding that they could not possibly be that way was continually denied. That was very frustrating, and I thank him for his encouragement.
In November 2021, Dame Kate Bingham called the decision to cancel the Valneva contract “inexplicable”. Do the UK Government still not get that? Why are they still not listening to the one person who came through the pandemic with their reputation enhanced, because she did the job she was tasked to do and did it well?
The British Society for Immunology has told me that it supports the use of all vaccine technologies where they have proved safe and effective in clinical trials, stating that a broad portfolio of vaccines is important as we move forward in providing protection against future variants. It also notes that mRNA vaccines were deployed first as they were the first vaccines to be approved. However, the Medicines and Healthcare products Regulatory Agency has since approved the use of eight different covid-19 vaccines that utilise a variety of technologies, including mRNA, viral vector, whole virus and protein-based platforms. What is the Government’s strategy to harness the power of all technologies, considering their intended partnership with Moderna?
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for bringing forward the debate. Like the hon. Member for Christchurch (Sir Christopher Chope), I understand exactly what he is trying to achieve. Lessons need to be learned. Does the hon. Gentleman agree that planning must be key to ensuring that our country can continue, Government can respond, our surgeons can operate and our teachers can teach? Should, God forbid, another pandemic emerge, we need to ensure we are better prepared and ready to do better.
Neale Hanvey
I thank the hon. Gentleman. In essence, we cannot unspill the milk. The milk was spilled and there were problems. We have to make sure that that does not happen again and that we learn from the process that led to such tragedy. We must make sure that we have not just a better approach, but the correct systems in place to ensure ongoing safety.
The BSI also emphasises a clear and urgent need for second and third-generation covid-19 vaccines, including a universal vaccine, a mucosal vaccine and vaccines that induce longer-lasting protection and immunity.
Furthermore, given that the “Innovation in diagnostics” part of the UKSHA science strategy specifically mentions
“research and development of new diagnostic technologies and innovative platforms”,
that begs the question of how closely corporate entities, such as Moderna, will be involved in directing the process. Will the Minister write to me, setting out in plain detail how such a strategy will harness the expertise of the domestic diagnostic sector, through organisations such as the British In Vitro Diagnostics Association?
During the pandemic, the UK Government stood accused of undermining the domestic diagnostic sector, driving some companies under with empty promises of orders, while innovative artificial intelligence technologies such as the Caledonia AI blood test and the Novacyt AI saliva test were sidelined. Both technologies can be adapted to screen for covid and other emerging threats, such as Ebola and dengue fever. Uploading profile information to AI would allow new, instantaneous border screening for new threats.
While the 100 days mission to respond to future pandemic threats may seem ambitious, the reality is that there are around 1.5 million people airborne at any one time, so the case for rapid deployment of accurate diagnostic screening could not be clearer. Almost everyone has a smartphone, and dongle-based AI testing could be deployed internationally at the stroke of a key.
Following my last Adjournment debate, I was given a commitment by the Minister in the then Department for Business, Energy and Industry Strategy to jointly host a UK industry roundtable. Sadly, despite my persistence, that commitment was not kept. If we lose this intellectual capability and capacity through Government inaction, that would be a further betrayal of the domestic diagnostic sector. What are the Government doing to secure and develop these technologies now, and will the Minister commit to meet me to consider a way forward?
Secondly, the timeline for the science strategy stipulates the creation of a vaccine development and evaluation centre by bringing together the UKHSA’s laboratory-based activity expertise and leadership in vaccine discovery, development and education. What is the need for the creation of yet another organisation, and what mechanism of funding and accountability does the Minister envisage for this body? Furthermore, how will this body ethically accommodate the corporate priorities of Moderna?
I am especially concerned about sustainability. In April last year, the UKHSA itself was stripped of funding as part of the living with covid strategy, putting the jobs of 40% of its workforce at risk. Yesterday, in a media interview, Cambridge virologist Dr Chris Smith warned that there is a risk that we lose focus and deprioritise funding and planning for biological threats. He argued for nimble, well-equipped public health systems in preference to top-down control. For grand strategic commitments to mean anything, funding and resources must find their way to the public health frontline. Can the Minister set out the plan and address how this new body will be insulated from political tumult and spin?
Thirdly, I remain uneasy with the undercurrent of institutional inefficacy from the days of Public Health England through to the UKHSA and the institutional vacuum in which emergencies are handled reactively by bodies such as the Scientific Advisory Group for Emergencies and Cobra. Module 1 of the current covid inquiry is a testimony to this continued trend. How does the Minister envisage the bolstering of these institutions in the face of future pandemics and, crucially, how will these institutions and partnerships be shielded from the perfidious private profiteering and VIP lanes that so compromised the UK Government throughout the pandemic?
Finally, there is another challenge at hand, which every single Member of this House will know from their inbox. It may be uncomfortable, but deal with it we must. The pandemic has driven a spike in online disinformation and misinformation, with social media the biggest source of false or misleading information about vaccines. However, we must ask, in light of the false reassurances admitted to yesterday by the former Health Secretary, whether silencing expert clinical voices is a solution to genuine concerns about the safety of novel therapeutic technologies. In my view, this challenge must be met with evidenced scientific argument and rigour, or we risk perpetuating the belief that something sinister is at hand.
My professional experience of managing cancer clinical trials and drug development teams is instructive: we need to take every reported adverse reaction seriously. That is the bedrock of developing and deploying safe therapeutic agents. There is also an opportunity to analyse outcomes on the back of the mass vaccination through a national clinical evaluation. Efforts must now be made to examine the vaccinated population and assess the efficacy and safety of the programme. That is quite normal.
Is vaccine injury possible? Of course it is. Injury is possible from exposure to any agent. The proposed mode of insult with mRNA—a systemic inflammatory response—is not a new phenomenon. There are established prophylactic protocols to manage such responses, but their efficacy must be tested. Pretending otherwise betrays the guiding words of Hippocrates—“first do no harm”. Systems for healthcare professionals and coroners to report suspected adverse drug reactions directly to MHRA already exist with the yellow card scheme, and they are very well established and used. Holding firm to principles of diligently reporting risk, minimising harm and ensuring ethical treatment do not indulge any conspiracy theory. They are fundamental to good clinical practice.
Members will also have received emails from constituents on the proposed role of the WHO international health regulations in co-ordinating future global pandemic responses. As I understand it, that proposal has now been modified to be non-binding on signatory states as a result of concerns over loss of local control and sovereignty. Yet it is of note that yesterday, the former Health Secretary attributed to the WHO the misguided advice he received. That deserves proper scrutiny. The response of Government should not be to mock, silence or ridicule Members who raise those concerns on behalf of constituents. The only way to address them is through proper clinical evaluation and absolute transparency.
Before I conclude, I want to raise some further points of challenge from the British Society for Immunology. The fact that media attention has drifted from covid-19 does not mean it is no longer a significant issue. The rolling seven-day average of deaths sits at around 30 to 100 per day over the last three months. Despite that backdrop, very few people are testing for infection. Limited testing means that strains can circulate in an unrestricted manner. The more the virus circulates, the more opportunities there will be for the evolution of variants of concern.
In the absence of regular widespread testing, it is even more important for waste water surveillance to be maintained at a relatively high level, to act as an early warning system for new variants of concern. According to the BSI, Government must prioritise the development of next-generation vaccines and long-term immune monitoring to determine how long effective immunity lasts in the vaccinated population, scale up testing capacity to ensure that previous failure is not replicated, introduce asymptomatic testing in the NHS alongside testing of patients and ensure that NHS laboratories have plans in place for infection surges of all respiratory viruses.
Therapeutic options are currently very limited, especially in groups that respond poorly to vaccination, while access to antivirals and monoclonal antibody therapies remains patchy across the UK and there is currently no recommended treatment strategy for persistent covid-19. Integrated care boards have yet to announce what will happen when the covid medicines delivery units are retired, and clarity is urgently needed so that clinicians can communicate plans properly to affected patient groups.
The delayed effects of covid are complex and difficult to quantify, but at present there is no long-term management plan for long covid. All those challenges must be met. There is no argument in support of the “pick and mix” approach of the former Health Secretary. If we do not capitalise on hindsight, we are damned to repeat the mistakes of the past.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey) for securing this debate and raising this important issue. It is correct that the Government are held to account on future pandemic preparedness and lessons learned from covid.
I remind the hon. Gentleman that pandemic preparedness is a devolved matter and Scotland, like all parts of the United Kingdom, faced huge pressures. I understand that the former Scottish Health Minister has been giving evidence today and has also pointed that out, saying that
“Scotland, like other countries throughout the world, was dealing with a virus which was unknown and new.”
She also said she did not believe that
“there is a plan that would have been possible that would have been able, in and of itself, to cope with covid-19.”
That sets out how all four nations of the United Kingdom were learning about covid. With hindsight, it is very easy to look back and make recommendations, and we must learn from those. I look with interest to the results of the covid inquiry to make sure that we are as prepared as possible for any future pandemics, whether of covid or any other disease.
For most people, covid-19 is now a much less serious risk than it was three years ago, and that is in no small part because of the UK’s world-leading vaccination programme. We were the first country in the world to administer an approved vaccine and the first European nation to protect half our population with at least one dose. That success continues, with vaccines and boosters still on offer to eligible groups, and we take recommendations on when to roll out booster programmes and who to vaccinate from the Joint Committee on Vaccination and Immunisation.
Antivirals provide a further layer of protection for those who are immunocompromised, enabling us to effectively treat eligible people with covid-19. All those successes have come to protect us against the virus and allowed us to live with covid-19 and regain many of the freedoms that we lost during the pandemic.
We have scaled back our covid-19 response because of that reduced risk, but that does not mean that the response is not there. It is scaled back, but it is ready to be stepped up should we need it, focusing on testing, diagnosing, treating and protecting those at greater risk of severe illness. We are keeping vigilant at all times. I work closely with the UK Health Security Agency, which is the organisation that leads on pandemic preparedness. We take its advice extremely seriously.
Maria Caulfield
We know that the virus has the potential to evolve with new covid-19 variants that may evade immunity and the vaccinations that we have in place. We also know that we could face new pathogens with pandemic potential, so we remain vigilant at all times not just in the United Kingdom but with our global partners.
It is imperative that we retain the ability to detect and identify any new covid-19 variants as well as wider threats. The House will be aware that the community infection survey ended in March. It was commissioned by UKHSA as part of a suite of covid-19 surveillance programmes and delivered by the Office for National Statistics. The survey was world-leading, playing a critical role in enabling decision making during the pandemic. However, it is right to ensure that that surveillance programme remains proportionate, cost-effective and commensurate with how we monitor a range of other infectious diseases that pose a similar risk to public health. That is why we have scaled it back, but again, should we need to, we can step it up.
That does not mean that we are not taking any action going forward. We are maintaining surveillance for covid-19 and respiratory pathogens through a number of programmes. Those programmes will enable the evaluation and effectiveness of vaccination against a range of clinical outcomes, informing vaccine deployment and appropriate disease management. Our surveillance programmes are underpinned by the continuation of genomic sequencing to determine and assess variant severity and vaccine effectiveness.
A range of vaccines are still available, which clearly we monitor on an ongoing basis. mRNA vaccines are one part of our toolkit, but others are still available. That is why continued surveillance is important, but it is proportionate that it has been reduced since the peak of the pandemic. UKHSA continues to sequence covid samples each week, so should a variant of concern emerge, we would identify it relatively quickly. It publishes the results of that sequencing and surveillance in the national influenza and covid surveillance report.
Obviously, covid-19 is a global risk, so as well as looking at what is happening in the UK, we continue to support international surveillance, and we work closely in partnership with other organisations and international partners to monitor covid-19 globally. The Government continue to fund new variant assessment platforms, increasing the capacity to provide genomic sequencing in nine countries and establishing the International Pathogen Surveillance Network. That will enable us to be alive to the risks of covid-19 elsewhere in the world. I am sure that hon. Members will recognise the importance of that work and agree that it is vital to continue it to understand and respond to dangerous new variants should they emerge.
If a variant of concern with potential immune evasion is detected, the Government have proportionate contingency response capabilities in place, a range of which are set out. Those capabilities will support an initial response to any new and dangerous variant of concern. The Department for Health and Social Care and UKHSA continue to work together to ensure that appropriate commercial mechanisms are in place to support a longer response to covid-19, whether through testing or vaccination.
I do not agree with the hon. Gentleman that vaccination is the only tool in our armoury. Our surveillance is our key weapon in identifying a new variant of concern. We still have testing capability should we need it, and of course, our vaccination programmes are nimble and can respond to any new variant should it emerge.
Neale Hanvey
The Minister is giving an interesting response to the question about surveillance. What is the surveillance mechanism exactly? Can she take us through how the virus is being monitored in the wild? What practical steps are being taken? Is waste water being assessed? How is it being identified? What border controls are expected if there is a novel threat somewhere else in the world? How are we managing our borders and ensuring that the 1.5 million passengers in the air at any one time do not immediately bring a new threat right to our door?
Maria Caulfield
There are several ways, and I did try to set some of them out. As I said, UKHSA tests samples from covid-positive patients around the country every week and does genomic sequencing to identify new variants or variants of concern.
We are not currently doing international border checks, but we are working with international partners, so should a new variant emerge in another country, we can step up that capability. We introduced border controls on new arrivals a couple of months ago due to the risk of a new variant from China, but that was stepped down because testing showed that there was no risk to the general population. Waste water testing is also still available should it be required, so there is a range of testing capabilities to identify variants of concern and respond quite quickly.
Moving on to vaccines, we are developing mRNA capability, but not just in covid-19 vaccinations. That is one way of delivering covid vaccinations, but that capability is also being used for respiratory illnesses and cancer vaccination trials. There is the potential for that technology to be used in a range of vaccines, not just for covid-19. A range of different vaccines are available, and should a variant of concern or change of variant emerge, we will take advice from the JCVI as to which vaccine is best to use and which group of the population is best to vaccinate. That is an ongoing piece of work.
On some of the hon. Gentleman’s other points, the covid inquiry is obviously ongoing. As the Minister responsible for pandemic preparedness, I am keen to learn the lessons about testing capability, PPE, and vulnerable groups that may need greater protection in future pandemics. But we also need to be live to the fact that a pathogen could emerge that is completely different from covid, flu, or avian flu, which we are also monitoring actively. We need to be nimble in our response to any future pandemic. My concern is that we may just look at covid as the only future threat, but that is absolutely not our policy; we are looking at a wide range of threats, both in the UK and abroad.
Sir Christopher Chope
The Minister referred to mRNA technology. Are the Government absolutely convinced that the technology is safe and effective? Are they in danger of putting all their eggs into that particular basket?
Maria Caulfield
We are certainly not putting all our eggs in the mRNA basket for covid, or for any other use of mRNA technology. Such vaccines must still pass the MHRA assessment in order to be licensed for use. As mRNA technology develops for other clinical conditions, whether cancer or respiratory illnesses, those vaccines will also have to be awarded a licence by the MHRA. It is not the case that mRNA vaccines are given carte blanche because they have been used in covid; they will have to pass the necessary research hurdles to gain licences for future use. We are certainly not just relying on mRNA for covid—although it has been effective and the technology means that it can react to variants and be altered depending on the variant. We are using other vaccines for covid, and working with other partners. I reassure my hon. Friend on that.
I am very happy to continue updating Members on the progress that we are making and any future booster vaccination programmes for covid-19 that will be running, and to update the House on the work of UKHSA regarding monitoring, surveillance, and future testing capabilities.
Neale Hanvey
I thank the Minister for being a good sport and allowing me to intervene again. I did make a couple of requests in my contribution: I asked for some written feedback from the Minister, and whether she would be able to find time in her diary for a meeting to discuss some of the finer points. I would be very grateful if she would agree to that.
Maria Caulfield
I am very happy to meet up with the hon. Gentleman, and also to write to him regarding the specific points on which he asked for clarification. It is important that we give the public confidence that our vaccine portfolio is very diverse, guarding against both current variants and future variants. The contracts that we have in place with vaccine developers are flexible, so should the need arise, we have the ability to stand up vaccinations in a speedy manner. I am happy to write to the hon. Gentleman and to meet with him, because in order to bust some of those myths that he has pointed out exist, it is important that we are open and transparent about the arrangements that are in place, the risks that we face, and the tools that we have in our arsenal to fight any future pandemic.
With that, Madam Deputy Speaker, I will draw my remarks to a close.
Question put and agreed to.