Immunisation: RSV
Debate between Lord Markham and Baroness Ritchie of Downpatrick(6 months, 3 weeks ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government when a decision on eligibility for a potential 2024 respiratory syncytial virus immunisation programme will be confirmed, and whether this will be aligned to the Joint Committee on Vaccination and Immunisation’s September 2023 advice.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government have made a policy decision on the eligibility of a potential RSV programme, which is in line with the JCVI’s September 2023 advice. We are working through the full business case, with costing and operational delivery, for final agreement in line with an autumn start.
Baroness Ritchie of Downpatrick (Lab)
I thank the Minister for his Answer, but what plans and resources, both staff and finance, are in place to enable the immediate implementation of any RSV immunisation programme for young infants and older adults, in line with the JCVI’s advice, once the ongoing market engagement and tender process is complete?
Lord Markham (Con)
That process is absolutely going on at the moment, as well as operational delivery aspects. For infants, it depends on whether we choose a vaccine that goes into the pregnant mother or the infant, as the delivery mechanisms are obviously different. We are looking at the effectiveness of not just one vaccination versus the other but the delivery mechanism. There is a different delivery mechanism for the group aged 75-plus. The full programme business case is considering exactly that to make sure that we can deliver in the autumn.
Lord Markham (Con)
Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.
Baroness Ritchie of Downpatrick (Lab)
My Lords, is the Minister confident that the implementation programme will take place before the 2024-25 winter period, as promised in previous iterations of this Question?
National Immunisation Programme
Debate between Lord Markham and Baroness Ritchie of Downpatrick(9 months, 2 weeks ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.
As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.
The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.
As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.
The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.
As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.
The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.
As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.
I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.
The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.
The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—
Baroness Ritchie of Downpatrick (Lab)
I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?
Lord Markham (Con)
Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.
In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.
Health: RSV Immunisation
Debate between Lord Markham and Baroness Ritchie of Downpatrick(9 months, 3 weeks ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what steps are being taken to ensure that appropriate funding is in place to deliver immunisation programmes for respiratory syncytial virus by the 2024/25 winter season, and when an implementation plan will be published.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government published a prior information notice on 27 November 2023 outlining the market’s intention to tender against its requirements for infant and adult RSV programmes in 2024. Following the tender and the confirmed potential budget implications, a final decision on programme designs will be taken alongside an implementation plan for autumn 2024.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank the Minister for his Answer. For the avoidance of doubt, can he explain to your Lordships’ House what funding has been allocated to the national immunisation programme for the 2024-25 winter season; what proportion of that funding has been allocated for immunisation programmes for adult, infant and neonate RSV; and what conversations have been held with NHS England regarding readiness to implement the RSV immunisation programme, as advised by the JCVI?
Lord Markham (Con)
First, I thank the noble Baroness. She has been a tireless campaigner on this issue and very good—quite rightly—at holding our feet to the fire. The exciting news is that the new vaccines that are coming along for both mothers and infants, as well as the over-75s, are now cost effective; that was recognised in the JCVI’s analysis. As part of that, we have plans to fund the programme, as mentioned. I would rather not go into the details of the actual budgets, because they depend on the tender and I do not want to give that information out to the market—but I can reassure the noble Baroness that plans are in place.
Cancer Research UK Report
Debate between Lord Markham and Baroness Ritchie of Downpatrick(11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government welcome the Cancer Research UK report Longer, Better Lives, which rightly highlights progress made against cancer. We have invested over £100 million in cancer research in 2021-22 through the National Institute for Health and Care Research. We are working closely with research partners in all sectors, and I am confident that the Government’s continued commitment to cancer research will help us to build on that progress, leading to continued improvement for all cancer patients.
Baroness Ritchie of Downpatrick (Lab)
I thank the Minister for his Answer. The CRUK manifesto clearly highlights the priorities required for tackling rising cancer rates with a growing ageing population, including the need for more investment in research, greater disease prevention, earlier diagnosis through screening, better tests and treatments, as well as cutting NHS waiting lists and investing in more staff. Can the Minister outline what steps the Government will take to implement this strategy, allied with resources and updated infra- structure in all hospitals?
Lord Markham (Con)
Absolutely. I thank the noble Baroness for the work that she does in this field. I welcome the manifesto, specifically on rebuilding the global position in research. We have done a good job on that: we have gone from a position of 26% of the clinical trial responses being in time to international standards to over 80%. The biggest prevention method that anyone could take is to stop smoking because, as we know, that is the biggest cause of lung cancer, so we are introducing steps to prevent smoking. On early diagnosis, we have introduced an excellent example in lung cancer. Some 60% of people used not to be detected until they were stage 4, which is often too late. Now, through the mobile lung cancer units, we are detecting 70% at stage 1 or 2, where they have a 60% chance of survival. Across the field, we are doing a lot on this that we can feel proud of.
Respiratory Syncytial Virus
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 3 months ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government, following advice issued by the Joint Committee on Vaccination and Immunisation on 7 June, whether they are planning to undertake an immunisation programme against respiratory syncytial virus before winter; and if not, what are the barriers to doing so.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, officials are currently developing policy options based on Joint Committee on Vaccination and Immunisation, or JCVI, advice regarding an expanded RSV vaccination programme for infants and older children. While officials are working at speed, challenges such as procurement negotiations, system readiness and delivery capacity mean that a universal programme in time for this winter is not possible. The department is working with partners to mitigate those challenges and to support implementation as soon as possible.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank the Minister for his Answer, albeit a little disappointing. When will that policy position on the introduction of the RSV immunisation programme be submitted to Ministers? When will the business case, including funding priorities, for the introduction of such an RSV immunisation programme be developed and put to the Treasury? Does the Department of Health plan to accept the joint industry offer to work with manufacturers to overcome barriers to rapid implementation?
Lord Markham (Con)
I thank the noble Baroness. The issue is that the current jab, palivizumab, is very expensive and lasts for only one month at a time, so it is logistically quite difficult. Promisingly, a new jab, nirsevimab, has just been agreed by the JCVI. It offers six months’ protection, is more effective and is lower in cost, so that is the one we are looking to roll out to more people. At the same time, there is a promising Pfizer jab which can be given to mothers. There are good new vaccines coming along; the issue is whether they are going to be licensed in time for us to be able to use them this winter.
Lord Markham (Con)
First, I thank noble Lord. That is the nicest thing anybody has ever said to me; I think I want to go on holiday at this point. This is a devolved matter, but it is something on which we are working very closely with the devolved Administrations. I must admit, as we discussed yesterday, that there is concern about the Northern Ireland Administration. Obviously, the Executive and Assembly not meeting at the moment makes some areas more difficult. We had examples of that yesterday, and we are about to have one in a minute when we talk about the fortification of bread. However, where we can, we are working closely with our colleagues.
Baroness Ritchie of Downpatrick (Lab)
My Lords, in his initial response to me, the Minister indicated that the policy papers were being drawn up. What policy options are being considered?
Lord Markham (Con)
The hope is that there will be two effective and cost-effective vaccines, nirsevimab and the Pfizer maternal jab. Those are much more effective and give longer periods of protection than the current monthly jab—they give six months’ protection. They are open to a mass campaign, particularly for young children, who are the most at-risk group. That allows us to have a negotiation with both parties with some healthy competitive tension so that we can get the best price, because we know that either one will do the job quite well. Where we can reach a successfully negotiated outcome, we hope that will set us up either to do either a year-round programme, if it really is very cost effective, or, if it is still quite expensive, to focus on the winter months, because that is the time when young children are most at risk if they have just been born. Those negotiations are live, and I will be happy to update the House as we learn more.
Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, the purpose of this instrument is to implement the EU Commission delegated directive (EU) 2022/2100 of 29 June 2022, which amends directive 2014/40/EU—the tobacco products directive—to withdraw certain exemptions in respect of heated tobacco products placed on the Northern Ireland market.
The instrument amends the Tobacco and Related Products Regulations 2016—the TRPR—in relation to Northern Ireland. The regulations will apply to producers, suppliers, retailers and wholesalers that produce or supply heated tobacco products for consumption in Northern Ireland. Subject to the regulations being approved by Parliament, they are due to come into force on 23 October 2023.
The regulations apply to Northern Ireland only and are made for the purposes of dealing with matters arising from the Windsor Framework. The SI implements a change so that, from 23 October 2023, heated tobacco products can no longer have a characterising flavour, such as menthol, vanilla and fruit flavours. This is not a ban on heated tobacco, but it will limit the flavours available. A characterising flavour ban is already in place for cigarettes and hand-rolling tobacco in the TRPR.
We do not need to make changes in light of the Commission delegated directive’s requirement for heated tobacco products to contain health warnings and information messages if they combust. If heated tobacco products that involve a combustion process were placed on the UK market, they would be regulated as tobacco products for smoking and subject to existing regulations in the TRPR that require these products to contain a combined health warning and information message. There are currently no heated tobacco products on the GB or Northern Ireland markets that involve a combustion process and, as such, they are subject to the labelling requirements applicable to smokeless tobacco products.
A full impact assessment has not been prepared for this instrument because the costs involved for business fall below the threshold for producing one.
Heated tobacco products on the UK market are produced and manufactured outside the UK by the tobacco industry. The characterising flavour ban will limit the products it can produce and supply to the Northern Ireland market and may impact on profits, in what is a relatively small market for the industry in Northern Ireland.
The DHSC has communicated with the tobacco industry, Northern Ireland retail representatives and enforcement agencies regarding the proposed changes. There is no significant impact on the public sector. Each district council in Northern Ireland will enforce the new requirements. They are not expected to be a significant burden on district councils, given the low use of heated tobacco products in Northern Ireland.
I am content to bring forward this legislation today. These regulations allow us to honour our current commitments under the Windsor Framework and will have limited impact on Northern Ireland business. I commend these regulations to the Committee.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank the Minister for his presentation of the statutory instrument. I have to declare an interest: I am a member of the Secondary Legislation Scrutiny Committee, and we discussed this SI. There was no dissent from it and there was general support, but we drew it to the attention of your Lordships’ House.
I am a supporter of the Windsor Framework, and any shilly-shallying around it can lead to uncertainty in Northern Ireland. It is important that we and the people of Northern Ireland, particularly businesses, can avail themselves of the economic opportunities in relation to access to the UK internal market and the EU single market.
Baroness Ritchie of Downpatrick (Lab)
I thank the Minister for giving way. In relation to what he said about the transport of these substances, I indicated the issue of regulation, as did the noble Lord, Lord Allan. In the past, during our troubled history, cigarettes were used as a form of smuggling, and also used as contraband by paramilitary organisations. The Minister says there is only minor use of these cartridges, for want of a better description—but I have seen them sold along with cigarettes in locked-up containers in shops, and young people purchasing them, particularly the fruit-flavoured ones. If they do not have access to that, how will they be able to get them? What mitigation and control measures will be put in place to prevent them becoming like contraband and being abused by erstwhile paramilitary organisations?
Lord Markham (Con)
I thank the noble Baroness for that remark. I think that I probably need to give that a detailed response as well. The point I was trying to make was that these heated tobacco products are a very small part of the market to begin with and the flavoured versions are even smaller again. While the noble Baroness is correct that that potential is there, the amount is very small indeed, but I will give her a detailed response on that.
I have tried to answer the specific points raised; as I say, I will follow up in more detail in writing. We have to honour the regulations set out by our commitments under the Windsor Framework agreement. With that, I commend these regulations to the Committee.
MMR Vaccine
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 3 months ago)
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Lord Markham (Con)
The noble Baroness is correct. The unfortunate Wakefield effect had quite an impact on that cohort of people, so the campaigns have been targeted particularly at specific communities in particular areas. Outreach campaigns are being done as part of that, looking at every area where it can be done. Sometimes that involves looking at colleges and sometimes it involves going specifically to community centres themselves.
Baroness Ritchie of Downpatrick (Lab)
My Lords, the Minister referred to outreach campaigns in relation to the take-up of MMR. Will that extend to children who are disabled and who are forced to be off school for certain periods of time to ensure that they are able to access their MMR vaccines?
Lord Markham (Con)
Yes. This whole campaign is looking particularly at hard-to-reach communities. The concern is particularly in London. Whereas we have about 85% take-up across England as a whole, in London it is around 75%, so that is where the particular outreach is. That also involves looking at children who are not able to go to school or who are home-schooled.
Community Health Services: Waiting Lists
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 3 months ago)
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Lord Markham (Con)
We all agree that unpaid carers are the backbone and hidden army behind a lot of what we see. We have made some good moves in that direction. We have the set-up for leave, so that they can have time away and a reduction in stress. We are setting up payment for them, albeit we all accept that there is such a hidden army we need to do more.
Baroness Ritchie of Downpatrick (Lab)
My Lords, recent research has found that almost three in five disabled children seeking physical and talking therapies are waiting more than 12 months for appointments, which is totally unacceptable? How do the Government plan to address such a large backlog and improve opportunities for disabled children? Perhaps the Minister can elucidate on that particular area.
Lord Markham (Con)
Unfortunately, as we know, we have a backlog in quite a few areas, often as a consequence of the pandemic and the period when we could not see as many people as we would have liked to. I wish I could say there was a quick solution; we all recognise the long-term solution is the long-term workforce plan, where we need to address the vacancies and have more staff to increase the output and supply. We are putting in a record investment of £2.4 billion behind this, but I freely admit it is not an overnight solution.
Respiratory Syncytial Virus
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 9 months ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government whether they have plans to introduce PCR testing and an annual vaccination programme for young infants, children and older adults in relation to seasonal Respiratory Syncytial Virus (RSV).
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
PCRs test are already in use to diagnose RSV and monitor its prevalence. Current RSV immunisation is targeted at infants at high risk of severe complications. New immunisation products, including vaccines, have been developed and are being reviewed by the Joint Committee on Vaccination and Immunisation, JCVI, which will potentially provide advice later this year. His Majesty’s Government will decide on future vaccination programmes once they have received that advice.
Baroness Ritchie of Downpatrick (Lab)
My Lords, as the Minister will know, RSV-related hospitalisations in the under-fives cost £48.2 million in the UK annually. At a time when the NHS is facing increasing pressures, both financially and through capacity, will the Minister clarify how the Government plan to reduce the infant burden associated with it to ensure that the NHS does not experience the same situation next season? If there are plans, will they publish them? If there are no plans, why not?
Invasive Group A Streptococcus and Scarlet Fever
Debate between Lord Markham and Baroness Ritchie of Downpatrick(1 year, 11 months ago)
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Lord Markham (Con)
I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.
Baroness Ritchie of Downpatrick (Lab)
My Lords, the UK Health Security Agency is to work in collaboration with the public health agencies in Scotland, Wales and Northern Ireland. What level of collaboration has taken place on issues around strep A and scarlet fever, and what have been the results and outcomes? I am aware that there have been some cases in Northern Ireland.
Lord Markham (Con)
I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.