Meningitis B Vaccine

Geoffrey Clifton-Brown Excerpts

Monday 25th April 2016 Westminster Hall

[Ben Howlett]

I thank the hon. Gentleman for his intervention, and my condolences go to Mia’s family, because obviously anybody who is lost to this tragic disease is a loss overall, and it is horrendous what Mia’s family have had to go through; I have seen that with the family of my own constituent, and as MPs no doubt we have all seen that. There is a question around age, and I will come on to that shortly. Like Mia’s family, Lee Booth is calling for the Government to extend vaccinations up to the age of 11, and I think that we need to review some of the evidence today.

[Geoffrey Clifton-Brown (The Cotswolds) (Con)]

I congratulate my hon. Friend on leading this very important debate. I have been involved in this campaign for a considerable while. Does he agree that there is not an issue about the safety of the drug, because it is very safe—we know that because it has been used very safely on students in American universities—and that it is simply an issue of cost?

[Ben Howlett]

I thank my hon. Friend for his intervention; I am aware of his work in championing this cause, which he has done for a while. I very much hope that the Minister will consider that point when she makes her summation.

Although it is quite difficult for all of us as MPs to say this, throughout this debate we must of course keep at the back of our minds the fact that the NHS has finite resources. Everything that the NHS provides has an element of cost to it, and a life cost-benefit, too. However, along with many other Members, I worry that the long-term benefits of childhood vaccination and the life chances that vaccination can give to so many children are not being considered as much as they should be.

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[Geoffrey Clifton-Brown (The Cotswolds) (Con)]

I am delighted to serve under your chairmanship, Mr Pritchard. I echo a feeling of sympathy for my hon. Friend the Minister, because in a sense she is the meat in the sandwich. Time after time she has to answer such debates, but, as she and the House know—the hon. Member for Foyle (Mark Durkan) certainly knows this, because he had an Adjournment debate on 7 July 2014 on this subject—there has been an ongoing campaign on this for a long time in the House.

My hon. Friend the Member for Bath (Ben Howlett) is right that meningitis B is a terrible disease that—as other hon. Members have said—comes on suddenly and, at least in the early stages, is often not recognised by health professionals, let alone parents. More publicity should be given to the disease so that people are aware of what to look for. Given that only yesterday I heard a public health advertisement to encourage parents to get their babies vaccinated against MMR, I am not sure why we should not have such a publicity campaign for meningitis B.

The Bexsero vaccine was first licenced by the European Medicines Agency on 1 January 2013. The Minister wrote to me in April 2014 and said that it would be rolled out for children under two months, with a one-off catch-up programme for children born between 1 May 2015 and 30 June 2015. I use that illustratively, because at that stage we did not know when the vaccine was to be introduced. The Minister will say that by 2017 all children under two years will be covered, but if the vaccine had been rolled out at the time of my Adjournment debate, in which we were urging the Minister to do that for all children under one, more children would have been covered. In that debate she said:

“Children aged less than five years are most affected by MenB…the peak of the disease is in infants aged 6 to 12 months.”

She went on to say that

“MenB is fatal for about one in 10 of those who develop meningitis…With early diagnosis and treatment, most people can make a full recovery”.

That is true. She also said:

“Incidence has been decreasing in recent years…but it is unpredictable and it could rise again quickly.”—[Official Report, 7 July 2014; Vol. 584, c. 137.]

The disease has an unfortunate habit of falling and rising in incidence, so it could very well start rising again. The Joint Committee on Vaccination and Immunisation set up a working party in 2013—I think in June—to look at vaccinating all children under one year. What has happened to that working party? Have we got the results yet?

This is an unfortunate issue, because as many hon. Members will know—particularly those who have had young children more recently than when my two were youngsters—we often have to take young children to the surgery anyway, so the costs to the NHS of administering the vaccine would be minuscule: just the cost of the drug. There is also a unit cost issue—if GlaxoSmithKline had to make more of the vaccines, presumably the price would come down. I urge the Minister to consider the anxiety that the disease causes and the vast number of people who signed the petition. It was the largest petition ever for such a debate, and I pay great tribute to the House for changing its procedures to introduce such interactive debates so that we can consider the concerns of large numbers of constituents on such issues. I originally got involved in the meningitis B campaign after my constituents, Dr and Mrs Turner, contacted me about their granddaughter, who sadly died from the disease, but it obviously concerns large numbers of constituents.

We should not consider this vaccine as just an issue of cost. We know that the drug is safe. It has been licensed since 1 January 2013 and in the United States, the student cohort at many universities received the vaccine at least two years ago, and it was also trialled in adolescents at a university in this country. It therefore appears to be safe, although the JCVI wants to look at that issue. I say as gently as possible to the Minister that we should not let this be purely an issue of cost. If we have a drug that works—we know it is effective—and it is simply an issue of cost, we should at least consider rolling it out to all babies under one year old and preferably to all children under five.

[Caroline Ansell (Eastbourne) (Con)]

My hon. Friend makes a powerful case for the drug’s safety. We just heard an agonising story from my hon. Friend the Member for Bury North (Mr Nuttall) about Charlie and his experience, so does he agree that the cost and suffering of those who survive men B should be factored into the consideration of a catch-up scheme?

[Geoffrey Clifton-Brown]

I entirely agree. I will ask the Minister to clarify this, because when I sat down she said sotto voce that it is one year, but my information is that, from when it started, it was for all those under two months of age on 1 September 2015, with a one-off catch-up programme for babies born between 1 May 2015 and 30 June 2015—those who were three or four months of age when the programme was launched. Therefore, while by now it may have nearly spread to one year, that was not the case when it was introduced. We should consider rolling it out definitely to those who are one year old today and preferably to those a little older as well.

I turn to the Department of Health’s cost-effectiveness methodology for immunisation programmes and procurement—the so-called CEMIPP, which is a dreadful acronym. The Minister will tell us that that looks at the life-cost issues, but those who contract meningitis and suffer long-term effects face not just the £30,000 to £40,000 of costs my hon. Friend the Member for Bury North (Mr Nuttall) mentioned, but considerable lifelong costs afterwards. The discounting rates, as hon. Friends have said, are particularly mean in that respect, so to look at the issue in the round we must look seriously at the cost to the public purse of not vaccinating. That route could show us more clearly that a roll-out to a larger cohort would be cost-effective.

[Neil Carmichael (Stroud) (Con)]

Meningitis Now is headquartered in my constituency. To follow on from my hon. Friend’s point, should we not think that prevention is better than cure? That should be the overall strapline to the debate.

[Geoffrey Clifton-Brown]

My hon. Friend is right. I pay tribute to the charity based in his constituency and to the other meningitis charity, because they have been campaigning for many years on meningitis B and all the other strains.

The point about rolling out the vaccine to the cohorts—I urge the Minister to go further than that—is that my understanding is that once someone is vaccinated for meningitis B with Bexsero, they are covered for life. Therefore, if more cohorts are covered by the roll-out, more of the population will be covered and the entire population will become less susceptible.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

My question follows on nicely from the point made by the hon. Member for Stroud (Neil Carmichael) in his intervention about the long-term costs. I first came across this issue at a reception held by Meningitis Now. I commend that charity and the Meningitis Research Foundation for their excellent work. In terms of special educational needs, long-term costs can come in when a child reaches 12 or 13 and it becomes apparent that they are not developing at the same rate as other children. All sorts of educational implications should be factored into the long-term costs.

[Geoffrey Clifton-Brown]

I could not agree more. That is why the CEMIPP group study should look at not only the medical costs but the educational costs, the cost of carers and so on. There are considerable costs to the public purse. We tend, under our democratic system, to be quite short-termist in our view of such matters. I am involved at the moment in work on drugs for cystic fibrosis, to which exactly the same issues apply. After the considerable cost at the outset, there is a lifelong benefit to babies from getting such drugs. If we are going to carry out a cost-benefit analysis for the meningitisusb B vaccination, that is what we should consider.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I agree with the vast majority of what the hon. Gentleman says. In actual fact, it was not possible to trial Bexsero in humans because this is such a rare condition, and therefore we do not yet know whether the immunity will be for life.

[Geoffrey Clifton-Brown]

I am extremely grateful to the hon. Lady. The benefit of these debates is that we always have a professional on hand who can give us the last word on the subject. My sister is a GP and would no doubt have given me that same advice.

I am grateful for the chance to speak in this debate. This is a tragic disease with tragic consequences. I urge the Minister to go further, and faster in rolling out a good, safe vaccine that will give immunity to a larger section of the population.

[Several hon. Members rose—]

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[Dr Wollaston]

I thank my hon. Friend. In fact, I will take us back even further by mentioning Ben Franklin, who said that

“an Ounce of Prevention is worth a Pound of Cure.”

He was referring to fire services in Philadelphia, of course, but the principle still stands.

In paying tribute to all who have brought us to where we are today, we should remind ourselves that vaccination is becoming increasingly complex to develop. Bexsero is being developed through reverse antigen mining and is extraordinarily expensive. That is why we have to consider cost-effectiveness, because in a system where finances are limited, what might be displaced if a new intervention is funded? In other words, we in this House and beyond have a responsibility to ensure that the money we spend can save as many lives as possible, and to consider that in the round.

That is why it is important to take account of the work of the Joint Committee on Vaccination and Immunisation in making its incredibly difficult decisions and judgments. It is absolutely important that we allow the JCVI to carry out its work without undue political interference. The role of this House is, of course, to raise awareness and to hold the Government to account for the way in which—and the framework under which—the JCVI operates. However, our role must never be to lean directly on members of that committee in the very difficult decisions that they make. I pay tribute to the JCVI—to Professor Andrew Pollard and his team—for their work. Their decisions are extraordinarily difficult, and they need to apply the science with a combination of judgment and sensitivity. It is absolutely right that we regularly review the criteria that they are able to take into account.

I thank the Minister for her letter today confirming that the cost-effectiveness methodology for immunisation programmes and procurements working group, or CEMIPP—it may need a catchier title—is going to publish its work in full. Perhaps she will say whether she has now received that report. It is absolutely important that the principle of transparency applies, so that we can all be clear about the decision-making process.

I support Members who have said that we should review the so-called discounting rate if it means that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) has pointed out, by the time someone is in their 20s, effectively no account is taken of them. It clearly seems reasonable that we apply the same principle that is applied to public health decision making in the NICE methodology, with its lower discount rate, so that we can take full account of that situation. It is also right for the House to reflect on views beyond this place by thinking, for example, about the social costs. I do not wish to repeat the many important points that have been made about that today.

The JCVI’s independence is absolutely vital. We in this House are not in a position to make judgments about the effectiveness and safety of vaccination. We have to rely on experts, and we are very grateful to them for their work. However, one thing that we have to do is hold the Secretary of State to account for implementing the decisions of the JCVI in a timely manner and for the time that it takes to carry out the negotiations on the cost of vaccines.

I would like to make a further point, which I do not think Members have brought up today. The level of variation in the roll-out of existing vaccinations needs to be looked at. During the Health Committee’s current inquiry into public health, we have been hearing evidence about the difficulty that public health professionals and directors of public health have in being able to access the data and information that they need to tell them where the gaps are in the roll-out of vaccination. Perhaps the Minister will update the House on where we are in that regard, because it clearly cannot make sense that artificial barriers have sprung up between those who are responsible for implementing the programme and those who are delivering it on the ground. It would be helpful to have an update on that issue.

It is also absolutely right that the House holds the Minister to account on what is being done to follow up the work that is happening on sepsis. As she will know, early diagnosis is critical. Although we want to focus on the number of cases that we can prevent, we cannot prevent them all, so we must also focus on early diagnosis and intervention and on ensuring that we have the right pathways in hospitals, so that the time it takes from the moment someone enters a hospital until they receive life-saving antibiotic therapy is kept to a minimum. Perhaps the Minister will update us on that.

[Geoffrey Clifton-Brown]

I hesitate to intervene on my hon. Friend, especially as she is such an expert on this subject, but as I understand it, Bexsero was licensed by the European Medicines Agency on 1 January 2013. It was not introduced in this country until more than two and a half years later, and people will have died of the disease in the interim. Does my hon. Friend not think that is too long a process when the argument is not about the safety of the drug but purely about the price? Something needs to change. The negotiation with the drugs companies needs to be done in a different way.

[Dr Wollaston]

I agree that there needs to be a better and faster procedure for negotiating about cost, but we cannot get away from cost, because, as I mentioned, cost-effectiveness is not an abstract concept. It means asking, could we save more lives by spending the same amount of money differently? If the cost of the drug is exorbitantly high, would it be better to invest the money in, for example, early diagnosis and intervention? Those complex decisions should not be made by politicians. Politicians and the public should be part of the process that sets the guidelines and advises the committee, but it is not for this House to make those decisions, although I absolutely agree that of course it would be better if the negotiations could be done more quickly.

I end where I began, by paying tribute to the very brave families for the evidence that they gave. I hope that the Minister will do everything in her power to ensure that we reach decisions as quickly and as fairly as possible.

[Philip Davies in the Chair]

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[Jane Ellison]

I have only had initial conversations with Public Health England about the shape of the campaign, but I can assure my hon. Friend that the officials and the other people working on this campaign will look very carefully at what has been said today, and at some of the ideas that hon. Friends and other Members have put forward, and of course they will take all those points into account.

[Geoffrey Clifton-Brown]

I fear that I am becoming the bane of the Minister’s life over this issue, so I apologise, but I am grateful to her for giving way. One of the issues that I raised in my speech was the unit cost. As I understand it from her reply today, she does not think that there is a case yet for rolling vaccination out to children under five. Would she undertake to keep this matter under review, and would she also undertake to ensure that the JCVI, or Department of Health officials, will continue to have discussions with GlaxoSmithKline on what the drop in the unit cost might be if all these extra vaccinations were given to under-fives?

[Jane Ellison]

I can assure the whole House that the JCVI keeps that under constant review. It is not something that is occasionally dusted off and looked at every four or five years. The committee looks at all the factors that go into making the relevant decisions. When the factors that contribute to its decision making change, it looks into them. I have already given the House the assurance that the JCVI will keep that under careful review. The Select Committees heard directly from Professor Pollard and had that assurance from him. However, I will draw the JCVI’s attention to the concerns raised in this debate and the huge level of interest in the matter in the House and among the wider public.

As came out in the evidence that the JCVI gave to the Health Committee and the Petitions Committee, under the current cost-effectiveness criteria, the men B vaccination programme was only just cost-effective even for infants on JCVI’s final analysis, but we did not shy away from introducing it because we know how devastating meningitis can be and how important protecting children from it is to parents. That is why we became the first country to have a programme of using Bexsero. Many other countries have asked experts to consider men B vaccine programmes, but because the cost-effectiveness is so borderline, to date only Ireland has recommended a programme. I understand that it will start in the autumn, using the same criteria as the UK’s programme. We are leading the way in protecting our children from men B.

As I draw my remarks to a close, I want to reiterate Members’ thanks. I appreciate the fact that so many Members have expressed their thanks to Professor Pollard and the JCVI for the complex and important work that they do. That also goes for the many clinical experts who give us their expertise on which to make these enormously difficult decisions.