Influenza A(H1N1)
The next item of business is a statement by Nicola Sturgeon on the influenza A(H1N1) virus. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions. It will be a 10-minute statement.
I am grateful to have a further opportunity to update Parliament on the current situation on the A(H1N1) flu virus.
Members will be aware that on 29 April—last Wednesday—the World Health Organization raised its pandemic flu alert to phase 5, following confirmation of person-to-person transmission in the United States as well as in Mexico. I remind members that that does not mean that we are in a pandemic situation, nor does it mean that a pandemic is inevitable. However, the risk remains high, so we must be ready for instant activation of pandemic responses when that is required.
As of this morning, the WHO reports that 1,516 cases of A(H1N1) have been officially reported across 22 countries. As members will know, Mexico and the United States have the greatest number of cases, but cases have been confirmed across Europe as well as in Canada, South America and the far east. In the United Kingdom as a whole, 32 cases have been confirmed.
In Scotland, we have four confirmed cases, including one case of person-to-person transmission. As I indicated yesterday, a further case in the Grampian area is considered probable—that means that the person has tested positive for influenza A—although we await further test results to confirm the strain.
In addition, there are 27 possible cases currently undergoing testing in nine national health service board areas. I would like to stress that they are all travel-related cases and are all being treated and investigated on a precautionary basis. They are not confirmed as having tested positive for influenza A, let alone for the specific H1N1 strain.
I should also confirm that the two Flybe passengers who were being tested as possible cases and whom I mentioned yesterday, have since been confirmed as having tested negative. It is likely that cases will continue to emerge, so we will continue to monitor the situation very closely. However, although numbers remain low, our focus continues to be on containing the virus and minimising further spread.
A total of 77 close contacts of the four confirmed cases have been identified and given appropriate advice and treatment. The fact that only one of those contacts has gone on to develop the virus is evidence of the success, so far, of the containment strategy.
I want at this stage to pay tribute to the efforts of staff across the NHS who have worked so hard and, to date, so successfully to stop the virus spreading. We should not underestimate the scale of the challenges that the NHS in Scotland has faced in the past ten days. It has coped with the first confirmed UK cases, the first documented person-to-person transmission in the UK, and the first exercise involving notification of all passengers and crew on an internal flight.
The NHS has responded swiftly and effectively to all those challenges. The response has involved many people working long hours, and considerable redeployment of staff. Our health protection response, which is usually invisible to the public, has been absolutely excellent. I am sure that all members would join me in commending and thanking Health Protection Scotland, the public health teams across Scotland and the virus labs for working so hard and so effectively.
Our containment strategy is so far proving to be successful. The continuation of the strategy at this stage is justified by the available evidence. Of course, that may change in the future—I will touch on that eventuality again in a moment—but a precautionary approach is currently entirely appropriate.
While we continue with our efforts to contain the virus, we must also continue to prepare for the worst. Emerging science suggests that, outside of Mexico, the virus may be less serious than was initially feared, but it is still too early to make—we have too few cases on which to base them—confident predictions.
What we have just now is nothing more reliable than the scientists' best guess, so a number of strong caveats require to be inserted. The virus might yet mutate and develop greater virulence, and it may return in the autumn and winter months as a more serious strain. Those are real dangers, so we must continue to plan ahead. I therefore now want to outline the wider action that we are taking to ensure that we are well prepared.
First, we have been working very closely with the other UK countries to ensure that we are in a position to secure supplies of a vaccine under our sleeping contracts at the appropriate time. I will keep Parliament updated on any developments in that regard.
Secondly, although we already have sufficient antiviral drugs to treat half the population, we have taken steps to increase stocks significantly beyond that. Our stocks are already being used to treat the small number of confirmed cases, as well as being used on a prophylaxis basis for the close contacts of probable and confirmed cases, as part of our containment strategy.
It is, however, important to point out that we may at some stage over the coming weeks require to move from a containment strategy to a mitigation strategy. That will be most likely when there is sustained community transmission—that is, when the virus is circulating freely within the community and among people who have had no direct or indirect connection to Mexico or other affected areas, or to other known confirmed cases. At that stage, although it is likely that antivirals will still be used for treatment, the use of antivirals for prophylaxis may require review.
In the event that the current outbreak becomes more widespread, it will be important that arrangements are in place for distribution of antivirals to large numbers of patients. In recent days, considerable progress has been made on that, which has involved significant preparation by NHS boards in identifying suitable collection points from where antivirals could be collected on behalf of patients with flu, and by NHS 24 in supporting the development of a telephone and web-based UK service that symptomatic patients would use to be assessed and issued with authorisation for antivirals to be collected on their behalf.
I will keep members updated as the detail of those arrangements develops. Of course, such arrangements would not be activated unless and until a pandemic was declared, but doing the work now means that we will be ready if that should happen.
With regard to wider preparations, I confirmed on Monday that Scotland would make available 1.45 million surgical face-masks from our stockpile of over 9 million to address a temporary shortfall of masks in England and Wales. That reflects the on-going close working throughout the UK in response to the situation. Deliveries of masks from Scotland are already being arranged, and additional face-masks are currently being procured for the whole of the UK, which will replenish our stocks.
As we know, a virus knows no boundaries, and we are clear that the issue demands that we work closely with stakeholders in Scotland, throughout the UK and internationally. As members will know, I recently met a range of Scottish stakeholders, including the main Opposition parties, to discuss our broader response to the current situation. That meeting was productive, and we have agreed to meet weekly, at this stage. We are continuing to work closely with our colleagues throughout the UK, using the daily Cabinet Office briefing room A arrangements to co-ordinate with other UK Administrations and to ensure that our response to the situation is consistent and well managed.
In addition, we are maintaining contact with the World Health Organization and the European Centre for Disease Prevention and Control to ensure that our unique Scottish experience can be fed in to international developments and understanding of the virus. We have also sought to maintain clear and effective channels of communication with Parliament, the media and the public.
A communications campaign started throughout the UK on 30 April. It focuses on respiratory and hand-hygiene messages, and aims to reach 98 per cent of the population within a two-week period. As members will know, an information leaflet is being delivered to every household in the UK as part of that campaign. The leaflet is also available on the Scottish Government website or via the NHS 24 website in a range of alternative formats, including large print and a variety of different languages.
In conclusion, the considerable planning that has been undertaken in Scotland over a number of years has so far paid off. At this point, I am very encouraged that we have been able to effectively contain the virus, although of course we are not able to predict with any certainty how things will develop, and we must and will remain vigilant. The NHS is working hard to disrupt the spread of the virus, and we in Government, with our partners across Scottish society, are working hard to support the NHS and to prepare for any future scenarios. I will continue to keep Parliament fully updated as the situation develops.
The cabinet secretary will now take questions on matters that were raised in her statement. We have around 20 minutes for such questions, after which I must move to the next item of business, which is already oversubscribed.
I thank the cabinet secretary for her statement and for the updates that she has given to MSPs so far. I join her in thanking the NHS and all other staff who have been involved in the containment, and in the preparatory work for what might be required in the future.
The cabinet secretary rightly stressed the need for containment to be the priority. Will contact tracing continue to focus only on confirmed cases, or does the cabinet secretary intend to widen it to include probable and possible cases? Will the cabinet secretary say a bit about her current working definition of "close contact", and whether that definition has changed in any way in the light of experience so far?
Is the cabinet secretary content that the information that is available from passenger travel records, for example, is being made available early enough to allow close contacts to be traced within the necessary timescales?
I thank Cathy Jamieson for her questions and I acknowledge her thanks to NHS staff and those more widely in Scotland who have been involved. I will run through the questions in order.
First, Cathy Jamieson is right to say that the containment strategy should continue for the foreseeable future. Indeed, that is what is going to happen. As I said in my statement, we will reach a point at which such action is neither practical nor effective and we will be guided in that by expert advice.
As far as contact tracing is concerned, I make it very clear that we are contact tracing not just for confirmed cases but for probable cases. As I said last week—this remains the case—probable cases are, in effect, treated as positive until we know otherwise. Such an approach is appropriate and in line with the precautionary principle and we will continue to operate on that basis, again for the foreseeable future.
As guided by Health Protection Scotland—which, I point out, guides me in all issues of expert concern—the definition of close contact that has been set out is, in short, face-to-face contact for around an hour. That definition is guiding our approach, and any people who fall within that definition have been, and will continue to be, traced and treated appropriately.
On information from passenger travel, I imagine that Cathy Jamieson is referring in particular to air travel. At this stage, we have been required to trace passengers on only one flight, and that was because of particular circumstances. However, flight manifests are now being routinely retained for longer, again as a precautionary measure. We will not always be required to make use of it, but the information is being retained, nonetheless. That said, I should point out that, as has been highlighted by the case of the Flybe flight that we had to trace at the weekend, we have found that that information is not always sufficient to trace people. Indeed, that is why, in that case, we put out a public alert.
I thank the cabinet secretary for her statement and join her in commending all the staff who have been involved. I also thank her on behalf of Parliament for working so closely with her Westminster partners and, indeed, for the very competent approach that she has taken to dealing with swine flu.
First, on the distribution system for antiviral drugs, should they be required, will the cabinet secretary assure people who live in Scotland's remotest islands that they will not be disadvantaged with regard to delivery times?
Secondly, is the cabinet secretary able to assure the many people in Scotland who received the flu vaccine last winter about their immunity to type A flu, at least, and to swine flu? Finally, has she begun to consider this winter's flu vaccine programme? Is it possible or likely that it will include a swine flu vaccine?
As I said in my statement, we continue to work closely not just with our Westminster colleagues but with our colleagues in the other devolved Administrations. Over the past 10 days, I have been in very close contact with Alan Johnson, Edwina Hart in Wales and Michael McGimpsey, the Minister for Health, Social Services and Public Safety in Northern Ireland. Those contacts are extremely important, because our response has to be consistent.
On Mary Scanlon's question about distribution of antivirals, I should point out that we are still dealing with a small number of cases and that those drugs are being distributed in line with our containment strategy. If the virus becomes more widespread and we need to get antivirals to more people, we will need to put in place alternative arrangements. Although our existing systems will cope with that up to a point, they will not necessarily be able to deal with the full sweep of a pandemic. As a result, we are working across the UK to establish a system.
The system has a number of different elements. First, our own NHS boards will have to identify collection points. After all, we do not want people who have the virus collecting antivirals themselves. Of course, that is important with regard to the rurality issue that Mary Scanlon raised, as we will have to ensure that the collection points are accessible to everyone, regardless of where they live.
Work is also being carried out on a UK web and telephone-based system that would allow for assessment of, and authorisation for, antivirals and we are seeking to supplement that with a resource that, for patients in Scotland, would be provided by NHS 24. Members will appreciate that that is very much work in progress. I will keep Parliament updated as much as possible on its details.
Finally, I turn to Mary Scanlon's questions about vaccines. The honest answer to the question whether the seasonal vaccine provides any protection against influenza A or the particular strain in question is that we do not know. It might do. I have not spoken to any expert over the past few days who would rule that out completely nor have I spoken to anyone who would categorically say that it provides such protection. At this stage, the question is open.
The coming winter's seasonal flu campaign remains on track. Obviously, decisions about a vaccine for the influenza strain in question will be taken in due course, and any impact—I stress the words "any impact", because we do not know whether there will be an impact—on the seasonal campaign will be explained in full at that time.
I, too, thank the cabinet secretary for the advance copy of her statement. I also thank her for the way in which she is maintaining contact not only with health spokespersons in all parties, but with other stakeholders. That has been extraordinarily helpful. Obviously, I associate myself with the remarks that other members have made in thanking NHS workers and other workers who have worked hard to implement a containment strategy that has been successful to date.
I make clear the Liberal Democrats' total support for the way in which the cabinet secretary and the Government are embarking on the containment strategy. We are not at all concerned by people remarking that simply because some cases so far have not proved to be fatal, one can somehow take one's foot off the accelerator. We regard that suggestion as unhelpful. Even if the health issue does not become more serious—I hope that it will not—with any such disease that spreads so quickly, a few hundred cases can be extremely dislocating to other services.
At the end of her statement, the cabinet secretary mentioned reaching 98 per cent of the population within a two-week period through the information campaign. Does she have any means, or is any method in place, whereby she will be able to assure herself or the medical profession that those who might be regarded as being most vulnerable will have been reached? People may not read information delivered by post. Given the prevailing suggestion that, with the country's climatic conditions, there might be recurrence of the virus in the autumn, does the Government simply intend to refresh the campaign in the autumn, or should the population retain information? Is that being made clear?
I thank Ross Finnie for his support for the strategy that we are pursuing. He has voiced wise words of caution about assuming that we are out of the woods and can take our eye off the ball because there have been mild cases so far. I assure him that that will not happen.
Ross Finnie is right to stress that we need to ensure that the information campaign gets to everybody; of course, vulnerable people in particular need to get information. One of the best assurances that that will happen is that we are not simply relying on one mode of communication. There is the leaflet to all households and over and above that, there are the television and radio adverts and there is the online campaign. Of course, we should not forget the normal routes of communication in the NHS, such as general practitioners and NHS 24, which are perhaps particularly relevant to vulnerable people. We will remain vigilant to ensure that the right messages get to the right groups of people.
On the possibility of a recurrence of the virus, one of the real dangers that we are all conscious of is the pattern that was followed in previous pandemics. We are conscious of the danger of seeing the virus petering out as the weather gets warmer and perhaps coming back in a more serious form in the autumn and winter months. We must be aware of that danger in all of our planning, and not least in our communications strategy. Future stages of the communications strategy are already being planned. When those stages are activated will depend on what happens in the next few weeks and months, but there will potentially be leaflets and adverts in the future. We will keep all such matters under review so that we respond to what is happening.
We come to open questions. There are less than 10 minutes for seven members to ask questions, so members should ask no more than one question each, please.
I thank the cabinet secretary for her comprehensive statement. Does she have any advice for employers on precautions that they should take for their staff?
Advice is available for employers from NHS 24 and Health Protection Scotland. At present, the strong advice to anybody who has flu symptoms and who has been to Mexico or other affected areas, or who has had close contact with anyone who has been to those places, is to stay at home. I know and expect that employers will be sympathetic to that message. That point underlines the importance of good communication with all our stakeholders, so that we are all singing from the same hymn sheet.
I am sure that the cabinet secretary will join me in criticising Richard North for his comments that the issue has been hyped. We all agree that the preparations have been appropriate.
The potential new swine flu vaccine will take six months to produce. What was the start date for that work and which companies are involved? At what point will the production of a new vaccine affect the production of the normal winter flu vaccine?
Richard Simpson raises several issues, so if I do not capture all the details in my answer, I will be happy to provide him with further information. It is wrong for people to say that the issue has been hyped. If they want to say that, they can do so, but I would rather be accused of overreacting than of underreacting to such a threat. I make no apology for the action that we have taken.
In relation to a vaccine, we have sleeping contracts in place and decisions must be made about when those contracts should be activated. At present, we are in a pre-pandemic phase and, in an ideal world, we would want to procure a pandemic vaccine, not a pre-pandemic one. The World Health Organization has been working to isolate the virus to allow vaccine manufacturers to start working on that. That work is under way. However, Richard Simpson will understand that I cannot at present answer fully the question about when that work is likely to get to a point at which we have a vaccine. However, suffice it to say that the topic is under active consideration by all the UK Governments.
I associate myself with the cabinet secretary's comments about the efforts of NHS staff. I mention particularly the staff of Forth Valley NHS Board, who have to a degree been at the forefront of dealing with the issue. The cabinet secretary referred to the fact that the virus could return in the autumn or winter when, traditionally, our NHS is under greater pressure because of the seasonal increase in influenza. Are any specific measures being taken to plan for the possibility of the virus's return in the autumn and the consequent resource impact on local health services?
I thank NHS Forth Valley staff in particular. I visited the Forth Valley control room yesterday and I know that the staff have been at the epicentre of the issue. If it had not been for the presence of mind of a general practitioner during that weekend, for the speed at which the board's system swung into action, and for the fantastic work of its public health team, we might not have been able to contain the virus as effectively as we have done. I cannot praise those staff enough.
On Michael Matheson's substantive point, we are preparing for a possible return of the virus, although we cannot yet say that it has gone away. Perhaps the biggest preparation for that is the work on a vaccine. If we face such a return, NHS boards must be prepared to deal with higher demand at a time when they might have staff shortages. The boards' work on their pandemic flu plans and the wider preparations are certainly well advanced.
It was recently announced that additional capacity had been provided at NHS 24 to provide information and advice through a helpline, and the cabinet secretary outlined in her statement the organisation's developing role. Given that NHS 24 has those responsibilities, which are in addition to its work of dealing with a significant number of daily calls, what steps has the civil contingencies committee taken to ensure that an overflow capacity can be created if the situation escalates? I point out that, in my constituency of Greenock, we have a telecommunications centre that has the appropriate skills and technology and that could be up and running at very short notice if required.
I thank Duncan McNeil for taking the opportunity to represent his constituents' interests. He is absolutely right to point out the crucial role of NHS 24. To cope with additional demand over the past 10 days, extra call handlers have been taken on. Last week demand for NHS 24 services was 15 to 20 per cent, and on some days, 25 per cent above forecast demand. Demand has scaled back considerably this week, but throughout the period, NHS 24 has continued to perform up to its required standards. It has been an absolutely fantastic effort.
Obviously, the potentially expanded role for NHS 24 in the distribution of antivirals on a wider scale that I spoke about today will require even further staffing commitments and resources for NHS 24. I assure Duncan McNeil that I will pass on his comments and the details of the particular company that he mentioned in his constituency.
In view of the probability that there might be further outbreaks later in the year, what advice will be offered to families who are planning to travel to international holiday destinations this summer, in the event of a local outbreak there?
As Jackson Carlaw knows, travel advice is a matter for the Foreign and Commonwealth Office and is kept under review. The advice at the moment is to avoid all but essential travel to Mexico and certain other affected areas. Should there be outbreaks elsewhere, I am absolutely sure that that advice will be updated appropriately. However, our message to the public just now should be: be vigilant, be cautious and help us to take all the right cautionary measures but, other than that, go about your everyday business as you would do otherwise. That is the message that we should all put across at the moment.
We have seen in England school closures as a precautionary measure. Are there any plans to close schools in Scotland as a precautionary measure?
Unlike in England, we have had no cases in schools. If that were to change, we would take appropriate action. There are no plans to close schools at the moment, but should there be cases in schools, plans would be reviewed. Obviously, we have contingency arrangements in place should, for example, the exam diet need to be disrupted, but we will deploy such arrangements as and when necessary.
On behalf of my constituents in Dunfermline East, I offer my thanks to the cabinet secretary, her team and everyone else who has been involved in the very hard work that is on-going in the health service. I note what the cabinet secretary said in her statement that
"The virus might yet mutate and develop greater virulence"
and that
"it may return in the autumn and winter".
Given that that presents us with an additional and even more serious challenge, has the cabinet secretary given thought to how Parliament will be kept informed of the developing situation—as there are barely six weeks left until the summer recess—and might that involve a recall of Parliament?
As I am sure the Presiding Officer will be quick to tell me, the question of recalling Parliament is not for me, but for him and his colleagues.
As I have done throughout the current outbreak, I will endeavour to keep Parliament updated as regularly as possible. I will make statements as regularly as I think appropriate and beyond that, I will continue to keep in contact with Opposition spokespeople to ensure that they have the information to pass on to their MSPs.