Influenza A(H1N1)
Good morning. We have a great deal of business to get through today, so I emphasise that brevity would be a useful watchword for members around the chamber.
The first item of business is a statement by Nicola Sturgeon on influenza A(H1N1). The cabinet secretary will take questions at the end of her 10-minute statement, so there should be no interruptions or interventions.
I am very grateful for this further opportunity to update Parliament on the current situation in relation to the influenza A(H1N1) virus.
As of this morning, the World Health Organization reports that 5,251 cases of the virus have been officially reported across 33 countries. There have been 56 reported deaths in Mexico, three in the United States of America and one each in Canada and Costa Rica. The WHO's pandemic alert remains at level 5, which means that we need to be ready to implement our pandemic plans, should they be needed.
A total of 71 cases have so far been confirmed across the United Kingdom. Here in Scotland, we have five confirmed cases. A further four cases are considered probable, which means that they have tested positive for influenza A, although further testing is required to confirm the strain. There are also 12 possible cases, seven of which are travel related, who are undergoing testing in four national health service boards. All those cases are being treated and investigated on a precautionary basis. They are not confirmed as influenza A, let alone as the specific H1N1 strain.
Since a 19-year-old man in Greenock with family connections to Mexico was confirmed as having tested positive, much of the focus in the past few days has been on further cases in the Greenock area. All four probable cases and many of the possible cases are in, or are connected to, Greenock. As I reported yesterday, the four probables are a three-year-old child, a five-year-old child, the five-year-old child's mother and a 16-year-old girl who is not—as far as we know at this stage—connected to any of the other confirmed or probable cases. Final test results for all four cases are still awaited from the laboratory in London.
Members are aware that the cases of the five-year-old and the three-year-old have resulted in the closure of Ravenscraig primary school and the Ladybird Pre 5 Centre in Greenock. The decisions to close the school and the nursery, in both cases for seven days, were not taken lightly. They are precautionary decisions that have been taken on the basis of expert advice from Health Protection Scotland and Greater Glasgow and Clyde NHS Board, with input from the Health Protection Agency. The close contacts of those two children at the nursery and the school have also been given Tamiflu, and parents have been offered appropriate advice and reassurance. The five-year-old child also attended an after-school club around the time he became symptomatic. The 17 children who attended with him and the staff who were there at the time have also been given Tamiflu. Parents of those children have been asked to keep them off school and away from the after-school club for seven days.
I understand how concerning and, indeed, inconvenient school and nursery closures are for parents. However, I know that parents will understand the reasons for those actions and I take the opportunity to thank them for their patience and understanding. I also thank Inverclyde Council and Greater Glasgow and Clyde NHS Board for their sterling efforts in communicating with everyone concerned and in offering appropriate advice and reassurance.
I stress that these are not precedent-setting cases. If similar situations occur in other schools in Scotland—we obviously hope that that will not happen—they will all be risk assessed case by case. However, there is evidence from England that suggests that very early precautionary closure of that kind—as happened at the school in Paignton—can be effective in disrupting further spread of the virus.
I said last week that our focus at this stage is on containing the virus and minimising further spread. That strategy has been successful so far; we therefore intend to continue with it for as long as we believe it will be effective in reducing spread of the virus. However, as I also said last week, at some stage over the coming weeks we might well require to move from a containment strategy to a mitigation strategy. That is most likely to happen when there is sustained community transmission. We are not yet at that stage, but we are of course monitoring the situation closely.
Our scientific advisers also continue to examine emerging evidence from worldwide and UK cases of H1N1. Although we still do not know enough about the virus to be able to draw definite conclusions, the science is beginning—albeit very tentatively—to point in certain directions. For example, emerging evidence suggests that healthy young adults and children are being proportionately more affected than other groups in the population. Early estimates also suggest an attack rate of around 20 per cent. That compares to seasonal flu attack rates of between 5 and 15 per cent, although I stress that in recent years seasonal flu attack rates have been lower than that, at around 2 to 4 per cent.
Early experience also points to its being an illness with relatively mild symptoms although, of course, we have to be very clear that even mild flu can be unpleasant and debilitating and that, in exceptional cases, flu can cause deaths. All in all, we have to be prepared for an illness that might affect large numbers of people with symptoms that, although mild, might see them bedridden for a few days. Members will appreciate that the impact of that, should it come to pass, on our national health service, our economy and wider society, could be very significant. Even in a normal flu season, the demands on the NHS can put severe pressure on services.
As I have said before, there is also the risk that the virus might mutate and become more virulent during the autumn and winter months. That is why, in parallel with our efforts to contain the virus, we are also working hard with our colleagues throughout the UK to prepare for further developments in its spread and severity, and to seek to reduce and mitigate its impact on the population and our economy as much as we can. Discussions on a web-based and phone-based system to facilitate distribution of antivirals to large numbers of people are very well advanced.
Another key issue that is under active discussion is a vaccine. An important development in recent days has been the identification by scientists of the genetic fingerprint of the European strain of the virus, which is a crucial first step in the production of a vaccine. Obviously, of key concern to all four Administrations in the UK is how best we can secure supplies of an effective vaccine as soon as one becomes available. Our clear and shared objective is to secure sufficient supplies to allow vaccination of the whole population, which is in line with the approach that is recommended by scientific advice, including that of the scientific advisory group on emergencies, which has advised that universal vaccination is the preferred approach.
As members are aware, the UK has advance supply contracts in place for a pandemic vaccine. Although those contracts guarantee a supply of vaccine, they can be triggered only in certain circumstances—for example, when the World Health Organization declares a pandemic by moving to alert phase 6. Obviously, we do not know at this stage when or whether those triggers will be reached. However, we do know that if we simply wait until then we risk losing the capacity that manufacturers have available now, which would allow us to build up a stockpile and to get a vaccination programme under way before the winter.
I can therefore advise Parliament that I have decided, after discussion with my colleagues the health ministers in England, Wales and Northern Ireland, to secure and purchase early supplies of vaccine. Negotiations with manufacturers are on-going and I hope that agreement on a contract and a delivery schedule will be reached very soon.
It is important to understand that by the time a pandemic is declared, global demand for a vaccine will outstrip the capacity to supply it. Under any scenario, and even after our sleeping contracts kick in, it will be a number of months before we can get sufficient supplies to vaccinate 100 per cent of the population. The decision that we have taken now to utilise spare manufacturing capacity is therefore very important in seeking to secure an early supply in order to allow a vaccination programme that is focused initially on priority groups to get under way as quickly as possible.
I hope that I have, in this brief update, managed to assure members that we remain focused on containing the virus for as long as we can, and that we are equally focused on preparing for the possibility of its further spread.
I will, of course, continue to keep Parliament updated on developments.
As always, the cabinet secretary will take questions on the issues that have been raised in the statement. We have around 20 minutes for those questions, after which I will have to move on to the next item of business.
I am mindful of your request for brevity, Presiding Officer.
I thank the cabinet secretary for her statement and I will go straight to asking questions. Will she confirm that antivirals have now been transferred to health boards and that that part of the process is complete?
The cabinet secretary talked about securing enough vaccine supplies to treat 100 per cent of the population. I understand that treatment of 45 per cent of the population was being aimed at in discussion with the UK Government. Has the policy changed? Given that coverage will depend to an extent not only on the supply of the vaccine but on international markets, is she confident that 45 per cent can be treated in the first instance and that she will be able to secure the 100 per cent coverage that she aims for?
Stocks of antivirals are available with health boards. For obvious reasons that Cathy Jamieson will understand, our larger stockpiles of antivirals are in undisclosed locations around the country. The plans to ensure that adequate supplies of antivirals reach areas as quickly as possible are well developed and well in hand. In partnership with the web-based and phone-based system that I spoke about, health boards and NHS 24 will be instrumental in ensuring that antivirals are available quickly—within 24 or 48 hours of patients becoming symptomatic.
Cathy Jamieson is right to draw our attention to the question whether the aim is 45 per cent or 100 per cent coverage. I will try to make the position clear. The scientific advice and pandemic planning have always made it clear that we should aim for 100 per cent vaccination of the population. That is my and my colleague health ministers' clear objective and policy. Discussions in recent days about 45 per cent coverage have related to the amount of vaccine that we might be able to secure through pre-pandemic contracts. Our objective is to secure as much vaccine as possible before a pandemic kicks in, but how much that will be will depend on manufacturing capacity and on when that point is reached. We do not know whether the World Health Organization will move to alert phase 6 next week or several months from now; that is uncertain. Obtaining sufficient vaccine supplies to vaccinate 100 per cent of the population will take time. Our clear objective is to obtain early supplies as quickly as possible in order to get a vaccination programme under way.
I thank the cabinet secretary for keeping Parliament updated. Will the vaccination for swine flu be contained in the winter flu vaccination programme? If not, will those who regularly receive the winter flu vaccine be given two vaccines this year?
The Westminster Secretary of State for Health has said that producing the vaccine would take six months to a year, whereas the cabinet secretary says that it will be available in months. Will she update us on that? Universal vaccination is recommended. What will be the approach to people who resist vaccination?
The flu strain currently affects young adults. Could any conditions make some people more vulnerable to it?
The advice is that the vaccine for the H1N1 strain will not be included in the seasonal flu vaccine and, as ministers, we must be guided by the expert advice. A separate vaccine is expected, which we would aim to administer as easily and effectively as possible. If it can be administered at the same time as the seasonal flu vaccine, we would seek to do that, but that would depend on the expert advice.
Mary Scanlon asked about timescales. As I said in response to Cathy Jamieson, obtaining sufficient vaccine supplies for 100 per cent coverage will take a lengthy time, but we are focused on securing a flow of supply as quickly as possible. I cannot say definitively when the first supplies would arrive, but I hope that it would happen before the winter months, because that would allow us to get a vaccination programme under way.
An early priority will be to deal with vulnerable groups. We know the vulnerable groups for the seasonal flu vaccination programme. As we are still learning about the new virus, our thinking about the priority groups for its vaccination programme might change over time. However, the priority will be to obtain the vaccine in order to enable us to start the programme as quickly as possible.
Mary Scanlon's final question was about people resisting vaccination. All vaccination programmes are voluntary. However, as with the seasonal flu campaign, we will work hard to persuade people of the benefits of vaccination.
I thank the cabinet secretary for the advance copy of her statement and for continuing to keep Parliament updated on the outbreak. I hope that she will understand if I concentrate on the four probable cases, as they are in the home town of me and two other members who are in the chamber this morning.
The cabinet secretary will understand that although only four probable cases exist, many people are anxious. They include all the pupils at Ravenscraig primary school, their parents and their teachers, and all those who attend the Ladybird Pre 5 Centre. Some of them—but not all—are the same people who attend the Enterprise after-school club. A fair degree of anxiety is felt. I associate myself with the cabinet secretary's gracious thanks to Inverclyde Council and Greater Glasgow and Clyde NHS Board for the effective action that they have taken, and particularly for dealing effectively with parents and pupils at Ravenscraig primary school and for making Tamiflu available. Anyone who saw the interviews with parents on television last night, or who read the newspapers this morning, will know that their calm and measured response is not only a credit to the people of Inverclyde but enormously helpful to the people of Scotland. In the face of such an outbreak, they understand that precautionary measures are being taken and that this is not a time for panic.
Can the cabinet secretary assist in any way with the timescale for giving more certainty to the Inverclyde community? She says that that will happen as soon as possible, but can she talk about days or weeks? I do not expect absolute precision on when the test results will be known, but a little more precision might help.
I agree absolutely with Ross Finnie that the closure of a nursery and a school at short notice is a difficult situation for anybody to find themselves in. That the closures were so smooth yesterday morning is a credit to everybody who was involved—parents, staff, the health board and the council. I repeat my thanks and congratulations to them all.
It is clear that the situation is worrying for people in Greenock. From what I have seen, I think that they are behaving extremely responsibly and in a measured fashion. We are acting to contain any spread as much as we can and we will continue to focus on that.
Ross Finnie is right to ask me about the timescale, but I cannot be definitive. As I have explained, we depend on the laboratory in Colindale in London—the UK reference laboratory for flu—to confirm cases, so that is not entirely within our control. I hope that the final test results of at least some of the four probable cases will be with us today. It is important to have as much certainty as possible, as quickly as possible, so I assure him that we will press as much as we can for quick results for all the cases.
We come to open questions. I stress that there is one question per member.
I thank the cabinet secretary for her statement. I was content to hear the positive remarks about Inverclyde Council, but what impact has the suspension last Friday of the council's corporate director of education and social care had on communications and activities between the council and the Government?
The suspension of the Inverclyde Council director is completely unrelated to the swine flu situation. As members would expect, I do not know all the ins and outs of that.
Notwithstanding that, communication with Inverclyde Council has been excellent. The acting director of education has been fully engaged and I spoke with the council's chief executive on Tuesday evening, before we announced the school closure. As members would expect, dialogue has been good. I repeat my thanks to the council for its tremendous work in the past few days to keep parents fully informed of the developing situation.
I congratulate the cabinet secretary on the continuing measured approach that the Government is taking to this problem. We must not allow a situation in which people become alarmed to develop. We have not reached that point, as yet.
First, could I have an answer to the question on registered retirees that I put in week 1? I have not had that as yet. As we prepare to move from containment and disruption to mitigation and a general situation, the issue is important.
Secondly, when I did my report—
Dr Simpson, I stressed that each member had one question.
That was a previous question.
That is one question, Dr Simpson.
The point that Richard Simpson raised in his question is important. I followed up on the matter the first time he put the question. I will ensure that he gets a full written response on the measures that health boards are taking to act on that helpful suggestion.
In the light of what has been said about the necessity for those who normally receive the seasonal vaccine to obtain the new one, what information campaigns are likely to be put in place to explain the effect of the H1N1 vaccine on the seasonal flu vaccine?
That is an important point. Obviously, our focus at the moment in our information campaigns is on advising people of the developing situation around this virus, and on giving them commonsense advice on how to protect themselves and the people close to them from it. That is the focus of the information leaflet that has been put through—or is in the process of being put through—every door not only in Scotland but across the United Kingdom.
Obviously, as the situation develops—and, certainly, as we approach a vaccination programme—we will need to ensure that the public are well informed on the matter and, of course, on the relationship between the H1N1 vaccine and the seasonal flu vaccination programme. I give Alasdair Allan an undertaking that that will be done. Even now, we should be sending out a very strong message that the seasonal flu campaign is important and that people should take up that vaccine, notwithstanding any developments around H1N1.
I thank the cabinet secretary for her statement and for keeping me up to date personally with developments. I echo the thanks that have been extended to NHS Greater Glasgow and Clyde and to Inverclyde Council's education services.
I am sure that the cabinet secretary would agree that special praise should go to Mrs Lind, the headteacher of Ravenscraig primary school, Mrs Allan, the school secretary, and Julie Douglas for their performance and their confident leadership which have given a great deal of confidence and reassurance to parents and it has been recognised by them.
Given that we now have a case involving a teenager, what discussions has the cabinet secretary had with the Cabinet Secretary for Education and Lifelong Learning on further school closures in the secondary sector and on the possible impact on exams? Will she make it clear that appropriate transfer of antivirals has taken place in recognition of the developing situation in the Inverclyde area?
I join Duncan McNeil in thanking very warmly the staff of the Ravenscraig primary school, the Ladybird Pre 5 Centre nursery and the Enterprise after-school club, all of whom behaved very professionally in difficult circumstances. Their contribution was in no small measure responsible for the smooth way in which all this has been handled.
I assure Duncan McNeil that contingency arrangements for exams in secondary schools are all in hand. It is not appropriate for me to go into detail on the personal circumstances of the 16-year-old girl. However, as we understand more about the case, any action that has to be taken will be taken. As has been the case over the past fortnight, our focus is on containing the virus as much as possible. We are in dialogue with all the relevant people with whom the member would expect us to be in dialogue on all the cases.
Before I call Dave Thompson, I say that I will on this occasion allow Dr Simpson to put his second question because the people who are necessary for the next item are not yet in the chamber.
I thank the cabinet secretary for her statement. I welcome the sensible precautionary action that she and the relevant authorities have taken over the past few weeks. We must ensure that we minimise the risk of the flu being passed on. Has any guidance been issued to parents on contact between children outside school?
Parents will be given appropriate advice, including on restrictions that require to be put on children. As we have said, the risk of passing on the infection tends to be when people are symptomatic. That said, there is some evidence that children can become infectious slightly before they become symptomatic, so the guidance on dealing with suspected child cases is being revised to take account of that. Where their child is symptomatic, parents will be advised to keep them at home and away from other children. That advice is being given more generally. In all cases, it is led by the expert opinion of Health Protection Scotland and the public health teams in the various health boards.
Thank you for your courtesy in allowing me in again, Presiding Officer.
My question is on the sleeping contracts. One of the things that I put into my report of 1999 was that there might be a bottleneck in respect of egg supply. I was laughed at in one cartoon for even suggesting that. Clearly, if we are trying to produce 45 per cent cover, we will need a vast vaccine production. Can the cabinet secretary assure Parliament that the sleeping contracts include adequate egg supply for production? Will production be in the UK or are we reliant on European supply sources?
I ask Richard Simpson to bear with me—I will come back to him on that question. I can, however, say that the sleeping contracts guarantee us, and other countries that are party to those contracts, a share of the vaccine supply as it becomes available. Not all countries are party to sleeping contracts. Having such contracts puts us in a very advantageous position. Because they kick in only in certain circumstances—for example, a level 6 pandemic alert being triggered—if we simply wait for them to kick in, we would miss an opportunity to use the spare capacity that we know exists at the moment.
I ask Richard Simpson and others not to get too hung up on the 45 per cent figure. In this pre-pandemic phase, we are determined to get as much vaccine as we can. If that is more than 45 per cent, we will not be limited by that. Obviously, we cannot guarantee that the figure will be as high as 45 per cent. We do not know when we will get to alert level 6, and therefore to the point at which our sleeping contracts kick in. That said, the clear objective is as much as possible, as early as possible.