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Avian Flu

My Lords, I join other noble Lords to thank the noble Baroness, Lady Byford, for her opening remarks in this important debate, and for her thoroughly researched and learned opening speech, which was helpful in starting us off. I must declare an interest of sorts because I am on the Select Committee on Science and Technology, which is currently looking at the issue of avian flu. Our report will be out before Christmas. I hope that none of my remarks will be seen in any way to pre-empt that report, but that they resonate with the report that we will eventually produce. I will focus my remarks principally on thinking the unthinkable, which the right reverend Prelate the Bishop of Chelmsford has already touched on, and on the aspect of research, which has not been adequately covered in any of the contingency plans. The third area is international co-operation and collaboration. There is a lot of talk about vaccination, antivirals and the focus on prevention, and the focus in agriculture. But when it does happen, panic will certainly set in, and I want to ask the Government specifically how they are going to cope and what plans are in place. For instance, when there is panic about anything we now see our supermarket shelves raided. There is a national shortage of HGV drivers. As our food depots are now so centralised, is there any plan in place to ask the big high-profit supermarket chains—I hesitate to name names because it is like advertising, but I am thinking of Sainsbury, Waitrose, Tesco, Asda and so on—to agree to pool their resources and send out goods from the nearest distribution centre to all branches, so that people get food from their nearest centre, irrespective of the label and the profit in such a situation? What about power infrastructure? We are reliant on mobile phone networks as a way of communicating. It was evident in the disaster in New Orleans that text messages from people to say they were safe were very important. If the power goes down, however, the mobile network lines go down quickly, so what are the backup systems within those? What has been done to get all the providers to work closely together? We will be reliant on broadcasting, as we are already. I agree with the comments already made that the media are talking as if there is an inexorable march across Europe of human avian flu, which is not the case at the moment. Monitoring is in place, and it needs to be done carefully. It is not responsible to have exaggerated reporting, as we have at the moment. I want to turn to research. As well as research into prevention, and talk of vaccines, we need to be doing the research now, immediately, into new vaccine production using things such as cell lines, so vaccine can be produced rapidly rather than with the lag period that there is with traditional vaccine production methods—which are also, ironically, based on eggs, where the vaccine is grown. When—and I do say when—the pandemic strikes, we need to have everything in place and be ready to go. There will be no time to draw up research protocols, consult ethics committees, apply for informed consent and so on. If we do not have the protocols already in place to collect all the data that we need, we will miss an incredibly important opportunity in terms of advancing our understanding of the disease. We will also potentially miss an enormous opportunity to save lives. The way that we manage cases in the first days of a pandemic should inform our thinking and knowledge on how we manage cases even a week later. But unless we systematically collect the data, we will not have a clue. We do not know whether Oseltamivir should be given within the first 48 hours or the first six hours of symptoms developing. We do not know whether it should be given in conjunction with something else such as Amantadine to obtain a dual antiviral effect. The only way we shall know that is through having a randomised control trial which is ready to roll out on day one. We must learn from the past. The MRC studies into childhood leukaemia did just that. Every child with leukaemia was entered into a study. Due to the systematic nature of those trials the mortality rate has been completely turned round from a massive rate to a small number of children now dying. Some of the regulation surrounding clinical trials will have to be abandoned if the Government do not act until the pandemic has arrived, or a system needs to be put in place to prepare everything beforehand. We will not be able to conduct random trials on a one-by-one basis; we need to consider cluster randomisation. For example, one city will get one system, another city will be managed differently and the data will be compared. We may be able to save thousands of lives in the second and third weeks if we use all the data obtained in the first week. In conclusion, I refer to the international community. We have already heard about poverty and the dependence of people on subsistence farming. If we expect poor countries to take radical preventive measures which will damage their economies hugely, there must be international support from the wealthier nations so that poor countries are not penalised for responsibly treating and isolating outbreaks. There has to be a system in place through the World Bank to support nations’ efforts so that we operate as a global community facing a global threat.