Harris and Featherstone quiz Johnson on Swine Flu

• Evan Harris (Oxford West & Abingdon, Liberal Democrat): ' . . IS the Secretary of State certain that we have right the proportions of the antivirals, Relenza and Tamiflu? . . '

I, too, want to thank the Secretary of State for coming to the House at the earliest opportunity to give this statement on what must be a busy day for him as he assesses the advice that he is getting. My hon. Friend Norman Lamb wants to apologise for his absence.

Does the Secretary of State agree that the difficulty in understanding the nature of the threat is caused by some of the mysterious aspects of this outbreak? Why do the cases appear so much more severe in Mexico than elsewhere in the world? Will the outbreak always be this virulent? Did it actually start in Mexico? The Secretary of State said he was convinced it did, although one cannot be certain that there were not sub-clinical strains elsewhere before the first Mexican report? Has the antigen drift made it less pathogenic as it has spread from Mexico? That is one cause for hope, and it is why we are seeing different pathogenicity elsewhere.

How easily is the disease spread from human to human? That is not yet known, but how easily the disease is spread from human to human and whether that transmissibility is sustained as the virus changes, as such viruses do, will determine as much as anything else the extent to which the disease is likely to become a pandemic. Of course, we do not know what protection, if any, is available from the H1N1 seasonal flu vaccines.

It is important to note that only one published paper on the two isolates from California has been available on the CDC-US centres for disease and control prevention-website. It is not yet possible to compare those isolates with the Mexican isolates to see whether the genetic changes-the genetic assortment that appears to have taken place, according to that paper, between the 1918 north American strain and the 1979 Europe and Asian strain-are replicated in all such cases. There are simply too many unknowns, so I share the Secretary of State's caution, but it is wise to assume that the worst may happen and to plan for it, which the Government appear to be doing.

I have a number of questions. First, may I pursue the issue of preparedness in other countries? We are in a world of global travel, so the weakest link in surveillance and reporting will be the one that causes delay in bringing the virus to scientists to study so that public health experts can give advice. Will the Secretary of State say more about what we can do to improve surveillance and public health in areas such as central America-not just in Mexico-as we needed to do, and still need to do, in the far east in relation to the threat of bird flu?

Is the Secretary of State certain that we have right the proportions of the antivirals, Relenza and Tamiflu? If there is a differential, and it is possible for the virus to become resistant to one but not the other, which would be unusual but possible, it might be good to have a balance of both. As I understand it, we have a preponderance of the oral form but not a huge amount of the inhaled version-for obvious reasons in terms of ease of delivery-and that might become a factor.

Has the Secretary of State given any thought to what might happen if worse comes to worst and the buying of antivirals by asymptomatic people, privately or over the internet, causes problems for public confidence in the distribution system? I share his scepticism about the appropriateness of providing prophylactics to travellers, as that might be an inappropriate way, outside a country's plans, of introducing antivirals that could lead to resistance.

Sylvia Heal (Deputy Speaker): Order. Perhaps the hon. Gentleman could draw his remarks to a conclusion, as a number of Back Benchers are hoping to contribute.

• Evan Harris: Finally, can the Secretary of State reassure us that there will be full international co-operation between scientists and countries? That scientific effort will give us the information we need, and the hope of a vaccine sooner rather than later.

Alan Johnson (Secretary of State, Department of Health; Kingston upon Hull West & Hessle, Labour): I think the hon. Gentleman was musing aloud during the first part of his contribution. I do not know the answers, and the WHO does not yet know the answers to the issues he raised about the strain and how we can deal with it.

The hon. Gentleman asked what we can do on the weakest link argument. What we can do is support the WHO. Although the WHO is keen to ensure that all countries co-operate, he knows that one country in particular-Indonesia-is refusing to provide certain information about avian flu that could help us. It is very important that every country gives information to the WHO so that it can co-ordinate activity. Supporting Margaret Chan and her colleagues at the WHO is the greatest contribution we can make.

The hon. Gentleman says that there is a preponderance of Tamiflu, which is quite true. I understand that Relenza can be used by women who are pregnant or breastfeeding, for whom Tamiflu is inappropriate, so I think that we have the right balance. There is a preponderance of Tamiflu because it can be taken by most of the population, except pregnant and breastfeeding women and some other groups. We are fortunate to have Relenza for them because many countries have only Tamiflu.

It is important that hon. Members do not get into the issue of buying antivirals yet-there is not a phase 6 alert. We have talked about all the things that we need to do at this stage, and the hon. Gentleman is right that full international co-operation is absolutely essential, which is why the WHO deserves all our support.

• . . Lynne Featherstone (Hornsey & Wood Green, Liberal Democrat): The idea of phoning NHS Direct is very good. NHS Direct would fax the chemist, and the person affected would get a friend to pick up the pills. My concern is that people will be very scared and NHS Direct might be overwhelmed with calls. What preparations have been made for escalating the number of staff responding?

Alan Johnson: That is the next phase. We are not at that phase yet. The hon. Lady rightly points to our plans, if we are at a stage 6 alert and are dealing with a pandemic, in which case we would want everyone, especially those who are elderly and living alone, to have a friend who can go and collect their drugs for them, to avoid people travelling around. We have good plans to ensure that, at that stage, people can access such a distribution system and that it would work. It is important to emphasise that we are not at that level at present, and I hope we never get to that level.

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