Covid: Vitamin D

I also want to place on the record my thanks to the Backbench Business Committee for granting time for this debate. I also thank those who have met with me and written to me in recent months on this subject, all motivated by deep concern about the shocking toll that covid-19 has had on so many families, my own included. Right hon. and hon. Members will know that I lost my mother-in-law in October last year to covid-19. It came very quickly. I think very few families have not been touched by covid-19 and have not lost family members as a result. It has been in every corner of this great United Kingdom of Great Britain and Northern Ireland.

The covid-19 pandemic sent shockwaves through societies around the world. As we gradually move towards life in a post-pandemic society, many questions will be asked as we consider the impacts of the disease on our communities and economies. Last night, I personally voted with the Government on the two motions that came before the House, because I believe—we have this saying, as I am sure you do, Mrs Murray—it is better to be safe than sorry. I think it is better for us to be more cautious and take the extra four weeks, and then I hope we can relax some of the regulations on 19 July and move out from there.

Some of the questions that will be asked will be difficult. What made the world so vulnerable, and why were so many people ill-prepared? I say people, but it was probably Governments that were ill-prepared. Predictability is one factor that was missing from this pandemic, and I understand that only too well. With previous outbreaks of swine and avian influenzas, there were key links to the ecologies of poultry and pig farming in certain nations, but nobody predicted the Ebola outbreak in west Africa in 2013 or indeed the Zika virus outbreak in South America in 2015.

I believe it can be said that covid-19 was the major global pandemic that the world expected to happen at some stage, and yet no country was prepared, ready or equipped to fight it as perhaps they could have been. I am ever mindful of the fact that this time last year—indeed, as far back as March last year—it was hard to know what was the right thing to do because of the uncertainty over how covid-19 would react and the number of people who were being diagnosed with, and dying from, the disease. It is always very difficult to find a strategy right away, but I think perhaps we should have been a wee bit more prepared to respond in a good way.

Many lessons have been learned, and I know that we are all learning. I am a great believer in the saying, “I learn something new every day.” Anyone who is of an inquisitive nature, as of course I am, wants to learn things so they can use them in the life they lead, as I do here as an MP, or when I deal with constituents back home in the office. Covid-19 first emerged from Wuhan in 2019, but it is important that we now focus on what needs to change in order to mitigate future harms, especially with respect to the most vulnerable, who have paid the biggest price in this pandemic.

I am greatly encouraged by the vaccine roll-out and the number of people who have taken advantage of it. It has been an absolute success story for our Government and for our Minister for Covid Vaccine Deployment, the hon. Member for Stratford-on-Avon (Nadhim Zahawi). Every region of the United Kingdom of Great Britain and Northern Ireland has benefited from the vaccine roll-out, and in Northern Ireland we are taking vast steps towards the inoculation of almost all the adult population with both doses. I had my last one in May, and my wife has had hers. My sons are 32, 30 and 28, and they and their wives have had theirs, so we are moving down into the younger category.

Robin Swann, the Northern Ireland Assembly Health Minister, is doing an absolutely superb job. The Secretary of State for Health often refers to the meetings that he has once, twice or three times a week with Robin Swann, and to their very close working relationship. I think we, as a nation, owe a debt to our Secretary of State for Health and to the Health Minister in Northern Ireland. There has also been co-operation with Scotland and Wales. We are better today because we have co-operated. I do not say that in a political way, but it really does show how the great United Kingdom of Great Britain and Northern Ireland can work better together to deliver for everyone equally, wherever they may be.

Compared with February 2020, where we stand today with the treatment of covid-19 has completely changed thanks to fast-developing treatments resulting from the incredible work of scientific researchers who successfully uncovered the viral sequence of SARS-CoV-2 during the early stages of the outbreak in January 2020. Every one of us is overawed by our scientists’ ability to find a vaccine. They worked hard at that, and our Government committed to buying the vaccine even before we knew it was going to be successful. That was visionary of the Government, and I am greatly impressed by their commitment. While the rest of Europe dallied and were not sure what to do, our Minister and our Government here were getting the vaccine and preparing for it.

Fewer people who go into hospital with the virus today are guaranteed to end up in an intensive care unit or on ventilation. The largest vaccination distribution programme in medical and scientific history has been developed in just one year. What a feat that has been for our scientists, the health service and the Government and Ministers here and across all the regions. That was no mean feat, when we consider that it took four years to develop the mumps vaccine. At that time, four years was considered a speedy process. That happened in my lifetime, and that was how long it took to make it happen. This vaccine was developed in six months—wow! Is that not an incredible feat of medical science? The scientists were able to do that, and our Government and Ministers worked alongside them, close together in partnership, to make it happen.

I pay tribute to all the scientists who began working on the vaccine as far back as February 2020, before the virus became a global pandemic, and to the clinical trial volunteers, who risked their own health—they were not sure—to take something that was only experimental for the benefit of others. I also pay tribute to our Government officials, who negotiated around the usual years-long red tape and bureaucratic processes involved with vaccine development to fast-track this life-saving vaccine without compromising public safety. I admire the people who became the guinea pigs—perhaps that is the way to put it—for the vaccine. They enabled us to receive it in the knowledge that it was safe. They have all shaped science in just over one year. That is an incredible result, for which we should give thanks.

We are gradually moving towards the post-pandemic world, but we know we are not completely in the clear yet, and it will take a while to get there. While the vaccine works its wonders around the world, we still rely on treatments for covid-19 that help to reduce the need for hospital admission and make the stay in hospital sooner and shorter for those who need to be admitted.

I believe in what the Minister, the vaccines Minister and the Prime Minister have said: we are not all safe until everyone has had the vaccine. The Government’s duty is to our own people and our country, but they also have the duty to ensure vaccines are spread across the world. The Prime Minister said that yesterday at Prime Minister’s questions, and the Government have committed to billions of vaccines. The G7 gave us an opportunity to reinforce that. I have no doubt that many other countries across the world, including the United States and other countries in Europe and the western world are committed to doing that.

The use of remdesivir and corticosteroids— dexamethasone and hydrocortisone—has become part of the standard treatment across the world and continues to improve patient recovery, but, as I have said, we need to mitigate future harms. One of the ways to do that could be through the use of vitamin D—as the title of this debate suggests—against the virus, and I want to raise awareness of that. Many of the people I have spoken to are clear that vitamin D could have a role. The right hon. Member for Haltemprice and Howden (Mr Davis) has been clear in his commitment to the plusses of vitamin D, and I think that is good.

At the start of this pandemic, a good friend of mine who has a nutritional degree warned staff in the office to start taking vitamin D, and I conveyed that to my own staff in my office. “Build yourselves up,” he told us, “to give your body the chance to fight at its fittest,” and he has been proven to be absolutely right. Vitamin D has several very important functions, the most vital of which is facilitating a normal and healthy immune system and resistance to certain diseases. Vitamin D was found by one particular study to be effective in regulating the mood and decreasing levels of anxiety and depression. We have had a very difficult year. The Minister responded to a debate yesterday, which I participated in as well, about the mental health of children and young people. She spoke very well in summing up. I think every one of us realises that high levels of anxiety and depression are prevalent among not just adults but children. Can vitamin D help with that? There is some evidence that it can, which is something that we should pursue.

The study found that people suffering from depression noted an improvement in their symptoms by taking vitamin D supplements, so it is easy to understand why it is often called the sunshine drug. It is not because the sun shines, but because it perhaps lifts the mood. Many of us feel that wee bit better every day when the sun shines. It gives our spirits a lift. By the looks of yourself, Mrs Murray, you have been getting a bit of sun down in your neck of the woods, and you will feel better for it.

As with any vitamin, however, it works most effectively when there is a deficiency. We get the most out of a vitamin if our body is deprived of it, and we will see the changes fairly early if we really need it, so if our body responds positively to vitamin D it is clearly of benefit. I was once told, “If your cup is full of tea and more tea is poured in, that isn’t useful as the tea will of course pour over the edges.” It is all about balance, and vitamin D gives that to those who need it, and gives them a lift.

Vitamin D deficiency is affecting an increasing number of people, mostly due to lifestyle and increased time spent indoors. My goodness, I am one of those who is not entirely convinced whether working from home is always the best. It is an opinion, and I try not to impress any of my opinions or thoughts upon other people, but I give that as an observation. The routine that we all need of going to work is probably good. If someone sits in a house all day that cannot be good. There is also the use of sunscreens, living in larger cities where sunlight is blocked, and having darker skin, because the higher the level of melanin the less vitamin D can be absorbed. I am very fortunate that I have lived in the countryside or small villages all my life. I have never had to live in the city. I do not mean this offensively to anybody who lives in London, but I have no wish to live in London or any of the big cities. I am very happy to be where I am.

Given our lifestyle over the past year, it would not be surprising to discover that a good number of us lost some level of vitamin D from our system, because if we do those things our vitamin D levels will be down and we will need to enhance them. We spent months living a very abnormal lifestyle as we heeded the message to stay at home and stay indoors, allowed only one session of exercise a day at the peak of the pandemic. Think back to those weeks and months between March and July last year and recall the empty streets, parks and beaches during the day because everyone was staying inside or around their house—our elderly folk in care homes even more so.

Our nature is to want to talk to each other; we are elected representatives because we want to engage with people, and we do so better when we are as close as we are now, or even closer over a cup of coffee, than when we are in a Zoom meeting. Zoom meetings had a role to play. They helped us to connect with people over the past 12 months in a way that I certainly never had before. Technologically I have probably advanced, but certainly not as far as my grandchildren, who are young. My level of capability is not very high. Zoom played its part, but it did not do all that we wanted.

Let us think back to those weeks and months between March and July last year. We all agree that that was not a normal way for us to live for any period of time, let alone for months. Because vitamin D is produced in the skin through exposure to the sun, it adds weight to the case that levels of anxiety and depression rose among people not just because of the impact of the pandemic in other areas of our lives, but simply because we were spending so much time indoors, out of the sunlight, for such a long period of time.

Some people, like myself, were fortunate to live in the countryside, where they were able to go for a walk every night. We were lucky because we had some of the best weather we have had for such a long time between March and July.

Most of us have heard of the condition seasonal affective disorder, better known as SAD, where, during the winter months, reduced sunlight can lower our levels of serum 25(OH)D, causing depression-like symptoms in some people. Various studies have shown that taking vitamin D supplements can improve the symptoms of that disorder.

Some foresight was lacking at the beginning of lockdown in 2020. In hindsight, it would have been a good idea back then to suggest that people got as much sunlight as possible, whether that was sitting by an open window or out in the garden where possible, or took vitamin D supplements if those options were not available.

Although the National Institute for Health and Care Excellence reported that there was insufficient data to recommend the use of vitamin D or calcifediol as a defence against or treatment for covid-19 infection, several recent studies have produced evidence that offer more hopeful results. I want to give some of the evidential base today.

An observational study carried out from March to May 2020 at Hospital del Mar in Barcelona tested 838 patients admitted with covid-19, of which 447 were given 530 micrograms of vitamin D on day one and 266 micrograms on days three, seven, 15 and 30. The other 391 patients were not given that treatment on admission. Of the 447 patients treated with vitamin D when they were admitted to hospital, just 20 needed assistance from ICU, compared with 82 of the non-treated 391 patients. The findings go further, and report that just 21 out of 447 patients treated with vitamin D died from covid-19, compared with 62 of the 391 non-treated patients. I suggest that we have an evidential base, from the trials and tests that were done at Hospital del Mar in Barcelona, that proves the benefit of vitamin D. When patients with covid-19 infections were treated with vitamin D on admission, it significantly reduced the need for ICU admission and more of them survived.

Other research has shown that those who experienced acute respiratory failure with covid-19 had high rates of vitamin D deficiency. I am particularly interested in the subject. As chair of the all-party parliamentary group on respiratory health, I take a deep interest in these issues. Although these are small, randomised studies, they provide a credible level of data and evidence showing that the lack of vitamin D is a factor in rates of ICU admission and mortalities. We need to look further for evidence that vitamin D deficiency plays a role in the mortality rate from covid-19 infection and consider sensitively why this virus has been so devastating for our black and minority ethnic communities here in this great United Kingdom of Great Britain and Northern Ireland.

A peer-reviewed article published in 2018 in BMC Pediatrics reported that vitamin D deficiency was on the rise almost exclusively among black, Asian and minority ethnic groups. A clear section of the community need help and support, and awareness needs to be raised on the need to take vitamin D.

The University of Birmingham supported the study, also reporting that the national diet and nutrition survey concluded that nearly half the UK’s population were vitamin D-deficient, with BAME groups in Britain and throughout northern Europe observed to be most at risk due to the fact that darker skins produce far less vitamin D. Also—I say this most respectfully—the observance of cultural traditions that require the wearing of clothing from head to foot results in a lack of skin exposure to sunlight on a daily basis.

In Northern Ireland, and maybe in Scotland as well—the hon. Member for Glasgow East (David Linden) will speak shortly—we do not get much of the sun, and when it does come, we tend to take advantage of it to the point where we burn. The point I am making is that those with ginger hair might find that they are unable to accept the sun. We have the first grandchild I am aware of in our family who has ginger hair. I am not sure if any family member has been ginger-haired before, but we have one now, so we will have to protect Max more from the sunshine than the rest of us. It is always good to be ready.

I made the previous point out of sensitivity. If we are to recognise this health matter, it must be taken into account. The most important source of vitamin D is sunlight, because so little is contained in food. I am not sure whether this is something that can be done—I am sure we will understand that from the Minister’s response—but it might be something to consider. The lack of vitamin D has a severe impact on children’s growth, so will she acknowledge the findings of the national diet and nutritional survey, perhaps in conjunction with the Department for Education, and ensure that our children and adolescents receive vitamin D supplements every day?

One thing I remember from school—I remember many things, although it is quite a long time ago—is that we had a bottle of milk every morning when we were at school. That goes back to the ’60s in my case. I remember it because it was important for us at that time to have the supplementation and the goodness that came in milk. Times have changed a wee bit, so we might now get the goodness, nourishment and benefit that comes out of vitamin D.

Where vitamin D is concerned, our supplementation policies and implementation strategies need to be updated urgently, especially now that rates of covid-19 infection have begun to increase with the delta variant. In yesterday evening’s debate, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that

“we must learn to live with this disease”.—[Official Report, 16 June 2021; Vol. 697, c. 388.]

That is my opinion as well. I get the flu jab every September or October, because I am a diabetic, which is one of the chronic diseases. I will probably get the covid-19 booster jab at the same time as that next year. We have got to learn to live with such things. Over the next four weeks or so, with the delay to the relaxation moving to 19 July, we will see how well that works.

Vitamin D supplementation must be adopted through an evidence-based strategy, and we have sound evidence-based findings from the University College London Institute of Health Informatics. The information confirmed that the death rate from covid-19 was about two to three times higher for BAME groups in England than for the general population. We have a really big job to do to look after that section of the community. We must raise awareness, perhaps with a strategy, and sometimes we need to involve community leaders, whether those be leaders of churches or community groups. There are many good people out there who want to help. I believe that if we can get them all together, we can do something.

With those tragic figures to which the University of London referred, we can see the sense in vitamin D being an effective way to mitigate future harm to our BAME communities from covid-19 infection. Can we prevent further loss of life on such a scale by prescribing for those who have been most vulnerable to the virus a simple but effective programme of vitamin D supplementation? That might sound simplistic, but there is an evidential base for the benefit that could be gained.

If that is something that can be done at small cost, with great benefits—as I believe them to be—it should be done. Will the Minister who is present today look—as I know she has—at the evidential base and the research? Will her Department be prepared to look at raising awareness among those in the community, and the BAME community in particular, across the whole of the United Kingdom, where responsibility lies, and perhaps to commit to new funding or investment, or talking in partnership with those who are involved in further research into unlocking the benefits of vitamin D as a defence against covid-19 infection?

I will conclude by saying that I believe this research is necessary—indeed, absolutely crucial—if we are to determine whether vitamin D can play an effective role in the prevention and even the treatment of covid-19 infection on a broader scale. I say that because the Government have proven, working alongside all the regional Administrations across our United Kingdom of Great Britain and Northern Ireland, that if we work together, we can, first, be stronger together and, secondly, be effective together. As I say, when it comes to looking at the treatment of covid-19 infection on a broader scale, we need to do that. We should also be very aware of the issue of vitamin D deficiency in the community, and the consequences for those who are vulnerable.

I believe that my job, and the job of all of us as elected representatives, is to represent our people well. I believe that every MP does that job well and we have a responsibility to do it well. One of the things that I have always been willing to do, all my life, is to help people, and I am very fortunate that I have had some 35 or 36 years to do that. Although we are able to pull off some great things sometimes and have some wonderful success stories, there are some times that may not be as easy. However, I believe that here we have an example of what we can do to do things better, and it is something that we can do better together.

In order for us to be as healthy as possible, which will help us all to fight covid, it is vital that everyone receives enough vitamin D. So, during the pandemic the Scottish Government offered everyone on the shielding list a free four-month supply of vitamin D from December 2020. Around 71,500 people opted to receive a supply, which was sent to their home from the week commencing 23 November.

However, the Scottish Government’s recognition of the importance of vitamin D to everyone’s health and wellbeing has not been confined to the pandemic. Indeed, the Scottish National party Government have recognised the significance of vitamin D for years. For example, since 2017 the Scottish Government have made vitamin D supplements available as part of the Healthy Start vitamins provided free of cost to all pregnant women. In addition, breastfeeding women and children under 12 months in Scotland can get free vitamin D supplements containing the recommended daily amount. The current advice in Scotland is clear that everyone should consider taking a daily supplement of vitamin D, particularly during the winter months.

The hon. Member for Strangford touched on the fact that perhaps we do not get the good weather. It is always a bit terrifying in Scotland when the good weather appears and people adopt what we call the “taps aff” approach. There is a balance to be sought between keeping a certain amount of clothing on in the good weather and the taps aff approach. As someone whose daughter has ginger hair, I would certainly acknowledge the difficulties that those with ginger hair might have.

It is specifically recommended that groups at high risk of vitamin D deficiency take daily supplements all year round. That includes pregnant and breastfeeding women, infants and children under five, and people who have low or no exposure to the sun. The hon. Member for Strangford was right to touch on this. Particularly people from minority ethnic groups with darker skin require more sun exposure to make vitamin D.

The Scottish Government have recognised that vitamin D is hugely important to our health and wellbeing as a whole, which will in turn help us fight covid-19. It is vital that we take all necessary steps to combat the virus, from continuing to wear masks and taking the vaccine—once offered, obviously—to, if possible, increasing our vitamin D intake. It is also important for our health all year round. The significance of taking vitamin D supplements should not be confined to battling covid-19, but should be seen as part of a holistic view of our health and wellbeing. I think many of us underestimate the importance of vitamin D, particularly during the winter months, which might have an impact on our health. For that reason I support the Government’s policies to provide free vitamin D supplements to pregnant and breastfeeding women, and children under 12.

The pandemic has made many of us reassess our own health and wellbeing, with many of us increasingly thankful that we ourselves and our loved ones are healthy. Vitamin D can play an important role in keeping ourselves and our loved ones healthy, particularly in battling coronavirus and other respiratory diseases. It has been my pleasure to be able to take part in this afternoon’s debate.

It is striking that yesterday, exactly a year since low-dose steroid treatment was found to successfully combat the virus in some cases, another life-saving treatment was discovered, in the form of artificial antibodies—a treatment expected to save six lives for every 100 patients treated. The prospect of vitamin D as a preventive measure and a treatment should be duly considered, particularly as it is cheap and widely available.

The hon. Member for Strangford touched on the evidence base in his contribution. Last December, the National Institute for Health and Care Excellence issued guidelines that said

“there was little evidence for using vitamin D supplements to prevent or treat COVID-19.”

In terms of prevention, NICE found that

“low vitamin D status was associated with more severe outcomes from COVID-19.”

For instance, in an audit of covid-19 patients in hospital in Newcastle, only one in five intensive care unit patients had vitamin D levels that would be considered adequate for overall health, contrasted with two in five non-ITU patients.

However, there is much still to understand about whether that is a genuinely causal relationship or a correlating one. In its assessment, the British Medical Journal said it may at least be partially due to correlations between vitamin D levels and other risk factors, such as age, genetics and obesity. Clearly, the evidence base is still developing. I would be interested to hear from the Minister about the latest information that she knows and how we might develop that evidence base going forward. For example, the Barcelona study that was mentioned was new to me, so I will certainly look that up.

The hon. Member for Glasgow East (David Linden) made strong points about the fact that, outside covid-19, vitamin D levels are an important area for us to focus on in this country. Vitamin D is important to keep bones, teeth and muscles healthy. We know that in this country the right levels of vitamin D are not being routinely met; I wonder if I might fall into that category. Some studies suggest that one in five Brits have vitamin D levels lower than in concentrations necessary for general health, but due to our climate—we all know this; we have enjoyed our one week of summer and it seems like it might be coming to an end—that rises to two in five in winter. In fact, we are one of the most vitamin D deficient countries in Europe. We should recognise that when considering general good health.

As colleagues have said, the deficiency is notably unequal and staggeringly high among certain communities. For instance, in the UK over 50% of those from an Asian background are severely vitamin D deficient, leaving them particularly vulnerable to musculoskeletal disorders. Since 2016, Public Health England has recommended that everyone over five takes a 10 mcg vitamin supplement in the winter months, but that does not seem to be gripping quite yet, either in its practice or its adherence, as the rise in Victorian diseases such as rickets confirms.

We should come together across the UK to do much more to boost vitamin D levels. I would be interested to hear the Government’s latest thinking on the idea of vitamin D fortification in the UK, a solution that would provide a boost to public health.

To conclude, much more research needs to be done on assessing the value of vitamin D as a defence against covid-19. We need every tool we can get, so that is the right thing to do. However, we know that the value of vitamin D more widely is significant and there is more we can do to ensure that that is a feature of our population’s health. That is something we could all come together to do.

Since the start of the pandemic, there have been reports that vitamin D may reduce the risk of coronavirus. I have to sound a note of caution here because, when looking at the data and the evidence, we cannot cherry-pick the odd report here and there. I am not accusing anyone of doing that, but we have to take a more robust view of the data and look at it in the round.

I will pick up on the points that the hon. Member for Strangford made about BAME communities. To date, the UK Biobank’s most robust data on covid, vitamin D and ethnicity has not found a link between vitamin D concentration and ethnicity that could reduce covid-19 infections. There was no link, sadly. It would really be encouraging for us if the data showed that vitamin D prevented people from catching covid—that would be quite amazing—and we are certainly working on and searching for that data, but we do not have it yet.

On 14 January, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), responded to a debate on this matter, in which the hon. Member for Strangford also participated. I welcome the opportunity to debate it further and set out the measures that we are delivering. As my hon. Friend said:

“Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19.”—[Official Report, 14 January 2021; Vol. 687, c. 597.]

Last December, the National Institute for Health and Care Excellence, the Scientific Advisory Committee on Nutrition, and Public Health England published rapid guidance in response to the queries that the hon. Member for Strangford and others have raised on vitamin D in relation to covid-19. The data was reviewed by an expert panel and included the best available scientific evidence published to date, including both randomised controlled trials and observational studies. The expert panel supported existing Government advice and the recommendation for everyone to take 10 mcg of vitamin D supplement throughout the autumn and winter to protect their bone and muscle health. However, the panel concluded that there is currently not enough evidence available to support taking vitamin D to prevent or treat covid-19.

There are still significant gaps in the current evidence, as was the case in January. To date, studies have not reached the high level of data quality required to revise the guidance. The current evidence base is mixed and dominated by low-quality studies, with substantial concerns around bias and confounding evidence. There are lots of studies out there, but some of them do not have the quality and the robustness of data and evidence that are required.

Currently, studies are unable to demonstrate a causal relationship between vitamin D and covid-19 for anyone. That is because many of the risk factors for severe covid-19 outcomes are the same as the risk factors for low vitamin D status. Owing to the lack of reliable evidence, the NICE guidance recommends that more research be conducted on the subject. Government guidance continues to stress the use of high-quality randomised control trials in future studies.

At present, more than 90 trials that are looking at the efficacy of vitamin D as an intervention for covid-19 across all stages of the disease are either under way or due to publish, either in the UK or internationally. Given that 90 trials are currently under way, possibly—hopefully—the evidence and data that we require will come our way soon. I would be really disappointed if those 90 trials do not give us the evidence we want. Let us hope that they do.

Some of the trials are of the high quality that we require to produce the data, and will answer key questions. NICE, PHE and the Scientific Advisory Committee on Nutrition are monitoring new evidence from trials as it becomes available.

The long-standing Government advice is that, every year, between October and early March, everyone is advised to take a supplement containing 10 mcg—400 international units—of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body and to protect bone and muscle health. In April and autumn 2020, PHE reiterated the advice and also ran a public awareness campaign throughout December 2020. That had a specific focus on BAME communities, where vitamin D supplementation is important.

Vitamin D is made in the skin when exposed to sunlight during the spring and summer months and the PHE advice to continue taking vitamin D supplements is therefore particularly important for those who were shielding, care home residents and prisoners, as well as those who choose to cover most of their skin when outdoors, as these groups are likely to have reduced sunlight exposure. Importantly, individuals with dark skin are more at risk of not having enough vitamin D and are advised to take the 10 mcg of vitamin D supplements all year round.

We have actively supported the uptake of the PHE recommendations. Over winter 2020-21, the Government provided a free four-month supply of daily vitamin D supplements to adults on the clinically extremely vulnerable list who had opted to receive the supplements, all residents in residential and nursing care homes in England, and the prison population, where Her Majesty’s Prison and Probation Service made supplements available across England and Wales.

The Government prioritised groups that were asked to stay indoors more than usual over spring and summer 2020 due to national restrictions. The supplements were provided to help support their general health and, in particular, bone and muscle health.

Recipients of the Healthy Start scheme are also offered supplements containing vitamin D by the Government. Guidance on vitamin D can be found online, and we encourage individuals to buy 10 mcg vitamin D supplements from retailers such as supermarkets, chemists and health food shops.

As research continues on the impact of vitamin D on covid-19, we will continue to monitor evidence as it is published. We have committed to keeping this under review and, as I have said, we are committed to keeping the 90 trials that are under way under review, some of which are high quality, producing robust information.

I hope that Members here today and Members from across the House will support the measures in their passage through Parliament, because we believe that they will be a key part of the tackling obesity campaign, which is so important in relation to covid-19. Helping people to achieve and maintain a healthy weight is one of the most important things that we can do to improve the nation’s health, and we are committed to meeting the challenge. My right hon. Friend the Prime Minister has been clear that

“we…must have a care for the health of our population and we will be happier and fitter and more resistant to diseases like Covid if we can tackle obesity.”

I will finish by saying that I think the objectives of everybody in the debate today are the same. I hope, along with other hon. Members, that we receive the robust data that we need; and if we do not, we continue with what we are doing, rolling out vaccines and dealing with the challenge of achieving a healthier nation via tackling obesity.