Health: Quad-demic

Question

Asked by

To ask His Majesty’s Government what steps they are taking to reduce the impact of a potential “quad-demic”, involving high prevalence of influenza, respiratory syncytial virus, COVID-19 and norovirus, following the warning of Professor Sir Stephen Powis, the NHS national medical director.

My Lords, levels of hospital admissions due to flu and norovirus are higher, while Covid hospitalisation rates are lower and RSV hospitalisation rates are about the same as the same time last year. The impact of these infectious diseases can be reduced through our annual vaccination programmes for flu and Covid-19, as well as the new year-round vaccination programme for RSV, and by observing good hygiene measures. Some 16.6 million flu vaccinations, 9.3 million Covid-19 vaccinations and 1.2 million RSV vaccinations have been delivered so far this winter.

My Lords, I thank my noble friend the Minister for that comprehensive Answer. I have to say that “quad-demic” was a new phrase for me and so I was very keen to understand what the Minister made of the announcements from the NHS national medical director, Sir Stephen Powis. From my point of view, it is vital that we learn the lessons of the last pandemic and I know a huge amount of work is being done to understand the implications of the recommendations from Module 1 of the inquiry. But, as I understand it from Sir Stephen’s announcement, the uptake of NHS vaccine programmes is much lower than last year, so I am concerned for us to be reassured that if uptake does not improve in the run-up to Christmas, we are ready and we have learned the lessons from last time and we will not panic and start making foolish decisions about PPE acquisition, for example.

We are absolutely committed to learning the lessons from Covid in order to build resilience. The recommendations of the independent review of procurement by Nigel Boardman have already been implemented and a Covid Counter-Fraud Commissioner has already been appointed to scrutinise contracts to learn the lessons and recover money for taxpayers. Professor Sir Stephen Powis, who I have spoken to about this, was not suggesting that there is a pandemic but more that four infectious diseases are coalescing to create a situation and that vaccination is crucial. His comments were a call to the public to get vaccinated, which I also endorse.

My Lords, currently the RSV vaccination is available to the older age group of 75 to 79 year-olds—of course, it is available to a younger age group for vulnerable people—unlike in the CDC advice, which is that over-75s should get the immunisation. Older people are more susceptible to RSV and end up with more severe disease and hospitalisation, so why is the advice in the United Kingdom that the over-80s should not get immunisation? It has been suggested that the trials had insufficient evidence. The two trials for Moderna and Pfizer showed that efficacy was maintained in the older age group and therefore the JCVI’s interpretation is rather narrow in scientific terms —or is it to save money?

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

The Minister says that we are determined to learn the lessons of Covid. During Covid we had vaccination rates of 90% but, as she said, only 16 million—just 25%—of our citizens have had the flu jab and vaccination rates among children are also deteriorating at a rate. I say this with some personal interest because there was an outbreak of the quad-demic in my own household at 2 am today. There are three times as many people in hospital today with flu than in this week last year. Can the Minister please explain what she is doing to increase vaccination rates, particularly among children?

We are aiming communications —I know the noble Lord will be familiar with this from his previous role—particularly at groups that are less represented in terms of vaccinations. From my discussions with the national medical director, I do not recognise the reference that the noble Lord made to hospitalisations; they are as I set out in the Answer to my noble friend. However, we are far from complacent and continue to push vaccination. We will get vaccination rates up because they are the best line of defence against infectious diseases.

My Lords, the chief medical officer at the UK Health Security Agency stated last week that NHS staff should get the flu vaccination. The Government’s own statistics show that last week, in the largest trust in the country, only 7.9% of those eligible had had flu jabs, and on average the number is in the lower 20%. Why has this happened? What are the Government doing urgently to improve the take-up of the flu vaccine by NHS staff?

I must be honest: I cannot explain here the exact reasons why NHS staff are not taking it up, but I assure the noble Lord, as I have assured other noble Lords, that our focus is on getting vaccination rates up. That is why the national medical director made the comments that he did, as well as assuring me that we are not nearing a pandemic.

My Lords, undoubtedly the vaccination programme has had an important influence and impact on our National Health Service as well as our economy. What further vaccines and vaccination programmes will be accelerated on to the national immunisation programme this year and in further financial years?

My noble friend has campaigned tirelessly for the vaccine rollout in respect of RSV, for which I thank her, and I know that many others would wish to thank her for that too. With regard to the other vaccines about which my noble friend asked, we will continue to work with the JCVI and, as there are further developments, I will update your Lordships’ House.

If the spread of any of the four viruses listed by the noble Baroness, Lady Morgan, were to turn into a pandemic, hospital capacity would be an issue of concern. Hospital capacity is already an issue in most winters. With that in mind, figures released last week show that NHS hospitals are operating at 95% capacity. Therefore, what discussions are the Government and the NHS having with the independent healthcare sector to utilise its spare capacity to help to alleviate the pressures, both this coming winter and in the face of future pandemics?

The noble Lord will be aware that being prepared for winter is crucial. It has felt for too long as though winter crises have almost become normalised. Certainly, our move towards a 10-year plan will ensure that we have an NHS that can provide all year round. To give one statistic on Covid, in the week beginning 1 December there were 1,390 hospital beds occupied by confirmed Covid-19 patients per day, which was 41% lower than in the same week last winter. However, we are absolutely aware of this issue and we are not expecting a difficulty in respect of beds.

My Lords, in her original Answer the Minister spoke about hygiene measures. I wonder whether she could expand on the advice that will be given to the public about considering washable face masks that can be recycled; about improving handwashing because of norovirus; and, particularly as we go into the Christmas season, about not washing poultry, which causes the droplet spread of campylobacter in kitchens and can lead to severe gastrointestinal infections. These will all increase the workload on the NHS if combined with the other infections that we have spoken about.

Prevention is key, rather than just focusing on cure. Communications thus far are focusing on handwashing; I will discuss the other points the noble Baroness raises with the department.