On Monday 25th April 2016, Public Health Minister Jane Ellison gave a speech to Parliament announcing a new public awareness campaign for meningitis, sepsis and septicaemia in response to a public e-Petition.
I would like to start by offering my condolences to the family of Faye Burdett whose tragic death sparked huge interest in the e-petition which has led to this debate.
I am aware of the huge support there has been for this petition to give the MenB vaccine to children up to the age of 11. With over 820,000 signatures, it shows the concern that parents and the public have about meningitis.
I have listened to the many Honourable members that have spoken this afternoon and I am sure that everyone has been moved by the stories we have heard of how both meningitis and septicaemia have affected families and, in some cases, changed their lives forever.
As has been made clear today, meningococcal meningitis [(the infection and inflammation of the lining of the brain)] and meningococcal septicaemia [(blood poisoning)] – which for simplicity I will refer to at meningitis - are very serious infections. They can be severely disabling and even fatal – this has been demonstrated movingly, and in some cases starkly, by Honourable members today.
It is absolutely right that we should have robust arrangements in place to protect against this disease. In fact we are the only country in the world with a programme for all of the major causes of meningitis and it is clear from the strength of feeling today that Honorable members fully support the meningitis and other world class vaccination programmes we have in place to protect individuals and the community as a whole from vaccine-preventable diseases.
MenB vaccination programme
For 35 years, successive governments have based decisions on vaccination programmes on independent expert advice from the Joint Committee on Vaccination and Immunisation - the JCVI.
At the recommendation of the JCVI, we introduced, in September last year, a MenB programme for infants using the vaccine Bexsero.
The programme is for babies born on or after 1 July 2015 – they receive a dose of vaccine at 2 months with a further dose at 4 months and a booster at 12 months.
To ensure we protected as many infants in 2015 from MenB before the usual winter peak in cases, we also offered the vaccine to babies born in May and June 2015 as part of a one-off catch-up programme.
This was possible because the vaccinations could take place when these babies were due to attend their routine immunisation appointments at 3 and 4 months. By May 2016 all infants under 1 will have become eligible for the MenB vaccine and, by May 2017, all children under two years of age will have become eligible for vaccination.
JCVI advised that this programme and catch-up would provide protection to infants most at risk – those under one year of age – and I can assure Honourable members that despite concerns there have been about supply of Bexsero, we have sufficient vaccine for our national programme.
Honourable members, and those that have signed the e-petition, want us to go further. I understand this. The term meningitis strikes fear into the heart of any parent [- Public Health England (PHE) surveys of parental attitudes regularly show it is the disease that parents fear most.] And when we hear very sad stories and see heartbreaking pictures of children like Faye, this of course adds to the fear and worry of parents. They want what is best for their children and this includes protecting them from meningitis if there is a means available.
The Government feels the same, which is why we have become the first country in the world to introduce a programme using Bexsero. But we do need to keep fears, difficult though it is, in perspective. Thanks in a large part to the success of our immunisation programmes, meningitis is now rare. Cases are currently at their lowest levels in more than two decades. [For example, cases of MenC have dropped from a peak of about 900 cases in 1998/99 to about 30 cases in 2014/15.] Very few children will get meningitis and thankfully deaths are very uncommon.
The petition calls for the MenB programme to be extended to children up to 11 years, although some Honourable members have suggested up to 5 years may be a compromise. I fully understand why parents and the public want this extension. But I hope that Honourable members and friends would agree that this is not a simple matter.
Any Government needs to make the best use of the resources it has to ensure it delivers the maximum benefit to the population. The greatest burden of this disease falls on the under-ones – that has therefore been, on expert advice, our focus.
Decisions on how to spend the health budget require difficult judgements. These judgements are based on NICE’s rules on cost effectiveness. These have helped successive generations of Ministers make decisions that are fair and justifiable.
I have personally spoken to Professor Andy Pollard, the chair of the JCVI, to understand the process the Committee went through when considering MenB vaccination and to be assured that the Committee’s recommendation is robust.
I have been reassured that the programme we have is the right one, targeting the group of children at highest risk of disease and death, and based on robust and independent academic cost-effectiveness modelling to ensure equity across the health system. Professor Pollard confirmed that a catch-up programme for 1-4 year olds would not be cost effective at a realistic vaccine price. Also, disease is so rare in the 5-11 year old age group that a programme for this age group would not be cost-effective and could not be recommended.
On the evidence I have, I cannot support extending the MenB vaccination programme to older children. However, I would like to emphasise that the JCVI keeps evidence related to all vaccination programmes under review. If their advice changes I will consider this as a priority.
Some Honourable Members have queried whether the cost effectiveness methodology that our experts use is right for immunisation programmes. [Many of the issues raised in today’s debate were factors that Ministers and officials had in mind when negotiating with the manufacturer.]
As some Honourable members have referred to, an independent expert group (CEMIPP) is considering the cost effectiveness methodology for immunisation generally. I look forward to receiving their report in the summer and I commit to publishing this report and considering if further consultation is needed. I will also provide the Petitions and Health Select Committees with a written briefing summarising the report and the Government’s proposed next steps.
A number of honourable members have expressed concern about whether the research requested by JCVI to see if a MenB vaccination programme for adolescents would be cost-effective is going to take place and how long it might take. I can confirm that a preliminary study of the meningococcal strains carried in teenagers is now underway and will report in February 2017. It will inform a larger study of the effect of MenB vaccination in this group. I commit today to commissioning this second study.
I recognise Honourable members concerns about how long this research is taking. Both they, and I, want quick answers. But robust scientific studies take time. My advisors have told me that this is a particularly complex study and a previous study had inclusive findings – we need to get this one right so we have a definitive answer. I am hopeful that this study could start in December 2017. It will take about 2 years.
Vaccination is not a silver bullet – even with a vaccination programme up to the age of 11 there would still be MenB cases in the under 11s as the vaccine only covers about three quarters of all MenB strains and no vaccine is 100% effective.
Parents and health care professionals therefore need to remain alert to the signs and symptoms of this disease. That is why I can announce today that I have asked PHE to develop a national awareness campaign that will focus on the dangerous infections parents most worry about – meningitis, septicaemia and sepsis - and the symptoms they need to look out for. We will be working with the appropriate experts and charities and more details will be available in due course.
We should remember that, even for infants, the MenB vaccination programme was only just cost effective on JCVI’s final analysis. But we did not shy away from introducing it because we know how devastating meningitis can be and how important protecting children from it is to parents.
As I have said, we are the first country to have a programme using Bexsero. Many other countries have also asked experts to consider MenB vaccine programmes, but because cost-effectiveness is so borderline, only Ireland has also recommended a programme which I understand will start in the autumn. So, we are leading the way to protect our children from MenB.
I would like to put on record my thanks to the Meningitis Charities who work tirelessly to support families affected by this terrible disease. And I would like to finish by recognising the courage that Mr and Mrs Burdett and other families affected by meningitis have shown over recent weeks.
Nothing I can say will make up for their losses. But they should be proud today of the role they have played in raising the profile of this disease and they should take credit for the new awareness campaign. It has the potential to save lives. I hope they will take a measure of comfort in knowing they have made a difference.