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Howe: The need for vigilance and flexibility on SARS

Speech in the House of Lords in response to the statement made by the Secretary of State for Health on severe acute respiratory syndrome (SARS).

I begin by thanking the Minister for repeating the Statement and by saying that I very much welcome both the fact that the Statement has been made today and, in broad terms at least, its contents. I say "in broad terms" only because, as the Minister might expect, there are several questions that arise from what she has said, which I hope she can answer. I will not take long over them.

One of the phrases that perhaps caused me to raise an eyebrow very slightly was the statement that SARS poses a low risk for people in this country. Based on the number of cases that we have so far experienced in the UK, that might be taken as a fair judgement. However, as the Minister herself said, the disease is a serious one and there is so much about it that we do not know that I should have thought that it was not yet possible to quantify the extent of the risk. We read only today of new precautions being taken in Taiwan, South Korea and the Philippines, and the Minister will I am sure confirm that the spread of SARS is far from being under control in many parts of the Far East.

I recognise that the Government have acted in accordance with advice from the WHO and the measures that they have taken are sensible and in the main reassuring. It is worth saying that we owe a great debt to the professionalism of the NHS staff who have successfully prevented the six SARS patients in this country from infecting anyone else. Nevertheless, I was always brought up to believe that within reasonable limits, and unless there is a good reason to the contrary, governments should adopt the precautionary principle in dealing with any threat whose cause is not fully understood and where the risk is for practical purposes unquantifiable.

The Minister said that the Government had decided not to make SARS a notifiable disease, at least for the time being. I am no more in favour of bureaucracy than she is, but the 1984 Act is there for a purpose. It is there to enable the authorities to act quickly should they need to protect public health. The value of making SARS notifiable is, as I suggested the other day when we debated this topic, that it would enable the authorities compulsorily to detain those suspected of incubating the disease at port of entry or indeed anywhere else.

The 1979 regulations do not, as I understand them, give the authorities more than a limited scope to examine a person, and then only in certain situations. That might not be sufficient in some circumstances. I take the point she made that most people do not refuse treatment when offered it. Nevertheless that is a proposition which takes a lot for granted when we consider someone who presents with a high fever and all the symptoms of SARS. Does such a person act rationally? Is an infected asylum seeker susceptible to polite requests to go to hospital? If the Government's argument was valid, there would be no need to make any disease notifiable, since everyone with a dangerous and infectious condition would always willingly submit themselves for quarantine and treatment when asked to do so. Frankly, I find it hard to understand why the Government do not take the necessary powers now, as a precautionary measure, to ensure that those powers could be used immediately if required. It is a simple parliamentary process which we on this side of the House would totally back.

Screening people by means of a questionnaire is a good idea but it is not of course guaranteed to yield substantive information, because people do not necessarily know if they have been in contact with someone infected with SARS. Similarly, exit screening at ports of departure abroad is welcome; but we have no means of knowing how efficiently or effectively it is being carried out. I am glad that observers are being sent to the relevant areas of the world to ascertain just that point.

The Minister correctly mentioned that there is no test to diagnose SARS. Nevertheless, I wonder whether the Government have considered using the Actin Serum screening test which, though non-specific, acts as an early marker for infection when a disease is being incubated. If they have not, I should be grateful if the Minister would look into this idea and let me know what conclusion has been reached.

I welcome the precautionary approach taken to the admission of foreign recruits into the NHS and that the start-date of such appointments from SARS affected areas is to be deferred. Can the Minister say how long the deferral will last? The Minister mentioned that confirmed UK cases of SARS have so far numbered six. Can she confirm that there are no other suspected SARS cases currently being treated in NHS hospitals?

Reverting to the situation in China, can the Minister confirm that the Chinese authorities are now co-operating fully with officials from the WHO as regards up to date information on the SARS outbreak? Have WHO officials been allowed to visit Guandong province to speak to doctors and nurses on the ground?

The key to the future, as the Statement emphasised, will be vigilance and flexibility. There is just a chance that a global pandemic can be avoided if governments across the world take the right measures in a timely fashion. I am pleased and reassured our own Government have taken the measures described today. However, as I have indicated, ideally I should like to see them going a little further.

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