Pneumococcal Vaccine

Over the past few months, I have been increasingly aware of an issue that affects the health and well-being of thousands of children throughout the United Kingdom. It places a significant burden on national health service resources, results in the deaths of 50 children each year and in other cases can leave parents and the caring professions struggling to cope with permanently damaged and disabled children. Yet, much of that is preventable. The issue in question is pneumococcal disease.

Many hon. Members are aware of cases of meningitis in their constituencies, the fear that outbreaks of infection can cause among parents and communities, and the devastation that it may cause. Many may not be aware that pneumococcal disease is the second greatest cause of meningitis in Britain. As a Scottish Member of Parliament, I am particularly concerned that there is a greater incidence of the disease in Scotland.

Media attention inevitably focuses on meningitis B, and overlooks the fact that although pneumococcal meningitis is not as common, it is more life threatening. Fifteen per cent. of children—one in six—who contract it die. Despite this age of rapid medical advances, that figure has, sadly, remained the same for more than 20 years. The chances of a child dying from pneumococcal meningitis are twice as high as they are for meningitis B.

When cases of meningitis are reported in the media, they are usually reported in the stark terms of a child's death, but it is important to remember that in the majority of cases children survive meningitis, although often at a high price. Those children and their families have to live with the disabling consequences of the disease for the rest of their lives.

It is obvious to my colleagues that I have a slight disability; I suffer from visual impairment. That resulted from measles at the age of three. It is a disability that people learn to cope with and adapt to and is comparatively trivial. For children who survive pneumococcal meningitis, life is not so straightforward. One in six will be brain damaged, one in seven will have epilepsy and a quarter will suffer from deafness. Overall, half the children who survive pneumococcal meningitis will be left with some form of disability, including spasticity, learning disorders and behavioural problems. Again, the record is worse than that of other forms of meningitis.

Pneumococcal disease does not cause only meningitis; it may cause a wide range of other serious and life-threatening illnesses. Every year, serious pneumococcal diseases such as meningitis, blood infections and pneumonia devastate the lives of thousands of British children and their families. Babies and young children under two are most at risk.

There are many facts and figures, but I want to go beyond the statistics and provide a first-hand perspective and insight into pneumococcal disease. I shall focus on two aspects: the difficulty of diagnosis and the long-term consequences of the disease for those who are lucky enough to survive.

The story of a little boy called Sam—I am very pleased that his parents are present to hear our debate today—was recently brought to my attention. Sam was only five months old when his parents became concerned because he had a cold, a temperature and was not sleeping well. One might think that those symptoms, being the normal symptoms of feeling slightly off colour, would not cause alarm bells to ring. Nevertheless, Sam's parents, ever mindful of meningitis, did not want to take any chances and took him to the local accident and emergency department where they were assured that he did not have meningitis. The following night, Sam's condition deteriorated and he had a burning temperature and bulging fontanelle. His mum and dad telephoned NHS Direct, which advised giving him paracetamol to lower his temperature. The following morning, Sam seemed better but then became worse and was again taken the A and E. A non-specific virus was diagnosed and he was sent home.

Back at home, Sam's condition continued to deteriorate. His parents were alarmed and returned to the A and E, where Sam had a fit on arrival. That time, the doctors recognised the signs of meningitis. Sam spent the next two weeks in intensive care, fighting for his life, and a further fortnight in an isolation ward. Laboratory tests revealed that he had had pneumococcal meningitis.Let me make one thing clear: doctors' failure to recognise Sam's condition is not an indictment of the doctors who saw him, or of the national health service. In the words of a leading expert, pneumococcal meningitis can be extremely difficult to diagnose because babies under 12 months old do not always have the classic symptoms of the disease, such as the rash that is often seen with other forms of meningitis. There is an important lesson for us all to learn from that. Pneumococcal meningitis is difficult to recognise and often, as in Sam's case, is recognised only when it is much too late. Common logic therefore dictates that, with that type of meningitis perhaps more than with any other, prevention is better than cure.

To return to Sam's story, thanks to the skill of the medical team and the antibiotics pumped into his body, Sam survived. However, as we have already heard, more than half of the children who survive pneumococcal meningitis are left disabled, and Sam was one of them. He came home paralysed down his left side, brain damaged, epileptic and profoundly deaf. Sam has, with the support of his parents and a range of specialist carers, made considerable progress. He has regained the use of his left side and, despite the meningitis having destroyed his sense of balance, now begun to walk. According to his dad, he has a great sense of humour and is full of beans. Inevitably, however, as happens with many other children affected by serious pneumococcal disease, most of Sam's disabilities will remain with him for life. That will mean the need for some care for him from his parents, family and the wider community for the rest of his life—a lifetime of care and support, and, for his parents, the knowledge that Sam can never lead the life that they might once have hoped for him.

Why, if pneumococcal disease is so difficult to spot and can have such devastating consequences, are we not doing something to prevent it? In a small way, we are, but in another important way, it seems that we have not quite decided. In January, the Department of Health announced that a new vaccine for pneumococcal disease, which for the first time is effective in children under three years old, should be given to the children most vulnerable to the disease. They include those with chronic heart, lung, liver or kidney disease, diabetes, sickle-cell disease and those with a poorly functioning immune system for other reasons.

The Department is to be applauded for that recommendation and for offering protection to those children. However, it is widely acknowledged that the vast majority of pneumococcal disease occurs in children who are otherwise perfectly healthy, just like Sam. Through the introduction of a routine immunisation programme, a major health gain could be won for British children. Despite that, the Department has not yet given a clear time frame for when the new vaccine will be made routinely available for all British children. That reluctance is surprising given that the Department has already conducted clinical trials on including the new vaccine in the routine childhood immunisation programme. At the moment, we have vague assertions that the possibility of an immunisation programme is actively being considered.

The disease is generally acknowledged as the commonest bacterial cause of pneumonia, which is a particularly dangerous condition in young children. Here in the UK, it is estimated that one in 200 children is hospitalised as a result of pneumococcal pneumonia before their first birthday. It is also important to recognise that the disease particularly affects older people. The pneumococcal polysaccharide vaccine could greatly benefit them, but I do not have time in this debate to pursue that further. Perhaps the Minister will comment briefly on it.

For the elderly and those in other age groups, pneumococcal pneumonia is responsible for the more serious types of pneumonia, which sometimes require surgery to resolve the damage caused and on occasion result in death. The disease does not only cause life-threatening and disabling conditions; it is a major cause of many common childhood illnesses, such as middle-ear infections. As any parent will know, such illnesses can cause considerable suffering and prove very troublesome, especially to those families who are least able to cope.

Nearly all children will have suffered a middle-ear infection by their third birthday. Although such infections can have many different causes, research shows that up to half of the cases that are bacterial in origin are due to pneumococcal disease. Moreover, severe, recurrent ear infections in children are more likely to be due to pneumococcal disease. Such infection can lead to a glue ear or a perforated eardrum—conditions that can have serious implications for a child's development, and which many families will have experienced. Those common diseases also impose a heavy burden on the national health service in visits to GPs and admissions to hospital.

There is growing concern about the use of antibiotics to treat conditions such as ear infections. Fears about the steady increase in antibiotic-resistant strains of bacteria—already seen in many parts of world—are very real and are now starting to become a major source of concern in this country. Recent figures from Scotland, for example, show a tripling of the rates of resistance over the past decade to both penicillin and erythromycin. The problem is twofold. First, the effectiveness of drugs vital in the line of defence against serious diseases such as meningitis is being eroded. Secondly, in an attempt to rationalise unnecessary antibiotic usage for minor viral illnesses, the more serious causes of recurrent, severe ear infections, such as those caused by pneumococcal disease, are being treated later.

A routine immunisation programme to prevent the most serious forms of pneumococcal disease would also produce additional benefits in reducing the amount of less serious pneumococcal illness commonly seen in young children. It could help score a useful win in reducing pressure on NHS beds, cutting the number of GP visits, reducing the prescription of antibiotics, and cutting demand for surgical procedures, such as the insertion of grommets in cases of glue ear.

Why does the Department of Health appear to be dragging its feet in introducing the new vaccine for all children under two, and not just those at most risk? We led the world in the introduction of a routine vaccination programme for meningitis C in 1999. Indeed, an exemplary partnership between the Department of Health, public health agencies and manufacturers allowed the immunisation programme to begin many months earlier than originally envisaged.

We want to see an early extension of the pneumococcal vaccine. The meningitis campaign itself has been amazingly successful. Cases of meningitis C—and resultant deaths— have tumbled by a staggering 90 per cent. in just one year. However, despite this major public health success, no timetable has been seen set for the routine introduction of the new pneumococcal vaccine in this country.

The efficacy and safety of the new pneumococcal vaccine are not in question. The vaccine has had extensive trials in the United States and Europe. Studies have been conducted in this country by the Public Health Laboratory Service, and the Government see fit to give the vaccine to at-risk children. In addition, the new vaccine has been in routine use in the United States for two years with considerable success. There it is recommended for all children under two years of age, and it is part of the federal childhood immunisation programme.

The UK has a long-established pre-eminent global position in the promotion of public health and immunisation policy. Yet, with regard to the prevention of pneumococcal disease, there is an inexplicable lack of urgency on the part of the Department and its advisers on the Joint Committee on Vaccinations and Immunisation. Perhaps the ongoing debate about the safety of the measles, mumps and rubella vaccine has drawn the Department's attention away from the next logical step in protecting the health of the nation's children. In the media yesterday, Dr. Paul Gringas made the point that concern over MMR has set back research into autism. I wonder whether this is another parallel. Perhaps the Government consider that winning the battle against meningitis C means that we can take a rest from the continuing war against other forms of meningitis. Sam, his family and others like them would disagree.

I congratulate the Department on the chief medical officer's report, "Getting Ahead of the Curve". It points out the major health gain for the nation that routine immunisation against pneumococcal disease could produce, not only for children but for the elderly, who form another vulnerable group. The report remarks on the"introduction of new conjugate pneumococcal vaccines to protect young children and the elderly from pneumococcal septicaemia, meningitis, pneumonia and ear infections, with the potential to reduce the annual toll of 22,000 hospital admissions and 3,000 deaths caused by pneumococcal infection".

"Getting Ahead of the Curve" is an insightful, forward-thinking document. However, there is a disconnection between its conclusions and the Department's resolve to act on them. The new vaccine is licensed and available, so surely the Department should act to protect our vulnerable youngsters as soon as practicably possible. Until the Department finds it timely to make its decision, its apparent procrastination and lack of commitment will continue to cost the lives of young children. Four will die each month, and many others, such as Sam, will be left with severe, permanent disabilities.

Can the Minister put on record when the Department of Health intends to introduce the new pneumococcal vaccine for all children under two as part of the routine childhood immunisation programme? An obvious first step would be to say whether the new immunisation programme is in her Department's identified spending plans for 2002-03. If it is not, she should say whether the decision rests on gaining adequate funding.