I will call on the Deputies who tabled questions to the Minister for Health and Children in the order in which they submitted their questions to my office.
Private Notice Questions. - Biological Attacks.
asked the Minister for Health and Children the action he is taking to protect the general public and postal workers from anthrax infection following the discovery of a number of suspicious packages throughout the country; the discussion which has taken place to date in relation to this matter with the committee on bio logical threat and the Garda; and if he will make a statement on the matter.
asked the Minister for Health and Children to outline what procedures he intends to put in place to deal with any anthrax attack on the State and to advise the public as to precautions that need to be taken to avoid false alarms; and if he will make a statement on the matter.
asked the Minister for Health and Children if sufficient supplies of drugs and medications are widely available to meet any potential problem with anthrax and other bio-chemicals and if he will make a statement on the matter.
Yesterday, I issued a protocol for dealing with a suspected anthrax attack or an anthrax attack in Ireland prepared by an expert committee under the chairmanship of Professor Bill Hall, director of the Virus Reference Laboratory. This committee was established at my request to develop a contingency plan which would be activated in the unlikely event of a biological attack. I considered this necessary in light of the events of 11 September in the United States.
The committee met on four occasions to date. While work on the detailed plan is progressing, a specific protocol to deal with a potential anthrax attack has been prepared at my request and was communicated to the media yesterday in light of the recent anthrax scares in the United States and developments there.
Prior to the launch of this protocol I met members of the committee as well as members of the Garda, fire services and Defence Forces. During this meeting the roles of the various bodies were clearly defined and agreed. In addition, I spoke with my counterpart, the Minister for Health, in the United Kingdom, to make sure our people here would have access to the committees in place in the United Kingdom and that best knowledge, expertise, plans and so forth could be shared.
He confirmed that our protocol is similar to that being put in place in the United Kingdom and offered the use of facilities there. The protocol deals with procedures to be adopted in the event of a suspected anthrax attack, including patient treatment and management and post-exposure guidelines. Guidelines for individuals and companies on how to deal with a suspect package believed to contain anthrax are included in the protocol. If a suspicious package or letter is received, the advice is to place the package in a plastic bag or other sealed container in order to prevent leakage. The room and premises should then be evacuated and the Garda contacted immediately. As the first line of contact, the Garda will assess the situation and contact emer gency services, such as directors of public health or the Army, as deemed appropriate.
I instructed that the protocol and guidelines be placed on my Department's website, www.doh.ie and I arranged for a copy to be sent to each Member of the House today. I am advised that the latter process has commenced. Yesterday, the protocol was issued to the fire service, the Garda, the Defence Forces and the directors of public health in each health board area. The dissemination of the protocol has continued today.
In relation to treatment in the event of exposure to anthrax, the Irish Medicines Board has confirmed to me that sufficient quantities of the antibiotic ciprofloxacin have been secured to treat patients in the event of exposure. In response to my request, the Irish Medicines Board has confirmed that it can also source quantities of the smallpox vaccine. I have arranged for the Public Health Laboratory in Cherry Orchard Hospital to receive both clinical and environmental samples. The clinical samples will be dealt with in Cherry Orchard, while the environmental samples will be forwarded to the United Kingdom for analysis.
A freefone information help line has been established by the Eastern Regional Health Authority to respond to the concerns of individuals within its functional area. The Garda has indicated that hoax calls will be dealt with severely. A meeting of European Union Health Ministers has been called for next week to put together a co-ordinated EU response to these issues. I take this opportunity to reassure the public that the risk of an anthrax attack in Ireland is low. The guidelines are being issued, in the first instance, as a precaution.
Would the Minister agree that the key objective is that fear must not be allowed to win? There is a strong perception that the Government and the agencies are not prepared for this. The area surrounding the post office was not sealed off yesterday during the anthrax scare in Enniscorthy. The Garda presence was low-key and people were able to talk to workers through the windows of the sorting office. Does the Minister believe that is acceptable? Does he believe it is acceptable that although the alarm was raised at 7.45 a.m. neither the South-Eastern Health Board nor the Garda knew what to do at 11 o'clock? Does this not contradict the Taoiseach's remarks in the House that a scheme is in place to tackle an attack if one occurs? While the risk of contamination from an infected person to another individual is quite low, I wish to know whether the Garda have been issued with protective clothing. If so, when it was distributed? Is there a specific trained team in each Garda division to deal with suspect packages?
What is reported to have happened in Enniscorthy does not accord with the protocol, which was issued yesterday. Likewise, what is reported to have happened in the offices of the Irish Independent yesterday is not in accordance with the protocol.
Following the terrible atrocities in the United States, I said this country was unprepared for a biological or chemical terrorist attack and that a specific response mechanism was not in place. I established an expert committee, chaired by Professor Bill Hall whose expertise is in the spread of infectious disease and viruses and agents of the type that could be used in a biological war. The committee has been working quietly in recent weeks to put together the bones of a plan, which consists of much more than the protocol that was issued yesterday. A broader manual which addresses other agents that may be used, has been prepared to be distributed to personnel in accident and emergency departments and other areas of medicine.
My information is that there have been 2,500 anthrax scares in the United States in recent days, including genuine false alarms and hoaxes. In my conversation with the British Health Secretary yesterday, it emerged that a similar process is developing in the United Kingdom. While the protocol was ready, I deemed it important to cut short the deliberations of the committee so that clear directions should be given to all concerned. The protocol reflects best practice, which is important. The committee took on board the protocols which are being used in the United States and in the United Kingdom. Did Deputy Naughten ask any further questions?
I asked about the Garda.
Both the Army and the Garda are operationally responsible in emergency situations, such as an anthrax scare. They have indicated to me that they have the capabilities to deal with such an emergency. The first task of the Garda Síochána is to seal off a site and to ensure that access is blocked to the package and the room where it was found until the Army comes to take it away. The protocol deals with the importance of decontaminating the site and individuals who were there. The package must be taken away in an appropriate way, with proper protection, to the Public Health Laboratory in Cherry Orchard.
I am sure the Minister agrees with me that while the circumstances under discussion are of low probability but high risk, a similar description can be applied to the events of 11 September. Does he agree that, in the public eye, there has been gross ineptitude and a lack of decision making and proper planning in the Government's handing of the possibility of an anthrax attack or an attack on Sellafield? Five weeks have passed since 11 September and two weeks have gone since the first anthrax attack in the United States. What does the Minister mean when he says there are enough antibiotics in the country? Is he referring to a sufficient supply if a limited number of people contract anthrax or is he referring to a certain percentage of the population? Can he indicate what training has been carried out to ensure that professionals in hospitals and in the emergency services are able to deal with an event of this type? Have rehearsals formed part of the training? Have measures been put in place to ensure that professionals will be able to deal with an attack?
I welcome that the Minister has been in contact with the Ministry of Health, as while we are not in the direct line of a possible attack, we could suffer as a secondary focus for an attack. Is this country self-sufficient in terms of the testing of samples? I note from newspaper reports that samples were sent to the United Kingdom for testing. As I recall, this was also the case during the foot and mouth disease crisis. Surely we must be satisfied that we are self-sufficient. If there was an attack in Britain, a circumstance we have to consider as a result of global terrorism, would we be self-sufficient to deal with it? As well as having a joint plan with the United Kingdom, can we stand alone if that country is under attack and the facilities there on which we depend are unavailable?
I do not accept that the Government's response, especially in terms of biological and chemical risks, has been inept. Public perceptions are one thing, but prior to 11 September, I do not think anyone envisaged the horrendous attacks that are taking place in the United States, where killer viruses have been sent to people via the postal service or in packages. I do not honestly think people in this country were focused on the possibility of such an attack in Ireland.
I read yesterday that a Commissioner acknowledged to an EU body that the EU needs to build on its existing communicable diseases network. He made the point that the surveillance network Europe wide needs to be developed in terms of looking for bio-terrorist attacks and that its early warning and response system needed to be significantly upgraded to provide the type of co-ordinated cover that members states now need. There is an acknowledgement on the Commissioner's part that, across Europe, there is a need to upgrade early response mechanisms.
In terms of the analysis of samples, the public health laboratory in Cherry Orchard can analyse clinical samples, such as nasal swabs. Regarding the incidents yesterday, approximately 28 clinical samples have been analysed by the laboratory in Cherry Orchard and the preliminary analysis is that all of them are negative. Full and final results are awaited, but that is the preliminary indication.
Environmental samples must go to the United Kingdom. The Government's view, which was shared by the chairman of the committee, is that Ireland did not have a high grade laboratory to analyse such samples. It was decided more than a year ago to invest in such a facility in the virus reference laboratory and this work is under way. Unfortunately, the capital works there will not be completed for another 15 months. Work has started and money was allocated more than a year ago to bring the facility up to world class standard.
In the meantime, the situation at the public health laboratory in Cherry Orchard is being examined in terms of whether a facility can be brought forward there that, in time, would allow the analysis of environmental samples to be undertaken. At present, such samples are sent abroad to the United Kingdom.
What about my question about antibiotics? We all recall that the Minister said there were enough iodine tablets.
There were existing supplies of antibiotics in hospitals that could be used for the treatment of anthrax. Additional supplies have been secured; 150,000 doses will arrive in the morning and 1.6 million doses are due to be delivered next week. I have been assured by the Irish Medicines Board and public health personnel that these supplies are more than adequate for our needs.
If one was reading the newspapers, there was some concern about whether it would be possible to obtain a vaccine for smallpox. The Irish Medicines Board has searched the globe for a particular vaccine. It has placed an order for a quantity of stock of smallpox vaccine.
The Minister is aware that the supply of iodine tablets disintegrated. Will he tell the House when fresh stock of such tablets will be available to meet the security needs of the State?
The protocol to which the Minister referred mentions that fire and ambulance service decontamination units should carry out decontamination of exposed individuals on site, using mobile units. Is the Minister aware that in 1985, the number of call outs for ambulances in Dublin was just over 28,000. In 1998, the year for which the most recent statistics are available, the number was more than 84,000 and it is probably approximately 90,000 today. However, there are still only 11 ambulance units operated by the fire service in Dublin. Given the protocol pertaining to the use of ambulances, they only deal with one incident at a time. Therefore, any major catastrophe, even a bus crash, would tie up the entire ambulance fleet.
Is the Minister aware that before recent concerns, senior management wrote to the health board, stating that the situation was critical and that there was a need for additional fire services. One source told me that the service should be doubled or tripled – I have no way of measuring what is required. However, from copies of correspondence that I have seen, management is most concerned that the situation is critical and more ambulances are needed for Dublin. I presume this pertains throughout the country. How does the Minister intend the ambulance service to carry out the protocol he mentioned in the case of an emergency given that there are only 11 ambulances for Dublin despite the explosion in the number of call outs for ambulances? There is an increased number of tourists and the population has increased. There are more building sites and many more cars on the road. The service cannot cope at present so what does the Minister intend to do?
There has been much progress in terms of expanding the ambulance service throughout the country in recent years. There was much more investment in recent years than previously.
There are still only 11 ambulances in Dublin.
A decontamination unit is a particular type of shower unit that is brought to a site. They worked well yesterday in St. Andrew's school and the eastern region has three mobile decontamination units that can be brought to particular sites. They are used to provide shower facilities for people who may have been exposed to a suspicious package.
I take the Deputy's point that, in an emergency, strain is put on existing services. By definition, that is what an emergency involves. Resources that are not usually called on are put into action and people are put under greater strain to meet existing services and requirements that may arise in the context of an emergency. This is why it is so important to send out a strong message about hoax calls. I went through the logistics yesterday of what was involved in terms of Army, Garda, ambulance and fire services personnel. I was acutely aware that any incident would draw on many of the resources of our emergency personnel. This is what happens in emergencies. One of the issues we are endeavouring to address is a reduction in the number of unnecessary calls on the services.
A tendering process has commenced in the procurement of sufficient supplies of iodine tablets for the entire country.
How long will it take?
My information is that the process could take approximately 25 days to complete so it could be two or three months overall. I will get a specific date for the Deputy.
Should we do novenas in the meantime?
Certain health board areas have iodine tablets. Such tablets should not have been destroyed without stocks being replenished. I have met a number of people who have different views on the life span of iodine tablets.
We had that as well in relation to polio vaccine.
I will defer to scientists in that regard. Different scientists have different perspectives on how long an iodine tablet lasts. Some of them differ from pharmacists on the matter. I have got more advice than most on this subject since the issue blew up. My function is to ensure that we procure a sufficient supply and that is under way. It is an emergency type tendering process. It is not the more usual process that could take a considerable amount of time.
People can rely on the power of prayer in the meantime.
Irish people have relied on the power of prayer for a long time.
Dr. Upton:
In the aftermath of the disaster on 11 September, the World Health Organisation flagged the risk of biological warfare. It is only in the past week that we have responded to that potential, based on the anthrax threats in the United States and more recently in Ireland. The Minister mentioned smallpox but are the terms of reference of the expert committee sufficiently wide to take account of the possibility of other types of biological warfare or threats?
The first meeting of the expert group was held on 1 October. It was formed in the aftermath of the statement of the World Health Organisation's director general, Dr. Brundtland, which called on countries around the world to review the potential of bio-terrorist attacks. The committee is examining a variety of potential agents. It has pointed out that a viral haemorrhagic plan is already in place to deal with outbreaks of ebola and other agents. That plan was completed in advance of 11 September. A pandemic influenza plan is available in final draft form. The committee is also examining the potential for the spread of a plague, botulism, small pox, anthrax and other diseases and is devising a manual to cover these issues for emergency personnel, particularly those in the health services.
The Minister's protocol states "The gardaí will tightly seal off the site and carry out preliminary investigations". To do so they must examine the room containing the suspicious package. Has protective clothing been issued to the Garda? When was the clothing distributed? Is there a specific trained team in every Garda division to deal with such an incident? While the risk of the spread of disease from one individual to another is minimal, if it became known that a person who was contaminated was in a specific hospital, there would be a panic in the hospital. Are there isolation units within the ERHA and the various health boards to address such a scenario? The ERHA's free helpline is open from 9 a.m. to 5 p.m. The majority of people who work leave their homes before 9 a.m. and do not return until after 5 p.m. If they encounter a suspect parcel who do they ring?
There are isolation units but the disease does not spread from person to person. The Garda has informed the committee and me that its personnel are trained to deal with issues of this nature.
Do gardaí have protective clothing?
Yes. The Garda has undertaken from the beginning to be the initial point of contact and gardaí will follow their protocols primarily to seal off sites and to make sure nobody gets near the—
The Minister's protocol states they must have air filter masks.
The Garda has said it is in a position to deal with such incidents.
What is the position in regard to the helpline?
I will review it.
I hope the Minister will review the fire services in Dublin because the level of service for the city and the greater Dublin area is not sufficient.
Following this debate I will refer back to the ERHA to seek its observations.
Will the Minister get back to me on that?
Yes.
The Minister outlined a number of points in regard to identifying suspicious packages and letters in his protocol. The phrase "if there is a ticking sound" will bring a smile to the faces of Members, but to whom will the protocol be circulated? It contains some sound advice in regard to identifying suspicious packages and letters. For example, will the protocol be circulated to health and safety officers in places of employment? Is there a health and safety officer in the Oireachtas? Has the protocol been sent to anyone to enable them to identify problems with incoming mail to the Houses? It contains a great deal of information. To whom will it be communicated?
I am anxious to disseminate the protocol as widely as possible. The first target group was emergency personnel operating in the fire and ambulance services, hospitals, directors of public health, the Garda, the Army and so on. We hope those organisations in turn will photocopy the protocol and send it down the line to various other units. It has been sent to every Member of the House. I will undertake to send it to health and safety officers as that is a good idea. The protocol is also being sent to major compan ies who need advice in the event of an attack on their facilities.
Written Answers follow Adjournment Debate.