Seanad Éireann debate -
Wednesday, 6 May 2009

Vol. 195 No. 5

Swine Flu Outbreak: Statements.

Minister for Health and Children (Deputy Mary Harney)

I welcome the opportunity to speak to the Seanad on the ongoing situation in relation to the current outbreak of influenza and the measures being taken in response to the outbreak

On Friday, 24 April 2009, a public health alert was received from the World Health Organisation indicating that human cases of influenza type A(H1 N1) virus infection had been identified in the US and Mexico. On 26 April, the WHO upgraded the pandemic alert level from phase 3 to phase 4 and on 28 April to phase 5. Phase 5 is defined by the WHO as clusters of the virus with human to human spread. These upgrades were anticipated in the context of our national influenza preparedness.

There is one confirmed case of A(H1 N1) influenza in Ireland. It was confirmed on 2 May 2009. The case involves a young male in the east who recently returned from travel to Mexico. The man, who is relatively well, is currently receiving antiviral medication in his home. Close contacts have been contacted and are also receiving appropriate treatment. There are no further probable or confirmed cases in Ireland.

In order to ensure people who may have influenza will come forward for investigation and, if necessary, treatment, it is proposed to maintain absolute confidentiality in relation to the identity and precise location of probable and confirmed cases. It is not proposed to report on numbers of people under investigation but rather to limit reporting to probable or confirmed cases, which provides important information for planning purposes and is similar to how this information is reported in other countries.

As of 8 a.m., there were 125 confirmed cases of the influenza in Europe, including the wider European Economic Area and European Free Trade Association countries, with 15 probable cases and evidence of community transmission in three countries. Outside Europe, there are 1,527 confirmed cases and 22 probable cases. The bulk of the confirmed cases relate to three countries. Mexico has 942 cases, the USA has 403 and Canada has 165. While there is no change to the current level of influenza pandemic alert, it is likely that the numbers of cases worldwide will continue to increase.

In the event that the WHO changes its pandemic alert level to phase 6, our national preparedness will allow Ireland to respond appropriately to this. Phase 6 would indicate sustained community spread in a second WHO region other than the Americas. It should be noted that some community transmission has been seen in the UK, Spain and Germany but it is not yet the sustained high level of transmission seen in Mexico and the USA.

It is too early to draw definite conclusions on the severity of illness caused by influenza A(H1 N1). However, cases that have occurred outside Mexico appear to be of mild illness. This is a cause for hope but not for complacency. We hope for the best but we need to plan for the worst. Influenza A(H1 N1) is a new virus against which there is no pre-existing immunity in the population and for which there is no vaccine. This means that, even if illness caused by influenza A(H1 N1) proves to be milder than initially suspected, levels of infection in the population might still be high.

On receipt of the alert, my Department activated our national plan for the health service response to pandemic influenza which was finalised in January 2007. The plan is accompanied by detailed expert guidance developed by the pandemic expert guidance group. In line with the plan, we have put appropriate governance structures in place to deal with the outbreak. This involves the HSE's crisis management team, the pandemic expert guidance group, chaired by Professor Bill Hall, and the EU co-ordination group, feeding into a national public health emergency team, NPHET, which is chaired by the Secretary General of my Department. This national group manages the interface between my Department and the HSE and is the main decision making forum for the health system response. We have also maintained close contact with the World Health Organisation on the matter.

To date the following measures have been put in place. Enhanced surveillance in the community and hospitals across the country to enable the detection and reporting of cases has been instituted. Improved viral diagnostic services and enhanced laboratory capacity, including out-of-hours arrangements, are currently in place, which strengthens our ability for early detection. Provision has been made for antiviral stockpiles to cover 47% of the population, which is among the highest levels worldwide. Some of these supplies have been distributed through public health departments to facilitate the treatment of initial cases. An advance purchase agreement with the vaccine companies is being put in place to secure the necessary supplies of a pandemic vaccine when these become available. Communication to professionals outlining their role in managing cases of influenza is updated on a frequent basis. Contact tracing arrangements have been established. Posters and leaflets have been placed in air and sea ports. The HSE has established a flu information helpline, freefone 1800 94 11 00, for the public which is available 24 hours a day. Up to yesterday it had received over 1,000 calls. A public information leaflet containing practical information for the public on what to do in the event of a pandemic has been printed and is currently being distributed to every household in the country. The leaflet is currently available on the HSE website. Supplies of personal protective equipment and other medications that are required for management of influenza have been issued. Frequently asked questions have been compiled and are updated daily on my Department's website and a travel advisory has been prepared and is updated daily on my Department's website and that of the Department of Foreign Affairs.

I am satisfied fully with our levels of preparedness and our capacity to deal with a possible flu pandemic. I compliment all those involved in developing our plans for a pandemic and pay special tribute to those throughout the health services who, since the current outbreak, have worked tirelessly to ensure our health system is geared up and ready to meet the challenge.

Senator Frances Fitzgerald

I would like to share time with Senator Liam Twomey.

I thank the Minister for coming to the House to brief Senators on the situation regarding influenza A(H1 N1). I pay tribute to the medical experts in the Department of Health and Children, particularly the chief medical officer, Dr. Tony Holohan, and his team, for their excellent leadership on this issue, the crisis management provisions which are in place and the briefing of the Opposition, which has been extremely helpful. I would like to see that continuing if and when the situation changes.

It appears that all those who should be involved are involved. It is not yet clear what the outcome will be internationally but we appear to be well prepared at this point. There is no doubt that new demands will be placed on the health services and that vigilance is absolutely essential. The key is information, education and forward planning. It would appear that much planning has been done. It remains to be seen how well the services will respond if the situation develops and, as the Minister said, that is likely. However, the indications are extremely good.

It is important that people are not panicked. Even if there are more cases of the influenza we do not want to see panic. People need to be well-informed and know what to do if they have symptoms of the disease. The general practitioners know what they must do, as do the public health experts. The readiness we have seen and the preparation thus far are very reassuring for people. However, I wish to put some questions to the Minister. We have seen a number of schools in the UK close to where a cluster of cases has been reported. What contact has the Minister's Department had with the Department of Education and Science? What plans are in place should such a situation arise here? That is not in any way to suggest that it will. What is our level of preparedness to deal with such a situation? Have school authorities been briefed on crisis management plans? Does the Minister intend to brief schools? How will these matters be handled and how have they been handled to date?

The Minister mentioned the work to develop a new vaccine for the flu. It would be helpful to keep the public as informed as possible in this regard. I understand the timescale for a new vaccine is between four and six months. It will take time to develop but in the meantime we must have an adequate supply of Tamiflu in Ireland which can prove effective against the disease.

I note the Minister is updating the travel advice on a daily basis which is very important. In the beginning different advice was given at EU level and national level, which was unhelpful. Perhaps the Minister will brief us on the EU response and the decisions taken at the recent Ministers' meeting also.

Is there any specific advice that the Minister or experts could give to people recently returned from Mexico? I commend the medical experts on their control of the issue to date and I wish them well in future. I look forward to hearing from the Minister on some of the details I have sought.

Senator Liam Twomey

I compliment the officials in the Department of Health and Children on their handling of the potential crisis to date. The lessons learnt by the Department in how to deal with a pandemic were greatly enhanced following the outbreak of SARS in 2003. It is clear from the response of the Department that it has learnt a good deal from that potential SARS outbreak five years ago. All measures established, including public announcements, and the way with which the matter was dealt, that is, by neither over-playing nor underplaying the nature of the crisis, indicate a positive response from officials in the Department. Although the structures are in place in the event of a pandemic, it is lucky for us that this virus seems to be no more virulent than any other influenza virus present in any country at any time. We have been lucky in the sense that it has not been a full-blown crisis. It has been only a potential crisis and, therefore, we have not been fully tested in respect of the potential outcomes. I am sure the Department in its wisdom will stress test its systems to establish how it would respond.

In the past when discussing SARS the issue arose of how best to use hospital beds. Does the Department believe this is still an issue? If this were a full blown pandemic of a highly virulent strain of influenza we would have to keep certain people at home as much as possible to isolate them from the general population.

I note there has been a great reduction in the HSE in the level of home help services and public health nurses provided. The recruitment embargo is impacting on primary care services. The slow roll-out of primary care, which has been a part of Government policy since 2001, would be severely tested if a highly virulent influenza virus struck the country. From that point of view not enough has been done to build up the level of primary care which has been promised for several years.

The HSE has indicated it has funding to build primary care centres, but not to take on staff for primary care centres, which has the potential to weaken primary care. There is also a manpower crisis in public health nursing and with general practitioners working in primary care services. The Government does not seem to be responding to these needs seriously. These matters do not reach the headlines unless something serious takes place. If the virus were to change and become a highly virulent pandemic we would be severely tested. There are still weaknesses in place. What does the Minister intend to do in this regard?

Senator Geraldine Feeney

I welcome the Minister and I thank her for taking time to come to the House this evening. We all woke up on 24 April last and heard the alert that Mexican or H1 N1 flu was here and had been detected in Mexico. It is an indication of the successful job the Minister is doing when one hears the two main Opposition speakers congratulating her Department and the HSE for the great work they have done in the past three weeks. I have watched the television news bulletins on the matter and I take my hat off to Dr. Tony Holohan. He gets better as time goes on. He has a very calm and experienced mind and is a very intelligent man. He allays the many fears the public may have with the calm way he assures people. I was taken by some of his recent comments. He stated that it was too early to reach a conclusion on the severity of the illness in cases reported outside Mexico. He further stated that any cases reported outside Mexico were milder than those detected in that country. He went on to state that this was a cause for hope but not for complacency. This sums him up because he has not been complacent by any measure or means and has been very much on the ball.

The Minister has referred to the daily meetings in her Department involving the Secretary General, Mr. Scanlan, and Professor Bill Hall. They have advised the public and kept it abreast of what is taking place. I check the website every day and it is updated almost minute by minute. I checked it on Monday and there were 985 confirmed cases outside Europe. This morning that number had reached 1,516 cases. That figure is even higher in the Minister's report, which is obviously several cases ahead of the report I examined. There has been no other flu, whether SARS or bird flu, on which we have had such a good handle and on which the public has felt so reassured by the response. I congratulate the Minister and her staff in this regard.

It is very important that we remain calm but vigilant as Dr. Holohan suggested. On my way to the Chamber I stopped briefly to talk with Deputy Rory O'Hanlon. He asked me to where I was rushing and I said I was going to speak on swine flu. I asked him what he would call it and he suggested it should be called Mexican flu. He stated how important it is to be calm and not to get too carried away. He further stated that every ten years a very strong variant of flu emerges and, unfortunately, takes lives. However, the difference in this case is that older people have built up a resistance. It is attacking younger people, especially children. I am glad that we have been very vigilant in our response to the single case in this country. The Minister outlined details of that case involving a male, living on the east coast who has been treated and is being monitored. Even his wider circle of friends are being monitored and probably treated too. It was interesting to listen to the World Health Organisation spokesperson, Dr. Kelly, a native of Curry, County Sligo. I am sure Sligonians are very proud of him. He is a young man but he certainly has a great handle on what is going on. I was interested the other morning to hear, I think on Pat Kenny's radio programme, a professor from UCD talk about the need for calmness. He said we should not get too carried away although he stressed that people should be vigilant. He pointed out that, each year, more than 25,000 people throughout the United States of America die from common colds. He put what has happened with swine flu and what has been said about it in context. It is interesting to note the Department of Health and Children's website has had 75,000 hits from the public. People are aware but they are not panicking or running around afraid.

On world travel, I note we are not telling people not to travel. We are saying that they should not go into Mexico. That is wise.

The Minister has done all she can through her Department and the Health Service Executive, HSE. I was delighted to hear her say that Ireland has one of the biggest stockpiles of any country of the drugs that would be used to treat swine flu. I think she said we have 47% coverage for our population. The information that is being given out on-line is excellent and people are reassured by it. I printed out a copy of the information that will go out from the HSE and the Department to people's homes in the next seven days. It is an interesting and easy read. Again, I thank the Minister, the staff in her Department and the HSE for the fine job they have made of allaying the population's fears.

Senator Joe O’Toole

We are quick to criticise the Department of Health and Children time and again when things go wrong. The morning after swine flu hit the headlines, one of the British-Irish tabloids carried a front-page story that Ireland was unready, unable and without plans to respond. The Minister and her staff at the Department have handled the matter with the expertise that I look for in Government. The calm and assured way in which this was presented to the public has been a model of its type. Dr. Holohan managed to convey in simple language the medical information about what is, no doubt, a complex issue. The message he conveyed reassured people. The information about the various back-ups within the Department and the level of readiness was also reassuring.

As I said, in bad times there is constant criticism so it is useful to recognise that swine flu has been handled, and continues to be handled, well. No doubt we are only halfway through it, a quarter of the way or whatever, but as an ordinary citizen I feel we are being well protected and well led on the issue. The Department reacted and responded as I would want it to have done. I would like the Minister to convey to her officials my subjective view that the matter has been handled with extraordinary expertise.

Senator Phil Prendergast

I extend a warm welcome to the Minister for Health and Children and thank her for coming this afternoon. She will begin to wonder what is wrong with us as we have nothing but praise for her today. I wish the gentleman who contracted the virus well and hope he continues to enjoy good health. I will wait to hear the Minister's answers to some of the questions that were put, but I join the other speakers in congratulating her on the way in which she and her officials have handled this epidemic. The information and the ways in which it has been provided have been effective and efficient, and the media reporting has also been good. I was especially grateful for the briefing Dr. Tony Holohan gave us in the Oireachtas last week and the fact that he took time out to explain to us what was happening. It is always better to give people the information before they read about it as that gives us a chance to have a prepared response. I hope swine flu will be contained and we do not get any more cases in Ireland. If we do, I hope we will handle them correctly. I thank the Minister again for the way in which the issue has been handled.

Minister for Health and Children (Deputy Mary Harney)

I thank all members of the Seanad who have spoken for their kind comments, particularly about the chief medical officer. I will certainly ensure their comments are relayed to him. He is a dynamic, visionary chief medical officer. He is new to his post. In fact, he took over the day before the pork had to be withdrawn, so he has had something of a baptism of fire. In thanking him, I also acknowledge Professor Hall from St Vincent's Hospital and UCD, who is chairman of the expert group, and Dr. Darina Flanagan and Dr. Kelleher from the Health Service Executive, HSE. They have been meeting each day, including over the weekend, to ensure they are on top of what is required. They have been connected to the WHO and at European Union level.

I was asked a number of questions. I share Senator Feeney's view that we must be vigilant and not complacent. When I attended the meeting last Thursday, I was reassured to know we are as prepared as anybody else, but it is clear that in the event of a pandemic, all health systems would be challenged.

On schools, swine flu was to be considered today by the Department of Education and Science at its management meeting, but the guidelines suggest that, in the event of an outbreak in a crèche, the crèche would be closed, and if there was an outbreak in a primary school, the class would be kept at home. In the event of an outbreak in a secondary school, the advice of the public health authorities would be sought. On the one hand, we have to be precautionary in the manner in which we deal with schools, but on the other hand, if we sent every child home from school, many of our health care workers would face a challenge in finding someone to look after their children, so we have to take expert advice on the issues. We must do the right thing, of course, but we must do it in proportion. The Department of Education and Science is on the interdepartmental group which met twice in the past week.

Reference was made to the number of people who die from influenza. At the EU meeting last week, the WHO made the point that across the European Union, including the European Economic Area and the EFTA countries, between 40,000 and 220,000 people a year die either from flu as a sole cause or from influenza and other conditions. It is important to put the matter in context.

The Labour Court recently adjudicated on out-of-hours cover for public health doctors. I understand it made a recommendation yesterday that will go to ballot with a positive recommendation from the IMO. That issue was raised last week. I very much welcome that and hope the recommendation will be supported.

The chief medical officer will be happy to ensure we continue to have appropriate briefings, where necessary, of key spokespeople from the political parties.

On hospitals, as Senator Twomey said, we want to treat people at home. For many reasons, we want to minimise the number of people who require hospital admissions, but in the event of a pandemic the protocols suggest that all non-urgent, non-emergency hospital procedures would be cancelled, not just so that we had the appropriate beds for patients who needed treatment but to minimise the chance of hospitals being the source of cross-infection and the flu being passed from person to person. I will ensure my Department circulates a copy of the plan published in 2007. It is easy to read and understand and it contains useful information for Members of the Oireachtas.

I remember two years ago when the issue arose of whether we needed to purchase anti-virals at a cost of €30 million, which would be stored until the event of their use being necessary, I commented to my officials that I was in the Department of Enterprise, Trade and Employment when we were coming towards Y2K. Much money was spent to ensure computers did not all break down and aeroplanes did not fall out of the sky. Afterwards we reflected on what it had cost. The same issues crossed my mind but the overriding concern must be that one must be prepared even in the event of it not being necessary. The same applies now to the vaccine.

To be in the queue to get the vaccine four to six months after the pandemic occurs — most people have said it would take at least six months to get the vaccine — we must pay money upfront, which will have to happen shortly. In the current environment where every €1 million is important, one might ask whether we have to do this now. The answer is "Yes" because in the event of it being necessary, it will be too late to join the queue. We have made a decision to procure the vaccine and pay a sum of money in advance to its producers in order to be in that queue. We will be with 15 to 17 other EU countries in that regard.

The issue of travel was discussed at the Ministers' meeting last week. The French Minister took the view that all direct flights between Mexico and Europe should be cancelled. That view was not widely shared because one can come from Mexico through other countries, including the United States of America and Venezuela. Ireland does not have direct flights with Mexico and yet we have had a case here of someone who had holidayed in Mexico. However, we took the view we should advise people not to travel to Mexico unless absolutely necessary. That remains the advice. I know of two people who have taken that advice and changed their holiday plans. Many people will take that advice but others may not.

I will be happy to come to the House at any stage to speak about the influenza if it becomes a pandemic or if the situation changes.

Senator Liam Twomey

Are the vaccines being bought?

Deputy Mary Harney

One buys a place in a queue. Clearly, a capacity issue will arise as to how quickly the vaccines can be produced.

Senator Liam Twomey

Is that a refundable purchase?

Deputy Mary Harney

I am afraid not. We bought the anti-virals two or so years ago at a cost of €30 million. They had been in storage and are now being used. The same applies to the vaccine.

We have had very close co-operation with Minister McGimpsey in Northern Ireland and I have had many conversations with him. We have linked closely with the UK because we share this island with the Northern Ireland authorities, so it is important we work together. We are at one in regard to many of these issues. Northern Ireland has joined the queue as have many other European countries.

Sitting suspended at 5.35 p.m. and resumed at 6 p.m.