STATES OF JERSEY
Flu pandemic funding
Lodged au Greffe on 13th May 2008
by the Minister for Treasury and Resources
STATES GREFFE
PROPOSITION
THE STATES
are asked to decide whether they are of opinion -
(a) in accordance with Article 11(8) of the Public
Finances (Jersey) Law 2005 to amend the expenditure approval for 2008 approved
by the States on 18th September 2007 in respect of the Health and Social
Services Department head of expenditure, to permit the withdrawal of up to an
additional £1,230,000 from the consolidated fund for its net revenue
expenditure in order to fund preparations for pandemic flu;
(b) to agree, in principle, that they will
approve an additional allocation of £590,000 to the Health and Social Services
Department in the event of an out break of pandemic flu.
MINISTER FOR TREASURY AND RESOURCES
REPORT
Background
Under the Public Finances (Jersey) Law 2005 heads of
expenditure for departments are, in the normal course of events, approved as
part of the Annual Business Plan approval process by the States. The sum of
such approvals is known as the “expenditure approval”. The Public Finances Law,
does, however, state in Article 11(8) –
“ … the States may, at any time, amend an expenditure
approval on a proposition lodged by the Minister on the grounds that –
(a) there
is an urgent need for expenditure; and
(b) no
expenditure approval is available.”
Two such spending pressures emerged in 2007 meaning
that the existing expenditure approval was no longer adequate. The States have
already approved amendments to the 2007 expenditure approval in respect of the
Social Security Department’s head of expenditure and the Health and Social
Services Department’s head of expenditure for 2007. The Health and Social
Services Department is now requesting the balance of the sum originally
requested for pandemic flu preparation in September 2007, less that approved in
December 2007. That request was withdrawn at the time pending further
consideration. The States approved additional funding of £517,000 in December
2007 to cover expenditure already incurred in 2007. The current request will,
in itself, not increase the base cash limit of the department in subsequent
years.
Funding for
pandemic flu preparations
Details of the need for the request for additional
funding are set out in the report from the Health and Social Services
Department attached at the Appendix to this report.
The States are requested to approve the additional
allocation of up to £1,230,000 in respect of expenditure already incurred on
preparations for a pandemic flu epidemic. This would increase the 2008 net
revenue expenditure of the Health and Social Services Department from
£147,901,500 to £149,131,500.
The States are also requested to agree, in principle,
to support a further request for funding of £590,000 in the event of an
outbreak of pandemic flu.
Financial
and manpower implications
There are no additional manpower implications arising
from this proposal. The financial implications are as set out in this report and
its Appendix.
APPENDIX
Health and
Social Services Department
Preparation
for an influenza pandemic in Jersey
Phase Two
(Updated)
(Paper for
States Assembly)
15th April
2008
1.0 EXECUTIVE SUMMARY
1.1 Current situation
- This report is an update from the previous report to the Council of
Ministers, titled Preparation for Pandemic Flu – Phase Two presented in
April 2007.
- The Minister for Health and Social Services (H&SS) is now
reassured that his questions concerning the original proposal have been
answered and he now supports option one from the Phase Two plan.
- In the meantime, the antiviral drug (Tamiflu) has already been
purchased to provide 100% island wide coverage.
1.2
Option one proposal (updated)
- Option one has been marginally updated from the previous report but
essentially requires the purchase of vaccines and additional medical
supplies as previously identified.
- The States Assembly is asked to support the proposal to make a
maximum of £1.24 million available to H&SS in 2008 for pandemic flu
preparation and to request that a further £0.59 million is available for
when the pandemic occurs.
- Option one (updated) is effectively the same as the previous
proposal agreed by the CoM in 2007 but excluding the purchase of the
antiviral drug (Tamiflu) which was approved separately.
- H&SS are unable to support this initiative within existing
agreed 2008 cash limits.
- In the event that the flu pandemic does not occur, H&SS commit
to updating the preparation plans (and if necessary requesting additional
resources) to coincide with the States Business Planning cycle.
1.3 Risk and Indemnity
- Any litigation costs arising from the use of the vaccines would
need to be met by the States.
- The financial risk from litigation has been assessed and considered
to be low. The States insurers quote for indemnity cover was not
cost-effective.
- The Council of Ministers are asked to support the proposal to the
States Assembly that the risk is carried by the States.
2.0 INTRODUCTION
The purpose of this paper is to update the States
Assembly regarding the current view of the Minister for Health and Social
Services on extending stockpiles of medical supplies in readiness for the
predicted world-wide flu pandemic and to request funds to support this vital
initiative.
In November the States Assembly received a proposal
extending flu pandemic medical supplies, under the Ministerial sponsorship of
Senator Syvret and Deputy Scott-Warren. The proposal was presented by the Minister
for Treasury and Resources. On his appointment as Minister for Health and
Social Services, Senator Shenton wished to review this proposal and asked a
number of questions about the phase two plan to the Medical Officer of Health. Due
to this request for additional information the proposition was withdrawn at
that time.
The Minister is now
satisfied that option one from the phase two plan, as previously presented to
Council of Ministers in April, has his support.
3.0 PANDEMIC STATUS
3.1 A pandemic is coming – a reminder
The World Health Organisation (WHO) and the Chief
Medical Officer (CMO) of England predict that there will be a worldwide human
influenza pandemic during the next three to eight years. A pandemic is an
outbreak of an infectious disease on a very large scale often associated with
increased severity and deaths.
It is predicted that the
next influenza pandemic will start outside Jersey, most probably in the Far
East, and spread to Jersey within one month. Most islanders will be susceptible
to the new virus and all ages will be affected.
3.2
Improved knowledge and technology
Both internationally, in the UK and in Jersey,
pandemic flu plans have developed during the last year, as has the research
base for more informed decision-making and new technologies. In March the UK
produced an updated plan which included more extensive stocks of protective
clothing and other supplies for infection control. As recently as November, the
UK Government announced that they would be stockpiling further supplies again
of protective clothing and antibiotics. They also announced that they would be
doubling their stockpile of the antiviral drug Tamiflu.
Here in Jersey, after reviewing the epidemiology of
the 1918 pandemic in Jersey and Guernsey, we have revised our initial planning
assumptions and now predict that a pandemic may run its course in Jersey in
only four weeks. We have discussed this revised hypothesis with Dr. Van Tam
from the National Health Protection Agency who has confirmed that this pattern
is more likely for a small island community such as ours. This has led us to
change our plan for managing the pandemic.
4.0 ANALYSIS
OF THE VACCINES
4.1 Pre-pandemic
vaccine H5N1 (generic)
A H5N1
vaccine has been developed by a number of companies for use before a pandemic
strikes – the ‘pre-pandemic’ vaccine. Pre-pandemic vaccines are the only
clinical countermeasure with the potential to develop population protection
before a pandemic virus emerges. Mathematical modelling indicates that such a
vaccine, given to the whole population, could, if combined with other clinical
countermeasures, reduce the pandemic’s impact to that of seasonal influenza.[1]
The
pre-pandemic vaccine is based on the H5N1 bird flu strain and is likely to
produce some protection against any human variety of H5 influenza. Although
no-one can be certain which strain will be responsible for the next pandemic,
WHO and the CMO of England predict that H5N1 is the likely source of the flu
pandemic when it arrives.
To date,
there have been 350 cases of H5N1 in humans with a mortality of 60%. If the
next pandemic were to be H5, 80% of the world’s flu virologists believe that
there is no genetic reason that requires a reduction of virulence to adapt to
man. Based on the experts’ opinion, a H5 pandemic would potentially be
catastrophic.
4.2 Pandemic-specific
vaccine
Pandemic-specific vaccine is expected to be the most effective vaccine
against the pandemic virus as it will have been manufactured against the actual
pandemic strain. The pandemic-specific vaccine, however, is unlikely to be
available until four months after the initial wave.
4.3 Assessing
the final propositions from the vaccine manufacturers
After a year
of top level effort and negotiations to secure pre-pandemic vaccine and an advanced
purchase agreement for pandemic-specific vaccine, three companies came forward
and offered us the opportunity to buy pre-pandemic vaccine (H5N1). The relative advantages and
disadvantages of each offer have been reviewed with a view to identifying the
best value offer for the Island. The
vaccination schedule for the H5N1 vaccine is two doses given three weeks apart.
In the event of the pandemic occurring, the manufacturers can offer an
advance purchase agreement for pandemic-specific vaccine.
5.0 INDEMINITY –
THE POTENTIAL RISK TO THE STATES
5.1 Proposal
from the States Insurers
For both the pre-pandemic vaccine and the pandemic-specific vaccine indemnity would need to be carried by
the States of Jersey and not by the manufacturers.
In April, the Medical
Officer of Health raised this potential risk with the Council of Ministers and
recommended that the States took out insurance from the States insurers to
cover this risk. Our assessment of the Insurer’s offer was that it effectively
failed to protect the States sufficiently in the event of any claims and would
not be cost-effective. The basis for this conclusion is that it is estimated
that in most cases the individual liability would be less the £100k and for any
significant case e.g. involving obstetrics the liability would probably exceed
the £1 million maximum.
5.2 Assessment of risk
We have assessed the magnitude of the risk by extrapolating the side
effects claimed for from the USA mass vaccination of 40 million Americans
against swine flu in 1976. Recent studies[2],
carried out since the USA Swine flu vaccine episode, indicated that the likely
risk of Guillain-Barre syndrome, associated with influenza vaccine, is in the
region of one to two people per million people vaccinated. This would equate to
0.1 to 0.2 islanders.
6.0 OPTIONS
6.1 Option one preparation package (updated)
Option one from my previous report[3]
aims to prevent severe flu for all. Every islander would be offered protection
in the form of Tamiflu and pre-pandemic vaccine under this plan. Also
pandemic-specific vaccine would be available and offered to those who could
benefit from it.
The additional supplies of Tamiflu (antiviral drug)
have already been purchased and the funding for this was agreed in a
proposition to the States Assembly on 5th December 2007.
In summary the phase two (option one) plan would be
to purchase –
- Pre-pandemic H5N1 generic vaccine for the whole population
- An advance purchase agreement to supply enough pandemic-specific
vaccine, once manufactured, to protect the remaining vulnerable portion of
the population
- Additional protective clothing for staff
- To create a rotating stockpile of antibiotics
- 11 non-invasive ventilators
- Undertake a pandemic major incident exercise in 2008
- Cold storage facility for vaccines
- Health population database server
- Validation check of database
The overall
effect of the option one preparation package is approximately £1.23m.
6.2 Option two preparation package (updated)
Option two from my previous report was to do the
minimum by keeping healthcare workers well to care for the sick and to treat
flu after diagnosis. In this option we would only procure sufficient quantities
of the pre-pandemic H5N1 generic vaccine to protect healthcare workers only.
Due to the low volume of the pre-pandemic vaccine
purchase it is highly unlikely that we would be able to secure the advance
purchase agreement to supply pandemic-specific vaccines even for healthcare
workers.
In summary the phase two (option two) plan would be
to purchase –
- Pre-pandemic H5N1 generic vaccine for the healthcare workers only
- Additional protective clothing for staff
- To create a rotating stockpile of antibiotics
- 11 non-invasive ventilators
- Undertake a pandemic major incident exercise in 2008
- Cold storage facility for vaccines
- Health population database server
- Validation check of database
The cost of
these items is approximately £0.23 million as identified in Appendix II.
7.0 ADDITIONAL
FINANCIAL EFFECTS IN THE EVENT OF FLU PANDEMIC
As stated above in 3.1 the pandemic is expected to strike within the next
three to eight years. Due to the uncertain nature of the consequences of such
an event it is extremely difficult to ascertain the exact costs when a health
service is overburdened with a demand of this nature.
7.1 Option
one additional costs
Under option
one H&SS would have made the best possible plans to defend against the flu
pandemic and we would be able to purchase the pandemic specific vaccine. We can
also confidently predict that we will need additional oxygen supplies in this
situation and will require a further £0.15 million to secure these supplies.
Therefore if
we adopt option one preparation the States is asked, in principle, to support
the request for an additional approximate £0.59 million for when the pandemic
strikes, see Appendix I. It should also
be noted that due to a predicted lower illness rate considerable costs from
excessive flu cases would be minimised.
7.2 Option
two additional costs
Under option
two we have only protected our healthcare workers against the full effects of
the pandemic and we would have been unlikely to secure any supplies of the
pandemic specific vaccine. As in option one though we would also need the
additional oxygen supplies meaning that the States needs to allocate an additional
£0.15 million for when the pandemic strikes, see Appendix II. In addition there
would be a greater number of islanders who would become ill which would create
a high burden of extra costs on the hospital and community health services.
7.3 Quantification
of total financial loss under option two
If option two is adopted then whilst there would be reduced financial
effect for the actual planning, the majority of the population would face the
full effects of the flu pandemic with limited defences.
The expected
effects are likely to be –
- 3% of children, young adults and older
people would die.
- 25% of the workforce would be off work,
sick with the flu.
- Doctors and nurses would be overwhelmed
(as well as considerable numbers being absent to look after young children
and elderly relatives).
- General panic and social unrest, probably
leading to a media frenzy and criticism of emergency planning procedures.
- Island supply chains would be
considerably disrupted e.g. food and fuel.
In an attempt
to quantify the financial effects of only undertaking option two the States
Statistics Unit has identified the number of Ftes and the annual profits per
Fte for the different industrial sectors on the Island.
Assuming that
25% of the workforce is off sick, losing 7 productive days as a result of the
flu pandemic, Appendix III shows that the financial effect of option two could
be to cause an approximate £11.6 million loss in profits to the Island’s
industrial sector (approximate £9.2 million of this figure is associated with
the Financial Services Industry).
8.0 FUTURE
REPLACEMENT COSTS
Due to the
rapidly changing nature of worldwide flu pandemic planning and the different
vaccines etc. that may become available in the future, it is very difficult to
exactly specify the replacement costs of this proposal.
In the event of the flu pandemic not having occurred within three years,
the Minister for Health and Social Services would present a review report with
an appropriate proposal to the Council of Ministers and the States Assembly for
flu pandemic preparation.
9.0 CONCLUSION
The pre-pandemic and pandemic-specific vaccines
were the key issues under review by the Minister from the Phase Two Plan. We
have reviewed the offers from three drug manufacturers to supply us with these
vaccines and have assessed the balance between the risk to the States posed by
pandemic flu without vaccine, compared with the risk from giving the vaccine. The
Pandemic Influenza Vaccine Subgroup (PIVS) has answered all the Minister’s
questions to his satisfaction and recommends option one. The PIVS also
considers that the occurrence of any significant side effects from the vaccines
is likely to be low and recommends, therefore, that the States carries this
risk.
10.0 RECOMMENDATION
We recommend that the States Assembly –
- Makes a sum of £1.23 million available to fund the purchase of the
medical supplies set out in the revised option one proposal.
This would also mean that
in the event of a flu pandemic, an additional £0.59 million would be necessary
for essential medical supplies.
- Agree that the States of Jersey carry the risk (expected to be very
low) in the event that there are claims against the States resulting from
the use of the vaccines in the context of a worldwide flu pandemic.
|
Dr. Rosemary J. Geller MB ChB FFPH |
Russell Pearson |
|
Medical Officer of Health |
Director of Finance and Information Systems |
15th April 2008
APPENDIX I
APPENDIX II
APPENDIX III
