Proposition 52K2162

Projet de loi contenant le deuxième ajustement du Budget général des dépenses pour l'année budgétaire 2009 - Section 25 - "SPF Santé publique, Sécurité de la Chaîne alimentaire et Environnement".

General information ¶

Submitted by

CD&V the Van Rompuy government

Submission date

Sept. 14, 2009

Official page

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Status

Adopted

Requirement

Simple

Subjects

budget national budget

Voting ¶

Voted to adopt

CD&V LE PS | SP Open Vld MR

Abstained from voting

Groen Vooruit Ecolo N-VA LDD FN VB

Party dissidents ¶

• Peter Luykx (CD&V) abstained from voting.

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Discussion ¶

Oct. 15, 2009 | Plenary session (Chamber of representatives)

Full source

I will keep it very brief because I have heard from the minister that the discussion is also in the Senate, and the committee members are waiting. Because of respect for the House, I will report here, and because of respect for my colleagues in the Senate, I will try to keep it short.

On 22 September there was a meeting in the committee on the A/H1N1 flu. On the one hand, the minister gave a stand-up on the state of affairs within Europe and also other countries, such as the situation in Australia and South Africa. On the other hand, it also lightened the situation within Belgium.

She also talked about the supply, more specifically how everything would go in his work, and also about the communication about the flu. Furthermore, it was discussed the task of the municipalities in, among other things, how to order the vaccines, the number of vaccines, and so on.

The first draft law is the draft law that grants authority to the King in the event of a flu epidemic or a pandemic, contained in document 2156. The bill should be seen as a measure taken by the government to prepare Belgium for a possible flu pandemic.

The bill identifies five matters that require a special approach and which grant the King a special authority. The first is the distribution and distribution of medicines. Second, it concerns the possibility of allowing more blood donations per year, and third, the possibility of recruiting other professions than health workers. The preliminary point is to make it possible for municipalities and provinces to obtain certain information in the healthcare practitioner register.

Finally, a more general authorization is envisaged for the situations that cannot be rationally foreseen at present. This authorisation is limited to situations that would pose a threat to public health. All these provisions shall have limited retroactive effect.

The bill was adopted in the committee with thirteen votes for and two abstentions. Today we met again briefly. Two additional amendments were discussed. They aim to clearly include in the law that vaccination for A/H1N1 should not be mandatory with implementation of the law. Members of the committee agreed that a relevant provision would be included in the law. The first amendment was unanimously adopted. Consequently, the second amendment, which has the same subject matter, remained without object.

A second bill allows the government to exceed the budget appropriation. It is about a sum of 9 million euros for the purchase of masks. The bill was adopted with nine votes in favour and five abstentions.

I leave the general discussion to my colleagues.

Mrs. Speaker, Mrs. Minister, colleagues, I also promise to keep it brief, but the topic is important enough to make our statement on this subject during this plenary session.

It is important to emphasize that this is a public health problem. Our group has no problem with the fact that the government has applied the precautionary principle. Again, the current situation should in no way give rise to creating an alarming or panic atmosphere. The way the Mexican flu now develops is not even reaching the level of an average winter flu. There is no reason for panic or hysteria. In that sense – and in that we do differ, Mrs. Minister – we ask ourselves whether it is necessary to approve a law of authority to give the government extensive powers, while it is clear in the field that there is no fundamental problem at this time.

I think we should talk about the criteria by which a pandemic is determined. After all, what we are experiencing today is largely the result of the atmosphere and regulation at the World Health Organization. The World Health Organization has expressed its concern very quickly, while on the ground it is now apparent that the existing criteria do not actually meet what one should expect in a globalized world.

Per ⁇ the time has come to say at the World Health Organization level that those criteria for determining a pandemic should be revised.

One of the key points in the debate was the discussion of whether or not obligatory vaccination. As a member of the Flemish Interest Group, I was proud to see that our critical questions were answered clearly. It is now clear — and in the amendment it was further clarified this afternoon — that the planned vaccination will not be mandatory, even for the risk groups concerned.

As a member of the Flemish Interest, to be somewhat cynical, I could ask whether the amendment was the logical consequence of a short litigation that a French-speaking civil organization has raised against the State. Would the majority, in this case our PS colleagues, have responded as quickly with a government amendment if the initiative had come from the north of the country?

As I said before, you will experience a historical moment, in the sense that the Flemish Interest will enthusiastically support the French-speaking civil society and approve the PS amendment without any problem.

I come to the essence. It is good that it is now very clear that vaccination is in no way mandatory in the current situation. However, given current international regulations, the World Health Organization may require us to vaccinate at some point. We need to see if this is healthy. The mandatory character must be absolutely avoided.

I acknowledge without any problem that the dossier has evolved in a positive way over the last few weeks and months. The members of the Public Health Committee who carefully follow the file will probably not contradict me. We can experience that the pharmacists as a group are indeed involved in the whole plan. In addition, general practitioners can now vaccinate themselves in their own practice; the original scenario of the municipal vaccination centers has been removed.

Mrs. Minister, there is still dissatisfaction among the general practitioners, with regard to that mandatory registration for the channel via eHealth. There needs to be clarity on this. You said this afternoon in the committee that this is partly related to the fee that the participants will receive for the vaccinations.

Mr. Bultinck, I would not want to confuse two things.

First of all, there is the question of the doctor’s fees. At the level of the nomenclature, we will work to remunerate them on the basis of fees that have been agreed with them. We have responded to their request. Then we also responded to their request to vaccinate in their office. Indeed, I considered that this was a very good method since the doctors proposed both to vaccinate in their office, but also to organize themselves so that, given the multi-dose bottles, to work in a framework that allows to vaccinate several people in a relatively short time. We have also agreed on this issue.

On the other hand, with regard to registration, a matter that has nothing to do with fees or with the fact of vaccinating in their office, I told them that in terms of pharmacovigilance, it was indispensable that patients could be registered or in any case that we could have a patient code to know the maximum coverage and pursue our public health policy serenely. I also informed them that we are organizing for data collection to be carried out with an algorithmic code that does not reveal the identity of patients. This is absolutely necessary since the responsibility of the State is engaged in the extent that it is he who organizes this voluntary vaccination.

The explanation you make is more than welcome. I think this refines the whole debate and for those who will read this debate it is also good that this has been confirmed in the plenary session today.

I will come back to another point of pain, Mrs. Minister. I am talking about the whole debate we have held in this dossier about the responsibility with regard to that vaccination. The question was asked in the committee and the answers were somewhat out of place. What if there are serious side effects or complications from the vaccinations? Who will ultimately be responsible for the possible damage incurred? I think it would be good if this debate was further clarified in your answer. There are still some concerns in this area. As a member of Parliament, I think it is my duty and duty to express this concern.

Another element in the whole debate, Mrs. Minister, is the safety and quality of the vaccine. I refer very explicitly to the Anglo-Saxon press where they report questions about the quality of this vaccine because here an accelerated procedure has been used. This procedure was much shorter than when developing a normal vaccine. Neither in the Dutch-speaking nor in the French-speaking press has been given much attention to this. I have taken note of the fact that in the Anglo-Saxon world there have been a number of questions about the safety of the vaccine. As a member of parliament, we have been infested in the last few days with all sorts of e-mails, whether or not well-intentioned and whether or not panicking.

On behalf of our group, I count on your confirmation once again that you can guarantee that the vaccines as they are now created are truly safe and non-toxic. I think that reassurance on the ground should be reaffirmed in the plenary session.

Mrs. Minister, I am slowly ending my story. I also promised to keep it brief.

I have pointed out to you – in this regard we did differ in opinions – from the beginning that the Flemish Interest has difficulty in approving a law of authority of a Belgian government simply without hesitation. This is ⁇ the case, now that we – I feel strengthened – find out on the ground that there is no reason to panic at the moment.

Mrs. Minister, I would like to reaffirm in this regard the good agreements made by all members of the Public Health Committee, on the difficult request of your servant, by the way, in the aforementioned committee. You then confirmed that the draft royal decree, should we ever have to resort to full-fledged CBs, will be notified in advance to the Public Health Commission. This would enable us to carry out the normal control procedure, for which parliamentarians are always the requesting party, before the draft royal decree for advice goes to the Council of State.

Mrs. Minister, before the agenda of the debates it would be good that you subsequently in your reply reaffirm the agreements made in the committee in this regard, so that everyone on the ground can be reassured.

I would like to limit myself to one punctual question. Can you confirm or not confirm that at this time any draft royal decree for the potential full-powered KBs have already been designed or written out? For the agenda of the debate and also for the debate that we will continue next week in the committee, your answer is not insignificant.

Mrs. Speaker, Mrs. Minister, colleagues, I will explain why we will continue to abstain in the plenary session. It is and remains important, for me and for my group, to give a signal of lasting concern. As a member of Parliament, I have a very difficult time approving merely powers for a federal, Belgian government. I also pointed out to you in the committee that the Flemish Belang is available to the population day and night. We are prepared to come to the Parliament day and night, if necessary, when it proves necessary and the Public Health is at stake, in order to pass urgent measures in the Parliament. This will be our lasting signal and also explains our abstinence later during the final vote.

Mr. Speaker, Mrs. Minister, colleagues, the Mexican flu may be at its peak in the coming weeks. For a few months, we have been in the ban of the Mexican flu. The draft that is now put to the vote is actually the closing point of a whole series of measures taken to intervene in the event of a pandemic.

In the Public Health Committee, the Minister has given us a very regular state of affairs over the past few months. The two main actions are undoubtedly the purchase of the vaccines and the establishment of a structure to cope with the situation in the event of a pandemic.

The vaccine has already arrived and has also been tested for safety, which was a breakpoint for Open Vld. It is now possible to start vaccinating. The start of vaccinations, first among health workers and later among the risk groups, has been arranged. Priority target groups have been deleted. In addition, there is also a clear structure that comes into action at the moment the epidemic becomes a reality. A clear and important role is played by local governments.

In the committee, we spent a lot of time on whether the flu was really so dangerous and on the safety of the vaccines.

Fortunately, the initial unhealthy reports about the dangers of this type of flu do not seem to translate into reality. For now, the Mexican flu is a mild flu, with the exception of viral pneumonia, which is dangerous. Of course, for caution, we will remain very attentive to possible mutations. Because the antigen and the adjuvants are separated in the purchased vaccines, in the event of a mutation the vaccine can be easily adapted.

Another important discussion in the committee was the safety of vaccines. It can only be administered after the European authorities have given their approval. This has already happened.

The powers granted by this law to the King are important, in particular the authority in article 2, paragraph 1, 6. There, we actually give the King the authority to take action for any problem that arises.

The amendment that we adopted today in the committee is important and makes it clear – as the minister has always said in the committee – that no one can be obliged to get vaccinated.

The powers granted to the King are also strongly framed, they are limited in both time and scope. Open Vld wants to be very pragmatic in this. We give the Minister a well-framed mandate in case the Mexican flu would develop into a public health crisis.

With this law, without sowing any panic around the Mexican flu, we simply take our responsibility. The English have a very good proverb for this: better safe than sorry.

In the hope that we will not need this law and its implementing decisions, Open Vld will therefore approve them.

I hope that the Mexican flu has also opened our eyes to the fact that there are many pandemics and diseases around the world that in the future will deserve our full attention and support.

Mr. Speaker, Mr. Minister, I would like to quote you first the fresh news coming from the Institute of Public Health. These are epidemiological findings that we have found today on the site of the said institute, which transmits the statistics of last week.

According to the latter, “the surveillance data show an increase in the circulation of the virus and a moderate activity of influenza syndromes.” According to the established criteria, Belgium is at the beginning of an influenza epidemic.

The incidence of influenza syndromes ⁇ by Vigies doctors continues to increase and the epidemic threshold has been crossed for three weeks. Of the 253 samples taken by vigilant doctors, 76 present the A/H1N1 virus, or 30%. This is, of course, an estimate, since these samples are taken by vigilant doctors and from which they extrapolate.

According to the Institute of Public Health, "this result shows a moderate circulation of the virus in the population. In recent weeks, no significant excess of mortality has been observed." Here are the news I can tell you.

Madame Snoy, I have to interrupt you. More than 20,000 cases of influenza have been ⁇ in our country. Until recently, three people had died and we unfortunately have learned that a five-year-old just died from the consequences of the A/H1N1 flu.

This is the fourth death.

I do not want to relativize a death, far from me this intention. However, I would like to know the number of deaths related to seasonal flu. The number of annual deaths caused by seasonal flu is much higher; it is estimated between 2,000 and 3,000 cases per year. The fact that the first three victims were middle-aged women surprised me. This is a question, I acknowledge. However, the phenomenon must be relativized.

Last week was the third week of the epidemic. Today we are in the fourth. The graphs provided by the Institute of Public Health actually show that the seasonal flu syndrome is high and rising very strongly in recent weeks and that the A/H1N1 flu syndrome is well below and remains proportionally fairly low, although it is also rising.

Like all the democratic political parties, we voted in committee for this draft exceptional law on September 22, 2009 because we considered the draft sufficiently marked at the level of powers conferred on the King. At that time, we were talking about a flu whose contagiosity was extremely high. This is not verified! The ISSP says that the circulation of the virus in the population is moderate, this does not seem to be verified. The project envisaged a proposal for recruiting staff as well as the delivery of medicines by other professionals than pharmacists. At this point, there was no objection.

This bill was accompanied by your promises not to use compulsory vaccination, to authorise vaccines only after approval and to guarantee non-toxicity through ad hoc bodies and that only target audiences would be called to use it. In addition, you know that the Health Commission has long been discussing this issue.

However, this draft exceptional law has caused many citizens’ reactions to which we could not remain indifferent. There are concerns about several aspects, mainly the possibility of a vaccine obligation.

Today, the majority introduced an amendment removing the possibility of opening a possible vaccine obligation. This amendment joined us and was voted unanimously in the committee. Very sincerely, I thank you, as well as my colleagues in the majority, for making this decision in order to soothe much of the citizens’ fears.

Nevertheless, we still ask ourselves some questions.

This law appears as a disproportionate arrangement in relation to the slight gravity of the situation. Should we really consider that we are in the presence of a major danger and that it is always justified to keep the provision of section 3.6 in the law of exception? This article gives the King a set of powers, related to the existence of a serious danger, which are not very clearly defined. Possibilities of sanctions, derived from the Criminal Code, are linked to it and could “criminalize” those who would oppose the measures taken.

Then comes the question of time. Vaccination will soon begin, you will probably tell us when. Some sources argue that two doses of the vaccine should be administered at a three-week interval and that this vaccine is effective only fifteen days after being administered.

Is it not too late for all the people at risk to be vaccinated? Will we not be beyond the epidemic? So is it still necessary to organize a massive vaccination campaign? We are doubtful. We do not want to oppose the vaccine or its administration, but rather a campaign that will, in some way, put a moral pressure on the public opinion, on companies and their bosses. For example, some large distribution managers have already told their employees that they should get vaccinated.

Madame Snoy, your statements are not in accordance with the vaccination program which, if it is voluntary, is reserved for certain priority groups and chronic patients described by the Scientific Committee Influenza.

To say that companies are pressuring everyone to get vaccinated is contrary to reality. This is contrary to the organization of vaccination.

I’m not saying you want it, I’m not saying it’s the command but...

It is impossible!

This is possible in the long term since you have planned 12 million doses.

Mr Snoy, you were in favour of this project in the committee. I understand your fantasies and actions. I understand that you would prefer to abstain here to gain a share of the electorate but I do not find this responsible attitude in public health!

I tell you clearly that what you are considering is impossible!

An entrepreneur, a manager of large distribution cannot force his staff to get vaccinated since this vaccination is not intended for everyone! It is the hospital staff that is targeted. These are general doctors. This is the management staff of the schools. If they wish! Then there are chronic patients. It is not Mr. And Mrs. All the World! Do not start feeding rumors and fantasies, please!

(The applause )

It is not impossible for an employer to pressure its employees to get vaccinated! It is possible, it is the reality.

It is impossible!

I am not telling you that employees are obliged, since legally they are not, but recognize the situation on the ground. It puts pressure on workers who often have an interest in obeying their boss. There is pressure on parents of children.

Let’s take the case of nurseries. No vaccine is mandatory, except for the vaccine against polio, but you know very well that most nurseries require a whole series of vaccinations to accept children.

These vaccines are not reserved for specific groups. Do you want to try to understand?

The seasonal flu vaccine is available at the pharmacy for those who want to get vaccinated. What you tell me here could possibly exist regarding the vaccine against seasonal flu. It is open to all those who want to buy it.

This vaccine does not follow the same scheme. You can’t go and buy it in the pharmacy, even under pressure.

In fact, it is necessary to be part of the priority groups, risk groups to have the possibility, if desired, to get vaccinated, after medical advice. So you can see that we are far from the new fantasy you are talking about.

In my opinion, a patient can ask his doctor to get vaccinated. You can’t control the number.

( ... ) : ( ... )

I am talking about possibilities. On the ground, a certain audience can quite be subject to moral pressure. It is a sociological, psychological situation that really exists and to which this law of exception contributes by creating a psychosis while dealing with a benign epidemic.

I would now like to address the issue of rapid development of this vaccine that contains adjuvants that could be dangerous. I submitted a question that was transformed into a written question on squalene. I have not yet received a response. If you could answer me tonight, I would be delighted.

Mrs. You are relaying questions that have been asked by ASBLs, and that is normal. I must tell you that not only did I answer these questions, but I also forwarded to the House Health Committee, when Ms. Gerkens was president, the questions and answers on the subject. I even read in extenso the whole answer to the question concerning the squalene. I repeat that we had a discussion on this subject in the Health Committee and, on this occasion, I answered as accurately as possible.

However, squalene is still subject to restrictions by some public authorities. In Germany, vaccines administered to pregnant women have been removed. My question remains legitimate. That being said, I am sorry to have to tell you that I have not yet received an answer to the question I asked you.

However, we have the right to question the safety and effectiveness of vaccines. Moreover, many are those including among scientists who question the effectiveness of flu vaccines in general.

It is not obvious to balance between the degree of effectiveness of flu vaccines and the importance of their possible side effects, which remain of relative importance, I admit. However, it is legitimate to ask these questions and we will continue to ask them.

The issue of administration of antiviral drugs remains: the strategic stock was rightly acquired during the threat of avian influenza, in order to mitigate the consequences of a serious epidemic. Today, generalists administer it to patients at risk, who have a flu syndrome, while only 30% are of type A/H1N1 and the disease is quite common. The question is whether it is really reasonable to consume the stock of these antiviral drugs for influenza A/H1N1.

As for the level of responsibility in the event of toxic effects of these vaccines, we still have questions about this. Does the Minister agree with us to say that even with the authorization of public authorities, the firms remain responsible and that the State only subsidiarily assumes responsibility in such a way as to guarantee compensation from the citizens? Some questions remain unanswered.

About the doctors who do resistance, I heard you recently in the commission. I understand that you intend to protect medical secrecy and that doctors will not be required to disclose the names of their patients in electronic files that will be disseminated to public authorities. It remains to convince doctors to work this way.

As for the cost for the entire budget of the Social Security and INAMI, the cost of vaccines and consultations is not yet insured. I also heard that you were offering a tariff of 6 euros, but the doctors have not yet accepted. So, a set of problems have not yet been solved at all.

I sincerely believe in your good faith. This is also why we voted this law here three weeks ago; today, however, given the evolution of the situation, we are in an excessive device, we use a bazooka to reach a rather small target.

Instead, we should think about how to manage a pandemic in case it becomes serious, significantly more serious than this pandemic. Instead of proceeding through an exceptional law related to a disease, epidemic or pandemic, we should consider setting up arrangements that allow you to act in the event of a serious health hazard, without resorting to emergency laws or exceptional laws.

This is the reason why, indeed, we will abstain and continue to ask in the public health committee that you report the situation very regularly.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. Those who are tired are more susceptible to flu.

Let us especially hope that we do not need the proposed measures this year, even if that is unpredictable.

We started the work before the summer. When the phenomenon was still far from our bed, the government and the Social Affairs Committee actively launched a debate on it. We have been informed more than sufficiently in advance with advance questions.

We have observed the precautionary principle and adopted a pragmatic attitude, the only right one. Again, let us hope that it will not be necessary, but it is written in the stars that the likelihood of pandemics of viral diseases will greatly increase. The portability has grown, we have become more vulnerable to infections, and global mobility has increased. Sooner or later, our country or one of our neighbors will be hit. It would have been a mourning if we had no book at that time.

There was room for broad discussion in the committee. We have collected all possible scientific information. Now we have a case-based model, which clearly determines who will play what role in such a situation. Such a model is implemented in practice. This has led to a number of adjustments, I think of the role of the municipal governments and the family doctors.

It is obvious that such a model must be legally ratified. For this, the necessary resources are needed. That in such a model one must resort to situational powers, I find no more than normal. It is important to think ahead and not, every time a new phase enters, to be delayed by parliamentary actions.

We actually have peace with it, we think a good model has been developed. We would like to ask, Mrs. Minister, that we continue to adequately align ourselves with the international context. Parameters are also being developed from the World Health Organization that should indicate when such a plan should be able to take effect.

Finally, Mrs. Minister, I would like to urge, especially to my colleagues, that if the pandemic does not occur this winter in our country, we will organize a debriefing on the model. Then we must examine whether, if the application of the model had been necessary, it would indeed have worked well. Of course we hope that there will be no disasters in our municipality, but it would be very careless if we did not have a disaster plan. It would be much more careless not to perform a test at any given moment to check if everything works properly and the appointments are fulfilled.

Therefore, in addition to following the current situation, in my opinion, in the committee we will have to evaluate the system thoroughly and in a scientific way, not just on the feel. All the actors who have now participated in the model must be involved. We must, of course, be promptly advised by the virologists who make up the cell that directs the policy.

We, as a country, must be armed to face such a pandemic and we will therefore approve these proposals.

Mr. Speaker, Mrs. Minister, dear colleagues, I will not return in detail to the debate that took place in the committee and of which we have already talked, but I will insist on a few points. You have repeatedly stated that vaccination is not mandatory. Votes have been raised to question this non-obligatory character. These doubts can be understood, given the scope of the bill and also, it must be acknowledged, the communication about the vaccine. These voices have been heard; the absence of obligation has been specified in the bill, and that is a good thing.

I can only return to what Ms. Snoy said a moment ago. One may be surprised at the inconsistency of an opposition that does not oppose and votes in favour of this bill fifteen days ago, which praises it or little is needed to oppose it today, even though we have reasonably amended it by guaranteeing the non-obligatory character of the vaccine. Are you annoying yourself? I confess not to follow your logic: I will vote this bill more gladly today than fifteen days ago because of the attention paid to these fears and translated by the non-obligation to vaccinate.

No medication, no vaccination is never anodine: the precautionary principle for the virus, it is imperative, it is logical but the same precautionary principle must apply to the vaccine.

Madame Fonck, since you have directly asked us, I find it logical to answer you. The situation has evolved. Like all of you, we were very concerned and wondered how this flu would behave, how dangerous it would be and above all how the epidemic would evolve. The epidemic is here! As long as the vaccines are ready, the epidemic will be half past. What is the purpose of continuing this way? It is all in the honour of politics to question themselves after taking the right precautions at the right time based on the information available at that time. Now that the information has evolved, this must be taken into account. If you do not find yourself in this approach, on our part, we find ourselves there!

Madame Genot, let us be a minimum of scientific and rational! It is not in 15 days that we analyze the numbers of the evolution of a flu! Of course, they must always be re-evaluated and must constantly be able to adapt. As much as I can hear that between June and September, there has been an evolution in the level of monitoring, so I can hardly trust your curve over fifteen days if not ten! We may be in the first part of the ascending phase or in its last part, but we might very well also have a much higher peak. No one can give you certainty, neither in one direction nor in the other. Neither you, nor I, nor even the Minister will change anything to the evolution of the numbers. On the other hand, we evolved together because this bill is now amended and the non-obligatory character of the vaccine has been "locked". We discussed this together in the committee and we think this is a good thing.

Madame Fonck, would you agree that Mr. Does Flahaux interrupt you?

I have no doubt that Mr. Flahaux wanted me to say this little word!

Once is not usual. I would like to come in support of Ms. Fonck. If Ms. Genot intervened in this way, it is probably because she did not attend the Health Commission. Now, in the Health Committee, the two Ecolo representatives at the time highlighted the fact that we were in a situation of much lesser gravity than what we could have smelled a few weeks ago. The argument now used by Ms. Genot is exactly the same that was used at the time of the positive vote of the Ecolo group fifteen days ago.

In fact, I was present in the commission on September 22 last. We have already asked many questions at that time, including the question regarding compulsory vaccination. Not only has the situation changed in the last three weeks about our concerns about the progression of the disease but, moreover, we have not obtained any answers to a series of critical questions we had raised.

In relation to this observation, I will clarify that this group voted in favour of a wider bill fifteen days ago and today rejects a stricter bill. Our group will not follow this logic.

Let me go back to my famous precautionary principle. It was obviously followed in relation to the management of the virus. This was necessary, but this precautionary principle should also be taken when it comes to vaccines. Certainly, we never have absolute safety for any medication, for any vaccine, regardless of the type of exogenous intervention, compared to a patient or a person. Given this relative security, I plead, Mrs. Minister, in favour of a complete and clear information for those who are expected to receive a vaccination. This is all the more true that, having flapules of ten doses, not accompanied by a notice, it is important to be able to adapt to the choice of the vaccine. The fact that the vaccination is done as part of a consultation and a relationship of trust between the general practitioner and his patient is a positive element in relation to this information.

Questions also arise more ⁇ in the head of vaccinators, general doctors, among others. Responsibility for the occurrence of a potential side effect as a result of vaccination. This afternoon we discussed the issue of coding. Indeed, difficulties are sometimes related to this logistical obligation to handle ten doses in a flapule that, obviously, must be thrown away after 24 hours.

I think therefore that it would not be unnecessary to provide logistical support to vaccinators, especially if the frequency of vaccinations increases. In the public interest, it is important that the arrangement set up fits the reality as best as possible.

Finally, I would like to emphasize the proportionality that exists between the extent of the flu and the resources released. It will be necessary to remain vigilant and measured, based on rational elements and not emotional elements.

Mr. Speaker, Mrs. Minister, dear colleagues, if I had to make a stone comment, I would say “neither fantasy, nor banalization; just ready.” In fact, I believe that we must cut off the wings to a whole series of ducks that overwhelm the sky of our reflections. When we hear the comments of some, we have the impression that we are preparing a seat. I am also surprised that there is a rapprochement between Ecolo-Groen! And the flame is surrounded by this fear.

The [...]

Madame Genot, I didn’t interrupt you.

If we didn’t do anything, the first to accuse us, rightly, would be members of the opposition. Today, we work effectively but members of the same opposition tell us, for some, that they do not want special powers for a Belgian government and, for others, that we risk possible special powers to the Latin American.

I think we should not exaggerate!

We never said that nothing should be done. This is a complete interruption of our intervention.

First of all, it is scandalous to make approximations between opposition parties that are absolutely not similar to each other, which do not have the same motives. Then, we never said that nothing should be done. We questioned the principle of an exceptional law.

We did not say that we should not vaccinate; we said that we should not dramatize. I’m tired of hearing that we’re talking about emotional arguments while I’ve just quoted statistics from the Institute of Public Health.

Colleague Flahaux, for good order and for good understanding, for all members, the following.

This will be a very interesting debate if one puts Ecolo and Vlaams Belang on the same line. I will make it even worse for Ecolo. They initially voted in favour of the powers, but this afternoon they abstained. So it is true that Ecolo in voting behavior followed the Flemish Interest.

Mrs. Snoy seems to be overwhelming and I can understand her. Mrs Snoy, I wonder in the same way why you sit in the European Parliament in the same political group as the N-VA. But this is another affair. You might not know it, but it is.

I will not comment on what we have just heard, because it is out of mind. I am surprised by the progress of the debate. I can understand that we question the different votes in the committee and in the plenary. Ms. Snoy explained to you what led us to this change of position. Instead, I would like to ask you what prevents you all from assuming your positive vote. The bill will pass: what worries you about the fact that a political group abstains? Tell us what you are interested in, what reassures you completely, we will listen to you. Try to convince us with arguments, but don’t try to assume our choice to us.

I would have a lot of difficulty assuming your choice to you: I don’t have the habit of changing attitude in 15 days. I assume our future vote, but sometimes it is difficult to follow you. In 15 days, you may change your mind again.

As I have already said in the committee, the same ones who today interpell and criticize us considered just a year ago, in terms of finance, that we were working in improvisation. However, we were able to work effectively, even if it was unfortunately improvised. This time, on the contrary, the government and the Minister of Health are preparing for the worst while hoping that the worst will not happen, as we all except ⁇ one or the other preacher of the worst – it is not you, I assure you – and we are accused of crushing a fly with a hammer.

This is completely ridiculous. You speak two different languages. I know that one of the important contributions of Ecolo, 15 years ago, was the precautionary principle. This principle has spread throughout the public opinion and political parties. We are now implementing this principle through this bill. From then on, I am sick, sidered, surprised, shocked even to find that you criticize us and reproach us for preparing us too much for what might happen, while hoping that it won’t happen.

Do you find that mr. Do Van Rompuy and Ms. Onkelinx have heads of neo-dictators who would like to establish a siege state?

Given the context, the precautionary principle is the element that should take us!

It is clear that a whole series of questions could be asked.

The issue of vaccination obligation was at the center of the discussions. In the Health Committee, the minister has clearly stated – this is shown in the excellent report of Maya Detiège – that there would be no obligation of vaccination.

Today we live in a media-driven society and every member of parliament receives dozens of emails every day on a whole range of questions. It is healthy. This is direct democracy.

In this context, the amendment that was voted by a large majority, this afternoon in the committee, should help reassure, not the parliamentarians since they were already, but the entire public opinion and let them know that at this stage, it will not be mandatory to get vaccinated. If this ever happens, further discussions should be organised within this Parliament.

We have reached an agreement on this issue. This is also the reason why it was interesting that we met this afternoon in the Health Committee and that we can discuss the different aspects of this bill tonight in the plenary session.

Regarding the mandatory declaration that doctors will have to make, our group leader, Daniel Bacquelaine, spoke about it in a committee just recently. Indeed, questions remain: from this mandatory declaration, is the field opened to a series of obligations for doctors, while the discussion is still ongoing on this level? The Minister has given answers that have reassured us and that allow us to abound in its direction.

In this case, we will maintain the bill. We are not in a situation of siege, but in a situation of precautionary principle. Nevertheless, and I would like to recall how strongly I had insisted in the commission on this subject, I still have a few questions to which the minister has only partially answered. The government will ⁇ have the opportunity to provide information when preparing the decrees that will be discussed and approved in the Council of Ministers; the minister has committed to engaging the parliament on a daily basis on this subject.

The first is the issue of blood donation. The project aims to increase the number of blood donations per donor. I have questions.

First, at present, blood donors are limited by age: 60 years, I think. So why not simply consider extending the age limit up to 65 years, for example? I don’t think that crossing the 60-year-old barrier makes the donor’s blood bad. The Minister should consider such a situation.

Secondly, myself and other parliamentarians, we have already questioned the minister on a specific point on the occasion of the reflection on blood donation. In the event of a pandemic, blood needs would increase considerably and I have to rest on the question of why the entire homosexual community is stigmatized about blood donation?

A few weeks ago, Minister Smet, Minister of Education in Flanders, was moved by the fact that he was banned from donating his blood because he is gay.

I can understand that people who have sexual risk behavior cannot donate blood but apply a refusal to a whole community as a whole, without distinction, is completely unacceptable. I take advantage of this debate to repeat it to the Minister, but I think she knows that too.

Then there is the problem of the number of doses that was ordered by the government, 12.5 million doses if I am not mistaken. It is true that during the debate in the committee, the minister pointed out to us that, in some cases, two injections may be necessary.

In this regard, I had suggested to think about the fact that we are not living on an island but in an increasingly open world, where people travel a lot. We also have a duty of solidarity with our third-world partners. In this context, it would seem normal to me that we can offer a portion of our dose capital to third-world countries. Moreover, it is in our interest because the more orderly the situation is in these countries, the better it works in our country.

In terms of information, we asked the Minister to ensure daily consultation, day and night, if necessary, with the Parliament and the Health Committee in particular. The Minister is committed to this. The coordination with federal governments should also be enhanced. Prevention is the responsibility of regional and community governments.

Furthermore, Ms. Fonck addressed the problem of prescribing doctors and nurses, but it is also necessary that the public be better informed. When visiting websites, information is sometimes difficult to find. Also, I tested it, the call center isn’t always excellent. An effort must therefore be made in this regard.

As I said in the Health Committee, now every city, each province is asked to establish an emergency plan.

It is requested that it be established not as part of this pandemic but generally. We are currently doing some sort of exercise preparing an emergency plan. I ask the Minister that after this crisis, which, I hope, will not take place, a debriefing be made to draw the useful lessons from the crisis situation, in order to develop, for the future, a comprehensive legal framework allowing to avoid working in the emergency as we are doing.

Mr. Speaker, Mr. Deputy Prime Minister, having heard Mrs. Snoy’s remarks, I wanted to react. As always, when a new epidemic, infection or parasite appears, it raises a number of legitimate concerns. This sometimes causes some anxiety, which requires public authorities in charge of Public Health to remain calm. Indeed, these subjects carry possible derivatives.

There are three obstacles that the political positioning should, in my view, avoid. The first is minimization, saying not to worry, everything will go well. We seem to have avoided this scourge. The second is that of dramatization: it will be catastrophic! Go home and don’t go out again. Abominable things will happen! This creates evil, which is neither good nor good. This dramatization has been avoided. The third scourge, I say clearly, are the obscurantist drifts.

Madame Snoy, we often tend to see the Ecolo program through the prism of energy savings, global warming, etc. We can join in a whole range of measures. On the other hand, this instinctive distrust that you develop towards science, scientific research and scientific progress must worry us!

This transcendental view of nature and of a necessarily predator man seems to me extremely reductive. At some point, if mankind has made many advances, it is because it has defeated nature. Viruses, germs are part of nature and at some point, they need to be combated. Therefore it is necessary to stop believing that everything that emanates from the reflection of man, from his brain, would be dangerous and could result in giant drifts and conspiracies. Conspiracy and obscurantism are not bearers of wisdom when it comes to considering problems that can affect each and every one of us. You should be very cautious about the type of speech that is being held at this time.

I would like to ask Mr. President to answer. Bacquelaine, because being treated as an obscurantist calls for a few nuances. And the expansions of the debate we witness here and the amalgamas are quite painful.

Have you heard all the scientists? Some claim that these vaccines are safe and safe. Others tell us that they pose dangers and are not devoid of side effects, related to adjuvants. Some people fell seriously ill after administering a series of doses of the vaccine. There is no consensus on this subject at the scientific level. Some studies show unwanted effects, while others exclude them. In most of our debates, we are faced with these differences of views.

It follows that politics must observe a certain distance, especially from the economic interests obscured by science. In this case, the majority may have worked too quickly in the sense of the great economic interests represented by such an operation. But I don’t want to imagine big conspiracies and that we are busy preparing us, I don’t know what. No, we are not supporters of the great conspiracy either! We ask for a bit of calm. We are against dramatization. We are also not in favor of minimizing the risk. We believe that the law of exception is not the right way to respond to the risk we face today.

Today, we will approve a bill that allows certain measures to be taken if they prove necessary, neither more nor less. We equip the public health of this country with a tool to cope with an evolution that we do not know perfectly. Epidemics are a bit like Ecolo’s positioning, they are variable. I would like to allow myself to tell you that a vaccination must be done before the epidemic is in its most active phase.

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You say anything! You are ignoring all scientific achievements! What you are interested in is to say what you want to say regardless of the reality of the sector. We are in the full stage of vaccination for the classical flu. Why choose October? There is a reason for this, which is recognized in all civilized countries of the world. Similarly, before the winter, we take certain precautions regarding vaccination.

You may not know this, but October has always been the vaccine period for the flu. Therefore, it is normal to get the vaccines at that time. As with normal flu, we will promote vaccination in risk groups. This is what we have done for the classic flu, always! People who have respiratory problems, people who have heart problems, people who have kidney problems are those who will receive the vaccine priority. Of course, it’s not about vaccinating everyone any way and any time, it’s about keeping up with the scientific experience of recent years in the field of vaccination. Therefore, the same scientific and methodological reasoning is applied to a new type of virus that has been proven for years.

Frankly, there is in Ecolo a derivative that wants to replace scientific objectivity with pure semantics, with theory, which corresponds to what you have the desire to say, because it does well at that moment and that comforts a certain obscurantist derivative.

I think it is useful to provide for intelligent vaccination, meeting the scientific criteria for this vaccination, and it must be done for people – if they want it, of course. Today, there is an amendment that clarifies this. In our minds and in the head of government, there has never been a question of promoting compulsory vaccination; nobody has ever said that. We simply give greater legal certainty in the text to the fact that vaccination is not mandatory. To ⁇ this vaccination, the collaboration of the medical body will be necessary. This is what is planned, this is what is done.

Sometimes we hear strange speeches; so I clarify that it is not about chaining ten patients who would come to consume the flapula of ten doses. Of course, it is not about that. If I specify this, Mrs. Minister, it is because it is necessary to inquire about possible contraindications before administering the vaccine. One could not vaccinate a patient with bronchitis of which he would not have spoken before and which would be in full evolution. After vaccination, the patient should be monitored because any vaccine, like any medication, can cause side effects.

For this reason I have accepted a specific consultation fee, so that there is a dialogue between the doctor and the person who comes to get information about vaccination.

As with any treatment, whether preventive or curative, positive effects and negative effects must be measured. In this case, in the face of the danger of an epidemic that threatens vulnerable people, vaccination is a useful tool for the community. Sometimes it is necessary to accept facts on the basis of their scientific veracity.

I look forward to the fact that we will be able to continue the debate on the issues that will inevitably arise, such as that of the registration, on which I spoke recently in the Health Committee. It should be done in consultation with the Privacy Protection Commission and the Public Health Sectorial Committee. This has been done so far and will continue to be done so. Per ⁇ medical orders will need to intervene about the use that could be made of the records.

We must protect privacy and freedom of choice in any decision we will be forced to make based on the evolution of this epidemic and we must reserve it a proper treatment without controversial or political recovery.

We are not – it seems to me – on a terrain that is suitable for strictly ideological and political argumentation. We need to be reliable in the decisions we are going to make. This is about public health, people’s health. This is what should guide us and I am delighted that the government takes things into its hands in this way and in this spirit.

Mr. Speaker, I normally never begin to talk about the differences between Flanders and Wallonia, because I love Belgium, but tonight I did not notice much difference between the statements of the Wallonians and the Flemish speakers. I propose that on Tuesday, when the debate will be held again in the committee, the text of the song "Mexico" of the Singers Without Name be brought. This may improve the atmosphere in the committee and lead to less long-term interventions.

I will be brief. Sp.a votes for the first bill because it is the logic itself that if a pandemic could break out, we should be able to give the King authorizations and be able to react very quickly.

At the vote on the second draft law, we will abstain because additional money is requested from this government to be able to take a number of additional measures. I have difficulty with that. In the past, there was the bird flu, SARS, the dolekoe disease and now there is the Mexican flu. Taking into account the worldwide mortality over all those years, fortunately we still find a similar number of deaths with a seasonal Belgian flu. I say this consciously. Considering the approach, not only in Belgium, but in Europe and around the world, we need to start thinking about the further approach in the future.

I remember the discussion about the bird flu. Everyone had to place a net above his bird hook. When I asked in the Foreign Affairs Committee whether Niger would do the same, the answer was “that’s not us.” If I then investigated further, Niger would not do that because Niger had no money. In this way, I want to say that there are often problems still arising, one wants to tackle such a thing globally.

In the committee, Minister Onkelinx gave a good and clear explanation. 12.6 million vaccines were ordered from GSK. To be honest, I was scared and still scared of that enormous amount. The minister has not really been able to convince me because I have noticed that in the past, with all other vaccinations, only 25 to 30 percent of the population was vaccinated. This has been conscious for years. As long as it is not mandatory, I don’t think we will ever need those 12.6 million vaccines.

I come to my second argument. I would like to get a little more documentation in this regard, but I will ask more detailed questions on Tuesday. Clinical tests are still insufficient, especially when it comes to the risks of vaccines. I see you cracking, so I expect more comments on that. Belgium ordered the most vaccines compared to other European countries. Those things are difficult with me.

About the negotiations with GSK I said in the committee that I felt very sorry, because normally vaccines work with public procurement and at least with more than one company. We have a few in Belgium — Solvay, Pasteur, Baxter — who also work and make vaccines for the common seasonal flu. I felt a little sorry that there was only a conversation with GSK. As a result, the costs are considerably higher. Had you spoken with other partners, then the costs could have been lower. The N-VA, for example, in the case of Mr. Van Noppen, has also argued about this. I did not immediately satisfy the answer.

The most sensitive point for me, an experience I’ve had for years in the pharmacy, are actually the stockconder breaks. I am a little worried that not only in Belgium, but throughout Europe, by massively dumping us on the production of the vaccine against the Mexican flu, the production of the vaccines for the common flu that makes many victims, ... Mrs. Avontroodt, I really mean that.

I think we really need to be careful. These firms must give the guarantee that they provide coverage for the regular seasonal flu for this winter period, because this causes – we know – indeed deaths. This remains a huge concern for me.

I would like to say a little bit about the circuits. I have noticed – this may be a signal for the future – that if there is a pandemic and one wants to supply the people well, one is best to use the circuits that the people know. In these, the pharmacists would be put in the cold. I understand that honestly not well. I have already cited that argument. Everybody knows that path. Everyone knows that prevention through that circuit is very easy. The pharmacists have refrigerators and everything you need. In short, respect those people.

Mr. Speaker, as you all know, since the beginning of the pandemic, I have tried to work on the basis of three key concepts: dialogue, serenity and vigilance.

The dialogue is daily, with scientific experts, medical authorities, health professionals, but also with all those and all those who want a clear explanation of the situation, who ask questions.

This is how, whenever we receive questionnaires from associations, groups, on the Internet or elsewhere, we have had the heart, with the Scientific Committee Influenza, to answer very precisely, because I know that rumors grow when one does not provide a clear rational response to the fears that can feed a vaccination campaign, especially against a flu.

We also have a dialogue with the Parliament. I take as witnesses those and those who are part of the Public Health Committee; they know that, from the beginning, I have come regularly before the committee and that I have tried to work on a response to the pandemic, concerted with the parliament, so that beyond the differences between opposition and majority, we can be together to address a public health issue, which has nothing to do with the discrepancies between parties.

From the beginning, I wanted to act in serenity. At no time did we give in to panic, and did not film about this A/H1N1 flu, even in the moments when panic was at the doors of parliament, at the doors of the country.

At no time have you heard us declare, even before there was a question of vaccination, that travel to Mexico should be banned. Remember that there was a request from France for Europe to go in this direction. We did not support it.

When it was about vaccination, we addressed the subject serenely. We have not, as it has happened in other countries, imagined the closure of schools; we have not worked on a plan to bring about exceptional courts. At no time did we give in to panic and, unlike other countries, we constantly said that in view of the data we had at our disposal, it seemed to us that this A/H1N1 influenza was comparable to the seasonal influenza, that there was no reason to panic and that, always with the consent of the parliament.

But we also said that we should be vigilant, which is quite normal. For public health officials, vigilance should be at the heart of action. Since then, we have continuously organized prevention campaigns with the Regions. Prevention is the mother of all policies. We then explained that, while this flu was comparable to seasonal flu, it had some peculiarities.

Therefore, this flu is much more contagious than seasonal flu. In addition, this flu attacks different age groups, including young people and working-age populations. These two factors combined and the fact, in addition, that this influenza A is parallel to seasonal influenza can raise fears that a much larger number of our fellow citizens will be affected by the influenza, with risk factors we know.

It is in this context that we have serenely organized not only the transmission of antiviral drugs and information about them but also the free, voluntary vaccination. You know that at no time – already before summer I said ‑ there was no question of compulsory vaccination. I do not want. This is written in the text of the law. This is even clearer.

This is my only criticism in view of your change of position, even though you have the right to change your mind.

I tried to stay outside the barriers between parties. I have tried to work with all the groups in Parliament. We were all together convinced and advanced hands in the golden hand, at a time when rumors and fantasies flood, this reversal can support this kind of questioning. This is what I regret because we were in a context of mutual trust. It’s your choice, let’s go!

This is the influenza A/H1N1. There are currently 20,100 people who have been infected in the country, of which more than 7,500 were infected last week alone.

We are currently in an upward phase. You are right to say that seasonal flu is deadly. of course ! She is deadly too. That is the truth. And whether there are few or many, we must always regret that people may die as a result of the flu and counter this strategy of the virus. This is what we do through vaccination and antiviral drugs.

I was asked whether the time of vaccination was appropriate in relation to the peak, to the epidemic. In the Southern Hemisphere, 25% of the population has been contaminated. An epidemic peak occurs when half of the total people infected are affected, i.e. 1,250,000 people. In our country, we have a little over 20,000. We are at the beginning of a wave. I don’t know what path she will take. Will it be ascending? Will it stabilize and fall back? Nobody at the moment could say that, but in accordance with my strategy in this matter, I advocate for serenity and vigilance. We will follow this wave to see where it will lead us.

Regarding the vaccination strategy, I am very happy to have been able to conclude agreements with wholesale distributors, with pharmacists, doctors, because this is done in a concerted framework.

I am happy that vaccination, even if we had imagined it, was not done in community centers, which could scare, with an invitation made to the population that could also raise fears. Rather, this vaccination will simply take place in medical offices, with a consultation fee, taking the time to discuss with patients. This will happen like an ordinary vaccination where, voluntarily, one goes to his family doctor and discusses whether one is in a priority group or in a risk group, whether there are contraindications, the usual perverse effects. The patient and the doctor therefore decide together, so I cannot be more reassuring than that.

In terms of information, we wanted to work on campaigns that advocate transparency. We have set up a call center that receives an average of 70 calls and 40 emails a day. We respond to all requests. This week, two new brochures appeared. There is a brochure for doctors, to properly inform them about the use and administration of the vaccine, and an information brochure for each person vaccinated. We want the most complete transparency. I cannot do more than that.

A media campaign is planned to remind that the vaccine is not for everyone but only for priority groups and risk groups. People are simply told that if they are asthmatic or diabetic, for example, they are among the priority groups and that they can go to their doctor to discuss the possibility of vaccination. I think it is necessary to provide this information.

Finally, some information on the concrete strategy. Vaccination will be conducted in two phases. It begins this Sunday, only for hospital staff. Hospital pharmacies will receive this week the necessary doses to vaccinate all hospital staff, of course on a voluntary basis. Doctors who wish to do so can also get vaccinated at the hospital. For the rest, whether it is other generalists who want it, or priority groups or risk groups, it will be from 1 November.

The strategy, as already mentioned, is through the medical offices, the doctors who, like for antiviral drugs, will go to the pharmacists and have available the necessary doses to meet the particular demand.

This is what I wanted to tell you, Mr. Bacquelaine. I fully understand the questions regarding the registration.

I will necessarily conclude by saying that it is with great pleasure that I will continue to inform the Commission. On Tuesday, there will be a debate on vaccination. I will warn next Tuesday about all the device regarding registration, privacy protection, in particular.

And when the pandemic is over, of course, Mr. Flahaux – the request is quite legitimate – I will do a comprehensive debriefing and we will try to see how better to prepare ourselves for the following years if a new pandemic is to emerge.

Dialogue, serenity and vigilance. I urge Parliament to support this strategy.