Dr. Kevin Kelleher:

Over the past 15 years I have been very involved in both immunisation and screening programmes here in Ireland. I was the person who introduced the cervical screening programme first in the mid-west as part of the national campaign. All public health programmes such as screening and immunisation have both benefits and risks. The screening programme equally has risks as much as vaccination has risks. Both programmes happen because the benefits greatly outweigh the risks. That is the fundamental decision made before any other decision about money or cost-benefit analysis. The first decision is whether the benefits far outweigh - not even outweigh - the risks. Senator Professor Crown has left the room but it is different even from how he would try to treat somebody. It is a very different decision. It is not just that it is better but it actually far outweighs the risk. It is carried out on people who do not have the disease or are unlikely to get the disease so one must be very careful. That is the first fundamental decision which is made with regard to all these programmes. However, I agree that both screening and immunisation programmes cause problems. We are very upfront about all of that in all our literature, both in hard copy and in greater detail on the Internet. We accept that all Internet information is not available to everybody but the hard copy literature shows that clearly.

We state very clearly in that document that the HPV vaccine only prevents 70% of cervical cancers. It does not prevent all cervical cancers, just as much as the cervical cancer screening programme does not prevent all cervical cancers. Neither programme does this. We are clear that these are preventative programmes. The information booklet took quite some time to be produced because we went through a very detailed process. We asked people to review the booklet with regard to the language and content used. We were told whether there was too much or too little information in the document. It is regularly revised and re-examined, as is all our immunisation documentation. We seek to present that information to everybody in so far as possible.

Whether these programmes are necessary is one of those fundamental decisions. To be clear, the HPV vaccine does not just prevent cervical cancer. It prevents the precursor to it but it also prevents another disease which is extremely common, anal-genital warts. We will not see the explicit impact of the vaccine on cervical cancer for quite some time because like all cancers it takes a time to come about. It takes ten to 20 years to occur.

In Australia, which was one of the first countries in the world to have a systematic programme of HPV vaccination, there has been quite a significant reduction in the number of people under the ages of 20 and 25 who have anal-genital warts. We know that anal-genital warts and cervical cancer are caused by HPV infection. That gives us a very strong indication that we will see a reduction in the incidence of cervical cancer, but we have not seen it yet.

One aspect of immunisation is that the vaccines are tested in a slightly different way. Other witnesses such as Dr. O'Flanagan could speak on this. In a sense one is saying that it will prevent something, which is always very difficult to prove. Most drugs are for a disease that exists and they stop that disease. With immunisation, we are saying that the disease does not come about. That is a problem for us because some people want to know why they are still being vaccinated against diphtheria and typhoid when we do not see those diseases. People ask why they are being vaccinated against polio when they do not see that disease. However, these are still extremely important diseases.

An expert committee, the national immunisation advisory committee, has examined the issue of how to deal with children coming from different countries with different schedules of vaccines. We have provided in the documentation advice that is given to the various doctors and also to parents on what they need to do. There are different schedules of vaccines. Most countries in Europe have pretty much the same immunisation programmes. We try to make sure that children complete the programmes they have started and also get the vaccines that are given in this country that they may not have got in their own countries. There is literature on that in the documentation, and that literature is given to all GPs and other people who give immunisations. It is available on our website, the website of the national immunisation office and the website of the Royal College of Physicians of Ireland.