Dr. Kevin Kelleher:

In regard to the timeline, the national immunisation advisory committee, NIAC, will first consider the vaccine's effectiveness and the next stage will be to consider how best to introduce it. When we introduced the meningococcal C vaccine, we also rolled out a catch-up campaign to vaccinate a larger group in the more susceptible population against the disease. This is the type of decision that needs to be made. The next stage is to ask the pharmacology economics unit at St. James's Hospital to conduct a cost-benefit analysis of whether it is appropriate to introduce it as a routine vaccine or to include a catch-up campaign for children under the age of two, under the age of five or primary or secondary school going age. The meningococcal C vaccine included all young adults under the age of 20. Issues also arise in respect of logistics and whether the system is able to achieve some of these objectives. We are also in the middle of other campaigns at present, including the HPV campaign and the HPV catch-up campaign for girls in secondary school. We also face a problem with both measles and pertussis and we are trying to increase vaccination rates for those diseases. The final decision on introducing the vaccine will be up to the Department of Health and the Government. Some of that will be reflected in the cost-benefit analysis. Depending on what is proposed, the administration costs may be high or relatively low. It will be simply be a matter of performing two tasks at the same time but if we ask people to do something de novo we could incur additional costs.

We are all medical practitioners. I spent my clinical time in paediatrics in the early 1980s. The changes we have seen in terms of meningococcal C, Hib and the pneumococcal vaccine have been immense. I used to have immense fears for children coming in with these diseases because they presented in a very poor condition and our ability to treat them was problematic, even in terms of inserting a needle. Changing methods of treatment but also the vaccines have made a big difference. Current medical students have no idea what Hib is. When I was a junior doctor croup was one of the most frightening diseases I saw. We have experienced difficulties recently with pertussis, or whooping cough, but many doctors do not recognise its symptoms. It is a dreadful disease and is especially problematic for young children.

Unfortunately there have been two deaths in this country in the last year from whooping cough in babies who could not take the vaccine. This is one of the fundamental issues in terms of vaccination. Immunisation is not only a question of protecting oneself. As a society we also have an obligation to protect the vulnerable. In these circumstances, vulnerable members of society include babies under the age of three months who have not started their vaccination programmes. These programmes put an onus on us as a community to protect the vulnerable. Vaccinating one's child also protects those babies who cannot yet take the vaccine and one's own baby until he or she is one or two months old. If this vaccine is seen to be effective we will have what is known as herd immunity and the incidence of disease will drop down to one or two because infection cannot spread. Some of these vaccines also impact on the elderly. The pneumococcal vaccine is only given to children but evidence from elsewhere in the world indicates that it helps to reduce the incidence of the disease among elderly people because it is not as widespread in the community.