Dr. Colette Bonner:

I thank the Chairman and members for the invitation to attend this meeting. Today I am joined by my colleagues Dr. Kevin Kelleher, Dr. Darina O'Flanagan, Dr. Brenda Corcoran and Dr. Joan Gilvarry. We look forward to working with the committee and extending co-operation and assistance to the Chairman and members in their work.

The committee requested information on specific issues prior to this meeting and will have already received the written information on these issues. Accordingly, I will comment briefly on some of the key issues regarding immunisation. Vaccines have saved more lives worldwide than any other public health intervention apart from the provision of clean water. A well-functioning national immunisation programme is essential for any country. The national immunisation programme, which is consistent with Government policy, aims to promote health by preventing death and disability from vaccine-preventable diseases. The programme provides infant and school immunisation free of charge to all children. Since September 2011, the national immunisation programme has administered a vaccination catch-up programme against HPV, which can lead to cervical cancer, for all girls in secondary school. This was one of the commitments given in the programme for Government and was achieved within the first 100 days, as promised.

The uptake of primary childhood immunisation - that is, the six-in-one vaccine - nationally at 24 months of age has increased from 83% in 2001 to the 95% uptake rate recommended by WHO since 2011. The national measles, mumps and rubella, MMR, vaccine uptake at 24 months has increased from 69% in 2001 to 93% in 2012. Since October 2012 a school-based MMR catch-up programme has been operated by the HSE to target those children who have not received the required two doses of MMR vaccine. This measure will assist in addressing the WHO target to achieve elimination of measles by 2015. In October 2000 the meningococcal C vaccine was introduced to the primary immunisation schedule. In 1999 there were 135 cases of meningococcal C infection and five associated deaths. In 2011 there were two cases of this illness. No deaths have been associated with meningococcal C infection since 2008. Pneumococcal vaccination has resulted in an 83% reduction in the number of cases of invasive pneumococcal disease in children under two years of age.

In spite of these achievements, it is important not to become complacent. The WHO is working towards the elimination of polio globally. In 2001, the European region was declared polio-free. However, in April 2010, a wild-type poliovirus type 1 outbreak was confirmed in Tajikistan, representing the first importation of a wild-type poliovirus into Europe since the region was certified polio-free in 2002. In January 2000, a large outbreak of measles in Dublin resulted in 100 children being hospitalised. Six cases required intensive care treatment and there were two measles-related deaths. It should be noted that the cost of treating a case of measles has been shown to be 23 times the cost of vaccinating one child against measles. Since early 2011 there has been an increase in the incidence of pertussis - that is, whooping cough. This year, up to 1 December 2012, 437 cases of pertussis have been notified to the Health Protection Surveillance Centre, and there have been two pertussis-related deaths.

These events underscore the importance of constant effort and commitment to ensure a high uptake of vaccination. In particular, hard-to-reach groups such as the Traveller community, ethnic minorities and those who object to immunisation on religious or moral grounds require diligent campaigns underpinned by unambiguous, simple, evidence-based information to highlight the importance of vaccination at both individual and population level. As many vaccine-preventable diseases have become so infrequent, parents may be unaware of the serious nature of some childhood illnesses. This makes it all the more important for all health care professionals involved in immunisation to explore new ways of communicating the benefits and risks of immunisation to parents. The national immunisation office has already commenced a number of worthwhile initiatives in this area.

Pharmaceutical companies continue to develop new vaccines, which may be added to our national immunisation schedule. This is beneficial in that it protects our population from an increasing number of illnesses, but on the other hand it is challenging due the increased complexity and costs of our immunisation programmes. Prior to the introduction of any new vaccine, a health technology assessment is performed, including a cost-benefit analysis, to help inform policy decisions. New models of vaccine delivery continue to be explored in order to increase efficiency within a sustainable budgetary framework. The Minister for Health, Deputy Reilly, the Department of Health and the Health Service Executive all remain committed to providing a first-class national immunisation service. I thank the committee for the opportunity to address it and will answer any questions from members.