Dr. Kevin Kelleher:

Like everybody else, we clearly understand this to be a major problem. It is important to emphasise that we are dealing with two linked but separate problems. First is the question of whether or not the vaccine programme is appropriate and safe and, second and just as important, is the question of how we, as a system, look after these girls who have experienced a series of problems. To reiterate, these are linked but separate issues. On the whole, we have presented a lot of evidence regarding the way we have to make these types of decisions. How we have made the decisions and how we continue to have to make them is based on the evidence or science that exists around the world and is produced for us in a very systematic and structured way by the bodies, both here in Ireland and in Europe, to which we are party. I personally have no doubt that we have shown today that we put a lot of effort into making sure the programme we are putting out there for girls is a safe programme. We have really tried to be party to that. We have made great efforts to get the information out there and to be party to that debate at a European level, where there is a whole host of information and a whole host of experts involved in those discussions.

Clearly, when one has a vaccine that says it will prevent a cancer, one will never see the direct impact of that in the short term, because cancer has a ten-year or 20-year period in which it comes on. That is a long time period. We do know the HP virus is involved in the development of cervical cancer. We know some of the natural history in that regard and we can see the changes that happen. As well as causing cervical cancer, the HP virus causes two other conditions, as we have heard, namely, anal-genital warts and the direct precursor to cervical cancer, which is called cervical intraepithelial neoplasia, CIN. What we are now beginning to see around the world, particularly in those countries where a lot of the vaccine has been given and which have a longer history than us of administering it, is the impact of the vaccine on those two earlier parts of that process. We are starting to see in both the United Kingdom, particularly in Scotland, and in Australia a significant reduction in the number of anal-genital warts in the relevant age group, which is 15 to 25 year olds. We are also seeing a reduction in CIN. A woman does not get cervical cancer unless she has CIN. She will not necessarily get cancer if she has CIN but only women with CIN will go on to get cancer. We are starting to see evidence of a reduction in the incidence of the precursors, as I said, but we will not see actual evidence of a reduction in the number of cervical cancer cases for another ten years or so.

We work closely with our colleagues in the screening programmes both here in Ireland and across Europe in analysing the impact of HPV vaccination programmes on countries' screening programmes. That debate is ongoing but already people are beginning to see a capacity to reduce the involvement of women in the cervical screening programme into the future. However, we will not do that until we have clear evidence it is the appropriate thing to do. The screening programme will continue but, as I said, health authorities in other countries are very hopeful of seeing an impact on their cervical screening programmes.

We are very much aware of the need to react better to children who have the types of syndromes we have heard about today. I am not saying we are the best at doing that. In fact, we need to improve how we are doing it. I am involved in a number of ways with some of the senior clinicians in paediatric services to see how we can do that. It is not easy and I am not saying we will come up with a quick and easy solution to this but we are trying to see how we can do something about it. We are looking at how we can put in stages and support to help people to get through the systems better. Given the nature of some of the symptoms people are reporting, however, it does not leave it open easily for that to happen. We are looking at how we can try to do something about that and we hope to make some changes in the coming months and years.