Dr. Kevin Connolly:

I stated very clearly that there should be ready and easy access for the children and their families.

Deputy Ó Caoláin said that the figure of more than 900 adverse events is concerning. It should be noted that adverse events occur in 30% or 40% of people who get a vaccine. Working on that basis, one would expect perhaps 50,000 reports. What is more important than the number of events is the severity of those events. We know there is significant under-reporting of adverse events and there is no legal compunction to report them.

Dr. Kelleher responded briefly to the question about when we will know for certain the effectiveness of the vaccine. There is very good evidence that in Australia, which introduced the vaccine in 2007, the incidence of high-grade changes has reduced to 25% of what its was before the vaccination programme was implemented. In addition, the incidence of anal-genital warts in young girls has gone down from 18% down to 1%. There is good evidence, therefore, that the vaccination is effective. Moreover, the immune response is shown to last up to ten years and there is also very good evidence of what is called a memory response whereby even if the immune blood test is low, if one is exposed to the virus, the memory cells in the immune system are ready to go out and work. The mathematical modelling suggests that effect lasts for at least 20 years.

Even if it does not, what we do with other vaccines as their immunity wanes is to give a booster, and that should solve that problem.

With regard to the question about multiple doses, one dose is significantly less effective than two doses. The two doses are more effective if they are given six months apart. If somebody has had only one dose, she should get a second dose.

On the registration of long-term adverse events, a number of countries have instituted long-term surveys regarding the effectiveness, the immunogenicity and, equally important, the safety of vaccines. Interestingly, the Nordic countries are one of the groups doing that.

The efficacy of the vaccine and screening was raised. Some 30% of cancers are not prevented by the vaccine, so screening is very important. Also, the incidence of cervical cancer under the age of 30 is low because the incubation period is long.