Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy O'Connell. She raised many issues I am very pleased that she raised the issue of the HPV vaccine because it is really important that - based on all of the medical advice available to me, the Department and the chief medical officer - I get to put on the public record my support for this very important vaccination programme . The Deputy is aware that the immunisation programme in Ireland is based on the advice of the national immunisation advisory committee, which is a committee of the Royal College of Physicians of Ireland and which comprises experts in a number of specialties including infectious diseases, paediatrics, and public health. The committee's recommendations are informed by public health advice and international best practice. In 2009, the committee recommended the HPV vaccination for all 12-year old girls in order to reduce their risk of cervical cancer and the vaccination programme was introduced for all girls in first year of second-level school in September 2010. As the Deputy is aware, there are two licensed HPV vaccines available in Ireland and Gardasil is the vaccine used by the HSE in the school immunisation programme. It is provided free of charge to girls in the first year of second-level school.

In September 2011, a catch-up programme was started for all girls in second-level schools and the 2013 and 2014 campaigns were the final years of the catch-up programme. I am very much aware of the misinformation out there to which Deputy O'Connell referred and I am extremely concerned about the impact that is having on the health and well-being of young women. Cervical cancer is the fourth most common cancer in women worldwide. Each year in this country approximately 300 women are diagnosed with cervical cancer and approximately 100 women will die from the disease. All cervical cancers are linked to high-risk HPV types of infection.

There are more than 100 different types of HPV but published figures for 2014 and 2015 show that the HPV vaccine uptake was 87%. That was the highest ever uptake since the programme began in 2010. While I do not have final figures for the 2015 to 2016 programme yet, preliminary figures released by the HSE do indicate that approximately 5,000 fewer girls received the HPV vaccine for the period compared with the previous year. That significant decline in uptake does vary across the country, with some western and southern counties most affected. The decline is extremely regrettable and I am concerned that it might be related to unsubstantiated concerns about the safety of the HPV vaccine raised by groups.

Information is available for parents and I encourage them to check out all vaccines. The information leaflet on the vaccine is available on the national immunisation website, immunisation.ie. The website has been accredited by the World Health Organization, WHO, for credibility, content and good information practices. It allows members of the public to contact the national immunisation office to ask questions if they require further information. Where possible, the questions are answered by a member of staff in the office within one working day. I encourage the parents of this country to access this service, ask questions and look at the information. The information that is provided on the website has been accredited by the World Health Organization.

Gardasil is a safe and fully tested vaccine which protects against the main cancer-causing strains of HPV. Approximately 300 women are diagnosed in this country each year with cervical cancer. By January 2016 more than 200 million doses of Gardasil have been distributed worldwide and in Ireland more than 580,000 doses of the vaccine have been administered. More than 220,000 girls have been fully vaccinated against HPV since it was introduced in 2010.

It is not just me who is saying this vaccine is safe and it is not even just evidence in this country. We have also seen the results of the detailed, scientific review carried out in November last year by the European Medicines Agency, EMA, an agency which I hope will locate in Ireland. It examined the evidence surrounding reports of two conditions, namely, complex regional pain syndrome, CRPS, and postural orthostatic tachycardia syndrome, POTS, another condition which causes symptoms such as dizziness and fainting as well as headache, chest pain and weakness. In line with its initial recommendations, the EMA confirms that the evidence does not support a causal link between the HPV vaccine and the development of the conditions. Therefore, there is absolutely no reason to change the way the vaccines are used or to amend current product information. The agency’s committee for medicinal products for human use also looked at the issue and concurred that the available evidence does not support that CRPS or POTS are caused by the HPV vaccine and it therefore also did not recommend any changes to the terms of licensing or product information for those medicines. Furthermore, on 12 January this year the European Commission endorsed the conclusions of the European Medicines Agency that there is no change to the way HPV vaccines are used or to amend current product information. The final outcome by the Commission is now binding on all member states of the European Union. The review recognised that at the time more than 80 million girls and women worldwide have now received the vaccines and in some European countries they have been given to 90% of the age group recommended for the vaccine. Use of the vaccines is expected to prevent many cases of cervical cancer - cancer of the neck of the womb - which is responsible for more than 20,000 deaths in Europe each year, and various other cancers and conditions caused by HPV.

The benefits of the HPV vaccine are well known. They are well endorsed, not just domestically but internationally and they are now binding on member states of the European Union since the European Commission examined the issue in January 2016. I assure members that the safety of the vaccines will continue to be carefully monitored, as is the case with all vaccines and will take into account any future new evidence. I am genuinely concerned about the much lower uptake of the vaccine this year compared to last year based on preliminary figures. That will result in people dying of cervical cancer, a cancer which could have been prevented were people vaccinated. I again encourage parents to check out the expert medical information available to them and the information endorsed by the WHO on the website, immunisation.ie. I would like to see the expansion of the vaccination programme to boys and we will come back to Deputy O’Connell with plans in that regard.

I know maternity services are an area of particular interest to Deputy O’Connell. In terms of the national maternity strategy, she is correct in identifying the similarities between it and the national cancer strategy because the model of the former is based on the national cancer strategy. We are about to launch a new national cancer strategy in the coming months. The country has made so much progress in terms of cancer services because not only did we have a coherent strategy but we drove it on. It was driven on quite courageously by my predecessors.

The national maternity strategy replicates that model. We will now see the establishment of the national women and infants' health programme to drive on the delivery of that strategy, which is really important, and the HSE has advised my Department on it. The HSE representatives may wish to comment further on it, but it is now at an advanced stage regarding the appointment of an interim programme director for a period of two years. The clinical director post will also be advertised shortly. This is about putting the meat on the bones of what is a world class document on which so many people worked very hard.

It is stating the obvious to say that global competition for medical consultants remains extremely keen. Comparing September 2016 to September 2015, we have seen 116 extra consultants employed. We recognise the need to work on various issues. The issues, as many Deputies and Senators have stated, do not concern pay alone. There is a range of issues in terms of making Ireland attractive. The MacCraith report provides a plan, which we need to get on with and implement. It speaks of a range of issues above and beyond pay, particularly in respect of training. In 2015, in line with the MacCraith recommendation, we increased pay rates for new entrant consultants. This was done within the context of the Lansdowne Road agreement. We have also allowed for incremental credit for previous experience so that new entrants do not have to start on the first point, but this work is very much ongoing. Perhaps Mr. O'Brien may wish to comment further.