Dr. Colette Bonner:

I thank the committee for the invitation to attend the meeting to discuss the issue of uptake levels of vaccinations. I am pleased the committee has also invited colleagues from the HSE and RCPI. I would also like to welcome Dr. Joan Gilvarry, director of human products monitoring, Health Products Regulatory Authority, HPRA. We look forward to working with the committee and extending to members every co-operation and assistance in their work.

Vaccination is regarded as one of the safest and most cost-effective of all health care interventions. The World Health Organization, WHO, estimates that up to 3 million lives are saved each year as a result of vaccination. All vaccines undergo long and careful review by scientists, doctors, and regulatory authorities to make sure they are safe.

Routine immunisation programmes commenced in Ireland in 1932 with the introduction of diphtheria immunisation. The current national immunisation programmes include the primary childhood immunisation, PCI, programme, which offers vaccination against 13 infectious diseases, and the schools immunisation programme, SIP, which offers booster immunisations to all children and the important cancer-preventing HPV vaccine to girls. In addition the HSE, through GPs and pharmacies, provides seasonal influenza vaccine and pneumococcal vaccines for people aged 65 years and older and those in medically at-risk groups. Participation in immunisation programmes in Ireland is voluntary, and, in the case of childhood vaccines, requires parental consent.

Ireland's immunisation policy is influenced by the policies that are developed through the WHO for the European region. The process and outcome targets established by the organisation have been used to guide the objectives of the Irish programme. These have specified the coverage levels to be attained, and outcomes such as elimination of target diseases, for example, polio, measles, and diphtheria. Other relevant international bodies include the European Centre for Disease Prevention and Control, ECDC, and the European Medicines Agency.

Immunisation policy and processes in Ireland are underpinned by the following principles, which support the Healthy Ireland goal to protect the public from threats to health and well-being - a fair equitable safe and relevant policy based on best evidence, and provided within a sustainable budgetary framework; a system of immunisation delivery which is flexible and cost effective to ensure easy introduction of new vaccines; promotion of immunisation equity; immunisation coverage uptake rates to achieve WHO targets of 95%; strong surveillance system which detects changes in rates of VPD, or new strains not covered by existing vaccines; information systems that can provide data of uptake and early warning of reduced uptake; and an effective public communication system capable of providing understandable scientific information which challenges misinformation from whatever source.

A number of key stakeholders are involved in immunisation policy and delivery of immunisation programmes in Ireland and I will briefly outlines their roles. The Department has ultimate responsibility for policy decisions relating to immunisation. It is also involved in securing the funding of immunisation programmes through the Estimates process, the legislative and regulatory framework underpinning immunisation programmes, and co-ordination between key stakeholders. The NIAC is a committee of the RCPI. It is an independent national technical advisory committee, which advises the Department of Health on vaccines, immunisation and related health matters in the Irish context. The HSE has a key role in the delivery of immunisation programmes, which it supports through the national immunisation office, the Health Protection Surveillance Centre, primary care and community health offices which come under the aegis of the health and wellbeing directorate. The NIO is responsible for the implementation of national immunisation programmes, and has a number of roles, in particular, communication with professionals and with the public about vaccination. The Health Protection Surveillance Centre, HPSC, is responsible for national surveillance of infectious diseases, including vaccine preventable diseases, VPDs, and acts as the focal point for communication with international agencies on VPD and immunisation uptake. Local primary care and community health officers co-ordinate invitations and the monitoring of the PCIP and school immunisation teams administer the SIP in most regions. The Health Products Regulatory Authority is responsible for licensing of medicines, including vaccines, in Ireland. The HPRA also monitors and evaluates adverse events relating to vaccine. General practitioners are contracted to administer the primary childhood programme. In some regions they deliver the SIP. They also provide other vaccination such as influenza to risk groups under contract. Retail pharmacists who have undergone the required training can apply for a contract to administer certain adult vaccines. Currently, pharmacists can administer seasonal influenza, pneumococcal and herpes zoster vaccines.

The State's immunisation programmes have had a significant impact in improving the health of the people. Diseases that used to be common in this country and around the world, including polio, measles, diphtheria, whooping cough, meningococcal Band C and many other serious infectious diseases can now be prevented by vaccination.

However, vaccines also can prevent the development of cancer, as well as preventing disease. The hepatitis B vaccine given as part of the six-in-one vaccine in the primary childhood immunisation programme helps prevent cancer of the liver caused by hepatitis B infection, while the human papilloma virus, HPV, vaccine given to schoolgirls can prevent the development of cervical cancer from that virus.

Ireland’s uptake rates for many vaccines in the primary childhood immunisation programme are close to the WHO uptake target of 95%. However, challenges remain. In recent years, due to the success of our programme many vaccine-preventable diseases have become so infrequent that we have lost the collective memory of how serious some childhood illnesses can be. Furthermore, some people believe the perceived risks of vaccines outweigh the risks of forgotten serious infectious diseases. For example, a scare surrounding the MMR vaccine in the 1990s resulted in a large reduction in uptake rates for this vaccine. In January 2000, a large outbreak of measles occurred in Dublin and resulted in more than 100 children being hospitalised, 13 of whom required intensive care treatment and there were three measles-related deaths. It has taken many years to get MMR uptake rates up to the current national level of 92%. However, this figure masks a small number of areas of low uptake. These areas are therefore vulnerable to measles outbreaks. Several European countries are currently experiencing large measles outbreaks, the biggest of which are in Romania, Italy and the United Kingdom. Last year, 40 cases of measles were reported in Ireland related to three imported cases from Europe. Measles cases occurred in children who either had no vaccination or were under-vaccinated. If Ireland is to achieve the WHO target of eliminating measles by 2020, efforts must be made to identify children who are at risk and offer them vaccines. The HSE continues to work in this area. Details of the work will be given later in today’s proceedings.

A similar situation pertains with respect to the HPV vaccine. Unfounded false claims of an association between the HPV vaccine and a number of conditions experienced by a group of young women have been made. There is no scientific evidence that the HPV vaccine causes any long-term illness. However, this misinformation has led to a significant drop in uptake rates of the HPV vaccine. As recently as last week, the director of the national cancer registry stated the reduction in uptake rate of HPV vaccine among Irish girls is very concerning. The Irish Cancer Society states that based on national cancer statistics, the drop in the rate of uptake to 50 % for the 2016 to 2017 academic year will lead to the death from cervical cancer of at least 40 girls who did not receive the HPV vaccine. A further 100 girls will develop cervical cancer and require life-altering treatments. Another 1,000 girls may require invasive therapy to prevent the pre-cancerous form of HPV.

Despite the availability of free and effective vaccines, a small number of people choose not to vaccinate themselves or their children in the belief that vaccines are unsafe or no longer necessary. People need to be aware that a decision not to vaccinate has a wider public impact. Such a decision may put a person's own life and that of his or her child at risk, as well as vulnerable individuals with whom the person comes into contact including people with a reduced immunity such as sick and elderly vulnerable patients, pregnant women or small babies who have not yet completed all their vaccinations.

The uptake of the seasonal influenza vaccine in health care workers in Ireland is disappointingly low. As a result of the winter initiative campaign this year, there was an increase in uptake rates compared to previous seasons. Some units achieved above the target of 40 %. However, the national rate fell far short of the target. As people who care for sick and vulnerable patients, health care workers need to consider their duty of care to patients and make it a priority to receive the flu vaccine every year.

Parents want to do everything possible to ensure their children are healthy and protected from preventable diseases. Vaccination is the best way to do that. It is understandable that parents may feel anxious about vaccinating their child, in particular when they hear or read alarming stories about side effects of vaccination. I urge any parent who has doubts or questions about vaccination to engage with his or her family doctor or to visit the national immunisation office website. These sources of information are clear, accurate and will answer any queries parents may have about the benefits and risks of vaccination.

We all have a public health commitment to our communities to protect one another and one another’s children by vaccinating ourselves and our family members.