Dr. Kevin Kelleher:

I thank members for the invitation to attend this committee meeting to discuss the uptake levels for vaccinations. I am joined by my colleague, Dr. Brenda Corcoran, who is a consultant in public health medicine at the national immunisation office. We welcome the opportunity to appear before the committee and engage with members. I appeared before this committee 16 years ago on a review of the same topic. The committee subsequently produced a very influential report. Dr. Corcoran and I are very proud of what we have achieved in the 15 years since that report. As Dr. Bonner said, vaccination uptake rates have increased dramatically. We have also introduced new vaccines.

An immunisation programme is one of the great benefits a state can provide for its community. It protects its community, in particular the most vulnerable such as children and the elderly. It is one of the most cost-effective health interventions available, being second only to clean water. Each year, it saves millions of people worldwide from illness, disability and death. In 2005, the Harvard school of public health observed that the economic benefits of immunisation have been greatly underestimated, which is true and very important. People do not understand how much of a change has taken place. Today’s witnesses are all doctors. Each of us has seen a massive change during the 20, 30 or 40 years that we have been in practice. I am the only witness who has been in practice for 40 years. There has been a massive change. One saw things then that one simply does not see today. Doctors and consultants now do not encounter diseases which I encountered in the 1970s.

The national immunisation programme aims to prevent diseases in individuals and groups by achieving the World Health Organization vaccine uptake targets of 95% for childhood vaccines and 75% for seasonal influenza. To achieve these targets, a well-functioning immunisation programme is essential, involving a multidisciplinary integrated approach from all key stakeholders, including the bodies represented here today. Other witnesses will give evidence of the very robust national and international processes that underpin the introduction of new vaccines, with patient safety considerations always being paramount.

Ireland has a strong history of having a comprehensive dynamic immunisation programme. Nine new vaccines were introduced to the childhood schedule in the 20th century. Since the year 2000, there have been 12 changes to the childhood schedule, including three catch-up campaigns. We are moving on and are protecting more people against more diseases.

We now provide several programmes, one of which is the primary childhood immunisation programme. It is provided free of charge by GPs, who are in contract with the HSE, to approximately 65,000 babies per year. Children require five visits to their GP which take place at two, four, six, 12 and 13 months. They receive seven vaccines which prevent 13 diseases.

That includes, in the past year, the new meningococcal B and rotavirus vaccines that were introduced at the end of last year.

The school immunisation programme is provided by HSE school vaccination teams to 70,000 junior infants through two vaccines preventing seven diseases and to nearly 60,000 students in first year of secondary school. Boys receive two booster vaccines that prevent four diseases and girls receive three vaccines that prevent five diseases over two visits. In 2016, 900,000 vaccines were given to babies and schoolchildren to protect them and the wider community through herd immunity from 14 serious diseases.

Each year GPs, pharmacists and occupational health services provide the seasonal flu vaccine to everyone who is 65 years or older, people under 65 with certain long-term medical conditions, pregnant women and health care workers. We distribute around 800,000 doses of flu vaccine every year and estimate around 700,000 are used.

We continue to reach the target of 95% for most of the vaccines given to babies. The uptake of the MMR, or measles, mumps and rubella vaccine, declined to 69% in 2001 due to discredited vaccine safety allegations but it has slowly increased to 92% or 93% in 2016. We still see measles outbreaks because not all children and young adults are fully vaccinated. Most recently there was an outbreak of 40 cases last year, half of whom were hospitalised. The human papilloma virus, HPV, vaccine uptake was 87%. The uptake has dropped due to vaccine safety concerns and rumour and is now estimated to be around 50% for this year. The uptake of the influenza vaccine has remained at around 55% for those 65 years and older and less than 20% for pregnant women. Uptake among hospital health care workers is still low this season at just 31% although it has increased from 22% last year. The rate of uptake by nurses has almost doubled this season, which is very impressive.

Significant efforts are made each year to understand the factors that drive and motivate people to be vaccinated. Campaigns and public health messages are designed with key stakeholders and service users. All of this work is regularly evaluated and future work revised to take cognisance of learnings to date and shifting behavioural trends. It is very important to note the immense amount of work done by nurses - be they practice nurses, public health nurses or school nurses - doctors, GPs, community medical staff, occupational doctors, pharmacists and clerical administrative staff. I highly commend the work of the national immunisation office, the health protection surveillance centre and our communications partners, internally in the HSE and our colleagues elsewhere who are outside of the organisation.

Although overall public trust in vaccination is positive, as evidenced by the generally high uptake rates, current parental concerns about HPV vaccine safety on social and local media, which have no scientific basis, have left large numbers of girls at a future risk of cervical cancer and at short-term risk of anal-genital warts. There is concern that the reduction in HPV vaccine uptake may lead to reduced rates in other childhood vaccines and there is some evidence that is happening. This may be due to vaccine complacency as many of the diseases are not visible now due to the success of vaccination or are not perceived to be as serious and immediately life threatening as they are. Ongoing concerted efforts are required from all health care professionals and opinion leaders to improve and maintain vaccine confidence in HPV and all vaccines. The scientific evidence is clear. Vaccination is the most effective intervention for the prevention of many serious diseases. Vaccines are one of modern medicine's major success stories and this public health success must be sustained.

My colleagues and I are happy to answer any questions.