Professor Karina Butler:

I am joined by my colleagues, Professor Mary Horgan, who is president elect of the college, and Professor Donal Brennan who is a consultant obstetrician and gynaecologist and scientist researcher into gynaecological issues. We thank the Chairman and committee for inviting us here today to focus on the important issue of vaccines.

I am a paediatrician and infectious disease specialist. I have worked in this area for a very long time; I shall not specify how long.

The benefits of vaccine are quite simply a matter of fact. Vaccines work. Vaccines save lives. Vaccines prevent illness, misery and hardship.

The committee has heard all of the numbers from Dr. Bonner and Dr. Kelleher. The numbers are dramatic. In 1959 there were over 15,000 cases of measles. In the 1970s, which is not that long ago, there were seven deaths a year on average. Last year there were 43 cases but that should have been zero. The number of diphtheria, pertussis and polio cases all tell the same story. I will not focus on the numbers but will try to give the real picture to the committee. When I think about the impact that vaccines have had on lives, I do not have to look very far. I can think of my own family in the 1940s, a time just before the initiation of vaccine programmes. My uncle, who was then four years of age, died of diphtheria. My grandfather shortly thereafter succumbed to oropharyngeal cancer. It is most likely such a cancer would now be preventable.

In the 1950s one of my generation, at six months of age, was taken from the family home in the midst of panic and driven to Cherry Orchard Hospital in Dublin. The child had polio and had to stay in an isolation ward in the hospital for over six months. I recall going to Cappagh Hospital in the 1960s and seeing alongside me the children who had been in the ward in Cherry Orchard Hospital. The wards were full of children wearing callipers and sitting in wheelchairs as a result of the polio epidemic.

In the 1960s we all experienced a series of measles, mumps, whooping cough and whatever. I remember them all. We were the lucky ones because we recovered. There are many people today who suffer chronic lung disease or blindness and there are those who did not survive.

In the 1980s there was another generation. My daughter almost died from haemophilus influenzae sepsis, while her playmate was in an intensive care unit with meningitis.

When I left my home this morning my two-year old grandchild, who was visiting me, ran around. I am delighted that he has had all of these vaccines and that I do not have to worry about him suffering those diseases. Luckily, he has also received the meningococcal B vaccine. I work in Temple Street and Crumlin hospitals and this week, I left the bedside of a child who is two years and four months old. He is fighting for his life having suffered meningococcal B meningitis because he was not lucky enough to be born in the era of a national campaign. We did not have funding for a catch-up campaign.

I have outlined the real impact of vaccinations. When misinformation spreads it denies people the benefits of vaccines, thus resulting in family tragedy and community tragedy. There has been a lot of misinformation about vaccines. We acknowledge that no medicine or therapy is 100% safe and nor is there a vaccine that is 100% safe for every person. It was not 100% safe for me to leave my house and drive my car here today. On a balancing of risks, the benefits of vaccines at an individual level and community level far outweigh those risks. It is important that we have close surveillance to pick up adverse events. We acknowledge that the history of vaccines is not without its problems. We now have very careful pre-licence and post-licence monitoring to detect signals that might say there is a problem.

Ireland, as a country and a community, cannot shy aware from problems. For example, narcolepsy has been associated with the pandemic flu vaccine. When a problem occurs it is investigated, acknowledged and then appropriate actions are taken.

If we contrast that with the current scares around the HPV vaccine, those concerns have been heard and I have seen patients with this constellation of symptoms in my clinic. It is a problem for the family. We do not deny that. These are very real issues when one has a son or daughter and saw the child performing very well, and suddenly it seems that the rug has been pulled from under him or her because he or she is tired and has muscle aches and pains. We do not understand that complex of symptoms. Those symptoms were there before the HPV vaccine. They are there in girls who are vaccinated. They are there in girls who are unvaccinated. They are there in boys. The European Medicines Agency, EMA, looked at it when that concern arose and the vigilance committee in the EMA looked at what the incidence rate was in the vaccinated and in the unvaccinated, and there was no difference. Contrast that with narcolepsy. When the EMA looked at it, there was a higher incidence in the vaccinated. The background instance had stayed the same. That is the difference between these two things, so we can be reassured that these symptoms, although they may temporarily occur after vaccines, are not causally related. What we may find, as Dr. Bonner has alluded to, is that children are missing out on the vaccines and will later suffer the impact from cervical cancers and other cancers, as Professor Donal Brennan can expand on later.

I put it to the committee that our national immunisation programme has safe and effective vaccines that benefit our community. We have to shatter the myths around vaccines, that diseases are extinct or no longer a threat, the myths such as happened with MMR that vaccines cause autism, the myth that HPV vaccine causes chronic fatigue symptom or the postural orthostatic hypotension syndrome. We have to communicate and learn how to better communicate that these vaccines are safe. What we really need to look at is how we can expand our vaccination campaign so we can protect the lives and health of others.

We need to look at how we can make sure that no other two-year old comes into our clinic with the meningococcal B infection when we know we have a very effective vaccine. It was introduced in the UK, our close neighbour, ahead of us. The UK has just published the data on the effectiveness of the first six months of the campaign, and the number of cases had already halved ten months after its introduction.

We have to look at why we are not using varicella chickenpox vaccine in this country. People have a wrong idea about chickenpox. They think it is a simple, uncomplicated illness. Just this week, I have tended four children hospitalised with serious complications from chickenpox. When they get chickenpox, they are vulnerable not only to its complications, but the complications of serious invasive bacterial disease. At the moment, we have a very invasive, nasty streptococcal disease that is causing bone infections and skin infections. It was called "the flesh-eating bug" in the newspapers, and we have seen that in children who have had chickenpox. I tended four children this week, two with bone infections and one with complicated seizures. There is an effective, safe, licensed vaccine. I have to ask why we are not using it in our programme. We would certainly like to.

We need to make sure that we strengthen our programme and expand it to benefit our community, both its health, but also, as Dr. Kelleher said, benefit it through the reduced economic cost. Thankfully, we have introduced rotavirus vaccine that will make a big difference to families and to workplaces, and to the country's economy.

I thank the committee for inviting us here today. I ask it to understand that all of us here are physicians. None of us wants to do any harm to any of our patients. We would not give vaccines if we did not truly believe they were safe. My girls were among the first to receive the vaccine, before it was introduced to the national programme. I gave them that vaccine because I had looked at the data and knew it was safe. I did not want to see my daughter, who now has one child and is expecting her second, succumb to cervical cancer in her 30s or 40s when her children are still young. However, I know someone who is in that very position today as we sit here debating the merits.