Dr. Kevin Kelleher:

The questions fall into two groups, the more general things about immunisation and the specific issue of the HPV vaccine. We will take the first group first and come back to the HPV issue.

We were asked about the low uptake of the flu vaccine among health care workers. It is a problem internationally. We are involved in a number of working studies. Last week, I attended a meeting with UK colleagues to discuss this issue. Internationally, people have taken two approaches to getting health care workers to take flu vaccines. It can be done through a major promotional campaign, which has a degree of success and we saw a significant change in the past year. However, it takes years. The UK has been going at that for some years. England has increased the uptake among health care workers to nearly 60% with some hospitals higher than 90%. They have been going at it for five or ten years. Interestingly, a number of states in the US have introduced mandatory flu vaccination for health care staff, primarily as a patient safety issue. Clearly, there are high uptake rates because it is mandatory.

There is an interesting thing about the attitude of health care workers, predominantly nurses. It is very difficult to say this because those of us on this side of the table are all doctors and it sounds classic doctor speak. Our problem has primarily been with nurses' uptake of the vaccine. We have been working very hard to try to understand that. Considerable work has been put in on it leading to changes. Clearly what works is having leadership in the institution concerned and, in particular, leadership from the nursing profession makes a big difference.

Incentives also work. I am not going to defend that, but it is clear that incentives work, including incentives for the institution or for individuals. They range from giving them chocolates - actually chocolates work extremely well and there is some very good evidence of that. Even the medical literature has some very good evidence of that. Chocolates, draws for iPads and things like that work very well in improving the rate of uptake. The Minister has been very clear about, and we are the same. This is a very important issue about us protecting our patients - how we do it and how we move on this into the future.

Interestingly, the push for the HPV vaccine came from outside the system - from the media and the public. There was a massive public campaign back at that time to introduce the HPV vaccine. Interestingly it coincided with the death of-----