Professor Karina Butler:

First, let me pick up on the flu vaccine. I can totally understand the question, "Are we not giving confidence?" There are some unique problems with the flu vaccine in the sense that flu changes every year so we are always in catch-up mode and we do not always catch up exactly on target.

We do not get 99% or 100% protection against 'flu. Our protection rates in the last season were approximately 68% or 70%.

Then there is the other issue, that people mistake what 'flu is. Even when the vaccine has protected them against real 'flu, they pick up another virus and think they have got 'flu. The protection that it affords is not as evident. The reality is it saves lives. Even when given to healthy children, it saves their lives. It saves the lives of elders in their community as well. The 'flu vaccine is unique. It is strange that those who have a difficulty with it are primarily among our nursing colleagues because also there is a perception we all have had 'flu, we will not get it again and it is a trivial illness.

Another big element that plays a key role - the chocolates work - is ease of access. One is on the floor and does not want to take time out to go and queue somewhere to get the 'flu vaccine. What the hospitals have been doing, because our occupational health colleagues have been looking at this, is bringing the vaccines to the floors and the uptake has increased. I anticipate we will see big improvements.

The 'flu has some unique issues in that there is not 100% guaranteed protection in any given season because the 'flu virus changes. We get lots of other illnesses that we mistake for 'flu. What made a difference in our hospital was when we had an outbreak in ICU and one of the nurses who was pregnant ended up in the ICU of an adult hospital. That changed a lot of attitudes towards the 'flu vaccine when it came round the following season. It comes back to Senator Dolan's point. It is a matter of communication and how we do that better.

The six-in-one vaccine was the question from Deputy Louise O'Reilly. Parents have concerns about giving the six-in-one vaccine because they think it will overload the immune system and one will get too many antigens. From a single infection, there would be multiples of the number of antigens that are in the 'flu vaccine and the body is more than capable of dealing with them all without any problem. What one has to do is ensure that there is no interaction, such as where giving one together with the other might blunt the response of the other, and that is done. That is always studied in any combination vaccine. Then it comes down to whether one wants to give his or her child six jabs by three - 18 injections - when one can, effectively and safely, give them together and, therefore, get protection quickly.

As for what we have in the six-in-one vaccine, one of the key elements in there is whooping cough vaccine. As for who is liable to die from whooping cough, the Deputy and I will not die. We will get a bad cough that will last for three weeks. If one's child under six months or one's six-to-12 months' old gets it, he or she will end up in ICU and die. That is why one would want to get in there early and why those vaccines are given in combination. As for who is most likely to get meningitis, our highest rates are among those under one year and the one-to-two year olds. That is why we want to get those vaccines in there efficiently. The reason we give combination vaccines is to make it easier for the child, not to give them so many shots and to get protection onboard at the time when the child needs protection, and immunologically, it is very effective and very safe.