Dr. Brenda Corcoran:

There were a number of questions relating to the HPV vaccination programme. I will take them in order. The first one related to the leaflet that we provide and whether we should provide supplementary information. The HSE is committed to providing clear, accurate information to all parents to allow them to choose whether to vaccinate their children in a school-based programme. In a school-based programme we do not meet the parents so we have to convey our information either through written information, the website or other media. We will talk a little bit about that later. Regarding the leaflet, at the start of the school year all parents receive a leaflet, consent form and invitation letter inviting them to take part in the HPV programme. They are also invited to get the other two vaccines that are given in the first year of secondary school. Those are a booster for tetanus and pertussis - that is whooping cough - and a meningococcal C booster. Three vaccines are given. The HPV vaccine is given to the girls and the other two vaccines are given to girls and boys.

The information leaflet we supply has been changed yearly, based on feedback from both parents and health professionals in the field. We also look at the information leaflets that are supplied in other countries that have had very successful immunisation programmes, particularly for HPV. We look at the information materials from the UK, where an uptake rate of over 85% has been sustained, and Australia, which sustains a 75% to 80% uptake rate. We compare our information materials with those supplied in those countries. We also have our information materials proofed by the National Adult Literacy Agency and they are in line with HIQA guidance on the use of plain English. That is why the information materials are worded and laid out in the way they are.

We work on what might be called an onion system, in that we provide layers of information. The information leaflet gives very clear guidance that if a person would like to receive more information they should go to our national immunisation website. That website is the only immunisation website in Ireland that has been accredited by the World Health Organization as having clear safety information on all our vaccines. It has had that status since 2008.

We do not provide the patient inserts, that is the licensed documentation, but in the leaflet we provide information on all side effects from the HPV vaccine that have been scientifically shown to be caused by the vaccine. The product insert, the patient information leaflet, is a licensed document, as has been referred to by Dr. Gilvarry. It is a licensed document that has been agreed by the European Medicines Agency. That document also contains a list of other symptoms that have been seen around the time of HPV vaccination, but for which there is no scientific evidence that the vaccine was the cause. The HSE includes the information on the side effects that are caused by the vaccine and in the information leaflet actively asks parents to go to our website, where there is a link to the patient leaflet where they can read all the information they want, as well as find a lot of other information on HPV vaccine safety, impact and facts. That is about the patient information leaflet but I fully accept all of the comments on communication with parents because that is a huge challenge for us.

As I already mentioned, we do not see the parents. That is why when we realised that the information was being misinterpreted and that there was a lot of misinformation in the public domain we developed a strategy to work with like-minded organisations. We have created an alliance with organisations such as the Royal College of Physicians in Ireland, the Irish Cancer Society, cancer support groups, the national cancer screening programme, the Irish Pharmacy Union, the Irish Medical Organisation, the Pharmaceutical Society of Ireland and the Marie Keating Foundation. All of us are working together to provide the same information.

In addition, we are working very closely with our colleagues in primary care. It is recognised, and there is a lot of research to show, that in spite of all the mistrust there is in the health services the primary reason that a parent chooses to have their child vaccinated is the recommendation of a trusted health professional. In that regard, we did a huge amount of training last year for HSE staff, but also for our colleagues in primary care - general practitioners and practice nurses - because they see parents on a day-to-day basis, perhaps about something completely different. We have given them information on the facts and figures and on the issues about which parents are concerned and we have asked them to act as advocates for us and to help us persuade parents to get this vaccine. We have also done some focus group work with parents to ask them the kind of information they want and we use that information to customise the information we give.

As we know, the uptake rate dropped to 50% for the first round. It is a two-dose vaccine, given firstly in September with a second dose in March. We instigated a programme to offer all parent a second chance in March or April when we returned to the schools. We sent all the parents another information leaflet, which was slightly modified based on the feedback that we received. Vaccination of those who took up the offer is being carried out in the schools at the moment and is ongoing. While it is very preliminary, the information from the schools so far is that the uptake appears to have stabilised. It has not dropped any further and there are a small number of parents who are coming forward to ask for their daughters to be given the first dose. It is good news but there is a huge amount of work yet to be done.

With regard to 2017-2018, we have already developed a leaflet for sixth class parents. That is being distributed to the schools to give parents more information in advance. That gives more information and advises parents to check the website. We will be running a comprehensive communications campaign between now and September and working with the partners that I have already mentioned and with HSE staff to introduce and implement the information in as clear a way as possible. This will include using social media, videos and bite-sized pieces of information backed up with scientific evidence while using the ways in which we now know parents communicate, adapting to this new landscape and bearing in mind all the constraints applied by not seeing the parents. We have to use other people to help us get our message out. There is a slight improvement, which is good news, but there is a lot more work to be done.