Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank all of the witnesses for coming. I will focus on where we are as opposed to the tragedy of people being infected with blood products.

The United Nations has a target to eliminate hepatitis C by 2030. Our aim is do so by 2026. I am concerned that the low hanging fruit have been targeted in the initial phases, by which I mean people who are more likely to adhere to a medical regime or are easier to reach. Let us estimate that the number of patients is 30,000 and we say we will deal with 18,000 a year. The HSE will not achieve its target of eliminating the disease by 2026 unless we double resources or the HSE doubles its efforts to eliminate it. Hepatitis C is a communicable disease. The medical treatment emerged in 2014 and was licensed for use in Ireland in 2015. There has been a significant price reduction. I compliment the people who negotiated the price reduction. However, I would not give them too much credit as most countries negotiated a significant price reduction.

Do the witnesses know whether tests on students have been conducted or whether the disease burden or load has been eliminated for 3,000 people? Do they have data to show how many more have been infected, either through intravenous drug use or the exchange of bodily fluids or whatever else?

I assume that the lead agency is in charge of reaching targets, but I did not see an annual target included in any of the reports. Therefore, it looks as if the can has been kicked down the road to 2026. The view seems to be that everything will be fixed by then, but I am concerned that no annual targets have been set.

Intravenous drug users are the cohort of patients who are the hardest to reach and make up probably half of the estimated number of patients. They tend to be hard to engage with because they have chaotic lifestyles. In my experience, as a community pharmacist who worked in a methadone service ten years ago, usually one finds when one engages with people such as these - I do not mean to paint everybody with the same brush - that they tend to adhere to regimes and turn up at their community pharmacy. The relationship tends to be strongest between a community pharmacist and the person receiving the methadone treatment. I very much welcome the suggestion treatment be moved to a community setting because I do not see how else we can target that portion of the population. Obviously, the service will involve prescribing doctors. I am sure pharmacists will be anxious to negotiate a very good price for the provision of such treatment.

It was stated each course of treatment cost between €23,000 and €92,000 per patient. I understand the negotiated drug cost is around €10,000 per patient. Can whoever knows the answer explain the difference between the figures of €23,000 and €92,000? Is it the price of administration or doctors' fees? Have I missed something?

I have seen evidence from other countries that there have been deals done with the drug companies whereby €100 million, for example, would be given to treat whatever number of patients, but if we find another 2,000, they must be treated. Have the witnesses come up with innovative actions to get the best value from the drug companies when it comes to dealing with this issue?

I am concerned about the database and confidentiality issues. It seems completely unacceptable that one does not know how many people have hepatitis C, who they are or where they are. As hepatitis C is a communicable disease, it is very important to know the dataset and who has the disease. The approach seems to be ad hoc. To tackle an infectious disease one must go at it and include every strain. It looks like the easiest people have been dealt with and that the hardest ones to reach have been left until the end. I find that concerning and do not think we will reach our target.

With reference to intravenous drug users, apparently one out of every three homeless people is hepatitis C positive. That is a big concern if people are living in communal hubs or hostels because I imagine the risk of transmission is extremely high. Do the witnesses have any idea of how many have been reinfected?