Mary Harney (Dublin Mid West, Progressive Democrats)

I am happy to have an opportunity to speak about this issue. In the context of the cancer programme on which the Government has embarked, there are a number of priorities from a clinical point of view. Clearly, the first priority is to ensure that we organise our cancer services to deliver better outcomes for patients. The manner in which our cancer services have been organised do not deliver good outcomes for patients, as we know, and do not compare very favourably to many other European countries in most cancers with the exception of children's cancer. It is centrally organised in Crumlin hospital and, therefore, we do extremely well compared to the experience in other countries not only in Europe, but elsewhere throughout the world. We do not do so well with other cancers. Our priority during the past 18 months has been to invest in putting in place eight designated centres with a multidisciplinary team of experts to be able to care for patients who are diagnosed with cancer.

A second priority is screening programmes. Many other European countries and countries beyond Europe have been involved in screening programmes for some considerable time. We are currently rolling out a breast screening programme, which will be completed during next year for those five counties to which it has not yet been rolled out.

We are also rolling out a cervical screening programme that began in September. Cervical screening has the capacity to prevent 80% to 90% of cervical cancers. Some 70 to 100 women present with cervical cancer each year. A national screening programme for women aged between 25 and 60 years of age has the capacity to eliminate the incidence of cervical cancer by 80% to 90%. Therefore, there was a choice presented with the roll-out of the cervical screening programme, which next year, in a full year, will cost €35 million. An extra €25 million will be allocated to that programme next year and an extra €15 million will be allocated to the cancer control programme to allow Professor Keane to continue to recruit the expertise we require in these eight centres to provide, in particular, multidisciplinary care. That €50 million funding has been identified for those two programmes.

In the summer of this year following a health technology assessment, I announced, based on the advice I received, that we wanted to introduce the vaccine from the school year beginning September 2009. The HSE believed at that time that this would be a challenge and in that context sought to defer it, as health services often do with computer systems and so on, but we believed it should be rolled out at the earliest opportunity. In a statement I made on 5 August, I said that it should be rolled out subject to two criteria, one being that it be cost-effective. Two companies supply the vaccine. One of the vaccines deals with four strains of HPV, of which there are 200 strains in all, while the other vaccine can eliminate two strains. I sought the introduction of the vaccine, subject to its cost-effective procurement and securing an 80% take-up of it. All the advice is that if we do not get an 80% take-up of it, we will not get the benefit of introducing it. Therefore, the permission of parents of 12 year old girls will be sought. It was subject to those two criteria that I sought Government funding in the context of the Estimates for 2009 to begin the roll-out of the vaccine next September.

Since then, as we know, there has been a considerable decline in our economic circumstances. Next year, for the first year in almost 11 years, health spending will not increase by 8%, 9% or 10% — the average annual increase has been 9% since 1997. Next year the increase will be just over 3%, which will present a challenge. As I said in the House during the debate on the medical card issue, when one has to find €700 million of planned expenditure for 2009 from the health Vote, it is a considerable challenge. There is no low-lying fruit in health — no easy pickings. Therefore, it was obvious that something that had not yet begun should not begin next year when we did not have the resources to do it. We must also consider this decision in the context of the pneumococcal vaccine, which has been rolled out to infants in respect of which there is a catch-up period of up to two years. That will cost €30 million next year to prevent certain meningitis strains. It is not a question that the decision on the vaccine was made in isolation, rather it was made in the context of many other big decisions that have been made.

I was asked parliamentary questions by Deputy Reilly and one of his colleagues on Tuesday and queries were also raised by a journalist. I gave the truthful answer that we would not be in a position to provide money for this during 2009. As the American presidential election took place the same day, I was accused of trying to go undercover and making the announcement on the day of that election. When parliamentary questions are asked, I believe they should be answered truthfully and people should not be misled into having a false view that sometime next year this vaccine would be introduced when I knew in my heart of hearts that I did not have money to do it.

When the HSE sent me its plan a few weeks ago and we discussed it with Department officials during the past two weeks, it was clear to me that we could not provide the additional resources without taking them either from Professor Keane's cancer control programme or scaling down the screening programme that has begun. I believe that when we begin something, we should do it well. Therefore, when it came to clinical choices, we had to continue with the decision that gives the best clinical return. The best clinical return is in regard to screening. That prevents 80% to 90% of cervical cancers, as we heard from Dr. Flannelly on the radio this morning. This vaccine has the potential to prevent 70% of cervical cancers, but the women to whom the vaccine would be administered would also have to be screened — it is not a question of either-or in this case.

Many other countries have introduced such a screening programme for cervical cancer. The UK introduced such a programme 20 years ago. We are only doing this now because, unfortunately, we had different priorities and did not have the resources of other countries to be able to introduce a cervical screening programmes 20 years ago. Our screening programme, as everybody here knows, only began this year in September. The announcement on Tuesday was not that we were scrapping the vaccine. What we said was that it is not being introduced from September next year.

There will be a challenge for the HSE in terms of when the programme can begin. One would hope it could begin as quickly as possible, but I cannot say that it will be introduced in 2010. I hope it can begin then, but I cannot give that guarantee now, unless the resources can be made available to do it. I hope we will able to introduce it as early as possible. Other European countries have not been in a position to introduce it either.

On the issue of the cost of the vaccine, it has been suggested that three doses of the vaccine would cost approximately €600 or €200 each. I do not know if that is the case. The HSE has estimated to me that for a full year it would cost approximately €16 million. The administrative cost of the vaccine is in the region of €6 million. As procurement of it has not taken place, I cannot say, with certainty, what the cost of vaccine would be, except I understand it has been suggested that if people can procure it privately, it would cost approximately €600.

When the HTA was done for me by HIQA, it said it would cost €390 for the vaccine. There are approximately 27,000 girls aged 12 in Ireland. We want to get an 80% take-up of the vaccine. On the assumption that we would, which was the only basis on which we were going to proceed with its introduction, it would cost in the region of €11 million for the vaccine alone and €6 million for the staff to administer it and for other non-pay and IT systems because we have to be able to track the people who are given the vaccine over a considerable period of time.

I am happy to explain the circumstances in which this decision was made. We wish we could make all the decisions that would benefit the health of our citizens all at once, but when it comes to priorities, clinical issues must come first. The clinical priority based on all the advice available to me as far as cancer is concerned is to continue with the reorganisation of services, which next year will require an additional €15 million for Professor Keane and to continue with the roll-out of the cervical screening programme to 1.1 million women, which next year will cost an additional €25 million over the €10 million that was provided for this year. That amounts to €50 million for those new cancer initiatives.

Regarding other issues, like the pneumococcal vaccine, etc., it was not possible to make resources available to the HSE from the autumn of next year to begin a programme in either national or secondary schools. It costs approximately €500,000 less to provide it to secondary schools because there are fewer of them. However, in terms of getting the consent of parents, we know who the national school students are and my view was that it might have been easier to reach those parents and get their consent in advance, which is required to administer this vaccine because we are concerned here with minors. Regardless of whether it was available in national or secondary schools, we cannot begin the programme in September 2009 as envisaged. It needs to be postponed for that reason.

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