Mary Harney (Dublin Mid West, Progressive Democrats)
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Following the introduction of human papilloma virus, HPV, vaccine internationally its safety, as is the case with all other vaccines, is being carefully monitored. At national level, the Irish Medicines Board is responsible for monitoring national and international emerging evidence about vaccine safety. The Irish Medicines Board, IMB, is also represented on the national immunisation advisory committee.

My Department has not been informed of any scientifically peer-reviewed research that indicates the HPV vaccine may be unsafe. However, I have been informed by the IMB of media reports in the US and EU that described some cases with fatalities following vaccination with the HPV vaccine. These cases have been reviewed by the authorities responsible in the jurisdictions in which they occurred and a relationship between the vaccine and these fatalities could not be established.

As is being done in other jurisdictions, Ireland is now considering the potential role of HPV vaccination in addressing the problem of cervical cancer prevention. The national immunisation advisory committee has recently undertaken a scientific assessment of the public health value of HPV following a request from my Department. The NIAC and the national cancer screening service agreed that this work needed to be complemented by a study of the cost effectiveness of the vaccine in the current Irish context. Accordingly, both organisations requested that the Health Information and Quality Authority, HIQA, undertake this study. International evidence as to the safety profile and side-effects of vaccines is considered by NIAC in formulating its advice and is kept under constant review. I understand the HIQA assessment will be completed in January.

Jan O'Sullivan (Limerick East, Labour)
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I raised this because I was contacted about it. There are always people who object to certain vaccines and it is important we clarify it. I support the introduction of a vaccine for cervical cancer. The Minister states there is no scientific evidence that it is contra-indicated for girls with a certain family history. I am not suggesting there is an issue but I seek clarity.

A report in a medical journal suggests boys may be considered as well as girls. Has the Minister considered that? This project is included in the programme for Government. Will it be done in the early or later stages of the life of the Government, if there should be later stages?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I will be careful because I am not a clinician. I understand that all vaccines have a downside as well as a benefit and, when a vaccine comes to the market, one takes a balanced view of whether it is likely to be beneficial or marginally negative. That is the case with this, as with any other vaccine. The authorities will advise the age at which it should be given, which is 11 to 12 years for girls. It is my strong view that it should be introduced in Ireland, subject to the advice confirming that in January. If that is the case, it makes sense to seek to do it in conjunction, not simultaneously but in the same period, with the roll-out of the cervical screening programme. This is a preventative measure and the benefits of it will not be seen until at least 20 years hence. We must act now in order to have the benefits in that timeframe. We must consider whether we will give the vaccine through schools and address matters such as parental consent.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In February this year the Minister announced the introduction of the cervical cancer vaccine available free to medical card holders and young girls presenting in the 11-13 age group. What is the opinion of the Minister of recent criticism by Dr. Kevin Connolly, a paediatrician and member of the national immunisation advisory committee, of the delay in determination of the safety of the vaccines, Gardasil and Cervarix? The criticism is of the inordinate delay in bringing forward these vaccines employed in other jurisdictions, apparently successfully. While I agree we must be fully certain of the safety to avoid dangerous side effects in any group of possible recipients, does the Minister have an indication of the interim determination of the HIQA studies on the vaccines?

In the programme broadcast last night in respect of Professor Tom Keane's role in British Columbia in cancer care redress, it was clearly indicated that the incidence of cervical cancer in the region had been reduced to minimum levels as a result of a combination of vaccination and screening. The programme here involves vaccination only. What progress has been made towards including screening as a component part of the programme aimed at dealing with this terrible scourge which is faced by too many women?

Mary Harney (Dublin Mid West, Progressive Democrats)
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A number of issues must be addressed. Deputy O'Sullivan inquired as to whether it should be made available to boys. We are awaiting advice in respect of these matters. If the advice from the national immunisation advisory committee and that which will emerge from the HIQA process, which is due in January, is positive, it would be my wish to make provision to have the vaccine introduced here. It is clear that this would not be a medical card issue and that it would be available to the entire population. All of the other population screening programmes are freely available to everyone, not just medical card holders. Cervical screening has been available in Canada since the 1960s or 1970s.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It has been available there for 31 years.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Canada was one of the first countries to introduce such a programme. The programme in question has been extremely successful, although its nature is being changed somewhat. The Minister for Finance will be making budgetary announcements in two weeks and I hope provision will be made for the roll-out of cervical screening programmes in the resources made available by him to the Department of Health and Children.

Brendan Howlin (Wexford, Labour)
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I will take a brief final supplementary from Deputy Reilly.

James Reilly (Dublin North, Fine Gael)
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I will be as brief as possible.

Brendan Howlin (Wexford, Labour)
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The Deputy should do so. We are already one minute over time on this question.

James Reilly (Dublin North, Fine Gael)
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I wish to refer, first, to the costings relating to the vaccine and Dr. Connolly's concerns regarding our ability to deliver a vaccination programme should the Minister decide to proceed with it. What will be the costings for the roll-out of cervical screening programmes? I spoke to the Minister six weeks ago about this matter in the House when I stated it was unlikely that she could succeed because there were no laboratories in place. Smears testing services are being outsourced. There is only one accredited laboratory in the country.

Brendan Howlin (Wexford, Labour)
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A question please, Deputy.

James Reilly (Dublin North, Fine Gael)
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I will be as brief as possible.

Brendan Howlin (Wexford, Labour)
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A question, please.

James Reilly (Dublin North, Fine Gael)
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Tá an ceist ag teacht.

Brendan Howlin (Wexford, Labour)
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It had better come quickly because I intend to move on.

James Reilly (Dublin North, Fine Gael)
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Is there a budget in place in respect of the roll-out of a cervical screening programme? Is the Minister in a position to guarantee the House that it will be rolled out by March next year? In light of the cutbacks taking place, is there any real credibility to her claim that she will roll it out?

A large advertisement appeared in the Sunday Independent last weekend in which company directors, whether their companies are large or small, public or private sector, were urged to take good care of everybody and ensure they were fully compliant before it was too late because they would be responsible. The Minister has a contract with the people to deliver health care services. She promised them that there would be no cutbacks and that any cutbacks would not hurt patient care but there were and they have done. How does she intend to come good in respect of her promises?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We will spend over €15 billion this year and spent €14 billion last year. We will spend €1.2 billion more than last year. I do not regard that as a cutback. It is the duty of the HSE to remain within the budgetary allocation voted to it by the House out of taxpayers' money and be able to meet the demands on services——

James Reilly (Dublin North, Fine Gael)
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The cutbacks should hit administration, not services.

Mary Harney (Dublin Mid West, Progressive Democrats)
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There has been a great deal of discussion regarding the report published last week by the OECD which indicated that spending in Ireland grew faster than in any other country.

James Reilly (Dublin North, Fine Gael)
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Because it started from such a low point.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We are spending 8.9% of our national income, the average in the OECD, even though——

James Reilly (Dublin North, Fine Gael)
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We have only just reached that percentage.

Brendan Howlin (Wexford, Labour)
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The Minister to conclude her final reply. We must proceed to the next question.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It would be easy to roll out all these vaccines in Ireland. The cost of a vaccine is the smaller——

James Reilly (Dublin North, Fine Gael)
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Roll out a cervical screening programme first?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We could also roll out the screening——

James Reilly (Dublin North, Fine Gael)
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The Minister promised it would be introduced ten years ago.

Brendan Howlin (Wexford, Labour)
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Will the Deputy, please, allow the Minster to conclude her reply?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The issue is that clinicians' and general practitioners' fees are substantially higher than in, for example, Northern Ireland, Britain or other jurisdictions. The cost relating to the vaccine is usually the smaller part of the overall figure.

James Reilly (Dublin North, Fine Gael)
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What about cervical screening?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The same applies to screening in respect of the taking of smears, etc. All of these things are more expensive here

James Reilly (Dublin North, Fine Gael)
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It did not apply ten years ago.

Mary Harney (Dublin Mid West, Progressive Democrats)
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They are more expensive, as the Deputy knows.

James Reilly (Dublin North, Fine Gael)
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That does not wash.