Ivana Bacik (Independent)
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I welcome the Minister of State to the House and thank her for dealing with this matter on the Commencement. Like the previous matter, it concerns the treatment of cancer. I ask the Minister for Health, in light of the concerns expressed by the Irish Cancer Society and others, about falling rates of take-up of the human papilloma virus, HPV, by parents of teenage girls. This is the vaccine that protects against cervical cancer.In light of these concerns and the decreasing take-up rates, from a rate of 87% in 2014 to a projected rate of below 50% this year, how does the Minister propose to increase take-up rates to help prevent the incidence of cervical cancer in the future? Does the Minister propose to launch a public awareness campaign to inform parents of the proven safety and efficacy of the vaccination programme? What plans does he have to extend the roll-out of the HPV vaccination programme to boys?

In recent days I met representatives of the Irish Cancer Society, who have also been engaged in briefing Members of the Oireachtas generally. They are deeply concerned about reports that appear to be putting people off vaccinating their children. The HPV vaccine is now being administered in Ireland to all first-year girls in secondary school. It has been offered for free to first-year girls since 2010 under the national HPV vaccination programme. Gardasil 4 is used in the programme and this protects against strains of HPV which cause seven out of ten cases of cervical cancer. It also protects against strains which cause the majority of genital warts. It is a very important health programme.

Concerns have been raised that there is a link between this vaccine and fatigue in teenage girls, particularly chronic fatigue syndrome. Clearly, any girl who suffers from such a condition should be offered clinical care pathways and treatment but that is a separate issue. We now have clear scientific evidence which refutes or denies any link between the vaccination programme and the incidence of chronic fatigue. Indeed, in December last year the World Health Organization global advisory committee for vaccine safety reviewed the evidence on the safety of Gardasil and concluded that it continues to have an excellent safety profile. In the month before that, November 2015, the European Medicines Agency similarly reported on a review of HPV vaccines and found no evidence the vaccine was linked to chronic fatigue conditions. Despite this strong scientific evidence and the clear need for this vaccination, the rates are falling even though we know that this year in Ireland, more than 90 women will die from cervical cancer. Many of us have friends or family who have been affected by this. A total of 280 women will be diagnosed with invasive cancer and a further 6,500 will need hospital treatment to deal with pre-malignant forms of the disease to prevent later development of cervical cancer. These are the conservative estimates put forward by the Irish Cancer Society. They should be a matter of huge concern.

The society says that if vaccination rates continue to fall, 40 unvaccinated girls from the cohort that should have received the vaccine this year will die in future years if one projects the estimates into the future. It is seriously worrying. We see scare campaigns being carried out in other countries, with the result that vaccination rates have fallen. In Japan the vaccination rate is below 1%. It is clear that further falls will happen in Ireland unless there is a strong, concerted, cross-party campaign by public representatives, the Government and the HSE to ensure information is provided to the public and the scientific evidence is presented to parents, so they will see the need for the vaccination programme.

To conclude with a positive story, Australia has conducted a robust information programme and it has high levels of vaccination. It has effectively achieved the elimination of genital warts, one of the conditions which the vaccine prevents. A vaccination programme for boys in Australia is also ongoing. We can learn lessons from countries where there is good practice. However, we need a strong intervention by the Minister and public representatives before the next vaccinations take place in schools to ensure that take-up rates do not continue to fall.

Helen McEntee (Meath East, Fine Gael)
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I am replying on behalf of the Minister, Deputy Harris, who cannot be here today. I agree with the Senator's concern that the figures have dropped, with an uptake of 87% decreasing to below 50% this year. I thank her for the opportunity to update the House on this important matter.

First, I note the concerns of families who believe their daughters have experienced adverse reactions and health issues after receiving the HPV vaccine. I know girls in my constituency who have experienced a very difficult time in the last number of years. No parent should have to see their child suffer. I assure these girls and their families that they are eligible to seek medical treatment for their symptoms. As the Senator mentioned, they should be provided with a clear pathway for any treatment they require. It appears that some girls first suffered symptoms around the time that they received the HPV vaccine, but this does not mean that the vaccine caused the symptoms. Negative publicity and misinformation are certainly affecting the uptake of the vaccine. We must ensure that people understand that the vaccine is safe and can save lives.

I will first present the facts.This vaccine protects against two high-risk types of the virus that cause 73% of all cervical cancers. It is estimated that HPV vaccination will eventually save 60 lives a year in this country. HPV vaccine safety has been monitored for more than ten years by many international bodies, including the European Medicines Agency and the World Health Organization. It has been found to be a safe and effective vaccination.

The HSE has been working with other stakeholders since early this year to counteract negative publicity and misinformation about the vaccine. The Irish Cancer Society has held two public meetings in Galway and Cork, two areas where uptake rates of the vaccine had reduced significantly. These meetings have included talks by a renowned international HPV cancer expert, Professor Margaret Stanley, as well as cervical cancer survivors and hospital consultants. The parents of first-year secondary school girls have been given revised information leaflets, consent forms and contact phone numbers for their local immunisation offices. Any queries they have concerning the vaccination can be addressed by the school immunisation team prior to vaccination day. In addition, girls who may have declined the first dose of vaccine will get an opportunity to receive this when the school immunisation team revisits the school. Information about the vaccine and its benefits has been circulated to all school principals, management bodies, the National Parents Council and general practitioners. Officials from the HSE have met representatives of the Department of Education and school management bodies.

Prior to the start of the 2016-17 school immunisation programme, there was a co-ordinated local and national media campaign involving the Irish Cancer Society, the HSE communications unit and the national cancer screening programme. This campaign stressed the importance and safety of the HPV vaccination. It is intended that the promotion of the HPV vaccine as a safe and effective vaccine will continue. The HSE plans to commence focus groups with parents in the near future. I take this opportunity to thank the dedicated people in all organisations who are working hard to improve the uptake of this important vaccine. They know how safe and effective this vaccine is, and I want to join them in encouraging all the parents of eligible girls to ensure their daughters receive this important cancer-preventing vaccine. The Department of Health has asked the HSE and HIQA to carry out a health technology assessment on the proposal to extend the HPV programme to boys. Any new recommendations in this regard will be considered.

Ivana Bacik (Independent)
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I thank the Minister of State for her very full reply. I know that, like the Minister, Deputy Harris, she has been very strongly supportive of the Irish Cancer Society and appreciative of the need to ensure there is increased take-up of the vaccination programme. While I join the Minister of State in expressing sympathy to the girls who have experienced chronic fatigue syndrome, and indeed to the families of those girls, I emphasise that the evidence says there is no link between that syndrome and this vaccination. Previous unfounded scares about vaccination programmes have exposed children to risk of death from measles, for example. This is very worrying.

I thank the Minister of State for setting out the position in respect of the public information and awareness-raising campaign. On 20 November last, an article by Susan Mitchell in The Sunday Business Postoutlined some of the issues that have arisen at public meetings in Galway and Cork and pointed out that there is a strong campaign to dissuade parents from taking up the vaccine. I think that is regrettable. It is important for public information campaigns to continue so that there is more public awareness every time a vaccination programme is proposed in schools. I think another stage of vaccination is due to begin in the spring. I hope we will see further raising of public awareness then. I will keep in touch with the Irish Cancer Society and endeavour in my own way to try to ensure this important issue for women's health is kept under review. I thank the Minister of State again for taking the time to reply to me.

Helen McEntee (Meath East, Fine Gael)
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I thank the Senator for raising this issue. As public representatives, we have a duty to encourage young women to take up this vaccine. As Senator Bacik said, it is possible that 40 women will die in years to come as a result of not taking the vaccine. There is an onus on those of us whose friends and family members who have been affected by cervical cancer to stress the importance of the vaccine. I outlined in my response a number of the actions that are being taken and have been taken to date. If the Senator would like further details in this regard, I can submit a request to make sure she is updated as the various events take place and as public information is disseminated.