Mark Daly (Fianna Fail)
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I welcome the Minister of State, Deputy Feighan, to the Chamber. It is appropriate that he is with us as he is a former Member of the Seanad. He will be responding to all of the matters selected today.

Lynn Ruane (Independent)
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I thank the Minister of State for attending and for his ongoing work in his brief in the Department of Health. However, I would like the Minister for Health, Deputy Donnelly, to make an effort to come to the House in future. In the previous Seanad, the attendance record of Ministers with particular briefs was very poor and we will be pushing for them to attend the House. That is not a reflection on the Minister of State who is welcome.

My Commencement matter relates to the HPV vaccine. The reason I raise this issue today is that for some years, there has been contention surrounding the vaccine, including misinformation and campaigns that have caused huge concern about it. This has negatively impacted on uptake rates and the impact on disadvantaged communities has been much more significant than on other communities. This could be for a number of reasons, including inadequate access to information and peer reviewed research and to professionals who could be asked appropriate questions on the safety of the HPV vaccine.

I was surprised to learn in recent weeks that although we have a brilliant campaign and brilliant efforts and public messaging around the safety of the HPV vaccine, there is no scope for parents and children who change their minds and respond positively to that campaign to access the vaccine. Children who do not get the vaccine in their first year at school are excluded from the vaccination process unless the fee of €700 can be paid. Disadvantaged communities have had the biggest drop in uptake of the HPV vaccine. Should families respond positively to the public messaging and campaigns around the vaccine, they are basically excluded from a whole area of health and health equity, affecting their future health prospects.

In the 2019-20 academic year, the programme was extended to boys, which is a positive development. However, I believe the length of time that boys receive the vaccine is much longer than in the case of girls. A 2014 study in the Irish Medical Journalfound that disadvantaged schools had a 6% lower mean uptake rate of the HPV vaccine than other schools and were twice as likely to have an uptake rate of below 50%. The 2019 annual report of the Health Protection Surveillance Centre states that the national uptake of stage two of the HPV vaccination programme, which involves the completion of a two-dose course, was 64.1%, which is a slight increase on the 50% figure in the 2014 study.

On receiving adequate information, some parents in my community, including some of my friends, approached the HSE and asked that their daughters receive the HPV vaccine along with first-year students. These girls could be in third or fourth year, but the requests were refused. The parents then approached their general practitioners and were told that because GPs do not stock the HPV vaccine, a €700 fee would be payable in order to access the vaccine. As Senators can imagine, not many families have €700 to spare, particularly those in disadvantaged communities. I would like the Minister to reassess this policy and create avenues that will allow parents who positively engage with the HPV programme to access the HPV vaccine for their children, free of charge, while they are still in second level education.

Joe O'Reilly (Fine Gael)
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I, too, welcome the Minister of State to the House and congratulate him on his appointment. It is great to have a former Senator, with whom I had the pleasure of sitting in this House, back in the Seanad as a Minister of State.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Leas-Chathaoirleach for his kind remarks. It is always good to be back in the Upper House, even if it is sitting in the Dáil Chamber today.

I thank Senator Ruane for affording me the opportunity to speak on this very important matter. The immunisation programme is based on the advice of the National Immunisation Advisory Committee, NIAC. The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. It makes recommendations on vaccination policy to the Department of Health.

The NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the pattern of disease.Therefore, the immunisation schedule will continue to he amended over time. In 2009, the national immunisation advisory committee, NIAC, recommended HPV, or human papillomavirus, vaccination for all 12 to 13-year-old girls to reduce their risk of developing cervical cancer when they are adults. In 2010, the HPV vaccination programme was introduced for all girls in the first year of secondary school. The NIAC recommended that the HPV vaccine should be given to boys. On foot of these recommendations, the Department of Health asked the Health Information and Quality Authority to undertake a health technology assessment to establish the clinical and cost-effectiveness of extending the current immunisation programme to include boys in the first year of secondary school.

HIQA completed the health technology assessment in December 2018, which recommended the HPV immunisation programme be extended to include boys. A policy decision was made to extend the HPV immunisation programme to include boys, starting in September 2019, with the introduction of a 9-valent HPV vaccine. However, the HIQA reports published in December 2018 did not recommend an HPV catch-up programme for older boys for the following reason: vaccinating boys in first year of school provides the best possible protection against HPV infection and boys already benefit from indirect herd protection provided by the girls' HPV vaccination programme which started in 2010.

The ages at which vaccines are recommended in the immunisation schedule are chosen by the NIAC to give each child the best possible protection against vaccine preventable diseases. As the HPV vaccine is preventative, it is intended to be administered, if possible, before a person becomes sexually active, that is, before a person is first exposed to HPV infection. It is important to note that HPV vaccine has not been shown to have a therapeutic effect on existing infection or cervical lesions.

The gender-neutral vaccination programme targets all girls and boys in the first year of secondary school to provide maximum coverage. It should be noted that all vaccines administered through the school immunisation programme are provided free of charge. The Department of Heath will continue to be guided by the NIAC's recommendations on any emerging evidence in the future.

I have listened to what Senator Ruane has said about the brilliant safety campaign and to the fact that if people change their mind, they can be charged up to €700 and what she says makes sense. I will bring that back to the Department in order that it might be looked into.

Lynn Ruane (Independent)
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I thank the Minister of State. It would be great for that issue to be brought back to the Department. The idea that the vaccine is most effective at the age of 12 or 13 is based, and I am open to correction on that, solely on the idea that any person after that age may become sexually active and would reduce the levels of impact. That is based on assumption. It seems that giving access beyond first year was more about cost-effectiveness rather than that the giving of the HPV vaccine at any age will have some effect. This may be based on the inaccurate assumption that anyone who is looking for the vaccine beyond first year has become sexually active.

I will be happy to further engage with the Ministers and the Department to remove the barriers so that when the campaigns do succeed in helping people to receive the proper information, it is not only those who are privileged enough who protect themselves against cervical cancer but that health equity should be for all. It should be a right and we should remove any barriers for anybody who has positively engaged with the Department of Health’s campaign to reverse the uptake statistics, which have gone down very poorly every year until this year. I thank the Minister of State.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator. Vaccines are one of the most successful health interventions of all time. They have saved thousands of lives in this country and have helped make diseases like polio and smallpox, which previously caused devastation to families and communities, largely a thing of the past.

Cervical cancer is the fourth most common cancer in women worldwide and one woman dies of cervical cancer every two minutes. Almost all of the cases of cervical cancer can be attributed to HPV infection.

HPV also causes other cancers.For example, approximately 60 men and women are diagnosed with HPV-associated cancers of the mouth and throat every year in Ireland in addition to other HPV-associated cancers.

Thankfully, the introduction of the HPV vaccine has had a significant impact in many parts of the world and countries with high vaccine uptake rates have seen the highest impact.

I will take on board the point about the cost of access. There are differences of opinion between the national immunisation advisory committee, NIAC, and the Senator. The Department of Health takes its guidance from the NIAC but I will bring the Senator's concerns to the Department of Health and to the Minister.