Tuesday, 28 September 2021
Nithe i dtosach suíonna - Commencement Matters
Cuirim fáilte roimh an Aire Stáit go dtí an Teach. I welcome her back to our original Chamber. I tabled a similar Commencement matter last April and I will continue to table this one because of its importance. This is particularly so from a County Clare perspective given the late Laura Brennan was from Ennis. She did so much in her campaigning to encourage both parents and young people to take up the human papillomavirus, HPV, vaccine. At one stage take-up was in excess of 80%, which is remarkable, even from a European or worldwide perspective. As we move forward through the pandemic, we see vaccine hesitancy in the country is very low by international standards. We have take-up of well over 90% in the Covid-19 vaccination programme. I want to see us achieve 90% take-up in the HPV vaccination programme because it does save lives. As Laura Brennan said on a regular basis, this is the one vaccine that will save lives. It is proven, tried and tested. The research and the facts speak for themselves. Obviously the programme has suffered an interruption due to Covid-19 and schools being closed, as well as the difficulties and challenges associated with that. Nobody can blame anybody for that. That is just the way it was. There was a public health emergency and unfortunately, a lot of healthcare suffered, including the HPV vaccine roll-out.
I have a couple of questions for the Minister of State on the update I have sought. The first seeks a general update on where we are with the HPV vaccine now, including what the uptake levels are like, what the plans are and what the expected uptake level is. The second question is whether we are thinking outside the box with respect to rolling the vaccine out.Obviously, schools are the easiest and most straightforward way of doing this but there are people who are not caught through that approach, such as those who are being homeschooled. We have a network of vaccination centres that have delivered the Covid-19 vaccine very effectively. We need to see if other vaccines can be delivered through that network, now that the centres are up and running. The flu vaccine is an obvious one, as is the HPV vaccine. I have raised this matter before. I would like to know if any of the vaccination centres have been used. If so, I ask for some detail on that. If not, are there plans to use the vaccination centres, especially in areas in which there is a lower take-up of the HPV vaccine than we would like? Clearly, we want 100% of people to take it up, but if there are parts of the country in which the take-up is lower than in others, maybe we need to look at other interventions, such as using the vaccination centres.
The HPV vaccine catch-up programme has come to my attention on a number of occasions. People throughout the country have heard me raising the issue and have contacted me. If parents decide not to go ahead with the vaccine because they are hesitant, concerned or fearful and then change their minds after six or 12 months, they have to pay a €600 fee to get the vaccine from their GP. We should not be punishing people who decide, albeit late, that they want to do what is right in the interest of their children's health. Can the Minister of State give a commitment that we will waive that €600 fee? If we got that out of this debate, it would be a major achievement and would certainly help in increasing the uptake of the HPV vaccine.
I thank Senator Conway for raising this matter. We have spoken about it previously and I fully agree with everything he has said.
I will address the Senator's concerns under the three categories he raised, namely, the plan, the vaccination centres and the costings. In 2009, the national immunisation advisory committee, NIAC, recommended the HPV vaccination for all 12 and 13-year-old girls to reduce their risk of developing cervical cancer when they are adults. In September 2010, the HPV vaccination programme was introduced for all girls in the first year of secondary school.
In 2013, NIAC recommended that the HPV vaccine should be given to boys. On foot of NIAC's recommendation, my Department asked HIQA to undertake a health technology assessment, HTA, to establish the clinical and cost effectiveness of extending the current immunisation programme to include boys in their first year of secondary school. HIQA completed the HTA in December 2018, which recommended the HPV immunisation programme be extended to include boys in their first year of secondary school.
A policy decision was made to expand the HPV immunisation programme to include boys, starting in September 2019, with the introduction of the 9-valent HPV vaccine. The ages at which vaccines are recommended in immunisation schedules are chosen by NIAC in order to give each child the best possible protection against the vaccine. It is important to note that for the 2019-20 academic year, the uptake for the HPV vaccine was recorded at 82% for the first dose of the vaccine and 77% for the second dose. This was the highest uptake of the HPV vaccination programme since 2015-16 and is especially encouraging because it was the first year in which boys were included in the programme. It also shows that the provision of the vaccine in community clinics did not adversely affect the uptake.
The programme for the academic year 2020-21 was paused during the first few months of this year due to school closures and redeployment of the staff. The inputting of the uptake information for the schools-based programme was also delayed due to the redeployment of the administrative staff. However, community healthcare organisations, CHOs, have reported that the vast majority of second level schools had their first dose of HPV vaccine delivered between October and December of last year. The current record uptake rate for the HPV vaccine in the 2020-21 academic year is over 73% and the figure is probably higher because the administrative staff have not updated it.All CHOs have plans to recommence their school programme this month, which will see the continued roll-out of the HPV vaccine.
At the request of the Department, HIQA is conducting a HTA on a school-based HPV mop-up vaccination programme for those who were previously eligible and missed out on the vaccine. HIQA has confirmed that the HTA has been added to its work programme for 2021-22. I am told today that it is hoped that this work will be completed in the coming months. The Minister for Health, Deputy Stephen Donnelly, has requested that officials give consideration to the outcome of this work.
Senator Conway inquired about the use of vaccination centres and if HIQA would consider redeploying the centres where we have a low turnout for a once-off mopping up programme. In the context of mopping up, we are talking about children within school and college settings, but it also includes those aged under 24 who have moved on into workforce settings. The mop-up programme is not set in a particular area. We have a very broad lens when we are looking at it. I am out of time so I will answer the Senator's third question when I speak next.
It is very encouraging to hear the statistics the Minister of State has put on the record. I very much welcome the mop-up programme and the broad lens approach that is being adopted by the Department and the HSE because that is what we need to do. We must think outside the box and the Department is doing that.
I wish to inquire about the cost of vaccination for people who decided latterly to take up the vaccine, having not done so when the opportunity was initially available in schools. Unfortunately, if parents see the obvious health benefits of vaccination and decide to bring a young person who was offered the vaccine six or 12 months previously for the vaccine, the cost is approximately €600. It is punitive and does not encourage people to take up the vaccine. I hope the Minister of State will look at eliminating the cost because it would make vaccination far more attractive for people who were initially hesitant.
Just before I came to the House today, I met the Minister for Health, Deputy Stephen Donnelly, because I was taking this Commencement matter and the issue raised is a serious one. I have two girls and I have inquired about the cost of getting the vaccine. Senator Conway is correct; it is between €400 and €600. I want my daughters vaccinated but like many other parents, I would like to bridge the gap and bring the current vaccination rate of 73% or 80% up to 100%. We must ensure we make the vaccine available free of charge to all young people under 24 years in order that we have 100% take-up. By doing that, we will bring everybody with us. In addition, as Senator Conway correctly said, we have, in the vaccination centres, a system in place that means we do not need to reinvent the wheel. We can use these centres to help in the mop-up exercise. I was heartened to hear that the Minister is putting a package together, perhaps as part of his budgetary proposals, and HPV is part of it.