On many occasions in the House I have drawn attention to the fact that the uptake of our childhood immunisation programme is only approximately 75%, despite the fact that the Department of Health and Children has set a target uptake of 95%. This is the level needed to ensure that the population as a whole is protected for nominated infectious diseases. We need to develop a phenomenon known as the herd immunity effect, that is the level of immunity in the population above which an epidemic cannot start. Once that level is reached the unvaccinated will benefit from everyone else's immunisation. However, unless a disease is eradicated from a population the risk of an epidemic arises if the uptake rate of immunisation drops.
I am alarmed by comments made by the director of the National Disease Surveillance Centre, Dr. Darina O'Flanagan, who has said that she had no doubt that unless we get our take-up rate up to the 95% within the next few years we can expect a major increase in the number of cases of measles. Many people think measles is a minor illness and in many cases it is, but in some children it can cause severe brain damage and one in 10,000 children who get measles will die from the disease. The figures from the Department of Health and Children for the take up in the various health board regions are: Midland Health Board, 68%; Mid-Western Health Board, 73%; Southern Health Board, 75%; Eastern Health Board, 76%; North-Eastern Health Board, 77%; and South-Eastern Health Board, 78%. These figures show that nationally one in four children of two years has not received the immunisation programme as desired by the Department of Health and Children. It shows that the policy has failed, that it is not a success and that it needs to be re-examined and revised if we are to avoid an epidemic.
The aim of the national childhood immunisation programme is to eliminate vaccine preventable diseases, including diphtheria, tetanus, whooping cough, polio, Hib disease, measles, mumps and rubella, by achieving the desired 95% uptake in the childhood population. Recent reports from the Eastern Health Board show an increase in the number of cases of measles for the month of January. Is this the tell-tale sign following a lower than desired uptake of the national immunisation programme?
A review group was established in 1993 to examine the low uptake problem. One of the recommendations of the group was that the GP was ideally placed to administer the immunisation scheme and should be the principal health professional involved in delivery. However, we are all aware of the difficulties which have arisen concerning implementation of the scheme. There was a dispute with the public health nurses who refused to implement the scheme for reasons which have now been resolved. They were not consulted on the development of the scheme. What has been done to follow up the position of those children who were not immunised at the time of the dispute? Apart from the low uptake, there was obviously a gap in the system at the time. I would like to be reassured that those children not contacted by public health nurses at the time have been followed up and have been immunised if the parents so wish.
I have asked questions on this matter on a number of occasions and have always been told that the health boards have put in place arrangements to evaluate and monitor the programme with a view to developing strategies to maximise the uptake. What monitoring of heath boards does the Department of Health and Children conduct to ensure that the maximum uptake is achieved? The Minister replies to my questions by saying it is a matter for the health boards, but if we have an epidemic, it will be a matter for the Minister.
It is important to treat the parents of young children with respect and to provide them with balanced information on the side effects or the adverse reactions. The advice from GPs to whom I have spoken has always been that it is safer to have children immunised and that there is evidence to that effect. However, I accept that, given information, people can make decisions for themselves. I am concerned that parents of young children are not contacted. A programme does not seem to be in place to contact all parents of young children to ensure that the children enter the immunisation programme.
Recently "Prime Time" covered the flu vaccine and highlighted the low uptake in the Dublin area. Only 23% of those eligible for the flu vaccine took it up. The fact that a GP had not contacted them was one of the main reasons given. Anyone who took the vaccine did so because their GP had contacted them or had explained the situation to them and they felt confident in taking the vaccine. It was not because they got a leaflet through the door or because they read newspaper articles or saw advertisements on television but because their GP contacted them.
What facilities are being put in place to bridge the gap between the national figure of 75% and the required figure of 95% to avoid an epidemic, which is looming, if we are to believe the director of the national surveillance?
