The primary childhood immunisation programme provides for the immunisation of children under two years of age against a number of serious infectious diseases including diphtheria, tetanus, pertussis, polio, hib, measles, mumps, rubella and meningococcal C. The present arrangements were introduced in 1995 and involve general practitioners entering into a contract with their local health board for the delivery of the programme. Under the programme, parents may have their children immunised free of charge by the general practitioner of their choice.
Prior to the administration of any vaccine, including MMR, the contracting general practitioner should take an appropriate medical history of the child, provide pre-immunisation advice and information to the parent and examine the child. In addition the consent of the parent must also be obtained. General practitioners are aware of the contraindications to the recommended childhood immunisations and parents should discuss any concerns they may have with the GP before making any decision about their child's immunisation.
In order to reassure the public as to the safety of MMR vaccine and to address the negative media coverage on this issue which adds to the confusion of parents in deciding whether or not to vaccinate their children, earlier this year I launched a document entitled "Measles, Mumps, Rubella Vaccine Discussion Pack – an information guide for health professionals and parents." The pack was produced by the National Disease Surveillance Centre and the department of public health, Southern Health Board, and was published by the Health Boards Executive on behalf of the health boards. This document sets out the facts in relation to the most common concerns about MMR in a way that will help health professionals and parents to explore these concerns together, review the evidence in relation to MMR and provide the basis for making an informed decision. The pack also contains an information leaflet for parents. The pack addresses such issues as the alleged link between MMR and autism or inflammatory bowel disease, e.g. Crohn's disease, the safety of the vaccine, combined versus single doses, and contraindications to the vaccine.
The international consensus is that MMR is a safe and effective vaccine and that the recently published medical evidence does not support a causal link between MMR vaccine and inflammatory bowel disease or autism. The institutions involved include the Medical Research Council Expert Committee UK, the British Committee on Safety of Medicines, the World Health Organisation, the Centers for Disease Control and Prevention, CDC, USA, the American Academy of Paediatrics and UK professional organisations, the RCGP, the Royal College of Paediatrics, the Faculty of Public Health Medicine, the BMA, the Royal College of Nursing and the Royal Pharmaceutical Society. Most recently, the United States Institute of Medicine also concluded that there was no link between the vaccine and autism or inflammatory bowel disease. This consensus is based on large-scale epidemiological studies and more specific studies done in the laboratory setting.
The primary concern of my Department in relation to immunisation is that the vaccines in use are safe and effective. The Irish Medicines Board and the Royal College of Physicians of Ireland support the use of MMR on the grounds that it has been demonstrated to be a safe and effective vaccine. There is a sound evidence basis for the use of MMR in the national programme.
In relation to medical card entitlement, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. Eligibility for a medical card is solely a matter for the chief executive officer of the relevant health board to decide. In determining eligibility, the chief executive officer has regard to the applicant's financial circumstances. Health boards use income guidelines to assist in determining eligibility; however, where a person's income exceeds the guidelines, a medical card may be awarded if the chief executive officer considers that the person's medical needs or other circumstances would justify this. Medical cards may also be issued to individual family members on this basis.
Non-medical card holders can avail of the drugs payment scheme. Under this scheme, no individual or family unit pays more than €65 per calendar month towards the cost of approved prescribed medicines.
