Vol. 557 No. 6
8 Mr. Killeen asked the Minister for Health and Children the research which is being carried out into the possible effects of MMR and various other vaccinations on the number of children presenting with autism, Asperger's syndrome and attention deficit hyperactivity disorder; if there are plans to pre-test children or to delay vaccination; and if he will make a statement on the matter. [22792/02]
The Irish Medicines Board, IMB, is responsible for the monitoring and safety of all pharmaceutical products in Ireland. The monitoring of vaccine safety is ensured through clinical trials prior to licence and post-licence surveillance by the IMB. The IMB liaises closely with international bodies, including the European Medicines Evaluation Agency and the World Health Organisation.
Extensive research has, and continues to be, conducted world-wide in relation to the MMR vaccine. The World Health Organisation has indicated that MMR vaccine does not cause autism and that there has been no new scientific evidence that would suggest impaired safety of MMR.
The WHO strongly endorses the use of MMR vaccine on the grounds of its convincing record of safety and efficacy. The international consensus from professional bodies and international organisations is that MMR is a safe and effective vaccine and that the existing research and medical evidence do not support a causal link between MMR vaccine and autism or inflammatory bowel disease.
The institutions include the Medical Research Council Expert Committee of the UK, the UK Committee on Safety of Medicines, the Centres for Disease Control and Prevention, USA, and the American Academy of Pediatrics. Recent studies by the United States Institute of Medicine concluded that there is 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. A large Finnish study involving 1.8 million individuals demonstrated that no case of inflammatory bowel disease or autism was linked to the MMR vaccine. A similar Swedish study found no increase in cases of autism in the ten years during which MMR vaccine was introduced. A recent UK study where researchers analysed some 2,000 studies from 180 countries found no evidence of a causal link between MMR vaccine and autism or inflammatory bowel disease.
In recent weeks, the New England Journal of Medicine published details of a study of more than 500,000 children born in Denmark between January 1991 and December 1998 which indicated that the risk of autism was the same for children regardless of whether or not they were vaccinated with MMR. On this basis, there are no plans for pre-testing children or delaying vaccination.
Additional informationEarlier this year, newspaper articles alleging a link between MMR vaccine and autism referred to a study by Professor John O'Leary into measles virus. In response to these articles, Professor O'Leary issued a statement indicating that the research referred to in no way establishes any link between the vaccine and autism. He further indicated that he and his research team have consistently advocated the use of MMR vaccine to protect the nation's children from measles, mumps and rubella.
MMR vaccine is in use world-wide. Most countries implement a two-dose MMR vaccine programme and this policy has been very successful in controlling measles where high uptake of the vaccine has been achieved.
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 sound evidence for the use of MMR in the national programme.
The report of the Joint Committee on Health and Children on childhood immunisation, published in July 2001, concluded that there is no evidence of a proven link between the MMR vaccine and autism and that there is no evidence to show that the separate vaccines are any safer than the combined MMR vaccine.
In order to reassure the public as to the safety of MMR vaccine and to address the negative coverage on this issue, which adds to the confusion of parents in deciding whether or not to vaccinate their children, I launched a document earlier this year 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 addresses such issues as the alleged link between MMR and autism, the safety of the vaccine, combined versus single doses and contraindications to the vaccine.
Medical experts in my Department, in conjunction with relevant experts from the Irish Medicines Board, the immunisation advisory committee of the Royal College of Physicians of Ireland and the National Disease Surveillance Centre review the latest developments and studies in relation to this and other vaccine issues. These bodies also provide expert advice and guidance to my Department on an ongoing basis on all vaccine-related issues. To date, there have been no reputable and validated studies which indicate a proven linkage between MMR and autism. I am not aware of any studies that have demonstrated a causal relationship between other vaccines and autism.
The schedule of immunisation for the childhood immunisation programme is based on the recommendations and expert advice of the immunisation advisory committee of the Royal College of Physicians of Ireland. The committee is made up of experts from associated disciplines in paediatrics, infectious diseases, general practice and public health. The committee launched its revised Immunisation Guidelines for Ireland in October 2002 in which it addressed this issue and it has stated that there is no evidence to support any link between the MMR vaccine and the subsequent development of either inflammatory bowel disease or autism.
The guidelines are an invaluable source of information to general practitioners and contain a substantial amount of detail regarding age for administration of vaccines, contraindications, etc. General practitioners are aware of the contraindications to the recommended childhood immunisations and parents should discuss any concerns they may have with their general practitioner before making a decision about their child's immunisation. Where parents feel they would like to discuss their concerns further, their general practitioner may refer them to a paediatric consultant.
I urge all parents to have their children immunised against the diseases covered by the child hood immunisation programme to ensure that both their children and the population generally have maximum protection.
I thank the Minister for his response. However, would he agree that notwithstanding the various bodies he mentioned and the involvement of the Irish Medicines Board, we should not put the vaccination regime on such a pedestal or elevate it to a status where it is beyond question? Does he also agree that we should continue to monitor developments and ensure that the findings by the Autism Research Institute and other bodies are taken on board?
Does the Minister accept that parents of children should have access to whatever testing they consider necessary? One advantage of this is that they could decide what regime best suits their children who suffer from autism or these conditions. It will also help to dispel conspiracy theories which inevitably arise when people believe they are being denied access to the kind of tests which would determine the causes of their condition. In the context of the Minister's commitment to the vaccination regime this would be very helpful and it would to some extent address the lack of services available to parents of autistic children and others with conditions of this nature in at least establishing for them, in so far as it is possible, the causes of the conditions. It would also help to chart for them the kind of courses of treatment, educational provision or whatever else might be required for the children.
The only way we can professionally address this issue is on the available medical evidence. Any public health decision taken by the Minister must be grounded on the medical evidence available from studies that are peer reviewed and published. This kind of research is the key benchmark against which decisions are taken in this area. There is no international peer review publication of which I am aware that proves a causal link between the MMR vaccine and autism. The studies I have outlined are significant, as are the international bodies that endorse the vaccine. They should not be lightly dismissed.
In Ireland, Professor John O'Leary has made clear that the research in which he is involved in no way established any link between the vaccine and autism. He has further indicated that he and his research team have consistently advocated the use of MMR vaccines to protect the nation's children from measles, mumps and rubella. My Department has published a document entitled Measles, Mumps, Rubella – A Discussion Pack, which is an information guide for health professionals and parents. It was produced by the National Disease Surveillance Centre and the Southern Health Board and was published by the Health Boards Executive on behalf of the board. It sets out the facts regarding the most common concerns about MMR in a way that will help professionals and parents to explore them together, review the evidence and provide the basis for making an informed decision.
In all cases where parents are in doubt we recommend they consult their GP and, if they consider it necessary and their child's medical history suggests it, a consultant paediatrician. As Minister I have no hesitation in saying that given the strong international endorsement by reputable medical and research bodies, the MMR vaccine is a very important public health measure.
I am worried about the declining uptake of the vaccine. There was a measles epidemic in Dublin in 2000, involving 1,500 cases and three infant deaths, and there was an outbreak in Tuam in March and April this year with 20 cases. My main objective is to increase with the relevant authorities the uptake of the MMR vaccine. We do not have complete herd immunity from measles, mumps and rubella because our uptake rate is well below the recommended participation rates that would guarantee it.
I agree with the Minister's approach to what is a very worrying issue for parents. With regard to the tragic deaths from meningitis in the last few days, will the Minister indicate if the children concerned were infected with meningitis C and will he also indicate if there is any plan to accelerate the campaign to vaccinate children against meningitis?
Will the Minister ensure that the message he is giving on the danger of measles in particular, and the importance of the MMR vaccine is continued and put across, especially to the parents of young children? Perhaps he will comment on the report by the Oireachtas committee, which looked carefully at this issue and came out very strongly in favour of the MMR vaccination programme.
As somebody who works in the front line in this area I am well aware of the importance of vaccinations and I am glad the Minister has issued such a strong statement on the use of the MMR vaccine. According to figures before me, the HIP and hepatitis C vaccination programmes are an outstanding success. The Minister will be aware of that. However, an element of doubt continues on the question of autism and there has been a massive increase in the number of cases. We should question if there is a role by susceptible children within the herd, to use the word employed in this context.
The document to which the Minister referred has been very useful in general practice in convincing parents that MMR is a safe vaccine. I am glad he has issued such a strong statement and I hope the programme will accelerate because vaccination levels are dropping significantly.
Does the Minister agree that some of the studies, especially those by Dr. Andrew Wakefield and Professor John O'Leary, cannot be dismissed, despite the subsequent statement from Professor O'Leary? Does he also agree that the capacity to tell the truth on this issue is severely diminished by the likely compensation claims that would ensue should a link be proved?
Given the unprecedented rise in autism, does the Minister agree that there are many factors involved, including environmental and genetic causes? Does he also agree it is time to have a national survey to show what is the likely cause of the huge increase in autism?
We are gone beyond our time and perhaps the Minister could reply in writing to these matters.
I will do so.
Written Answers follow Adjournment Debate.
