HPV Vaccine: Motion [Private Members]

I move:

“That Dáil Éireann:

recognises that:

- the Human Papillomavirus (HPV) vaccine protects young girls from developing cervical cancer when they grow up;

- vaccinating pre-teen boys also protects them against HPV-related cancers later in life;

- the Health Service Executive (HSE) estimates that 300 Irish women get cervical cancer every year, with up to 90 deaths; and

- according to official figures, over 220,000 Irish girls have safely received the HPV vaccine to date;

notes that:

- more than 200 million doses of the HPV vaccine have been administered worldwide, with no serious side effects scientifically attributed to the vaccine; and

- Australia, which was one of the first countries to introduce the HPV vaccine, has seen a 50 per cent drop in rates of pre-cancer of the cervix over the past decade;

unanimously supports the campaign to encourage parents to avail of the HPV vaccine for their children in their first year of secondary school; and

calls on the Government to further extend the HPV vaccination programme to include boys in their first year of secondary school.”

I appreciate the Minister of State, Deputy Daly, being in the Chamber for this motion. He could be here for a couple of hours. It is unfortunate that the Minister for Health, Deputy Harris, could not be here tonight for this debate. I am aware that he is very busy and I understand that. The Minister is aware of this issue. I have spoken with him about it on many occasions. I feel very strongly about it and this is why the Labour Party is using its Private Members' time tonight to put forward a motion to ensure greater uptake of the human papillomavirus vaccine, HPV, in part to protect children but more to ensure the vaccine is extended to boys. It is important that this happens.

The HPV vaccine is currently offered to 30,000 girls in their first year in secondary schools. The uptake of the vaccine has been at 50% due to many different reasons but in particular due to unfounded concerns of some parents in recent years, much of which went on social media. I am delighted to be able to say that due to work of the HSE, it is improving. We come in to the House and we criticise each other quite a bit, but in fairness to the Minister for Health, who has just arrived to the Chamber, I compliment him on the work that was done in the last year to increase the vaccine uptake to 62%. We still have a lot of work to do but this figure is very positive. There are, however, more than 11,000 girls who remain exposed to HPV infection and are at risk of HPV-related cancers and diseases in later life. Consequently, approximately 30,000 boys each year are also at risk due not being offered HPV vaccination.

There is a significant public health risk associated with not vaccinating both boys and girls against HPV. We need to get to an immunity level of over 80%. We have brought the motion forward because we believe it is a critical issue from a public health perspective and it needs to be progressed. As of March 2018, globally there are 84 government-funded HPV immunisation programmes, 18 of which are now universally vaccinating both boys and girls against HPV. Countries such as Canada, Slovenia, the United States, New Zealand, Australia and Italy are vaccinating boys and girls. Vaccination of boys and girls improves the effectiveness of national vaccination programmes and promotes greater health equality in the prevention of HPV-related diseases. Given the critical role that males play in the transmission of HPV infection, an effective way to achieve the greatest protection against cancer and other HPV-related diseases is to vaccinate adolescent males as well as females.

Programmes vaccinating boys and girls have been modelled to be more resilient than gender-specific HPV vaccination programmes, which enables the programmes to protect against a loss of effectiveness resulting from temporary coverage reduction. In the case of a drop-off in vaccination take-up it would be mitigated somewhat were both sexes vaccinated.

I draw the Minister's attention to the real issue - about which we have spoken at length - concerning his request to the Health Information and Quality Authority, HIQA, to conduct a health technology assessment, HTA, to extend the HPV vaccine to boys in the current programme. I hope the Minister agrees that this decision needs to happen pretty soon. The current timeframe for the decision means it would not be possible to start vaccinations until September 2019. Nationally, this would leave approximately 30,000 young boys without a HPV vaccination in the 2018-19 academic year. I am aware that HIQA is under pressure with regard to resources but I implore the Minister to use whatever influence he has to ask HIQA to bring forward the HTA as soon as possible. There is a lead time. The Minister and I are aware of this and anybody who follows this is aware of it. The lead time needs to be taken into account.

When it first commenced in 2010, the administration cost of delivering the HPV vaccination programme in Ireland was €3,785,000. This cost covered two cohorts - a single cohort in first year and a second catch-up cohort in the sixth year of secondary school. The uptake by young girls in the early years of the programme was extremely positive; we reached almost 82% in one year. Due to campaigns that were launched and targeted with misleading information about the vaccine, these take-up figures have dropped off.

Extending the HPV vaccination programme to boys would require an additional vaccinator visit to boys' schools. This visit could be done in conjunction with the programme that is already in place. This would create economies and ensure the programme is cost-effective. If we can get more than 85% of boys and girls taking up the vaccine then the programme would be more than cost-effective. In the long run, it would actually save money. The vaccine will save money once we can get the take up to a certain level.

If the Acting Chairman agrees, I would like to share five minutes of my time with Deputy Joan Burton.

I will now turn to the vaccine itself.

The manner in which the vaccine itself has been attacked by a number of different organisations and groups is very regrettable. It is irresponsible and the targeting of certain schools is not justifiable or fair because, in response, we have seen a difference in the take-up of the vaccine in disadvantaged schools. The HPV vaccine is completely safe and is endorsed by the Irish College of General Practitioners, ICGP, the Irish Pharmacy Union, the Irish Cancer Society and by major medical and scientific bodies worldwide, including the World Health Organization, the Centers for Disease Control and Prevention in the USA, the EU-funded European Centre for Disease Prevention and Control and the International Federation of Gynaecology and Obstetrics. Professor Grainne Flannelly, consultant obstetrician-gynaecologist at the National Maternity Hospital, has noted:

As a Consultant Gynaecologist I see all too frequently the impact of HPV infections and the reality of cervical cancer. The evidence for the vaccine is compelling. We have a very real possibility now of eliminating cervical cancer in future generations of Irish women. But to achieve that we need to maintain our momentum in addressing our uptake rates and continue to restore them to where they were [a number of] years ago.

We also need to extend it to boys. The universal HPV vaccine will have a dramatic impact on HPV and related cancers in men. HPV causes multiple diseases in males such as genital warts and certain cancers like anal cancer and skin cancers. The vaccination of boys in addition to girls will reduce the HPV-related disease burden in males and would allow a reduction in HPV-related cancer cases in females, compared with vaccinating females only. HPV transmission is higher from women to men than from men to women, suggesting a need for prevention interventions such as vaccination for men. Antibody response to natural HPV infection is lower in men compared with women and there appear to be differences between men and women in the efficacy of this response to protect against future infections.

Screening methods for cancers caused by HPV in men are currently not routinely available. The inclusion of boys in a national HPV immunisation programme is likely to reduce the impact of temporary changes in vaccine uptake. Though there might be an increasing HPV vaccine uptake nationally, there are regional variations, which mean that men are particularly vulnerable in areas where female vaccination rates against HPV are low. Mapping vaccinations show these regional differences and if one considers the evidence alongside the misinformation that is being spread across the country, one can see a correlation that is quite disturbing.

I have looked at the success of immunisation programmes in other states. Australia introduced its national HPV vaccination programme in 2007 and recent research suggests it will eliminate HPV-related cervical cancers in the future. Over 9 million doses of the vaccine have been given to girls and young women in Australia. There has been a 92% reduction in the HPV types that are responsible for almost 75% of cervical cancers. There has been an almost 50% reduction in the frequency of high-grade cervical abnormalities in girls in the state of Victoria aged between 18 and 21.

In Scotland, researchers have found a 90% fall in levels of the human papilloma virus in women since the vaccine was made available. In Sweden, a nationwide register-based study included the entire Swedish population of girls and young women aged between 13 and 29 and showed that the vaccination was effective against high-grade cervical lesions in real-life settings. It has a dramatic impact in the prevention of cancer.

We should all support this and be very positive about it, as it can prevent cancer in future generations of girls and boys. We need to improve the rate at which vaccinations are given to girls and we need to extend it to boys in the coming months. Almost every sexually active man and woman in Ireland will get HPV in their lifetime. For many people, HPV clears up on its own but for others it can cause certain cancers and disease like cervical cancer. Ireland has one of the highest rates of cervical cancer in western Europe, and that is the key message we need to take home from this. An estimated 420 cancers were caused by HPV in Ireland each year in the period between 2010 and 2015 and an average of 178 men and women die from HPV-related cancers in Ireland every year.

Currently, 18 countries globally, including large countries, provide successful universal vaccination programmes. They are supported and promoted by national organisations and world regulatory bodies. In Ireland, the National Immunisation Advisory Committee, NIAC, recommends that HPV vaccines be given to males as soon as possible. The vaccination of boys is particularly important in the context of herd immunisation, given that the disease can be transferred from male to male, and it will protect gay men into the future. The National Sexual Health Strategy 2015-2020 calls for an extension of the HPV vaccine and the National Cancer Strategy 2016-2025 states that the vaccine should also be available for men between the ages of 16 and 26. It expresses the belief that international evidence supports its roll-out and that it should be done as soon as possible.

We brought forward this motion to raise the level of awareness of the need for the vaccine to be taken up by more girls in order that we can get back to where we were a number of years ago, at over 80%, and thus to ensure young women and young men are protected into the future. We need to push on with putting the vaccine in place for boys as soon as possible as this can reduce the volume of different cancers that are becoming prevalent in the absence of bringing this in thus far. I implore the Minister to ensure that the Health Information and Quality Authority, HIQA, brings in its assessment on the vaccine as soon as possible because the timeframe is critical. If it does not bring it in until September 2019, as is currently projected, some 30,000 boys will not get the protection, which will ensure men and women will end up with cancers that could easily have been prevented.

Approximately 20 years ago, my very beautiful, lovely, happy, first cousin Marie became ill with cancer of the cervix. After what seemed like a very short period, that is, a couple of years, and an awful lot of suffering which she bore very bravely, she died and left her three boys behind to be reared by their father on his own. This is a very common story of what happens to women, particularly women who are younger or in the middle stages of life when their children are still dependants, a time which in many families is probably the best for a couple and their children.

As we know, families cope and no matter how awful the situation is, they carry on for the children. It is very hard to lose one's partner, wife or mother to such a killer disease. Although treatment has progressed, as any cancer specialist will tell us, it is still a very difficult disease that no parent would wish their child to be at risk of developing. In all the debate, it may not have really got through just how difficult this cancer can be and how devastating it is for a family to lose usually a mother as a result of it.

I did not know much about cervical cancer until my cousin lost her life to it. My aunt Kay, Marie's mother, knew even less and, to be honest, we were all bewildered, particularly her children and her husband. Some 20 years later, we do know much more and we know that it is possible to be vaccinated against this potentially killer disease. While the cure rates and treatment have improved and the hospice service in Ireland has improved, it is far better if we can vaccinate people so that the risk of getting this killer disease is very significantly reduced if not completely wiped out. The vaccine is highly effective, as Deputy Kelly said. If it is made available to boys, this will reduce the infection rate and the death rate.

This is not a party political issue of any kind. We are putting this motion forward because I suspect that many of us in this Chamber know at first hand - whether it is a relative, a friend or a neighbour - women who have lost their lives to this very difficult disease. I know that parents worry about their teenage children, particularly nowadays in the context of social media information. The evidence is compelling that using the vaccine will enable the public health system in Ireland, possibly, over a period of time, to almost totally eliminate this killer disease. We know this because it has happened in other countries. To parents who will be thinking about this coming up to a new school year in the autumn, I ask them to please think of all the Maries in Ireland who lost their lives to this killer disease, and to think that 20 years from now, they will want their current teenager to be protected against it.

I thank Deputy Alan Kelly for putting down this very important motion. I genuinely believe it is one of the most important Private Members' motions we have had in this House in long years. As Deputy Burton eloquently said, it is not a party political pop or a motion to score points. It is providing the House with an opportunity to unite and send out a very important, powerful message that all of the people's representatives stand behind our doctors and our immunisation programme, and stand behind debunking the myths. I really hope all Deputies on all sides of this House will unanimously support the Labour Party's motion. The most important line in the motion is the one calling on Dáil Éireann to support unanimously the campaign to encourage parents to avail of the HPV vaccine for their children in their first year of secondary school. I certainly hope there is no Member of this House who would have any difficulty with supporting that call. It is also a very important motion in the sense that it gives me an opportunity to update the House on where we are currently and where we would like to be in the future in respect of boys as well.

I thank Deputy Burton for sharing her own family story in respect of her late cousin, Marie. That makes it very real. This is a very real and painful situation that has been experienced by so many families, and we have a way of preventing it. It is so important that we all do everything we possibly can in this regard. I think we all know that immunisation is regarded as one of the safest and, indeed, most cost effective of all health care interventions. It is also one of the most effective ways a parent can protect the health of their child. The childhood immunisation programmes in Ireland have had a huge impact in improving the health of Irish people. Diseases that used to be common in this country and around the world such as polio, measles, diphtheria, whooping cough and many other serious infectious diseases are now preventable thanks to vaccination. I am proud to note that the uptake rates for many vaccines included in the childhood immunisation programmes are close to the WHO recommended uptake target of 95%. However, we must continue to work so that uptake rates for all childhood vaccines do not just meet but exceed the WHO target.

It is important that we remember why this issue is so important. Worldwide, cervical cancer is the fourth most common cancer in women and HPV immunisation is an important part of our childhood immunisation programmes, which protects women from developing cancer later in their lives. Cervical cancer impacts the lives of a large number of women in Ireland every year. It is the second most common cause of death due to cancer in women aged from 25 to 39 years. Mortality from cervical cancer in Ireland is above the European average. In 2018, more than 90 Irish women will die from cervical cancer. A further 280 women will need intensive treatment such as surgery, radiotherapy or chemotherapy to help them overcome invasive cervical cancer. Unfortunately, four in ten of these women will die within five years. A further 6,500 women will need hospital treatment to remove precancerous changes to the cervix. The average age of diagnosis is 46 years and the average age of death is 56 years.

Treatment is very dependent on a number of individual factors. Where exactly the cancer is detected, whether it has spread, how abnormal the cancer cells are - these are just some of the factors that a treatment team will have to consider. Doctors can draw on a number of different forms of treatment to treat and manage cervical cancer. If the cancer is diagnosed early, these treatments usually have a good outcome. However, if the cancer presents later or is more aggressive, outcomes can be less favourable.

We are all aware of the old saying that prevention is better than cure, and this is especially true when it comes to cervical cancer. That is why in September 2010, the HPV vaccination programme was introduced for all girls in first year of second level schools. In 2011, a catch-up programme commenced for all girls in second level school and was completed in 2014. Uptake rates for this vaccine peaked at 87% in 2014-15 but have fallen since then.

There are two licensed HPV vaccines available in Ireland, Gardasil and Cervarix. Gardasil is the vaccine used by the HSE in the schools immunisation programme. It provides protection against two high-risk HPV types that cause 70% of cervical cancers and pre-cancers, and two HPV types that cause 90% of genital warts. It has been licensed worldwide since 2006 and is used in over 25 European countries, the US, Canada, Australia and New Zealand. To date, over 227 million doses have been distributed worldwide. In Ireland, over 730,000 doses of the vaccine have been distributed and more than 238,000 girls have received the full vaccine course.

The introduction of HPV immunisation has had a significant impact in many parts of the world. Countries with high vaccine uptake rates have obviously seen the highest impact. In Scotland, where 90% of girls have been vaccinated since 2008, there has been a 90% fall in HPV infections in vaccinated girls. Pre-cancerous growths of the cervix have been reduced by more than 50% in countries such as Australia, which is referenced in the motion, Sweden and Scotland. Finland recently published the evidence that HPV immunisation protects against invasive HPV associated cancer.

One of the reasons we need this motion is that unfortunately, in recent years, the spread of inaccurate mistruths and misinformation concerning the safety and effectiveness of the HPV vaccine in the media, particularly on social media, has had a significant impact on uptake rates. If parents are worried tonight about getting factual information about a vaccine, I urge them to get it from a doctor. I beg them not to get it from a public representative who might like to be a doctor but is not, or from anonymous accounts on social media.

We have a doctor in the House - Deputy Harty - who, I am sure, will tell us that this is a very safe vaccine. It is supported by the medical community. I take my medical advice from doctors and other medical professionals. There is one Irish website that is WHO-accredited for information about this vaccine, and that is www.hpv.ie. Parents requiring factual information should have a conversation with a doctor or check out that website.

Misinformation is not harmless. It is not something that is a bit irritating or annoying. It is dangerous; it causes death. It will cause the unnecessary deaths from cancer of Irish girls. The responsibility for that must rest with those in this House who advocate against a vaccination programme. If a person advocates against a vaccination programme, he or she is doing so in the knowledge that all of the WHO evidence suggests that the vaccine is safe and that it saves the lives of girls. That is backed up by our medical community. The fall in take-up rates to 50% in 2016 will result in 1,000 girls requiring invasive therapy, a further 100 developing cervical cancer, which will require life-altering treatment, and the deaths of at least 40 from cervical cancer who did not receive the HPV vaccine. These are numbers, but they represent real girls in parts of this country who are going to require invasive treatment or who will die as a result of not getting this vaccine.

It is very important that we passionately unite to fight back and combat the misinformation. One of the most important things we can do is provide accurate and credible information. I am encouraged by the fact that the HSE launched a very effective campaign to raise public awareness in conjunction with the medical community and an alliance of health care professionals. I thank Deputy Kelly for his kind words about the HSE in that regard. As a result, we have seen the take-up rate increase this year to 62%. We have a long way to go to get back to the 87% coverage we previously had, but I welcome the reversal of the trend.

Two weeks ago, I had the great pleasure of joining with the HSE to launch phase 2 of the new campaign. I want to pay particular tribute to an amazing girl called Laura Brennan, who has just turned 25 and who is from County Clare. Laura has incurable cervical cancer and she contacted the HSE to say that she wanted to front this campaign and spread the word to girls and women of her age, and to mothers, that this vaccine is important and can save lives. I want to thank Laura and her family for their generosity and for the power of her story, which can be seen via the HSE's social media portals and also through its advertising campaign.

I am aware that this House is also discussing the matter of extending the immunisation programme to include boys, who are currently not offered the vaccine. It should be remembered that our understanding of HPV as a cause of cancer originally concerned cervical cancer, and that much of the early work focused on the introduction of HPV immunisation programme for this purpose. There was a large amount of evidence at that time to show that HPV immunisation was effective in preventing the development of cervical cancer. However, there was less evidence available at that time that there was a health benefit to boys. Consequently, it was decided that the vaccine would be offered solely to girls. In recent years, there has been increasing evidence to show an association between HPV and other cancers, found both in men and women. Indeed, the evidence of a link between HPV and these cancers has become stronger. I am aware that 17 countries have already adopted a universal, gender-neutral vaccination policy.

There is a process in place to enable me, as Minister for Health, to make decisions concerning changes to our immunisation programmes. The national immunisation advisory committee, NIAC, makes recommendations on immunisation policy. This is an independent committee of the Royal College of Physicians of Ireland and is comprised of experts in a number of specialties. NIAC's recommendations are based on the epidemiology of the relevant vaccine-preventable disease in Ireland. The HIQA conducts health technology assessments, HTAs, to establish the clinical effectiveness of any proposed changes. I have asked that HIQA carries out a HTA. I share the Deputy's view that it should be concluded as quickly as possible and, subject to a favourable HTA, I will prioritise this motion in terms of seeking to extend this vaccine universally.

I thank Deputy Kelly and the Labour Party for its leadership on this and I look forward to all colleagues uniting to send a strong, unanimous message in support of this life-saving vaccine.

This is a timely motion because of the efforts of the past number of years to increase the take-up of the Gardasil vaccine in girls due to the fact that there was a major fall-off, as outlined by previous speakers, in recent years. That fall-off happened in large part due to concerns that were raised through social media and by parents of girls with chronic fatigue syndrome and other types of symptoms they associated with the Gardasil vaccine. However, the empirical evidence is quite clear, and we can only make policies in this Chamber that affect not only the health but the lives of people based on such evidence. If one looks at the international reviews of the various HPV vaccines, it is clear that it is very safe and that it saves lives. In this country alone, it will save the lives of 90 women every year. The fact that there was a drop-off in the take-up of the Gardasil vaccine will cost women their lives in the years ahead. We have to be very honest when we say that. Misinformation being put out on social media, for whatever reason, has an impact in the sense that a reduction in the take-up means that there will be severe consequences for a certain percentage of women in the years ahead, as outlined by the Minister.

The motion, sponsored by Deputy Kelly, is timely. It allows to us again show our commitment to the vaccine as a public health policy initiative and to encourage the greater take-up of it. We have been involved for a while on an ad hoc, cross-party basis in recent times to help increase awareness levels of the vaccine and to get parents and youth organisations involved in discussing this issue to ensure that there is at least a knowledge of what it is about. We have to let them know that much of the information available on social media describing the damage the vaccine can cause is misinformation, is incorrect, and, in some cases, is being sponsored by people who are opposed not only to this vaccine but to vaccines in general. That issue has to be addressed and challenged on a continual basis.

The WHO's commentary on the vaccine demonstrates its safety quite clearly. There have been approximately 200 million doses of the vaccine administered across the globe. It is without question an exceptionally safe vaccine. We have to accept not only the WHO's findings but also the evidence from the vast majority of the countries using the Gardasil HPV vaccine. These are First World countries with First World health systems. There are checks and balances in their health services. The countries using the vaccine include Australia, Canada and most European states. We can be very confident in that context that there are very thorough checks and regulatory assessments of vaccines before they are administered. The context of the monitoring of the vaccines and the impact they have on the impact of the health of the various populations is something we can take comfort from.

The reason there was a fall-off was due to a campaign against the vaccine. When there is no proactive response to such a campaign the misinformation becomes the information of the day. If there is no rebuttal, it can gain traction and can take on a certain element of credibility. We have made the point at the Joint Committee on Health and at the cross-party meetings we held to try to highlight the need to increase the take-up of the Gardasil vaccine that said vacuum cannot be allowed to exist for long from a public health policy point of view. I believe that for a period we were lethargic in challenging the particular information that was circulating concerning the impact that Gardasil vaccines have on the health of young girls. There is no doubt that there is a cohort of people who are absolutely convinced that their child was or is damaged because of the Gardasil vaccine. When there is no response to or engagement with that and these particular cases are allowed to come to the fore in social media and then in mainstream media, the public health policy of trying to get as many young girls to get this vaccine is undermined. It was a big mistake, from a public health perspective, not to challenge and not to engage with the individuals who had concerns. The amendment tabled by Deputies Wallace, Clare Daly and Pringle indicates that this is of concern. We should learn the lessons from that particular episode.

Reference has been made to the new campaign that has begun. This motion will help that. Laura Brennan's story was also mentioned.

It demonstrates the stark reality that people discouraging the uptake of this particular vaccine, for whatever reason or motivation, will impact on women's heath in the years ahead. It will cost people their lives, and we know that for a statistical fact. When people talk about this particular issue and their concerns, they have to realise at the back of their minds that the empirical evidence is clear and concise. This is a very safe vaccine.

The reason for this motion is not only to encourage the uptake of the Gardasil vaccine among the female population, but also among the male population. We all know that herd immunisation is what we want, that is, the point where a critical mass of people have taken the vaccine. I implore the Minister of State, the Health Information and Quality Authority, HIQA, and those who are doing the assessment to move quickly to ensure that this is also rolled out to boys throughout the country. Where it has been rolled out in other countries, it has had a meaningful impact in reducing harmful cancers among the male population. As I said, we are aiming for cross-immunisation and herd immunisation. For all those reasons, I compliment and concur with the motion. I urge people to engage positively with the information published by the national and international public health authorities, and accept that this is a safe vaccine and that it does and will save lives.

I also compliment Deputy Kelly and the Labour Party on bringing forward this Private Members' motion. I hope that they get the unanimous support of the Dáil. Unanimous support is not something that often happens here, so I wish them good luck.

When I was first elected, I met with several parents who had genuine concerns about the vaccine because of the chronic fatigue syndrome from which their daughters subsequently suffered. I listened to their case and I was very sympathetic to what they experienced. However, a presentation on the issue was given in the AV room several months later. What got the issue very clearly over the line in my mind was that in Australia and in Finland, studies were taken out on the frequency of chronic fatigue syndrome prior to the human papillomavirus, HPV, vaccine being administered. They were then able to compare data to the vaccinated population. As it turned out, the incidence was no higher or lower. It was exactly the same. As such, there is nothing to scientifically support a link between chronic fatigue syndrome and the vaccine. Moreover, the incidence of chronic fatigue syndrome in males, who do not get the vaccine, is at the same level. The evidence really does stack up.

It will save 90 lives per year, and that is something of which we have to be very cognisant. In 2010, when the then Minister for Health and Children, Mary Harney, refused to cover the cost of the vaccination programme, I remember calls for her resignation. It is amazing that an entire population can be outraged at the failure to provide funding for a vaccine, but five years or six years later the uptake has fallen from 90% to around 60%. We need to get the uptake to more than 90%. We need to get the male population vaccinated and develop what is commonly called "herd immunity" to get rid of this very serious and life-threatening cancer. Once again, I compliment the Labour Party for putting this forward. It has my full support, and I hope the full support of the rest of the House.

I am delighted to see this motion before the House and I compliment Deputy Kelly. Each year in Ireland more than 6,500 women need hospital treatment for pre-cancer of the cervix. Some 300 women get cervical cancer, and ultimately 90 women die from it each year. Cervical cancer is caused by the HPV and we must trust the full spectrum of Irish health professionals, the World Health Organization, WHO, the Irish Cancer Society, the chief medical officer and the general medical advice which confirms that the HPV vaccine can be used and can save lives.

It is clear however, that there is unease about the potential side effects among many parents of girls who are due to receive the vaccine, notwithstanding the absence of any clinical proof of such an impact. That unease needs to be addressed to save lives. Just this evening I spoke with a mum from Ballyjamesduff. Her daughter received the vaccine and she claims that her daughter has acquired chronic fatigue syndrome as a result. If we are serious about saving lives, it is most important that the Minister, the Minister of State and their Department engage in a sympathetic and conciliatory way with those parents who feel that they did not get the correct information at the time, or that they were in some way uninformed about the vaccinations their daughters were about to receive.

Countries with high rates of uptake of the vaccine have seen the greatest impact. In Scotland, 90% of girls have been vaccinated since 2008. In Australia, where the vaccine was first introduced in 2007, the vaccine has prevented one in every two new cervical cancers. There has been a 90% fall in HPV infections in vaccinated girls, even better results than were anticipated. Information, and lots of it, along with less misinformation, will be critical if we are serious about ensuring that the girls of the future continue to get this vaccination. I know there is a lot of work to be done in terms of catching up because we have seen a fall-off in uptake. Coincidentally, the mum that I spoke to tonight talked about boys. I know Deputy Kelly raised that point in his initial address and vaccination should be made available to boys. That will also be critical in moving this matter forward

I support vaccination for the HPV and the benefits it can bring to young girls, young women and boys. My colleague said that we must trust the Health Products Regulatory Authority, HPRA, the European Medicines Agency, the HSE and all of our physicians, and of course we want to do so. It is not a case of scaremongering or anything like that, but I remember when many of us here in this House and the Seanad, where I was at the time, as well as wider society, trusted the International Monetary Fund, IMF, the European Commission, the Economic and Social Research Institute, ESRI, the Organisation for Economic Co-operation and Development, OECD, the ratings agencies, and most economists of the day. We paid a very heavy price in this country for not listening to dissenting voices. While we cannot ignore expertise and knowledge from all of these great organisations, it would be foolish in the extreme for us to effectively dismiss those people who are suffering symptoms which they believe are connected in some way to this vaccine. There are other vaccinations like Pandemrix, as well as issues with Lyme disease and so on, around which we could listen more to dissenting voices and do what we can to embrace the needs of those people.

The patient information leaflet which accompanies Gardasil 1 effectively states that 2.3% of patients suffered severe side-effects. For Gardasil 9, which is the newer model, that figure is 2.5%. That proves that there are serious side effects, because their own patient information says as much. Among those serious side effects are swollen glands, joint pain, unusual tiredness, weakness or confusion, chills, generally feeling unwell, leg pain, shortness of breath, chest pain, aching muscles, muscle weakness, seizure, bad stomach ache, bleeding or bruising more easily than normal, skin infection and fainting.

In Ireland, there have been 1,100 reports to the HPRA of serious side effects. There have been 20,000 reported in Europe and 84,000 worldwide. The people concerned are not dreaming this up. I have outlined the symptoms they are feeling. They are listed in the patient information leaflet for the very drug, yet we are choosing not to embrace the fact that, here in Ireland, approximately 400 young girls are complaining about these issues. As I said, there have been 1,100 cases. We are giving them paracetamol and telling them to go home and that the problem is in their mind. We are telling them to see a physician or shrink and not to be talking down what is, in effect, a very useful and good vaccine.

As I said, I am in favour of vaccines and I am in favour of a vaccine for this disease. In Denmark, the authorities have ceased to use the drug in question. In Japan, they have stopped using public vaccination. It is only available privately now. This very week there was a conference on this matter in Japan at which Ireland was represented.

Let me return to the dissenting voices. There has been a lot of discrediting by those associated with mainstream medicine. I have been shown tweets, Facebook posts and so on from established names we see on television in this country effectively abusing the people affected and their families, who are struggling in very difficult times.

Some of the responses to parliamentary questions that were passed on to me — I am not sure whether this was by the Minister of State, Deputy Catherine Byrne, or her colleague — state the Government is putting in place an established pathway for the people in question. It is stated the HSE is currently working to put in place a clinical care pathway appropriate to the medical needs of this group. The group is called REGRET, as many will know. What stage are we at in this regard? Are we providing meaningful treatments to those concerned? Are we providing medications to them? Are we providing financial support where some have had to go abroad for treatment, to the Czech Republic and elsewhere?

Just because we listen to dissenting voices does not mean we are rubbishing an entire treatment. We have learned our lessons financially in this country from not listening to them in the past. I beseech the Minister of State not to let those dissenting voices fall on deaf ears. As stated in the patient information leaflet, the side effects are real and acknowledged by the company.

The figures for cervical cancer and the HPV vaccine in this country are quite stark indeed. Every year, over 6,500 women need hospital treatment for pre-cancer of the cervix. We learn that a woman is diagnosed with cervical cancer almost every day. Almost two women die every week from it. Those figures speak for themselves. Cervical cancer is caused by HPV. The HPV vaccine, which since it was introduced has protected girls from developing cervical cancer when they grow up, has done a great job. The HSE has offered the vaccine to all girls in first year in second level schools since 2010 to protect them from cervical cancer in adulthood. Over the past two years, we saw a downturn in the number of girls who took up the offer. This is mainly because of unsubstantiated claims that have been made associating the vaccine with a number of conditions experienced by the group of young women. It is very important to state there is no scientific evidence that the vaccine causes any long-term illness. Reports of such claims led to a significant drop in the uptake rate of the vaccine, from 87% to 50%, meaning that a large cohort of girls is now at risk of developing cervical cancer later in their lives.

Last week, the HSE launched the next phase of the vaccine information campaign, which aims to support parents in making an informed decision. This coincides with the return of the vaccination teams to second level schools. It is important that parents take the opportunity to listen to the information campaign, which started on 22 March on radio and on digital and social media. It features videos of individuals who volunteered to become involved.

When we examine the evidence from Australia, which is one of the first countries to introduce the HPV vaccine, we note it has seen a decrease of more than 50% in rates of pre-cancerous conditions. It is important that we take all this on board and support parents in making the right and informed decision.

I thank Deputy Alan Kelly and Members of the Labour Party for introducing this motion. We will be supporting it.

There can be no equivocation. The HPV vaccination programme and information campaign must be supported, and it must be supported by all of us. We have to lead by example on this.

Cervical cancer is the second most common type of cancer that affects women worldwide. It is linked to a sexually transmitted infection with the HPV. Ireland sees 6,500 cases of pre-cancer of the cervix each year. The Irish Family Planning Association has shown that approximately 300 women per year are diagnosed with cervical cancer and 90 of these women will die from that illness. Thankfully, many such deaths should become a thing of the past because of the HPV vaccine. It is right that we should extend that protection to boys as well as girls.

Owing to the immense dangers of the HPV, the vaccine is offered to girls in their first year in secondary school. The move by the HSE in offering a catch-up facility for girls to obtain the HPV vaccine where they have missed it is very timely, particularly given that we experienced a significant drop in the vaccination rate.

The vaccine is the most effective protection against two types of the virus, which cause over 70% of cervical cancers. It also protects boys from cancers and from HPV transmission. The vaccine is recommended by the HSE, the World Health Organization, the International Federation of Gynaecology and Obstetrics, the National Immunisation Advisory Committee and the Irish Cancer Society, among others. The medical evidence supporting the HPV vaccine is overwhelming. The research is global as well as national. As head of the National Immunisation Office, Dr. Brenda Corcoran said the vaccine is one of the most studied ever and that all evidence shows that there has been no increase in any longer-term illness after the vaccine.

For proof of the success of the vaccine, we need only look to Australia, which is referred to in the motion. Australia was one of the first countries to introduce the vaccine and it has seen a 50% drop in the rate of pre-cancer of the cervix over the past decade. In Scotland and Sweden, pre-cancerous growth of the cervix has been reduced by more than 50%. That is the benefit of the vaccine and that is why it should be made universally available.

I commend the HSE for working hard to combat misinformation on the vaccine and for the new information campaigns that have been launched. I join others in offering my thanks and praise to Laura Brennan, who has been involved in the HSE's information campaign. Those who may be unaware of Laura should note she is suffering from terminal cervical cancer. She was diagnosed in 2016. In January 2017, she began rounds of radiation and chemotherapy, and tests later confirmed she had the all-clear. Sadly, the cancer returned and Laura said her only option now is palliative chemotherapy to extend her life. Let me quote what she had to say about the vaccine:

I made contact with the HSE after I had been diagnosed with terminal cervical cancer. I'm only 25 but there is no treatment that will cure my cancer, only treatment that will now prolong my life. I didn't get the HPV vaccine – it wasn't available in schools when I was a teenager so my parents didn't have the choice. The reality is that now there is a vaccine that protects girls from getting this horrible disease. No parent wants their daughter to get cervical cancer. If anything good comes from my situation, I hope that parents consider this – get the facts, get informed and make the decision to get their daughters vaccinated. The HPV vaccine saves lives. It could have saved mine.

The bravery of this young woman is an inspiration. If sharing her story encourages one parent to get his or her child vaccinated, it will be a success.

Precaution and vaccination against cervical cancer through the HPV vaccine are very important. It is the best way to protect against cervical cancer.

It is important that our health system reacts to cervical cancer and has world-class diagnostic services. CervicalCheck Ireland does great work and provides free smear tests in certain categories. It is life-saving work and the doctors and nurses who operate at its coalface deserve great credit for the way in which they have grown and improved the service, in particular over the last decade. I call on the Government to ensure that free cervical smear tests are provided to all women, including those who may not be in a high-risk category. It is important that our system does not discriminate on the basis of age-old preconceptions about sexual activity and risk. Recently, it was relayed to me by a friend that she had been charged €80 for a smear test because she was over 60 years of age. It is important at all ages to keep women informed. The collective measures of vaccination and smear testing are important as they give us the chance to protect women and work towards eradicating cervical cancer. It beholds public representatives to support health campaigns which aim to improve the health and well-being of people across the State. The HPV vaccination programme and its associated information campaign do that.

Where the medical evidence as to the benefits of a vaccine are as apparent as they are overwhelming, we must defer to that medical evidence and to the medical professionals. Let us not forget that across this country and the world diseases which used to be common, including polio and diphtheria, measles and whooping cough, to name but a few, can easily be prevented by vaccination. One of the most important things we can do is support the provision of accurate and credible information to enable parents to take fully informed decisions about the HPV vaccine. We know the HPV vaccine works and saves lives. The vaccine not only contributes to cervical cancer reduction, it addresses other cancers associated with the virus which affect both men and women, including anal, genital and throat cancers. The HPV virus is also associated with the development of penile cancer and causes genital warts in both men and women. Therefore, I support the motion's call for the Government to further extend the HPV vaccination programme to include boys in their first year of secondary school. Again, I cite Australia, which introduced the vaccine for boys and girls in 2006. Since then, there has been a 90% reduction in the number of cases of genital warts in men and women reported. Vaccination against HPV can help to prevent these sexually transmitted infections and cancers for boys as well as girls. I am happy to note that Sinn Féin will support the motion. We see support for any public health campaign which aims to improve the health of our people as essential.

I rise to speak in support of the motion as well as in defence of science. However, I wish also to set out why I think many ordinary people might have a distrust of that science. Vaccination saves lives, as many other Deputies have said. Along with the advent of modern sanitation and access to clean water, vaccination is responsible for saving millions of lives globally. Stephen J. Gould, the renowned scientist, wrote a great essay in which he referred to the death of the daughter of Charles Darwin. Mr. Gould made the point that when people sought to wax lyrical about the golden age of past centuries, he reminded them that, thanks to modern medicine, most of us in the west enjoyed a privilege never before vouchsafed to any human group. He pointed out that our children will grow up; we will not lose half or more of our offspring in infancy or childhood. He said we will not have to sing the song of the death of our children. One sees in old graveyards the headstones of young children struck down in childhood in pandemics and epidemics as well as by diseases of poverty and lack of access to clean water. They died from diseases which today are almost eliminated, including smallpox, polio, yellow fever, diphtheria and measles. We must begin by celebrating the fact that modern medicine has made great strides. We must think before we cast doubt on the efficacy of vaccination what we are actually saying and what the consequences of raising those doubts will be for the lives of people. I start, therefore, by celebrating the fact that millions in this generation do not have to sing the song of the death of their children.

The biggest problem we face globally is the lack of access of so many children to medicines, clean water, sanitation, vaccinations and, often, the food which could save millions of lives. According to the World Health Organization, the number of measles-related deaths decreased by 79% in the 21st century up to 2014. Measles vaccination has played a key role in reducing child mortality. As to the HPV vaccine, we know that more than 90% of cervical cancers are caused by HPV, a disease which killed 270,000 girls worldwide in 2012, while 10% of women have required invasive treatment for a pre-cancer over their lifetimes. Numerous studies show that the HPV vaccine is extremely effective against this virus and has the potential to reduce dramatically the incidence of cancer and to save untold lives. One study in Scotland found a 90% reduction in HPV among young Scottish women. The director of Scotland's HPV reference laboratory says these new findings indicate that the positive impact of the HPV vaccine may be even greater then was initially thought. He says the data demonstrate collectively the significance and continued benefit of HPV vaccination programmes in Scotland which have achieved a consistent and high uptake of approximately 90% in 12 and 13 year old girls.

While we will support the motion, that does not mean the families of girls who experience the onset of illness and other long-term health problems should be sneered at. As the amendment proposes, the HSE should engage with those families and girls. In all honesty, the HSE should engage with every group of people who have concerns about their health and the health of their children. The HSE should engage and look after those who suffer from disabilities and who need access to proper health care. Witness those who were outside the gates of Leinster House today who have been grossly disappointed by the removal of the protocol from the United Nations Convention on the Rights of Persons with Disabilities which we ratified last week. There are huge issues with the way in which the makers of Gardasil Merck have collected reports on adverse reactions as well as with the methodology they have used. There are issues with the European Medicines Agency. People have a right to question big pharma and to seek answers about their children's health.

However, people may distrust science and scientists for the same reasons they distrust instinctively many in authority. They distrust the economists who tell them they must accept cutbacks or that a vital public service cannot be funded. They distrust the Ministers who tell them they must accept this or that extra charge on their wages because there is no alternative. Scientists tell those who are disappointed with authority and the misuse of power that they must use this or that vaccine and confusion can easily arise with opposition to authority generally. However, when all of the evidence points to the fact that the vaccine saves lives and prevents suffering, we have a duty to be careful about how we pose questions. My understanding is that much of the illness and many of the effects of which young girls complain can occur in the same age bracket as the age at which the vaccine is administered. This is what parents are concerned about. That does not mean the vaccine caused those ill effects. However, parents might connect those ill effects with receiving the vaccine and they have legitimate questions about the timeframe. We must understand their concerns and answer them without dismissing them and without categorising all of their questions as irrational or anti-science. I have been struck, however, by how sneering and dismissive many who call themselves scientists and defenders of rationality can be. We have a right to question the actions of big pharma and its obsessive drive for profits. We have seen these companies put profits before people's lives and health in the past.

Telling people to trust scientists who show them contempt and who do not engage is not how we should do this. We can defend science and the advances of modern medicine while pointing out that the pursuit of profit and corporations are at the heart of a lot of these serious consequences. We can point that out and campaign for a better health service, better access to life-saving medicines and better oversight and accountability of corporations. At the same time, we must support and defend the medicines and vaccines which all peer review shows effective to prevent life-threatening illnesses.

For that reason, we will be supporting the motion and, indeed, the amendment to the motion that the vaccine should be available to young boys as well as young girls. It has had an amazing effect on reducing cancer in young girls. I welcome the motion.

I move amendment No. 1:

(a) To insert the following words after "decade;":

“— a number of individuals who have received the vaccine have experienced severe health problems in the time period after receiving the vaccine;"


(b) To insert the following words after "secondary school; and":

"calls on the Government to:

— instruct the HSE to engage with those who have experienced health problems in the time period after receiving the HPV vaccine in order to determine the cause of that damage;

— ensure proper medical and other support is available to those who have suffered health problems in the time period after receiving the HPV vaccine, whatever the ultimate cause of that damage;

— fulfil the programme for Government commitment to put in place a scheme, on a no-fault basis, that will respond to the needs of people with disability arising from vaccination;"

I will concentrate my remarks on the amendment.

I very much welcome the opportunity to discuss this issue today. Like everyone else, I think we must start from the point that vaccinations have made an enormous contribution to public health around the globe. They have transformed the situation for ordinary people, particularly the vulnerable. That is critical. Such recognition does not mean, however, that in the minority of cases where people will have an adverse reaction to a vaccination there is not a certain responsibility to deal with those people. I think there is, and, in fairness, the programme for Government recognises that also when it calls for the long awaited and long-lobbied for national vaccine injury compensation scheme. Let us be clear that if we want people to support vaccination programmes and overcome their concerns, the best way of achieving that is to provide such a scheme. It is proven that it would have an impact on increasing rates of participation in schemes and have a far more positive outcome in that regard than the manner in which much of this debate has been conducted so far not in this House tonight, but in society over the past period. People who have raised doubts, asked questions and have seen their loved ones suffering ill effects having received a vaccination have been vilified and demonised for asking those questions. This is abhorrent, and it is increasingly becoming a mark of discourse in society not only on this issue, but a number of others.

My daughter is celebrating her 18th birthday today - I said I would try to get that on the record at some stage. She received the vaccination along with many others but some of those girls, whose parents also trusted and who also received the vaccine, unfortunately, are perhaps not in such good health as they were previously. I am not saying that is connected with the vaccination but nobody can say positively that it is not. What we can say with absolute certainty is that severe health problems exist in those young girls. All the amendment calls for is that the health service engages with them and their families to determine the cause and also to support them in their medical care. Critically, it calls on the Government to fulfil the programme for Government commitment to introduce a no-fault vaccination scheme. If we did that, we would make this society much safer and improve vaccination rates.

In 2001, the Oireachtas health committee recommended that such a scheme be put in place. Eight years on, the vaccine damage steering group stated that there is an onus on the State to look sympathetically at the very rare number of cases where children suffer serious adverse reactions as a result of vaccination. The group followed that up by stating that this should be through a no-fault compensation scheme. Such a scheme operates in 19 countries worldwide. It reflects the fact that it is fair and reasonable that a community that is protected by a vaccination programme accepts responsibility for and provides compensation to those who are injured by it.

The numbers may be small. Figures from the US no-fault scheme show that for every 1 million vaccine doses eligible for compensation that were distributed between 2008 and 2016, the court compensated one injury. At one in 1 million, the number is small but that does not mean it is non-existent. Depending on the gravity of the disease in question, obviously, receiving a vaccine is far less dangerous than remaining unvaccinated. The tetanus vaccine, for example, causes a life-threatening allergic reaction in at most 0.0006% of those who receive it, while the fatality rate from tetanus is 13.2%. From the point of view of public health, it is far better that people are vaccinated, but some are injured by it and we need to take steps to deal with them.

It is inevitable, when one is giving a drug to hundreds of thousands of people, that small numbers will not react to it well. We know what happened in the Pandemrix situation which caused narcolepsy in some recipients. It happened with the three-in-one vaccine administered in Ireland in the 1970s which caused brain damage in a very small number of cases. Other vaccines caused less serious injuries.

On the rare occasions where things go wrong, the State has a responsibility to mitigate it. The alternative is that families are forced to slog their way through litigation which drags on for years, at enormous stress to them and enormous cost to the State. We are seeing exactly that happening with the Pandemrix cases right now. There is no argument whatsoever that Pandemrix caused narcolepsy in some of those who received it. There is a proven and accepted link between the two. Despite this, the first compensation claim for damage by the drug, which the HSE continued to administer after knowing there was a proven link between Pandemrix and narcolepsy, has not even been allowed to start in the courts. That is because, 16 months after an order for discovery of documents was made by the High Court in November 2016, the HSE has not yet complied in full. This is outrageous. Individuals debilitated by narcolepsy as a result of being given a drug that the HSE knew caused a serious illness should not have to fight for years to be compensated. It is unspeakable as far as I am concerned. That is why the no-fault vaccine scheme was recommended by so many health committees. That is why, I presume, it is in the programme for Government.

Another reason it is urgent is that if one is brought in, it would increase vaccination rates. That will be the positive impact of it. What is happening with Pandemrix will not instil confidence. In fact, it will make parents doubt the HSE and believe the State is circling the wagons and is not taking any responsibility for its action by stating one should trust it and all will be well and good.

There is no sin in admitting that in a small number of cases - one in a million or fewer - somebody will suffer damage from a vaccine. I accept people are bad at understanding risk. People are more afraid of flying than they are of driving when everybody knows it is far more dangerous to drive than to fly but that does not mean one denies the small risk involved, and it does not mean one should not drag people through years of litigation. No fault compensation schemes are critically important. They will make it easier for everybody. They will make vaccinations much more acceptable and protect public health in that regard. In that sense, the amendment is an important addition to the motion.

We move to the Rural Independent Group, Deputy Michael Collins.

I am happy to be able to speak on this motion this evening. There has been much controversy over this topic and I have had a number of concerned parents come to me in my constituency clinic in west Cork and here in the Dáil about it.

I believe it is up to individual parents to choose whether they want to vaccinate their daughters. It is not fair that the HSE and the Minister for Health are pushing it down their throats. Many parents have genuine concerns but they are being totally ignored. The head of the HSE went as far as calling them "emotional terrorists". Frankly, that is appalling.

Many young girls and their families have serious concerns about the reaction to and side effects of this vaccination, but they have been totally ignored. I ask the Minister of State, Deputy Catherine Byrne, to walk in the shoes of these parents who have watched their daughters' health deteriorate since getting the vaccination.

I will speak in favour of this motion. The human papilloma virus, HPV, causes cervical cancer and a vaccine to prevent such a cancer is welcome. HPV is sexually transmitted and, therefore, it makes absolute sense that both boys and girls should be vaccinated against this virus. This would have two effects. First, it would reduce the transmission of the virus; and, second, it would reduce male associated cancers, which are cancers of the rectum, the genitalia, but also head and neck cancers. The incidence of these are increasing dramatically and often are associated with HPV. For those reasons, it is very important that the vaccine is delivered to both boys and girls.

The vaccine will not prevent all cancers. It is an important message that not all cervical cancers are related to HPV and it is important that women continue to attend for cervical screening and have cervical smears to pick up cancer.

Cancer of the cervix is slow-growing. There is a cancer prevention programme for those between the ages of 25 and 60 years. It is very important that, even though they are vaccinated against the virus, girls should continue to attend for cervical smear tests because not all cancers are prevented by this vaccine. The reason is that not all cancers are virus-related and not all sub-groups of the virus are contained within the vaccine. We must be careful that we do not give people a false sense of security.

There have been reports of side effects or, more accurately, adverse reactions or possible adverse reactions to the virus. They are real and, as Deputy Clare Daly said, we must have a programme to give people compensation if they are deemed to have these very rare side effects. We should not dismiss that out of hand. There is no such thing as never and there is no such thing as always in medicine. We must be vigilant that the vaccine could be related to serious adverse reactions. That said, the HPRA, NIAC and the WHO have cleared this vaccine and we have to accept that. Nevertheless, we do need to monitor any potential side effects.

Cancer is a desperate disease that affects so many people. Having attended the funerals of so many young women who have passed away because of cancer, I would certainly advise people to have the HPV vaccine. There is a lot of weight behind its approval. I have to acknowledge the people I have met, young girls who have had an adverse reaction to this vaccine. It really did affect them. I met many of them on my travels during one election campaign. Those people have to be acknowledged and their concerns must be addressed. When they present with side effects, they need to be helped. I am asking the Department to ensure that they get help when they present with adverse reactions.

I am glad to be able to speak to this motion this evening, which I am not supporting. I will be supporting Deputy Clare Daly's amendment to the motion.

I have concerns about the vaccine as it has been rolled out in recent years. I have met countless families with daughters who have had adverse reactions to the vaccine. They cannot prove it but it is a big coincidence. There are nearly 500 families in Ireland who are very concerned about the state of their vibrant, sporting, capable and able daughters, who, having had the vaccine, are literally lifeless. They cannot say that the vaccine is definitely the cause but it is too much of a coincidence. They are traumatised, have lost out on school, have lost out on friends and participating in activities. I know one girl, Monnie, who was a very able horse rider at 12 or 13 years. She could do anything with a horse she could tackle them, pet them, ride them, jump them and everything else and now she is barely able to walk. She is now travelling around the world to try to find a treatment. There are huge efforts. My wife and I made the decision that we would not allow our daughters to get the vaccine. It is a personal decision for any family. People should tread with caution. We have seen the might of the pharmaceutical companies. I have seen it in Tipperary but it is evident all over the world and it is an issue.

Tomorrow, an international speaker will be here to address this matter. The 500 families whose daughters are affected have formed an organisation and are lobbying. They are entitled to do so. Any of us would lobby if our child was very seriously ill. For the people to whom I refer to be told by the CEO of the HSE, Mr. O'Brien, that they are emotional terrorists is outrageous. When I told the Minister that Mr. O'Brien should at least be reprimanded - he should have been sacked - the Minister stood up and said that he was right. How can a person say that about concerned parents? Any of us would die for our children. How could anyone accuse parents of being emotional terrorists. The emotional terrorism is going on day in, day out in the hospital wards, with their queues and the trolleys, as my colleagues alluded to earlier. Sleep deprivation is a war crime. I have said this before. People are denied sleep in trolleys and chairs in emergency departments sometimes for 36 hours or it could be three full days or longer, where they cannot sleep for noise, lights and everything else. If this was a war situation, they would be referred to the Hague for war crimes. For the Minister to stand up in the Chamber and say that Mr. O'Brien is right is outrageous. If he had any moral respect, he would also resign. The 500 families are just concerned and raising issues. They are not well-off or well resourced, and they are entitled to have their concerns without being described as emotional terrorists. It is outrageous and I hope that the Minister of State will correct the record this evening and perhaps give them some solace.

I thank Deputy Kelly for drafting the motion on behalf of the Labour Party and I acknowledge the widespread support of practically everyone in the Chamber who has spoken. It was almost everybody, which is very welcome. That is really important. As Deputy Bríd Smith observed, the concept of vaccination has saved millions of lives around the world.

The motion relates specifically to the HPV vaccine and its extension to boys. The background is that the percentages of take-up among girls who were being offered it in schools had fallen to 50%. Thankfully, it has now increased back up to 62% but it needs to be much higher. Examples from other countries show take-up rates high as 90%. We have to continue that we ensure that we get the rate up as high as we possibly can in this country and that we extend the vaccine to boys.

Deputy Harty just gave very strong medical evidence for why we should extend it to boys. The fact is that boys get cancers that are preventable through use of the HPV vaccine. They also transmit cancer to girls and women in later life. The importance of extending the vaccine to boys is very scientifically evident and I am glad the Minister has accepted that on behalf of the Government. However, we do need to address the issues which have been raised here by some Deputies here in respect of adverse reactions. I hope I am quoting Deputy Fiona O'Loughlin correctly when she said that there is no scientific evidence that the vaccine has long-term adverse effects. People acknowledge that there are a small number of adverse reactions and we need to be respectful of the parents who have recognised adverse reactions in their daughters. However, difficulties arise when that becomes a lobby which actually discourages people from having the vaccine. It is at this point that we must be clear and unequivocal that we advocate and encourage parents to ensure that their girls are vaccinated and, when the programme is extended, that their boys are vaccinated too. That is why I am very disappointed by Deputy Mattie McGrath indicating that he will not support the motion. One can be respectful and recognise parents who have concerns but when one transfers that into advocating for people not to be vaccinated, then one does a really strong disservice.

Several speakers referred to Laura Brennan who has cervical cancer which has no treatment, or rather she cannot be cured of it but treatment could prolong her life. She is a very vibrant young woman who should have a whole life ahead of her but the vaccine was not available when she was of the appropriate age. She was quoted in full earlier but I want just read one sentence into the record, namely, "If anything good comes from my situation, I hope that parents consider this – get the facts, get informed and make the decision to get their daughters vaccinated". People have quoted facts from the various bodies, including the Irish College of General Practitioners, the Irish Pharmacy Union, Irish Cancer Society, the HPV Alliance, major medical scientific bodies worldwide, including the WHO, the Centers for Disease Control and Prevention, the EU-funded European Centre for Disease Prevention and Control and the International Federation of Gynaecology and Obstetrics.

They are just some of the bodies that have endorsed the vaccine. It is therefore quite clear that the scientific evidence for the positive effects of this vaccine is overwhelming. That is the message we need to get out there. As public representatives we have a very strong duty to encourage parents in every way we can to take the positive approach to this, to get the vaccine and to prevent the spread of cervical cancer. We know that 300 people per annum are diagnosed with cervical cancer. That is one of the highest rates in the world, so we clearly have a problem. While I welcome the progress that has been made, we need to make an awful lot more.

I also support those who have talked about other screening. Deputy Harty talked about the need to continue to have cervical screening even when one has had the vaccine. I have had cervical, breast and bowel screening myself and I encourage everybody to do so. We need to encourage people to take up offers of screening. The extension of these various screening programmes over recent years is very positive and we need to continue that extension.

People have talked about the eradication of disease. There are people living in this country who have what is called post-polio syndrome, but there are not people with polio because of vaccination. There is also vaccination for other diseases such as diptheria, tetanus and so on. The measles, mumps an rubella, MMR, vaccine has also been the subject of some controversy. In my constituency there is an outbreak of measles. It is in one particular part of the city and it is affecting quite a large number of people. The HSE has now extended its vaccination clinics. I attended a briefing a couple of days ago at which public representatives raised the issue of extending the clinics to after office hours and the HSE has agreed to do so. That is happening because of this outbreak of measles. This outbreak is a direct result of people being discouraged and not taking up the MMR vaccine. Measles is a serious disease. Public campaigns against general vaccination have serious consequences. I believe "herd" is the word used, but there certainly needs to be a broad uptake for there to be a public health benefit that saves people's lives.

The most important thing is obviously saving people's lives and giving people quality of life, but preventative medicine such as this, and public health in general, also prevents people taking up space in hospitals. We all know the problems of overcrowding. The whole argument around preventative health measures has to be constantly on the agenda because it is probable that not one of us does enough to ensure that we stay as healthy as possible. One of the most effective and in some ways easiest way in which to do that is to ensure that we avail of all of the various screening and vaccination programmes that are available.

Ultimately we have to depend on the scientific evidence. Deputy Daly raised issues of previous controversies around vaccinations, but the message today in respect of this particular vaccine and the associated public health programme has got to be absolutely unequivocal and clear that this vaccine has a positive effect and that it saves lives. It saves a very large number of lives when one considers the number of people who contract cervical cancer in Ireland. It is really important that we send out a positive message in that regard. That is why I welcome the very broad support for our motion today and the public health campaign that the Department and HSE have been continuing with. It behoves all of us in political life to support that and to continue to speak out on these issues.

On behalf of the Minister, Deputy Harris, and myself I thank all those who contributed to the debate on this motion. I also thank Deputy Alan Kelly for bringing this very important motion to the floor. As a mother and grandparent I am very conscious of the fact that I have four daughters, four granddaughters and two grandsons. I want what every parent and grandparent wants, to make sure that their children and grandchildren get the best of what our health service can offer and that includes vaccination and everything else. I agree with Deputy O'Sullivan on what she said at the end of her contribution about it being so important that women and men avail of the services that are there, particularly the screening services for breast cancer and bowel cancer and even smear tests. As a mother and as somebody who has had most of the tests available to me I know how important it is to continue to make them available to people.

A number of issues were raised. I cannot comment on some of them because I do not have the reply in front of me. I will comment on two of them. Deputy Kelleher raised one issue. I remember that, at the time when Deputy Kelleher and myself were on the Joint Committee on Health, we met parents who said that their children had been affected by the vaccination. It was very emotional for everybody on the committee to listen to the stories that were told. All of us who are not medical professionals, GPs or otherwise in the business of health have to rely on what is being said by the professionals, who are the GPs, and on the scientific evidence.

Deputy MacSharry and Deputy Daly raised the issue of the clinical pathway care approach to the medical needs of this group. I have no further update on this but to say that the HSE is definitely working on it at present and as soon as some information becomes available to the offices of the Minister, Deputy Harris, and myself, it will become available to all the Deputies here.

I will continue on with some of the notes which I have been given. I know that the Minister, Deputy Harris, covered some of them in his opening statement but I will go back on some of them myself. Cervical cancer impacts the lives of almost 7,000 women in Ireland every year. In 2018 more than 90 Irish women will die from cervical cancer; a further 280 women will need intensive treatment, such as surgery, radiotherapy or chemotherapy; and another 6,500 women will need hospital treatment to remove precancerous changes in the cervix. Some 99% of cervical cancer is caused by persistent infection of certain high-risk types of human papilloma virus, HPV, which is acquired during sexual contact. HPV vaccination prevents this.

In September 2010 the HPV vaccination programme was introduced for all girls in first year of second level schools. In 2011 a catch-up programme commenced for all girls in second level school and this was completed in 2014. Gardasil is the vaccine used by the HSE in the schools immunisation programme. It provides protection against the two high-risk HPV types that cause 70% of cervical cancers and pre-cancers and the two HPV types that cause 90% of genital warts. In Ireland nearly quarter of a million girls have received the full vaccine course. However, uptake rates for the HPV vaccine peaked at 87% in 2014-15 and have dramatically fallen since then. The main focus of the programme is to increase HPV vaccination uptake rates in girls.

One of the most important things we can do is to provide accurate and credible information to enable parents to make a fully informed decision concerning HPV vaccination. The HPV vaccine information campaign helps parents access trusted sources of information. The initial evidence suggests that this campaign is having a positive effect with provisional figures showing uptake rates having increased by 11% to 62%. I concur with the many Deputies who have said that this increase is not enough. Many spoke about herd immunity. Until a few weeks ago I had never heard how important it is to reach 90% to ensure that people are covered. It is important that we, as public representatives here in the Dáil, do everything we can to promote that fact and to encourage parents to continue to have their children immunised.

I know that many parents have concerns, as did I when I was having my children vaccinated, but we depend on our GPs and the medical professionals around us at the time. We had an incident in my family in which one of my family members had a severe reaction to a vaccine but thankfully that family member has recovered and is now living a normal life. That does not always happen and I share the concerns which some parents raised at the Joint Committee on Health when I was on it.

In recent years, increasing evidence has shown an association between HPV and other cancers found in both men and women. The evidence for a causative link between HPV and cancer has become stronger. The process to enable an informed decision concerning the extension of the current HPV immunisation programme to include boys, underpinned by objective and scientific evidence, is already under way. HIQA is undertaking a HTA, at the request of the Department of Health, on extending the national immunisation schedule to include HPV vaccination for boys. The HTA will establish the clinical basis and cost-effectiveness of providing the vaccine to boys. I hate to use the word "cost-effectiveness", but I understand things are already beginning to happen in this area and we must wait until the evidence is back. The Government is supportive of the intentions of the motion but, as has already been said, we await the completion of the HTA later this year, which is the appropriate way to approach this.

The HSE immunisation teams have started their second round of visits to secondary schools. I again encourage the parents of all eligible girls to ensure that their daughters receive this important vaccination. I thank all Deputies for the varied contributions they have made this evening. It is unfair of anyone to come into this Chamber and make - I will not say an accusation - a comment that we do not care as parents. I certainly care as a parent but I also care as a politician about what we put in place.

I thank all the Deputies who contributed to what has been a really important and powerful debate. I thank my colleague, Deputy Kelly, for drafting the motion on behalf of the party and placing it before the House. It is my hope and expectation that it will pass without dissent, and perhaps that will still be the outcome of the debate.

One of the greatest advances by humanity was the harnessing of the power of vaccination to combat disease. Throughout our history, the scourge of viruses and bacteria has devastated people across the globe. Epidemics and plagues were a constant fear. Through the application of centuries of scientific research, we, as a species, have been able to combat dozens of diseases that once routinely killed millions. The success of these efforts should not be forgotten, and we will continually search out new ways to defeat diseases that so often were a constant threat to our very survival as a species. However, in some ways the success of vaccination has inured us to how radical a development it still is in preventing disease.

This history is important for us to remember. When Edward Jenner used cowpox material to inoculate against smallpox in 1796 and publicised his findings throughout the then known world, he began the process of eradication that officially achieved, in 1980, the eradication of the once dreaded disease of smallpox. It was the first disease to have been fought on a global scale, and millions of human beings have been spared the horror of smallpox as a result. In 1885, Louis Pasteur's rabies vaccine added to our arsenal against yet another lethal disease. Progress accelerated in the 20th century with Salk's vaccine for the debilitating polio virus, while vaccines were developed to combat tetanus, anthrax, typhoid, tuberculosis, diphtheria and more. Even in our own folk memory, we can recall the horror of the word "tuberculosis". Generations of Irish people were horrified by the notion of tuberculosis and those who suffered from it were avoided.

One of the greatest successes has been in combating childhood diseases such as measles, mumps and rubella, dangerous diseases that have nearly been eradicated in many areas. However, the false concerns raised about a link to autism saw rates of vaccination plummet. The consequences of this have been, as my colleague, Deputy Jan O'Sullivan said, renewed outbreaks of a potentially lethal disease in our country. Therefore, we really must be vigilant and clear about these matters. To quote the director of the European Centre for Disease Prevention and Control, "It is tragic and unacceptable that 49 children and adults in EU countries have died from complications of measles infection in the past two years, while safe and effective vaccines are readily available." Despite Andrew Wakefield's 1998 report linking MMR and autism being disproved, surveys have shown that up to a third of parents still automatically link the vaccine with autism.

People will always be concerned about the risks of vaccines, or indeed the risks of any medicine or treatment. As Deputy Harty rightly said, there is no such thing as completely risk-free treatment of any kind. However, the risks must be constantly balanced by the enormous benefits that can come from proven treatment. Millions of people are alive because of vaccination.

The 2008 Nobel Prize in Physiology or Medicine was jointly awarded to Harald zur Hausen for his work on identifying HPV as a cause of cervical cancer. His discoveries in the 1970s and through the 1980s were groundbreaking as they went against the dogma of the time on how cancer was caused. There are more than 100 types of HPV, 15 of which put women at a high risk of cervical cancer. More than 5% of all cancers worldwide - I ask the House to think about this - are associated with HPV. On foot of the fact that HPV is the most common sexually-transmitted disease, affecting anywhere from 50% to 80% of the population, it was this pioneering work to link it to cancer that gave us the real chance to protect us against all these cancers. Science builds on the work of others, and from that original research a vaccine was developed. That vaccine now provides greater than 99% protection from infection from the most high-risk strains, namely HPV 16 and HPV 18, as well as two others.

This means that the vaccine as used in Ireland, Gardasil, is effective, as my colleague, Deputy Kelly, said, against seven out of ten of all cervical cancers. Deputy Burton indicated how awful a disease cervical cancer is, how cruel a disease it is for young women in particular - for all women - and asked why, if we have a method of preventing it in seven out of ten cases, we would not advocate it from the rooftops. The more people who are vaccinated, the lower the levels of cancer and the lower the risk to the population as a whole. In populations among which the vaccine has been widely adopted there has been, as speaker after speaker has indicated, a major drop in the levels of cervical cancer. The most progressive countries use it and have proven its effectiveness. We want the vaccine extended to boys in their first year of secondary school because they too can develop HPV-associated cancers in later life. Extending the HPV vaccine to boys makes common sense and medical sense. The evidence for this is to be found in analyses carried out across the globe in countries such as Australia.

The HSE campaign to promote the HPV vaccine is under way. I welcome the take-up figures. They are slowly rising, with an 11% increase, as the Minister has said, to 62%, compared to 51% last year. The figures on HPV and Ireland are stark. Speaker after speaker has told us this. Some 300 women in Ireland will be diagnosed with cervical cancer this year, 90 of whom will die. These are enormously tragic occurrences for all the families involved. I urge all those concerned to consult the HSE website to ensure they get the facts that are grounded in medical truth. Misinformation must be tackled. The brave personal testimony by Laura Brennan, who has terminal cervical cancer, should be listened to by all who are concerned or worried about the vaccine. She is taking part in the HSE's campaign, as others have said. Her bravery should be acknowledged and her words listened to.

Our objective in putting this motion before the House is certainly not party-political.

There is no party-political advantage in this. That is because we really regard it as one of the major health issues of our time. If we can succeed in winning over the vast majority of the people to accepting this, we can put a lethal disease into the category of smallpox and largely eliminate it. We will not eliminate it entirely because we do not have a vaccine that is 100% effective yet, but we can reduce it in so many cases.

Earlier, I referenced the 2008 Nobel Prize. That same year, the scientists who discovered the link between HIV and AIDS were also awarded the Nobel Prize. As of yet, science has not been able to develop a vaccine for that dreaded disease and it remains a serious health challenge. We can hope that a both a cure and a vaccine can be found in the future as medicine and medical research advance, a lot of it now, thankfully, in our country. Where we can tackle disease and where there are vaccines we should do everything possible to promote them to eradicate disease and illness and ensure, as far as possible, our people are protected. This is why the Labour Party is calling for unanimous support for the HPV vaccination programme, and its extension to boys so the greatest possible number of our population can be protected against HPV.

Amendment put and declared lost.

No, the Minister of State may not.

The motion is accepted only if the HTA makes positive recommendations in respect of it.

Motion agreed to.