A matter under Standing Order 29 was raised by Senator Joe O'Reilly. The practice is that the Minister be given 20 minutes to reply.
Adjournment Under Standing Order 29: Flu Epidemic: Motion.
Acting Chairman
Before I begin I ask your permission to give the last few minutes of my time to Senator Willie Farrell who wants to contribute to the debate.
Acting Chairman
I understand that the length of time allowed for this debate is one and a half hours. The Minister will have 20 minutes to reply.
I move: "That the Seanad do now adjourn." I decided to put this motion before the House for a couple of reasons. First, because I have the honour of being my party's health spokesperson in the Seanad and, secondly, because I believe one of the primary functions of Seanad Éireann must be to debate, on an on-going basis, the welfare of our citizens in terms of health, education and lifestyle, that as well as engaging in important abstract discussions we must never lose sight of our responsibility to improve the quality of life of our people.
This motion tonight has very real significance and importance at the moment because there is tangible and concrete evidence that a flu epidemic is on its way to this country. This evidence is coming from the most conservative of sources. Medical opinion that has traditionally taken a fairly conservative line now claims that on this occasion we will have one of the worst epidemics for 30 years. That is a very serious matter and one that merits discussion in this House. This flu epidemic will cause particular problems for those with respiratory ailments, asthma sufferers, diabetics, kidney sufferers and, of course, the old and the very young. The old and the very young, represent a very large section of our population.
It should be clear to the House that the Government and the health boards were not ready for this emergency and did not anticipate it. The Department did not anticipate the emergency and the loophole in the 1970 legislation in relation to GMS patients needed to be rectified immediately to allow free vaccination. I am glad that negotiations are on-going at the moment in relation to that. I urge the Minister to bring the negotiations to a speedy conclusion so that GMS patients will immediately get free vaccination against the flu. It is reprehensible that a couple of doctors were charging and that the anomaly in the legislation is there. We hope there will be an immediate rectification of this matter, thus facilitating the vaccination of health card patients.
It is a very serious matter that we have been caught without a sufficient level of vaccine to provide a national vaccination programme. Obviously, this has its roots in a lack of planning and, of course, in the general cutbacks to the health boards. It is a very serious matter for two reasons. First, because the vaccine in question, according to most medical opinion, has a fairly high success rate and, therefore it is important that it should be made available and secondly, failure to properly vaccinate our population nationally will result in a greater degree of hospitalisation for already cramped hospitals.
I was glad to hear today on the news bulletin that the Minister was able to announce there are 25,000 more shots of vaccine being made available. This is welcome but I would argue it is too little, too late. I do not believe it will be enough to implement a national vaccination programme of the kind we need. I contend strongly, that vaccination should be available on demand to all the population. I accept that the main national drive must be to ensure that the old and the very young are vaccinated but there should be adequate supplies of vaccination for those who feel they need it because it is not always the case that middle aged persons will necessarily be the least vulnerable.
Having checked a number of places today I am told from a reliable authority that there is a 95 to 96 per cent bed occupancy in the Dublin hospitals. For seasonal reasons, there is a very high bed occupancy throughout the country at present. I noticed recently that a lot of the debate has focussed on the Dublin situation. It would be regrettable if we were to lose sight of the fact that there is a problem outside Dublin as well. Given that there is a very high level of bed occupancy in our hospitals at the moment, the impending flu epidemic must pose major problems for us.
I believe the Minister, the Department and the health boards must put in place as a matter of urgency, within the next 48 hours, an emergency plan to have extra beds ready in our hospitals in the event of an epidemic and also of staffing. A large number of the hospital staff will themselves become the victims of the flu epidemic. There is a hospital at the moment very badly affected in this way and if they become the victims of this epidemic they will need staff replacements. There will be need for extra beds in hospitals.
We need immediately an emergency plan and a set of contingencies to deal with what looks like being a very serious epidemic. At the moment in a number of counties, particularly Longford, schools are closed because of this flu. It is affecting industry and it is only beginning to become a problem. Most of the experts argue that it will become a greater problem in late December and in January.
Despite the fact that we may be acting too late, it is important that we act decisively now and that we put in place immediately an emergency programme in making extra beds available and making available relief staff.
It is a matter of grave urgency. A lot of the public will look to us in future months and judge us on how we coped with this question. I believe it is time that action was taken on it. I propose to rest the matter for the moment.
Mr. Farrell
Ba mhaith liom fáilte a chur roimh Aire Sláinte ar a chéad chúirt don Teach. It is his first time here since we came back into our new establishment and it is good to see that the Minister is here to reply to an Adjournment debate raised by a Senator from his constituency. I would like to congratulate Senator O'Reilly for bringing this matter before the House tonight because it is very important that we discuss this situation.
We must be realistic. This is the first time we have had an epidemic in 12 years. If we had been stocking up with vaccine over the past number of years, it would have been thrown out and wasted because it would not have been needed. It is impossible to see into the future. I understand the time for vaccinating people is in late autumn. I wonder how many people, if we had had supplies in the months of August, September or early October, would have gone to the doctor to get the jab? I would say very few. I wonder at this stage if it is too late for the preventive measure to work.
We should also be very careful because during the Carter administration in America, it was feared there would be a big outbreak of swine flu, which I understand is very serious if people get it, and which does happen, and many people were vaccinated. The flu epidemic did not materialise and the cure ended up worse than the disease because thousands got the flu as a result of the vaccine. We should also issue a word of warning because quite honestly too many people are running for what they think is the easy way out. I have seen recently that there are more people sick now from reaction to drugs and tablets. Side-effects are nearly as big a problem as the original ailment.
I often warn people at health board meetings about being too fond of always opting for drugs. When I had a very serious accident myself — I never take drugs or anything unless it is purely a case of having to — I was out of hospital in ten days and everything was healed up perfectly. They told me it was because my system was clean and there was no reaction to anything. People should remember that if they are trying to prevent every little thing they can have a build-up of drugs in their system that may react if they really have to have a serious operation. It is something they should consider.
At this stage if the flu is here and people get it they should consider the old remedy where people took hot drinks and went to bed. If they did that they would get over it quickly themselves and they would ensure they would not give the flu to anybody else. A lot of the media hype about this is unnecessary. I often think if those people were so brilliant as they appear to be when something happens, they would have warned us last July, August or September that this flu was on its way. I did not see any newspapers report saying there was a dangerous flu on the way until it was here. Now they are hyping it up. They have a lot to account for by doing that.
I would like to assure the people, as Chairman of the Association of Health Boards of Ireland, that the health boards are geared to cater for this epidemic if it arrives. It might not be half as serious as all the talk would lead us to believe. I can assure the House that the health boards, the doctors and those people in the health services will cope with the flu epidemic if it arrives.
I agree with Senator O'Reilly that there is an epidemic of flu on the way but there is no evidence that it will be the worst epidemic in 30 years. It will certainly be the worst one in the past 13 or 14 years but there is no evidence that it will be worse than previous epidemics.
Senator O'Reilly made the point that clearly we were not ready for this emergency. I can tell him that we were not surprised at this particular situation developing because we knew that at some time we would have a flu epidemic again in the winter.
Flu is a feature of Irish winters. We have flu every year; 105,000 people approximately get the flu each year and there are 125,000 people vaccinated against flu each year.
It appears from what Senator O'Reilly said that he knew we would have this major flu epidemic this year. I agree with Senator Farrell that people who knew this had a duty to tell us. Even the experts in the various centres around the world did not seem to know or I presume they would have told us in advance.
On the question of the free vaccination, I have noted reports that medical cardholders have been asked to pay for the vaccine, but when inquiries were made to the two health boards concerned in the reports — the Eastern Health Board and the Southern Health Board — we found that no complaints were made to either board that such charges were made. I would be concerned if medical cardholders who received the vaccine are being charged and I have requested the health boards to ensure that no charges for vaccines are levied on such persons.
With regard to Senator O'Reilly condemning the Government and the health boards for not having a national vaccination campaign, Senator Farrell has dealt well with that. It would not be appropriate. First, I do not think people would turn up. In view of the fact that for the last 12 or 13 years we did not have any influenza in the country I believe the vast majority of people would not present themselves for vaccination. We do not have compulsory vaccination in this country. I do not believe, even if we attempted it, that it would be successful.
I also agree with Senator Farrell, on the evidence before us over the last number of years, that it would be inappropriate to even ask people to come forward for a national vaccination programme against influenza each year. I take the point he makes that if you do this type of mass vaccination you want to have justifiable reasons for doing it because there is a risk, I know it is minimal but, nevertheless, there can be risk there.
The question of a national vaccination programme at this stage is one that I believe is questionable because it takes at least two weeks before the first signs of immunity develop and probably another two weeks before you have full immunity through the vaccination. It is important, in view of the wide publicity, that we recognise that the management of a flu epidemic does not depend on mass vaccination. That is not the answer to a flu epidemic. We have a history of it. We have it every winter and indeed we have had major outbreaks of flu at regular intervals throughout our history. Until somebody finds a cure for it, I presume that will be the position.
The management of it, when it arrives, is not to go out with a mass vaccination programme. The management of it is to give good common-sense advice to people because there is not a cure for flu itself. The old remedy is still the best, to take something like aspirin or paracetemol, a hot drink and take to bed, although one would not advise aspirin for small children because of the side-effects. That is the way it is managed. It is not a mass vaccination programme.
The question of the high bed occupancy was raised. There is a high bed occupancy and always has been. The history of hospital beds is that you will always have patients to go into hospital beds; you will never have a situation where you have plenty of empty beds. Any of us in the Houses of the Oireachtas would question a situation where the health boards, or indeed the Government, maintained a large number of empty beds at a very high cost of staffing those beds just on the off-chance that we might have a flu epidemic. I do not think that makes very good sense medically because I believe the resources should be targeted where they are needed. They are certainly not needed manning empty beds on the off-chance that we might have a flu epidemic. I believe nobody in this House would thank anybody who maintained a few wards on the off-chance that there might be an epidemic of one description or another. I can assure Senator O'Reilly, and indeed the Seanad, that we monitor the situation continuously in relation to particular illnesses and indeed to particular epidemics and whatever contingency arises we have arrangements in place. We will be able to deal with it.
On the question of the vaccine itself, the World Health Organisation monitors the prevalence and the strains of influenza worldwide. On the basis of this they recommend to each member state the likely types of influenza organism that would come during the winter. The World Health Organisation also recommend the vaccine type most likely to be of value in combating the current year's strains of influenza. During the 1988-89 northern hemisphere winter the influenza season began earlier than usual in November 1988 and outbreaks were observed in Japan, Europe and North America. During the period two subtypes of influenza strain have been circulated, sub-type A, hini being more widespread than sub-type B, H3N2 except in the USA where influenza B predominated. In April 1989 the World Health Organisation recommended that the vaccine for use in 1989-90, the current winter, should be trivalent and should contain the following antigens. While I appreciate that this is somewhat technical, it is important to have it on the record because of the various strains and because it is one of the reasons why vaccine is not stacked up from year to year. The antigens they recommend were an A Singapore 686 strain hini-like antigen, an A Shanghai/11/87; H3N2-like antigen and a B Yamaga/16/88-like antigen.
In May 1989 the Department of Health advised each health board of the World Health recommendations following which health boards made arrangements with the suppliers to purchase their estimated requirements of the vaccine. Supplies of the vaccine, which would have been more than adequate to deal with a normal situation, had been brought into the country during the late summer and the early autumn, which was the appropriate time for people to have vaccination against influenza. As I said, 125,000 people are vaccinated against flu each year which is greater than the number who get the flu. The doses are distributed through the health boards to provide vaccination to priority groups, the priority groups being the elderly, particularly those who suffer from a particular illnesses like chest disease, diabetes, kidney disease.
The report of an influenza epidemic in the United Kingdom has created a certain level of pain which has resulted in a very high level of demand for vaccine. This, in turn, has led to a run on stocks of the vaccine and the present stocks have now been used up. The Department of health have been in touch with suppliers around Europe in an effort to seek further supplies, I am glad to report to the Seanad that despite international competition and shortages a further 20,000 doses will be in the country on Friday, 15 December, and a further 5,000 doses will be delivered early next week. However, I have to point out that influenza vacine takes approximately six months to manufacture so that it is not possible to simply mass produce further vaccine at a moment's notice.
The short life of the vaccine has to be considered. This is related to the fact that it may be a different vaccine for each season depending on the particular strains of the influenza that will come during the winter. The World Health Organisation advise on what strains will cause influenza in a coming winter and then the manufacturers produce a vaccine to meet the demand. For that reason the manufacturers would not produce more vaccine than is necessary or that might be demanded during the coming autumn, which is the usual time for people to be vaccinated.
The manufacturers would only produce and supply the vacine in accordance with the expected demand. Having estimated the likely requirement earlier this year prior to any indications of a possible epidemic they have only limited supplies available at the moment. As I say, we have received confirmation that we will have a further supply at the weekend. That supply will be made available through the health boards. It will be targeted at those at risk, the elderly and those suffering from specific illness that I mentioned, chest disease, heart disease, kidney disease, diabetes. It will be available to them. I can assure Senator O'Reilly that it will also be available to medical card holders free of charge. As I said, there is no evidence from the health boards that there has been any complaints about patients being charged.
Would the Minister state if there are others besides the categories mentioned by him?
I mentioned chest diseases and other diseases.
The Seanad adjourned at 10 p.m. until 10.30 a.m. on Thursday, 14 December 1989.