By agreement of the House, the time limits are seven minutes for spokespersons and five minutes for other Senators.
Hepatitis C Screening: Statements.
I am glad to have the opportunity to respond to the Senators on this issue. The Blood Transfusion Service Board informed me on Thursday, 17 February, that evidence had emerged that there was a possible link between the product anti-D immunoglobulin and hepatitis C. The board made arrangements to change the product and this took place on Friday, 18 February, 1994. The board has introduced a new virally inactivated product which has been supplied to hospitals around the country. I have already publicly outlined the importance of anti-D immunoglobulin in the treatment of rhesus haemolytic disease of the newborn and the importance of the administration of the anti-D immunoglobulin to mothers who may have babies with this condition.
The hepatitis C virus was first described in 1989. The question of introducing a screening test for hepatitis C for donations nationally had been considered in 1989 and in 1990. During this period the Blood Transfusion Service Board and the Department of Health examined the possibility of introducing such a test. However, a review of international practices and discussions with medical experts abroad revealed that there was insufficient scientific information about the test to approve its routine introduction. The position was carefully monitored and when the test was considered sufficiently reliable for the purposes of screening donations, it was introduced to Ireland. This occurred in 1991 at the same time as this screening was introduced in the United Kingdom. I would like to emphasise that cost is not a factor in the timing of the introduction of such tests. In fact, £1 million for hepatitis C testing by the Blood Transfusion Service Board has been approved to date.
In January 1994, as part of the ongoing monitoring of quality assurance procedures by the Blood Transfusion Service Board, it emerged that a disproportionate a number of rhesus negative female donors had antibodies for hepatitis C. On further investigation it was found that nine of the ten female rhesus negative donors had received anti-D in 1977. This was linked with an earlier report of six cases of jaundice which had been investigated in 1977 when no cause for the jaundice had been found. It would seem now that the anti-D manufactured in 1977 is potentially the cause of this problem.
I must commend the BTSB for carrying out this thorough type of research, which is essential in the monitoring and quality control of blood products which it processes.
When this matter was brought to my attention my immediate concerns were first, to protect all future recipients of anti-D immunoglobulin and, second, the identification of any risk, however small, for any mothers who received the anti-D immunoglobulin product in the past. I agree that the action taken on Monday last by the Blood Transfusion Service Board was correct as the safety of blood products must be the first priority at all times.
The Blood Transfusion Service Board has announced its intention to follow up all of the mothers who may have been at risk of contracting hepatitis C from the anti-D immunoglobulin product. A special public awareness campaign has been launched to inform the public as to the possible risks. This campaign will continue until every woman who wants to be tested has received a test.
Special arrangements have been made to provide information to general practitioners, who in many cases will be, and indeed have been, the first point of contact for the women concerned. While a small number of general practitioners did not receive their information packs on Tuesday, 22 February, the Blood Transfusion Service Board has assured me that every effort is being made by the board to ensure that all general practitioners are fully informed on this matter. Seanad Éireann will appreciate that facilitating the testing of as many women as quickly as possible is of the utmost importance. The question of negotiating the fees will be dealt with in consultation with the IMO, commencing tomorrow.
Free phone lines have been put in place by the Blood Transfusion Service Board to provide information to people who might be anxious, and special arrangements for the testing of women at risk have been made at several locations throughout the country. The locations will continue to stay open and a new list will be announced in addition to the 12 centres announced by me yesterday.
Blood testing at the Blood Transfusion Service Board centres and at general practitioners' surgeries will be administered free of charge. I am determined that every woman at risk will, as far as practicable, be identified. The Blood Transfusion Service Board is making specific arrangements to trace the cohort of mothers who were given the anti-D product in 1977 and are focusing at this time on those mothers. Because of changes of address, it may not be possible to trace everybody and therefore the public awareness campaign has been launched. Decisions on the individual follow-up necessary will be made as a result of the ongoing testing process.
I would like to emphasise that all women who were administered with anti-D immunoglobulin, or who believe they may have been, are being requested to avail of the nationwide free blood testing services provided by the Blood Transfusion Service Board during the coming weeks. Anti-D was introduced in 1970 and the object of the campaign is to advise all women who had anti-D immunoglobulin from 1970 to the present to come forward for testing. I would like to stress, however, that where the test is negative for hepatitis C, there is no need to undergo a second test. It is accepted that all medical interventions, including the use of blood and blood products, carry some risks which require the balancing of the benefits and risks of particular treatments.
The prevalence of hepatitis C in Ireland among blood donors is low and compares favourably with other European countries. This implies that hepatitis C is not widespread in the population. Should any of the people given anti-D immunoglobulin need special medical treatment for hepatitis C as a result of receiving this product, I can confirm to the Seanad that whatever treatment prescribed by the clinicians will be provided by the public hospital services free of charge.
Before I call Senator Taylor-Quinn, I omitted to mention that by agreement of the House, the statements on hepatitis C will conclude at approximately 9.30 p.m.
I stand here as one of a thousand Irish women who need to be screened. I have received three anti-D injections within the past ten years.
The manner of the public announcement left much to be desired. It flung many women into panic, confusion, fear, suspicion and in general need of reassurance. Many disliked the tone and the patronising effect on the way in which the news was imparted. Frankly, it lacked understanding and definitely lacked any element of sensitivity.
Many questions need to be answered and clarification is necessary. What is hepatitis C? I heard the announcement on the 11 o'clock news when I had left a meeting in Newmarket-on-Fergus. My first question was what is hepatitis C? I know what hepatitis A is and I know that hepatitis B can sometimes be fatal, so I assumed that hepatitis C was a degree more serious than hepatitis B. That is the first question that needs to be answered.
Could children conceived after a mother received the anti-D injection be at risk of hepatitis C? I ask this question because in my first pregnancy I was pregnant with twins and miscarried one after three months. At that time I received an anti-D injection, so the remaining six months of the pregnancy of the second twin were after I received the anti-D injection. What is the position of that child?
What is the position of people who received blood from rhesus negative donors? As the Minister is aware, rhesus negative donors are universal donors, which means their blood can be used in an emergency. This blood is much sought after by the transfusion board and is used in cases of emergency. What is the position of people who received blood from the rhesus negative group, that is, women who received the anti-D injections? Are these people now at risk?
The Blood Transfusion Service Board is at the centre of the controversy and serious questions have to be asked. One has to find out immediately what the source of blood and blood products are in this country. How reliable are they? What type of testing is done? Where exactly do they come from? It is now widely accepted that there was knowledge of the risk in 1989, a reliable test was developed and screening was put in place in Britain in 1991. Why was full screening not put into place in Ireland in 1991?
It was.
Why is it now being stated that only women who received the anti-D injection prior to 1991 need to be screened? Given that the product was changed last Friday, does the Minister consider that women who received anti-D injections between 1991 and 1994 should be screened? If not, why not? Do we take it that a new product was introduced in 1991 which protected women from 1991? Do we conclude that full testing and screening should have been introduced in 1991 rather than 1994?
It is vital that a proper national screening programme be put in place. Thought needs to be given to the structures and it is essential that no one slips through the net. A counselling service is also required and every effort must be made to ensure that no further pressure or anxiety is caused to the women involved. Many questions have to be answered and there is still much confusion among the public. Women are worried about the situation and rather than proceeding as was done last Monday evening, it would have been more appropriate if the Blood Transfusion Service Board and the Department of Health had first advised all general practitioners, hospitals and health boards of the impending situation and, having prepared and advised them, then go public. In this instance the cart was put before the horse and the proper structures were not put into place until the public announcement was first made. This is most unfair to the 100,000 women concerned.
The manner in which some people have commented on the issue since it was announced leaves much to be desired. I refer in particular to the consultant, Mr. Terry Walsh.
I ask the Senator to refrain from naming anybody who is not here to defend themselves.
Over the past 24 to 48 hours comments have been made by certain personnel on the airwaves that leave much to be desired. This is extremely unfortunate. There is a real possibility that over 1,000 women are infected by hepatitis C. That is a grave matter which should be dealt with seriously and not in a casual fashion. The question of compensation was raised in the course of one of these programmes and it was dismissed in an offhand fashion, which is completely unacceptable.
I realise the Minister has much work to do. Many areas in his Department require attention and the Department of Health demands time and resources. In this instance there is an urgent need to allay many of the fears, anxieties and worries that exist across this country. These worries are not just for the women themselves. Many are also concerned for their children, and there are people who have received transfusions in emergency situations over the past number of years who are equally concerned about the dangers of contracting hepatitis C. Clarification is needed urgently and I request the Minister to supply that as soon as possible.
Ar dtús baíre, ba mhaith liom comhgháirdeas a dheánamh leis an Aire as ucht na hoibre a rinne sé san fhadbh seo. It is sad that any aspersions should be cast on the Blood Transfusion Service Board. It has done a marvellous job for many years and saved millions of lives. There was not test available when this happened. The media has treated this very fairly. An article in today's Irish Independent carries the headline: “No case for scapegoats.” It continues:
The testing process is now underway and the results will come through quickly. Then the investigation should start. This investigation must not be allowed to degenerate into a search for scapegoats. When the problem first arose in 1977, no one knew about hepatitis C either here or in the rest of the world. There could not, therefore, be any test to detect it.
That answers it all.
No one is talking about 1977.
In fairness, the Blood Transfusion Service Board has done a wonderful job. Despite the fact that this problem has arisen, as this article says, thousands of children have had a good life and been brought into this world free of any disease, impediment or disability. We must look at the good things the board has done. Medical science will always be a challenge. The Minister and the Blood Transfusion Service Board should be congratulated. They acted fast and have put every mechanism in place. I pay tribute to the 1,700 general practitioners around the country who have decided they are going to do their utmost to ensure the tests are done as soon as possible.
It may not be as serious a problem as some people try to make out. It is sad that anybody should start blaming others and attacking people by saying this is a serious problem when we do not know whether it is or not. Why do some want to generate anxiety and worry among people by this kind of debate? It is wrong and is neither caring nor respectful. It does not take account of the situation in which these people find themselves.
We know all about it. We are living with some of them.
The Senator does not know if he has a problem. Let us wait until the tests are done.
We do not want a lecture from the Senator.
Wait until the screening process is completed. The Senator is expecting the worst which may not happen.
I did not say that.
The trouble that some believe is around the bend may not be there at all. Let us not play politics when we are dealing with people's health.
We are not playing politics.
People's health and problems within families are too important for us to be raising hares that are not in the lair to be risen.
We do not need a lecture from the Senator.
We should not be scaring people unnecessarily. The Government, the Minister and everybody concerned are doing their utmost to ensure we get to the root of this problem and that everybody who was given this injection is tested and screened. I have no doubt that in a month or two we will realise that this is not as big a problem as people are trying to make it out to be. I do not think it will be a big problem, because if it has not shown up in 20 years it is unlikely to blow up into an epidemic now.
We should not start looking for scapegoats. Claims were mentioned here earlier. Litigation is the order of the day in today's world and everybody makes claims. The opinion of an eminent solicitor is reported in today's Irish Independent and I wish to read it into the record of the House.
Women seeking compensation for receiving infected anti-D blood products were advised yesterday to pursue litigation with caution, writes Gordon Patterson. As the Dublin solicitor specialising in medical negligence cases commented, "Do not consult your lawyer just yet". He said from the city centre practice yesterday: "At this very early stage, I would advise all women to co-operate fully with the Blood Transfusion Service Board. If it turns out they have hepatitis C, it could have come from the blood product in question or it could have come from some other source. To get compensation the person must prove the defendant was negligent as opposed to being careless or merely lacking in knowledge. For example, they did not know there was a problem in 1977 and they did not have adequate knowledge. That would be what is known as state of the art at the time defence, that is, they did not know the product was contaminated."
That is the opinion of an eminent solicitor who specialises in this type of business, so the case for litigation seems to be very weak.
I am delighted with the quick action taken by the Minister and his Department. I am also delighted with the public information in all the daily papers today. I can assure the House that the Minister's wishes will be carried out and nobody will be left untested. I do not believe that this will be as big a problem as some people are saying it is. I pay tribute to the media for the very balanced way in which they are approaching this very emotional subject.
I welcome the Minister to the House. While I realise that this is a very personal, sensitive and emotive issue for all women who fear they have been infected by hepatitis C, it is unwise to castigate the Blood Transfusion Service Board, which I know, having had dealings with blood transfusion services in many nations, is one of the finest in the world. It is most important to point out, and I am very glad the Minister did so in his introductory speech, that this problem only came to light because of the vigilance and intelligence of those working in the blood transfusion service, Dr. Power and her co-workers, who pointed at the fact — it is quite hard picking these things up when an enormous amount of testing is being done — that there was a cluster of rhesus negative women in Cork, that there was a problem, and who were able to correlate it back to the giving of anti-D immunisation at the same time in 1977. When one is examining a large number of charts and tests this takes a lot of doing.
We must congratulate the blood transfusion services on their quality assurance procedure. We must not concentrate too much on this specific case, because the message I have for the Minister tonight is that our commitment to the monitoring of health care is one of the most important functions of all of us who work in the health care area and specifically of the Department of Health. Not only have they to make sure that we who work in this area monitor health care but they must also make sure we have the funds available to do so. I congratulate the Minister on what he has done to date. He could not be described as having alarmed women. There is an enormous difference between alarming and alerting women, and the women had to be alerted.
The Minister was wise to go public with this because if he had sent notification out to general practitioners, within no length of time the general public would know there was something going on and what was going on, and the Minister would have been accused of a cover up. What the Department of Health and the College of General Practitioners did was the right way to go about things. An enormous amount of testing must be done. It is important that these 100,000 women be tested. It will be about that number, 10 or 15 per cent of the women of child bearing age over a 20 year period. It is not essential to go today. Someone said to me that she was going next month. If she has had it for the last 14 years, she said, she would go next month. It is very important to make people aware that it is not absolutely essential to get there immediately.
The media campaign has been very good. However, I ask the Minister in about six months' time or perhaps longer — a long time lag will be necessary — to ask the maternity hospitals to go through their records and tick off all the people who responded to the media campaign. Of course, they can start now. Those records should be correlated with those of the maternity hospitals which were given anti-D, fanning out from the 1977 era. That appears to be what the Minister wants to do. It will be worth while doing that, because a certain number of these women will have emigrated or changed addresses.
I would be glad if the Minister would specifically emphasise the importance of this campaign for people who had miscarriages and stillbirths. These people may not pay as much attention to the media campaign, because all of us will associate the immunisation with the result of a live born child, and its association with a previous miscarriage or stillbirth may be pushed into the background.
I am glad the treatment for those who are found to be positive will be free. It is important to point out that this will be a very small number. It is suggested that people might have got it from ordinary rhesus negative blood transfusions, but I have been reliably informed that this is a very remote possibility. It must be remembered that the anti-D immunoglobulin is heavily concentrated and the problem lies where a concentrated dose is given. We do not know everything about hepatitis C now, nor did we in 1991 when the screening was introduced, but I am confident that those who have it will be properly dealt with. We should emphasise that while some people will be affected, the incidence of cirrhosis from hepatitis C is very small. This is not being said enough, and I would be glad if the Department of Health would make this known.
I praise the Department of Health, because what the Minister and his Department have done this time is in marked contrast to the troubles we had in the past with various women's health issues. I wonder whether any Members here remember what happened with the Dalkon Shield, an intrauterine device which caused severe problems in this country and with which the Department of Health gave little or no help to women who were trying to pursue justifiably legitimate claims against the manufacturers. There was also the lack of attention given at the time to women who had had Diethylstilboesterol. Very little help was given to them, even though it was a much more serious problem: their children were the victims of cancer in some cases and the women involved had a higher incidence of breast cancer. The Minister has done the right thing in this case and I congratulate him on his change of attitude and on that of the Department. The diethylstilboesterol campaign was appalling. Were it not for the persistence of a woman, Mrs. Daphne Passmore, who had been a victim of the drug, and the setting up of a clinic in the National Maternity Hospital, I do not know if anything would have been done about these cases. So, while the Minister has given more money to the Health Research Board, let this be a lesson to us. Quality control is very important.
The general public have an idea that medical research is to do with laboratories and stunning breakthroughs in determining the cause of some disease. It is not. It is just this sort of thing, slogging through charts and tests and having the wit to realise what is happening. I ask the Minister and his Department to emphasise this and to let the general public know that this is a most important area of medical research. It will not be supported by the general public; it has to be supported by the Department.
I welcome the Minister to the House and thank him for taking this debate here tonight. I congratulate him and his Department, and particularly Dr. Joan Power, for the work they have done in this area and the prompt actions they have taken. It is a pity that Senator Taylor-Quinn has left the Chamber because I would have said that her outburst was far from helpful. This is an area that should be looked at calmly. Instead of raising fears about this situation, it should be factually considered.
Hepatitis C is a new strain of hepatitis which was discovered in 1989. People involved in medical research understand that one does not know all the facts as soon as a strain is identified. One must find out where it came from and how it may be cured. This takes years of research and, as the Minister pointed out, international research did not provide sufficient answers about the identification of hepatitis C until 1991.
Anti-D immunoglobulin injection was of great benefit to many women because it resulted in approximately 100 babies being born alive each year. This would not have happened 30, 40 or 50 years ago when babies would either have died in early infancy or, if they had survived, they would have been anaemic and would have suffered from the blue baby syndrome. Many parents were happy this injection was given to mothers after the birth of a child because it ensured that future children were safe from a reaction to the mother's Rhesus factor. We must be thankful for this. As the Minister said, there may be negative effects from an injection. A small percentage of people may be infected, but this should not take away from the fact that the anti-D immunoglobulin injection has been of great benefit to parents.
In January this year a link was discovered between a group of women donors who were Rhesus negative and had hepatitis C antibodies. As Senator Henry pointed out, the link was forged as a result of people carefully watching what they were doing. Links may be forged between coincidences, but it took time to examine the charts and establish a definite link between these two factors. Last Thursday the Minister was informed that this link existed. Since then, he, his Department and those in the Blood Transfusion Service Board have worked day and night to put procedures in place before the public could be informed. Additional blood products were imported from Canada as a precaution. However, this was not intended to create fear, but to ensure that people were safe.
The Minister has provided clear information about this matter and we have heard nothing tonight which was not in the newspapers or on the airwaves on Tuesday morning. The Minister and Dr. Power have not kept information from the public. Many women did not understand the situation and perhaps a small percentage became unduly anxious. However, that is a small price to pay for an awareness campaign. It is more important to be informed than to sweep the issue under the carpet.
I congratulate the Minister for the prompt action he has taken to organise special arrangements, such as telephone lines and 12 information centres. I took a friend to my local centre last night, which is open from 10 a.m. to 8 p.m. Such a service had to be organised because it did not happen overnight. Women should thank the Minister for caring enough to do that. He could have sent letters to GPs instead, but this would have achieved little. The GP would either have left the letter in his file or, if he was consistent, he might have informed his patients.
I welcome the Minister to the House and I hope he will be able to answer my questions. People may get too annoyed about certain situations. I understand it takes a long time to find answers to problems. Hepatitis C became an issue in 1989 and it has taken two years for Dr. Power and others to identify the problems. Were any indications given that there was a problem with this vaccine and was it still being used last week?
I am worried about the third last paragraph of the Minister's speech which states: "It is accepted that all medical interventions, including the use of blood and blood products, carry some risks which require the balancing of the benefits and risks of particular treatments." This is a glib comment and we should not accept such a situation. It is difficult to get everything right and to ensure that what is a problem today will not be one in ten or 15 years' time, but people need better assurances than this. Perhaps this is not possible because of the introduction of new products into the system. We welcome new products which help people with different illnesses. However, I am worried people will not trust them.
Yesterday I was listening to an interview on the radio about this issue. Compensation was mentioned, although I do not support the compensation syndrome. The impression I got from the answer was that it was like betting on a horse in that one takes a chance. People took the injection because that was what they wanted at the time; they took a chance. It was prescribed by a doctor and if it did not work they lost out. We should not be able to wash our hands of all responsibility when something like this happens. We do not want that type of society. We care about people's health; we care about people in all walks of life. I would not like to see this developed further because, whether we like it or not, 80 per cent of people will read all the newspaper articles and 20 per cent will not. There will always be a fear among a small percentage of the people and it is our job to ensure that that is not confirmed by glib replies to questions at interviews.
If people are to take anything from tonight's debate they would be well advised to take the very learned and informative discourse by Senator Henry. That is the sort of information people want.
This has been one of the best days for the Irish public service for many years. I agree with Senator Henry that the Blood Transfusion Service Board has behaved magnificently. The Department of Health's response has been nothing short of magnificent. It belies the idea that the Irish public service is slow to respond in a crisis, that it cannot do what the private sector can. It proved not alone that it can do it but that it can do it quicker and more efficiently. I listened to Senator Taylor-Quinn; I have to be mindful, as a male, that I did not have this injection and she did. I respect the concerns she has voiced but I think she is wrong when she mentioned a "casual" approach. Nothing could be further from the truth. This was the opposite to a casual approach. The approach to this issue was what I expected this Minister to take. It was the same public information approach he took in the Kilkenny rape case, involving full disclosure and putting systems in place.
In all fields of human endeavour, nothing evolves as quickly as medical science; it changes almost daily. When something happens that nobody can foresee, the political head of a Department has a number of responsibilities. One is to ascertain the scale of the problem immediately and assemble the relevant information. Second, the defective product must be removed and replaced with a product which is not harmful. All those things were done. The third step is to fully inform the public, which is what the Minister did. The reason there is no sense of panic can be laid at the door of the Minister for his performance and that of his Department — and let us be fair, the performance of the Opposition in the Dáil and in this House. Nobody tried to make political capital out of this situation. This is not a political issue. The way it was handled by the Department and the Blood Transfusion Service Board is a matter of great pride to us all. The Department and the Minister have performed in an impeccable manner. Women have every reason to be happy not just that the Minister — who may change from time to time — is in charge of the Department of Health but that it is staffed by officials of enormous competence.
I am glad this issue has been treated in a serious way by all concerned. Tribute was paid earlier to the media. If this was England I shudder to think what The Sun, The Star and all of these Fleet Street journals would make of an issue like this. They would say, let us sell papers. This is a good story. That does not happen in this country because we have higher standards and, thank God, we are a little more civilised when dealing with serious issues.
I know other Members want to contribute and I will not delay the House any longer. I conclude by paying tribute to the Minister, Deputy Howlin, his officials and the Blood Transfusion Service Board.
I too welcome the Minister and thank him for coming into the House to speak on this matter. As a mother who received the anti-D treatment after the birth of each of my three children, I think it is essential that the matter be dealt with in a responsible, calm and transparent manner by the Minister and the Blood Transfusion Service Board.
My immediate reaction on hearing the news on the radio on Monday evening was one of shock. The urgent and dramatic circumstances in which the press conference was called were bound to cause concern among some women. Like all women, in the beginning I was looking for information. What exactly was hepatitis C? What were my chances of contracting it? What effects would it have on my health? My concern, and the concern of many women who contacted me, was whether it would affect children born to them after they had received it.
The person to whom most people go for information on their health is their GP. I disagree with Senator Henry and others when they said that the press conference should have been held before GPs were contacted since many women immediately rang their GPs who were not in any position to reassure them because they did not have the information. I realise the Minister's dilemma. It was a difficult decision but I think he went the wrong way about it. I accept his sincerity and his efforts to try to do the best thing. However, when one is affected, these things can mean something different. It is easier to be more detached when you are not at risk. That was the difficulty with many women; they panicked because they could have been affected. In that way they differed from officials in the Department and the Blood Transfusion Service Board.
The Minister has promised complete openness in dealing with this situation and I welcome this. The outstanding question that needs to be answered is: why were mothers like myself not alerted of the possible dangers before now? The virus was discovered in 1989 and the Blood Transfusion Service Board apparently became aware of it in 1991. I would like the Minister to clarify this. I would also like to know if a more effective screening service was available earlier and if a more effective testing mechanism was available abroad. If so, why did we not have it? I understand that a mechanism was available in Canada and the United States from 1993, although I do not know that for certain. I would like the Minister to confirm it.
I was surprised to hear in his statement to the Dáil yesterday that over the weekend a virally inactive product was imported from Canada. Does that mean that up to last Friday women who received the anti-D vaccine were still at risk? GPs were confused about this. In the letter they received yesterday they were told to test all women who had received the anti-D injection in 1977. When they phoned Pelican House they were told to test women who had been injected during the period 1977-91. I would like the Minister to state whether GPs should now test women who received the anti-D up to last Friday. It is essential that this be made clear.
The GPs would like a system to be established. At the moment they are being told that containers for blood samples are not being sent out automatically by Pelican House; perhaps they could be sent to the health boards for distribution. It is very difficult for GPs to get through to Pelican House by phone at the moment. One GP — with whom I am sure the Minister is familiar — told me this evening that he would be willing to organise this himself.
The present alert also raises the matter of hospital records. Some hospitals do not have records going back to 1977; that is the difficulty. Today I was contacted by a woman who had a baby in 1977. When she contacted the hospital they could not tell her whether she had received anti-D. My advice was for her to have the test anyway. The records system for women patients, particularly in maternity hospitals, needs to be looked at. Since what happens in childbirth can affect one's subsequent children this is very important. The area of women's health has not been treated with the urgency and importance it should. I hope that is now changing.
I am glad this testing can be done by GPs because while there are not health centres all over the country, women in rural areas have ready access to their GPs. It is important to maintain a sense of balance. I agree that the discovery of anti-D has saved the lives of thousands of children. Before its introduction more than 100 babies died each year from blood mismatching; now the figure is less than five per year. We must keep this issue in perspective. It is vital that women who are receiving anti-D vaccine this week are reassured that the product is safe. I appreciate the fact that I was given the anti-D vaccine. Women like my mother, who were Rhesus negative, did not have the benefit of the vaccine. As a result children, including my brothers and sisters, had to be given several blood transfusions. There is always a balance of risk and benefit. I am glad to have the benefits. However, the Minister should reassure women about some of the issues I have raised.
I welcome the Minister. I share the view that he is a Minister who has established his credibility from the first day of his appointment on this and other issues which he discussed in the Seanad.
I have no personal experience in this matter so perhaps it is wrong of me to disagree with some of the women who have such experience. I do not think the manner of the Minister's announcement was insensitive or lacking in understanding as was suggested by Senator Taylor-Quinn. There was openness and honesty as soon as the matter came to light. The media behaved in a responsible manner also. The Blood Transfusion Service Board acted immediately and informed people. As Senator Honan said, there was some confusion about whether general practitioners had been informed. If the Minister had waited until every GP had been informed we would have come to this Chamber to demand an immediate public awareness campaign. We would have cited the ten to 14 day delay in postal deliveries in some parts of the country as a factor in not making people aware of the risk. It is unfair to say the Minister should have taken a different course of action. The announcement was made in the most efficient and effective manner possible. General practitioners may believe they were excluded but the public awareness campaign was the necessary course of action.
Senators have said that the importance of the anti-D treatment must be taken into consideration. Senator Honan said that if there was a choice of availing of the anti-D treatment or not, few women would refuse to take the risk. Reference was made to the fact that medical treatments are not totally safe. The medical profession, including my GP, will agree that there is no medical treatment that does not carry some risk, no matter how slight. That applies to any treatment, even aspirin. Having given our children aspirin and taken it ourselves for years we discovered that there is a risk. Any treatment carries risk no matter how small. If the Minister is criticised for referring to that fact we can return to the days of the spin doctors and the PR agents who gave us the flavoured story. I do not want that brand of politics. I prefer to be given the facts.
I do not think this matter is causing panic. The facts should be repeated; Senator Taylor-Quinn suggested we did not act as quickly as we should have. The screening test was introduced in 1991 — not 1993 — at the same time as the UK when it was discovered that the test was reliable. I would not criticise the Blood Transfusion Service Board in that regard. As Senator Henry said, it was due to the board's quality control mechanism that the problem was discovered. The worst thing we could do is criticise the good work of the Blood Transfusion Service Board. If the board had brushed this under the carpet for another ten years there would be a different debate on this matter.
I agree with Senator Taylor-Quinn and Senator Honan that an information campaign on hepatitis C is necessary. I have not got a clue what it is and it could be a cause of worry. That should be the next part of the campaign if a second phase is being considered. People should be told about the virus, the likely percentage of people who might be affected and the effects.
It is true that there is great concern among women, men and families about this matter. The concern does not arise because we were not informed but because we do not know what the results will be. The women to whom I have spoken are concerned but they are calm. I believe that is due to the way this matter has been treated. Nobody welcomes the problem that has been discovered. However, if we face it openly and honestly people outside the Oireachtas will respect us and have confidence in us as legislators.
The Minister is welcome. It is a pity this matter is the reason for his visit. I hope we will see him here on many occasions in the future when there will not be a semi-crisis.
I support Senator Taylor-Quinn who asked a number of questions. This evening was the appropriate time to ask those questions, if they had not previously been answered. Those who criticise the Senator for doing so are having a political go at her and I do not like that. If questions must be asked they should be asked when the Minister is here. There is no reason the Minister cannot intervene to make a further statement later and we can bend the rules if necessary so that he can do so.
I support Senator Taylor-Quinn's comments. If there were ten Ministers in charge of this matter there would be ten different programmes to deal with it. Individuals are different; we are not clones. The Minister undertook a certain course of action. I might have waited for another 24 hours or, depending on the circumstances, I might have done something different. The Minister should be open to mild criticism.
This has not had a shattering affect on the nation. People who get half of the message — who only tune into the headlines on the radio — are the people we worry about. If this was a crisis, getting the message across without giving all the information would have created difficulty. Many people only take in half of the message; they read the newspaper and take in only half the information. Later, over a cup of tea perhaps, the person may give another that information whereupon that person may begin to wonder and worry if he or she will die immediately. That has happened.
Some GPs received information which was not correct. Brushing that under the carpet will not do any good. We might learn from it for the future. I am speaking for people throughout the country but mainly for those in my constituency of Cavan-Monaghan. I am anxious that the Minister be clinical in his approach to ensure that everybody receives the information and that the information is complete. Many people here did not know about hepatitis C. If they have it they do not know if it will be bad, very bad or terrible. There are big gaps in the information people have acquired and those gaps must be filled.
On behalf of my constituents, neighbours and friends I urge the Minister to be as clinical as possible for as long as possible to ensure that everybody gets all the information and that people do not think they have the illness when they do not. Already, there are 100,000 possible cases; each probably thinks she has it. Ultimately a small percentage may have it but until that groups is investigated nobody will know.
Let us ask the questions tonight and get the answers. We must ensure that people are given complete information on the matter.
The Minister said: "Special arrangements have been made to provide information to general practitioners who, in many cases, will be the first point of contact for the women concerned". It is important that the Minister would justify not having fully consulted with the medical profession at both GP and hospital levels to ensure that the maximum and most effective screening could be carried out with a minimum of anxiety. They were unaware that this was to explode in the media.
The Minister decided to raise the issue through the media and by doing so highlighted the need for screening but he also increased the level of anxiety among women. GPs and many hospitals were not in a position to give any information and help at that point. I accept that what the Minister said was clearly and easily understood but there should have been consultation with the GPs and the hospitals before he went public.
The other point I put to the Minister is the time lag involved between the discovery of the necessity for hepatitis C screening and its implementation. It is crucially important that the population's trust in our excellent Blood Transfusion Service Board, which is the envy of Europe, is maintained and that every measure is taken to ensure this occurs. My main point is that there should have been more consultation. I accept the sincerity of the Minister and the Department in this matter but a lot of anxiety was created that could have been avoided.
I am happy to have the opportunity to reply and I thank Senators for thoughtful and considered contributions. They were particularly valuable from the women Senators, who would be concerned for their own health, and as a male Minister it is important for me to listen carefully to the points made and the anxieties they expressed. Many positive things were said about me for which I am grateful, but more importantly about the Blood Transfusion Service Board and the officials of my Department.
I am proud and impressed at the amount of work undertaken since I was alerted last Thursday evening. I got the first written report on Friday and the staff of my Department and of the Blood Transfusion Service Board have been working around the clock since then, right through the weekend. My commitment was to have public information available.
The point of criticism from some Senators was that we should have waited until all GPs were notified. That was something which had to be considered but, on balance, it would have been impossible. There are 1,600 GMS GPs. How should they be contacted? By telephone? Should we have written to them all? The Dublin GPs would have got the information a day before the country GPs. It would have been impossible for anxieties not to build up. Some of the GPs' wives would possibly need the test. Within a day of the notification, there would have been widespread concern, confusion and total panic. The couple of hours gap between the public campaign beginning on Monday evening and the post arriving on Tuesday morning was an acceptable level of confusion in handling an extraordinarily difficult and complex situation.
Over the weekend the Blood Transfusion Service Board put in place a nationwide screening process on an unprecedented scale. Four shifts of people are working around the clock from yesterday to carry out 6,000 tests every day from yesterday. They will have results within a week from each test. That work is ongoing around the clock. We hope to be able to screen all the women who present themselves within a matter of weeks. As I said this is an unprecedented scale of operation. We brought in the GMS Payments Board to assist over the weekend so that labels would be printed for every doctor and the postal information would go out to them.
The tests are carried out in the Blood Transfusion Service Board in Cork or Dublin. The GP is asked to take a blood sample which is part of his routine work for 101 other conditions. There is nothing complex in taking the blood sample and sending it off, and we will be negotiating with the IMO tomorrow about the fee structure.
The more important issue was to get a mechanism in place to inform everybody. That is my style; it will be my approach to any issue that arrives on my desk — people have a right to know about information that pertains to their health and I have no right to keep it from them. That might be crude or even insensitive but, after the initial shock, that is the approach most people want from the Minister for Health. They want the truth immediately and I am most anxious that all information will be made available as quickly as possible.
A few specific questions were raised that I will try to answer as best I can. As I said in the Dáil, I am no expert; in the last four days I have had an intensive course in the effects of anti-D immunoglobulin, hepatitis C and its six strains and the methods of transmission and I am still not an expert. I put together the expertise of the country as best I could over the weekend, including the specialists from the hospitals, to give the best advice to people to people and to make it available. That will continue. It is a little over 48 hours since the campaign started and I dare say that few women are unaware of it now. Yesterday 60,000 individuals tried to get through on the freephone lines and many thousands of them were counselled and advised. Obviously there will be difficulties. Not every GP got the pack in time but I hope they have it now, and in the fullness of time all lines of communication will be perfect.
Let me reiterate points I have already made. Hepatitis C was identified in 1989. I am no expert, but it is an extraordinarily elusive virus. It was discovered not by being identified itself, but its shadow was discovered by electron microscope. I think the people who worked on that project got a Nobel prize for their work. For years it was known as non-A non-B hepatitis until it was finally identified. It took a long time for an acceptable international test to be worked out. The Blood Transfusion Service Board was to the forefront in dealing with a proper test and participated in many international fora until an acceptable international test was agreed. It was introduced in Ireland at the same time as in the United Kingdom in 1991.
The question was asked when we had reason to be concerned that there was a fear of contamination with hepatitis C from anti-D. I was made aware last Thursday; the Blood Transfusion Service Board came to the conclusion in January from its own internal research. Praise is due to Dr. Power for the detective work and the research that brought her to that conclusion and so quickly brought us to the point where we are concerned enough to take the action we have. It is a great credit to the quality assurance mechanisms that are in place and the reputation of the Blood Transfusion Service Board.
People asked what is hepatitis C. The virus was first described in 1989. It is considered that this virus has evolved in the human race over many hundreds of years. Work by the Scottish National Blood Transfusion Service Board has classified six types of the virus. Types one, two and three are most commonly seen in western Europeans. Infection with hepatitis C may cause jaundice immediately. However, more usually the recipient is totally unaware of infection. In a small number of cases the virus may persist and cause chronic inflammation of the liver many years of decades later. The prevalence of hepatitis C is low in Ireland and compares favourable with other European countries.
Although we were testing anti-D since 1991, I was anxious to be absolutely certain. I used what some would call a belt and braces approach and brought in virally inactive anti-D last Friday. I have asked that all women who received anti-D from its introduction here in 1970 up to last Friday should present themselves for a test to be sure there were no difficulties and to set their minds at rest. That is what we hope to do. In my view it is better that women be told everything rather than being left in the dark. That was the decision made and I fervently believe it was right, although there is an argument on the other side.
Senator Henry talked of quality control and complimented the Blood Transfusion Service Board. I thank her for that. I fully accept what she said about quality assurance measures generally and the value and importance of health research. That is why I was happy to give a significant increase to the Health Research Board for 1994.
The Senator also asked about the correlation with maternity hospitals. That will be done. The Blood Transfusion Service Board has the names of two-thirds of the woman who received anti-D since 1970. It has established a data bank into which all the testing names are being inputted. At the end of the process, in a week or two, the board will correlate all those who present themselves for testing with the known names and try to identify those who are missing. The hospitals will help in that tracking system.
Senator Farrelly asked about the gap between 1989 and 1991; I have explained that. The virus was identified in 1989 and the first international test was developed in 1991. The test was introduced here at the same time as in the UK.
There were comments about the paragraph in my speech about risk. There will be associated risks but my job is to ensure risk is minimised. In fairness to the Blood Transfusion Service Board, it has worked remarkably over the years to ensure all the blood products it presents and the whole blood and plasma it produces are as safe as it can make them, which is as safe as any country in the world. We should all maintain confidence in one of our most important institutions, responsible for preserving the lives of millions of people since the mid-1960s when it was established.
I join with Senator Magner in complimenting the media. They have been most responsible when one considers what might have happened in other jurisdictions. They have been balanced and helped the board communicate the message in a clear way. The questions asked have also been fair because they reflect the questions surfacing elsewhere.
Senator Honan asked why mothers were not alerted to the risk of anti-D. The answer is that we were not aware of the risk until last month when Dr. Power's research concluded there was reason to suspect a link between hepatitis C and the 1977 product and I was not aware of it until last Thursday. I think that justifies testing everyone to ensure all fears are allayed. Every woman who has had anti-D should be tested.
The Senator also mentioned the wider issue of women's health. I am making a speech on that issue tomorrow morning in the Coombe Hospital — if I may promote that. It is an extremely important issue and I will deal with it by publishing a women's health strategy document this year as part of the national health strategy. In accordance with the request from the Council for the Status of Women I hope to bring a women's health plan to Government for approval before the end of the year.
Senator McGennis talked about bare facts, and I agree with her. I am in favour of giving bare facts. That is my job. I do not agree with Senator Cotter that I should have held off for 24 hours. That cannot be justified because of the fear and confusion which would have instantly arisen. The Senator said people were getting a half message. If I had fed the information selectively to professionals or some other group, there would have been a half message because it would have spread a shadow across the country.
Senator Sherlock spoke about the same issue. He demanded that I justify disclosure. I do not think I need to justify telling the women of Ireland what the case is. I have a responsibility to do that and no coterie within the population——
Is the Minister justifying failing to consult the professionals? He misunderstood me.
An Leas-Chathaoirleach
The Minister without interruption.
——whether doctors or other professionals, has a right to information before the people. If someone is ill, he or she has a right to know and I have no right to prevent access to information.
Was it right to use the media?
It was the only way.
The message is what was important.
Full information had to be given. The question is a legitimate one. I have been asked by doctors whether I should have informed them first. I thought it was much more important to tell everyone in the nation at the same time. That is my style and I can be criticised for that. Openness and having all the information available was what the people wanted, particularly the women. They do not want the information filtered through any source.
Senator Sherlock also mentioned the time lag before the introduction of screening. I repeat that there was no time lag. We introduced screening as soon as an internationally acceptable test was available. It was introduced in 1991 at the same time as in the United Kingdom.
I am grateful for the interest and the support of so many Senators. There is a problem which needs to be addressed and women who have been tested will be anxious until the results come back. We will work as diligently as possible to support the Blood Transfusion Service Board through its difficulties and we will help it give accurate information to patients. I hope to be able to keep this House updated as I receive the information.
An Leas-Chathaoirleach
When is it proposed to sit again?
Tomorrow at 10.30 a.m.