Vol. 166 No. 16
I move:
That, pursuant to section 4(4)(c) of the Commission to Inquire into Child Abuse Act, 2000, Seanad Éireann approves the draft order:–
Commission to Inquire into Child Abuse Act, 2000 (Additional Functions) Order, 2001.
a copy of which, in draft form, was laid before Seanad Éireann on Thursday, 17 May 2001.
Before seeking the approval of the Seanad for this important resolution, I would like to give some background information concerning the events which have led to the making of this order. I have no doubt this House will agree that one of the success stories in relation to human health in the last century has been the reduction and, in some cases, elimination of disease and death due to infectious diseases, particularly in relation to diphtheria, pertussis and polio. Many of us may recall stories told by parents or grandparents of whole families being wiped out as a result of diphtheria. Thankfully, those days are no longer with us. Vaccines against a range of serious diseases, such as diphtheria, pertussis, polio and measles, have been developed and introduced into vaccination programmes around the world, and Ireland has been no exception in this regard.
The background to this draft order is that as a result of media interest in 1990 and 1991, three vaccine trials that had been undertaken on children in care in Ireland in the 1960s and 1970s were brought to the attention of the then Minister for Health. Two of these trials were the subject of published articles in peer reviewed medical journals. The then Minister for Health answered a question on the matter in the Dáil in May 1991. Interest in these trials continued and on 9 July 1997 the then Minister promised to have inquiries made into the matter following which he would consider appropriate action. The chief medical officer of the Department of Health and Children was asked to make these inquiries on the Minister's behalf and his report entitled report on three clinical trials involving babies and children in institutional settings 1960-61, 1970 and 1973 was laid before both Houses in November 2000.
The Minister has welcomed the interest which Members of both Houses have shown in the report and he shares the view that answers must be provided to the various issues raised in the report. He is also acutely aware of the serious concerns of former residents of a number of children's homes who are concerned that they may have been involved in these trials. These children were in the care of the State and it is important to establish if the State fulfilled its obligations to them.
It is important to state that, in this case, we are looking at marginal degrees of difference in the vaccines administered not at experimental, unproven or dangerous medications. Furthermore, we must take into account that the protocols of 30 years ago are not necessarily the protocols applied today. However, the Minister has already indicated that he is not satisfied that the chief medical officer has been able to establish that solid informed consent was given by the people entitled to give it. He rightly considers this issue of consent to be absolutely fundamental.
The Minister has raised questions which he considers must be asked, irrespective of the overall intent of the trials and irrespective of the indications that no child suffered medically as a result. These are questions which unfortunately the report cannot answer; questions such as, why children in care were given a more experimental vaccine than children not in the State's care. Was the end result from each trial for the public good or for the commercial advantage of a manufacturer? Why were some medications given to children who were outside the age group at which those medications were known to be effective? And above all, why are the records of some of the trials so woefully inadequate at almost every point? These questions must be asked in a context which offers the competence to thoroughly investigate the matter. For that reason, the report has been sent to Justice Laffoy so that the Commission to Inquire into Child Abuse may consider it as part of its wide ranging investigation.
This decision is based on the rights of those involved who are entitled to a thorough wide ranging and public investigation of all the issues involved. The Laffoy commission offers the best mechanism for dealing expeditiously and rigorously with the totality of the issues. The appropriateness of referring the report to the Laffoy commission was raised in the Dáil last November. At that stage, the Attorney General advised as follows: The definition of "abuse " in the Inquiry to Child Abuse Act, 2000, includes any wilful infliction of physical injury or failure to prevent such injury to a child and any failure to care for a child, or act or omission towards a child which has serious effects on the child's behaviour or welfare".
In so far as clinical trials are alleged to have been conducted without the appropriate consent and in so far as these trials are alleged to include the use of injections and intra-nasal administration of drugs, quite clearly an issue arises as to whether any such trials amounted in law to an assault or an unlawful invasion of the physical integrity of the children involved. Likewise, the consequences of participating in any such trials are matters relating to the welfare of children. All these issues fall within the scope of the commission as expressed in section 1 of the Act.
It was further stated by the Taoiseach and the Minister for Health and Children that the issue of whether the commission required additional powers by means of a Government order to investigate the vaccines report would be considered by the commission. It was also made clear by the Taoiseach that the approval of both Houses would be sought should such an order be deemed necessary.
Having considered the relevant issues in the intervening period, it is the clear view of both the Attorney General and the chairperson of the commission that, as matters stand, the Commission to Inquire into Child Abuse has the competence to investigate the vaccines report. However, the chairperson has suggested to the Minister that it would be helpful, for the sake of clarity, if the terms of reference for the commission's investigation into the report were to be incorporated in a Government order. This course of action has been agreed following consultation between the commission and the Attorney General's office.
The purpose of the draft order is to define the parameters of the commission's inquiry into the vaccine report. The Government may, under section 4 of the Commission on Child Abuse Act, 2000, by order confer on the commission and its committees additional functions or powers connected with their functions and powers. The proposed order provides for additional functions to be conferred on the commission as follows: to inquire, through the investigation committee, into the circumstances, legality, conduct, ethical propriety and effects on the subjects thereof of (i) the three vaccine trials referred to in the report and (ii) any systematic trials of a vaccine or the mode of delivery thereof to test its efficacy or to ascertain its side effects on a person found by the investigation committee to have taken place during the period commencing on 1 January 1940 and ending on 31 December 1987, and to have been conducted in an institution, following an allegation by a person that he or she as a child in the institution was a subject thereof, and to prepare and publish to the general public in such manner and at such time as the commission may determine a report in writing specifying the determinations made by the investigation committee in its report under article 4 of this order.
The Minister has outlined on a number of occasions the advantages of having the report and its implications fully investigated by the Laffoy commission. The commission has the full range of powers and personnel needed – an experienced secretariat, a strong panel of experts with the requisite qualifications and an investigative and legal infrastructure.
There is a clear synergy between investigating this matter and the other matters being addressed by the commission and the Laffoy commission offers a comprehensive vehicle for dealing with the totality of these issues. Ms Justice Laffoy has indicated her willingness and competence to take on this role and, as the Minister indicated, the Department of Health and Children will fully co-operate with the commission in the course of its investigation.
We believe that entering this process makes a clear and unambiguous statement to those involved in the trials that every effort will be made to find out if their rights were protected all those years ago. We wish to do this in a forum that has the power to investigate, to compel witnesses and to publish its findings without fear or favour.
The Laffoy commission, for all the reasons I outlined, offers by far the best opportunity to secure answers to the many questions raised in the report. I ask Members of the House to approve this resolution.
I welcome the Minister of State to the House. I am pleased the draft order is before us for approval, but the concern of the Minister for Health and Children, Deputy Martin, that the Minister of State outlined rings hollow given it is more than 12 months since this issue was raised. When the draft was published in The Irish Times last March the Minister stated specifically he would publish it within weeks, but then there was a six months' delay up to November and the draft order has only come before us 12 months after the issue was raised. That does not reflect that the Minister considers this matter to be extremely urgent, which we believe it to be.
I recall Fine Gael policy on the matter at the time, particularly Deputy Gay Mitchell stating he wished the Oireachtas Committee on Health and Children had the power to compel witnesses to attend and to answer questions, but that did not happen. As a member of that committee, I am aware the draft order was laid before us, but it has not been debated. While I accept there is a heavy volume of work before the committee, there has been a long delay in debating this draft order, particularly in the context of the safety of vaccines. We spent a considerable number of months dealing with groups in the health area, including health boards, medical personnel and parents who are extremely concerned about possible links between particular vaccines and autism. The Minister should have responded must faster.
There are many questions to be answered. What struck us most at the time was that 123 of the 211 children concerned – which is a considerable number – in the period between approximately 1960 and 1973 were residents of children's homes. That is absolutely dastardly considering the State has such a responsibility for children in the care of the State and that this practice continued for quite a long time. Fortunately for children throughout the rest of the country from what we know, it appears most of the institutions involved were in Dublin, although we do not know that conclusively until the commission inquires into it and, as outlined by the Minister of State, its remit is quite specific.
I would have preferred if there was compellability of witnesses. Will we ever know the full truth regarding witnesses and consent? I read the various newspaper reports on the issue. The Irish Times mentioned that Professor Irene Hilary repeatedly asserted that she invariably sought the consent of the appropriate authorities, whether it was parent, management or medical officers, before conducting the trials. That statement shows she was specific. Twelve months later, why have we not at least cleared up the matter of consent?
Another serious issue concerns the risk of infection as a result of receiving experimental vaccine. This point was omitted during a lengthy period of correspondence. The Laffoy Commission will examine the matter. The report of the chief medical officer of the Department of Health and Children did not draw conclusions, so it is obvious that we need to investigate further. The fact that it was the children in care who received the experimental vaccine suggests that they were discriminated against in favour of the children living in normal families, who received the standard approved vaccine.
There are many questions to be answered on this topical issue. In conducting my research, I looked at the British public health sector and the Vaccine Damage Payments (Specified Disease) Order, 1995. When one finds that other countries have progressed so far in terms of investigating problems associated with experimental vaccines, etc., one realises that we have more to do than merely check what happened to the children who were victims of vaccination experiments.
One must question whether the end result of each trial was for the public good or, as the Minister of State mentioned, for the commercial advantage of vaccine manufacturers. Additionally, one must ask why so many vaccines were administered to so many children who were known to be outside the age group within which the vaccines were known to be effective. This is a serious issue.
The Minister of State did not say when we might expect to have the reports. We do not know how healthy the victims are, who are now adults. Why were the records of some of the trials so inadequate, almost in every regard? I know that the Minster for Health and Children said that the issue of consent could not be fudged, but he stated that there was evidence of solid informed consent given by those entitled to do so. He also said that there was a lack of documentation regarding the trials that was puzzling and unsatisfactory. I appeal to the Minister of State to inform the Minister for Health and Children that we require a speedy reaction to one of the most serious cases that a commission has been given to investigate. We should be particularly concerned about children in State care. If they were used as guinea pigs and their health has been damaged or impaired, I hope the Minister will compensate them adequately, if this is possible.
This matter has been debated before so I will be brief. I am as anxious as Senator Jackman and the Minster of State that we should attain the facts on the vaccine trials in question. I am also anxious that when the Laffoy commission investigates this it takes cognisance of the standards of the times. We cannot apply the standards of today to the actions of yesterday, although things have happened to children down through the years that cannot be excused.
If Edward Jenner was starting work today he would lose his licence to practise as his standards were horrific when compared with today's standards. He was responsible for the elimination of smallpox. It is important that we consider this matter in context and educate ourselves in the way we approach children with regard to their rights and other childhood issues. This report can be an educational one for the State and those employed by it in loco parentis to care for children outside the home. It can help to underpin our understanding of childhood and how we should treat children.
It is helpful to this debate that the Minister is a general practitioner and we have the benefit of Senator Fitzpatrick who is also a GP. There are few people other than GPs who know about the difficulties with vaccination. I am sorry the Commission to Inquire into Child Abuse Act, 2000 (Additional Functions) Order, 2001, is being used to investigate this situation, because I do not think these children were abused.
Both the Minister and Senator Fitzpatrick know the value of vaccination as well as I do. Sadly, there are too many people nowadays who forget it as they are not in a position to remember the polio epidemic which preceded these trials. I come from Cork where there were over 100 deaths and thousands were crippled from the disease. Everyone in this House wants to protect the rights of children, especially children in care. I speak frequently on this and I hope we do not end up with a situation where far more children are put at risk because of the drama which has been created about these trials, which at the time were absolutely ethical and, indeed, would be ethical today.
One cannot carry out trials for childhood vaccines on adults. Senator Fitzpatrick referred to Jenner. If he had not started in this area, would we be without smallpox now? I do not know if the medical profession has made people think that all these matters are safe and that nothing will ever go wrong, but certainly the type of trials which were carried out were absolutely ethical. At that time Professor Meenan was a World Health Organisation expert and Dr. Irene Hillery, who carried out the practical part of the trial, went on to become, and still is, an international expert.
Of course more emphasis should have been put on consent. As president of Cherish, the organisation for single mothers which was set up around that time, I can attest to that more than anyone. I am only too well aware of how little consideration was given to the consent of mothers. Those in authority in institutions perhaps gave consent too regularly, but we allowed them act in loco parentis and that is what they did. We cannot describe these children as guinea pigs, as I have seen them described in media reports, because that is not so. If I had been asked to let my own children, who were being immunised at that time, take part in the trials, I would have done so.
Last year we brought in immunisation against meningitis and it has been an astonishing success. Given the terror that surrounded its introduction, I am glad I have never been a general practitioner involved in vaccination. Understandably, parents will always look for a reason if something goes wrong with their child. However, many children's problems are only discovered around the time of immunisation. Take the current controversy linking autism to the measles vaccination. The evidence to connect them appears to be very slim, whereas the genetic evidence appears to be much stronger. Tragically it seems that family linkages are a factor. We are just beginning to find out about many of these issues.
Last year we had 1,500 cases of measles and two deaths. The year before we had only 47 cases of measles and no deaths. We knew there was an epidemic coming, and two children died from conditions associated with measles, so I hope that this issue will not be blown up too much. We are forgetting about diphtheria, which is breaking out again in eastern Europe, and polio which has nearly been eliminated. If we do not immunise, our children will suffer.
One of the most extraordinary things about these trials is the stage we are at now. I ask the Minister to confirm that there will be a change in immunisation policy as of June. In the trial carried out in the 1960s Dr. Hillery investigated the possibility of reducing the number of injections given to children. At that stage we did not have the oral polio vaccine and children were given the triple vaccine for diphtheria, tetanus and pertussis as one injection and the polio vaccine as another. Dr. Hillery investigated whether sufficient immunity could be achieved by giving all the vaccines in one injection. As Members will be aware, however, the more injections one gets, the lower the uptake of an eventual vaccination programme. This is because parents are naturally upset by the distress children experience when getting injections – even a slightly sore arm causes distress – so the number of children being immunised falls.
Some adults have contracted polio from faeces while changing the nappies of babies who have recently received the oral polio vaccination. I understand that a quadruple vaccine programme will be introduced in June, which will vaccinate children against pertussis, diphtheria, tetanus and polio in one injection. If that is true, it means that Dr. Hillery's work will have become standard more than 30 years later. Someone has to do the work to show whether the immunity achieved is adequate. One cannot simply decide to change from one vaccination to another without examining whether children will receive adequate immunity.
The vaccination programme in the 1970s investigated the possibility of reducing the number of organisms of pertussis in the injection. This was because some children got very sore arms and even systemic reactions to the pertussis part of the vaccination, which entailed injecting dead organisms. Dr. Hillery examined whether one could greatly diminish the number of dead organisms and still have a satisfactory result. From June onwards, we will reduce the dose to part of a dead organism in line with the work carried out by Dr. Hillery. She should be praised for her work and these unfortunate circumstances should not have been allowed to arise. It is extraordinary that we are investigating these trials when we are about to introduce a vaccination programme based on her work.
We must be very careful to ensure that this legislation is not used to investigate all sorts of matters. We could end up investigating the lack of facilities for neonates, on which I have had a heated correspondence for the past couple of years. In a couple of years' time we will have an investigation to establish why some children did not get adequate treatment just after they were born, because the State did not supply adequate facilities. We will have another investigation looking at the implications of the drastic reduction of the number of nurses who were available to treat these children. In 1980 we had 29,000 nurses and we now have about 11,000. Members will be relieved to hear that clerical and administration staff in the health services have risen from 5,400 to well over 11,000. They have more that doubled while the number of nurses has gone down. The number of doctors has risen by about 20%. Will we have an investigation about this under the Commission to Inquire into Child Abuse Act, 2000? Children's operations are repeatedly put off. They do not get the quality intensive care nursing they should. Why do we not investigate this under the Act?
I am glad Senator Fitzpatrick said this must be looked at in the context of the times. Trying to get records from 30 years ago is difficult as we know. While it is important that we look into this from the point of view of those involved, we must remember that the protection of our children is also the physical protection of them by the immunisation programmes we set up. We certainly do not want the current drop in the vaccination uptake to be repeated.
I welcome the Minister of State to the House. I will be brief because I have spoken on this matter before. I do not agree with Senator Henry that the Minister has not attached importance to this. The function of this proposal is to ensure that the Laffoy commission has the competency to investigate this matter. I think it is accepted that it has, but this will clinch it and make absolutely sure that everything is above board.
The record keeping of 40 years ago is far removed from what it is today. Both the Minister and his predecessor ensured that once the complaints came from a former resident of a children's home in Dublin, by way of correspondence with the then Minister, they were investigated. It has already been said that there were some reports in the peer review journals. If there was wrongdoing or impropriety in the past it will be investigated. It is important that the public, who look to the Houses of the Oireachtas to protect their interests, have confidence that whatever happened, however long ago, will be investigated.
I strongly agree with Senator Henry's views on the importance of vaccines. I regret to say that I lost my eldest brother at four-and-a-half years of age due to complication arising from measles. Vaccination is very important.
Much has been said about the competence of the people involved in those days. The question raised by the Minister about why one group of children were given an experimental vaccine while children not in the State's care got a regular vaccine must be answered. Was the end result for the public's good or for the commercial advantage of a manufacturer? That is a very pertinent question. Why were the medications given to children outside the age group for which it was known to be effective?
I commend this order to the House.
As with other Members I welcome and lend my full support to the resolution. The attitude of the Department, as set out by the Minister in his speech, is to be welcomed. It marks the changing attitude, which we all have, to accountability for things which happened in the past and indeed reconciliation with things that happened then. We are going through a period which, while painful, is certainly necessary and ultimately will be very healthy. We must examine files relating to events which took place in past decades, particularly in State institutions, and bring those accountable to justice where necessary. The use of experimental vaccines is one example of children in care being treated very differently from those not in care.
I do not intend to speak on the medical issues as Senator Henry has already done that. I will deal with the general issues raised and the Laffoy inquiry into child abuse. It has been pointed out by the Minister that the Attorney General's advice, as given to the Dáil last November, makes it clear that any wilful infliction of physical injury, failure to prevent such injury to a child or failure to care for a child which has serious effects on the child's behaviour or welfare, comes under the definition of abuse in the Act. In that regard this issue can be sent to the Laffoy inquiry and can be dealt with adequately. I hope that the issues raised can be reconciled there. I hope that it will be given full public examination and reportage because that is an important part of the processes of accountability and reconciliation.
The investigation by the Laffoy commission is extremely important. I hope that it will be possible to reconcile the quite serious differences that have emerged between the groups representing those who have been abused on the one hand, and the Departments of Health and Children and Education and Science and the commission on the other, so that the commission can do its work and come to its conclusions. The differences must be reconciled so that those who have been victims of abuse can feel that not only have their cases been adequately and publicly heard, but that accountability and justice are seen to be done. We have some way to go to achieve that, and I extend every best wish to those involved in ensuring that happens. It is undoubtedly one of the black clouds that hangs over the State's care of children in the past that needs to be dealt with if we are to move into a proper democracy.
Senator Henry referred to issues surrounding the care of children in the current era that would certainly come under the definition of abuse as outlined by the Attorney General. One can only think of the care of troubled teenagers and the necessity to provide resources, not only in our cities but throughout the country, and to look carefully at how we need to deal with that problem. Times and issues have changed but that is one of the most urgent and important issues regarding the care of children that has to be dealt with by Departments today. I support the commendation of this order to the House.
As part of a study on the Famine and related issues which I carried out in my school in Drogheda some years ago, I ended up reading about the children in care in the foundling hospital in Dublin at that time. I found that they were dreadfully abused and maltreated in those days, and over the centuries the care of children has certainly improved.
I welcome this initiative from the Minister. I welcome the consensus here that this inquiry must take place in the manner in which it is proposed. The work of many organisations down the years has not been in vain and the rights of children, who have been in care and are in care, are being vindicated. Regrettably this is happening much later than it should have because we were not aware of the abuses taking place, and that is the significant aspect of it. The concept of care and the number of social workers and health board employees who are working full-time in the care of children, particularly children who are in care, are about to be put in care, are in temporary care or are in foster care, is something to which we are paying a great deal more attention now.
The only problem I see as important now, which is why I rise to contribute on this issue, is that there are many young single mothers who have nowhere to go with their children, who end up in bed and breakfast accommodation or inappropriate poor housing. The reality is that the rent allowance to which they are entitled gives them access to the worst, rather than the best, accommodation in our society. This is an area we ought to look at. We ought to provide especially for young mothers, some of whom have been in the care of the State until they were 18. Having left the care of the health boards, these mothers with young children in my area are coming to me for help. There is a lack of interest in their position because there is no statutory requirement in place. There is a lack of communication with those families and a lack of ongoing empathy and concern which they need.
I support the Minister in what he is proposing here. It is one part of a long process. I hope we are coming to the end of the sad, sorry, disgraceful saga of the way people in care have been treated in our society in the past. We all share the blame. We must all work together to make sure it never happens again and that whatever can be done will be done to address the wrongs done to all those people.
I thank all the Senators for their contributions and for their support for this order. Senator Jackman was concerned about the delay, but in these issues it is sometimes difficult to get things off the ground. I hope, now that it is in the arena, it will not take too long before this commission sits and brings forward its findings.
No doubt this is a difficult subject. As Senator Fitzpatrick said, one cannot apply the criteria of today to what happened 30 years ago. Senator Henry also made the point that she was a little perturbed about it coming under the area of child abuse because we are talking about vaccination and it was done according to best practice at that time. There is much good which has come out of many vaccine trials. It is best for us to wait and see when all the facts in this area are elucidated. I hope the commission will bring forward clear findings.
Over the years we have learned a great deal about vaccines. Senator Henry alluded to the hope, which I share, that we do not put off mothers from vaccinating their children because there is much unwarranted fear regarding vaccines. Certainly in regard to autism, that has not been cleared up as yet and at present there are many theories. Nevertheless, we are learning all the time, especially in regard to genetics, which have changed the issue and provided much of our knowledge on the issue. I hope this commission will get to the bottom of the issue and produce a report which will be fair to everybody.
I propose that the House suspend until midday.
Is that agreed? Agreed.
