asked the Minister for Health whether any health board in the State are refusing or failing to provide the 3 in 1 vaccine; the reason for any health board taking such an attitude; and the steps being taken by his Department to deal with the matter.
Ceisteanna—Questions. Oral Answers. - Provision of Vaccine.
Vaccination against diphtheria, pertussis and tetanus is being offered by each health board in the State.
Vaccinating doctors in the public health clinics in Galway city have sought clarification from the Western Health Board about their position relating to one of the contra-indications to the vaccine which would necessitate their having information about the infant during the newborn period. Pending the resolution of this matter, pertussis vaccine is not being administered through public health clinics in Galway city but is available through family doctors.
My Department are, of course, concerned that the vaccine should be made available through the public health clinics in Galway city and are in regular contact with the Western Health Board in the matter. The health board hope to resolve the question in the near future.
Will the Minister confirm that the vaccine he has referred to that is not being administered by the Western Health Board is the vaccine to prevent whooping cough? Will the Minister indicate if the reason members of the medical profession in the Western Health Board area are not administering that vaccine under the health board scheme is due to the difficulties that have arisen in the past in the context of alleged brain damage being caused to a small number of children who, due to certain conditions, were vulnerable to such brain damage as a result of the administration of the whooping cough vaccine? Will the Minister indicate for how long doctors employed by the Western Health Board have been refusing to administer whooping cough vaccine?
I should like to stress that in all health board areas throughout the country, and in the areas outside Galway city in the Western Health Board area, the vaccine is available in health clinics. It is not available in Galway city as a result of the refusal of vaccinating doctors in the city clinics to administer the vaccine unless the health board agree to indemnify them against the risks of damage to the infants to whom they administer the 3 in 1 vaccine. I understand that the health board hope to resolve the issue during this month taking the view that indemnification is covered by the doctors' Medical Defence Union or Medical Protection Society and that a separate scheme of indemnification is not necessary. The Department hold the view that a special indemnity is not necessary.
Is the Minister satisfied that the questions his Department require doctors to ask parents to discover whether a child is suffering any contra-indications that would indicate that the whooping cough vaccine could be a danger to the child adequately deal with the problem? Is the Minister satisfied that since this form of questioning commenced about 1975 there have not been any cases of brain damage to children as a result of the administration of the whooping cough vaccine?
The policy of my Department is that the decision to administer any vaccine rests with the vaccinating doctor who will be aware of any contra-indications which may exist. In view of the fact that it may be difficult for vaccinating doctors, particularly for those in the public health service, to establish if certain contra-indications exist in specific vaccines the Department, in their most recent circular, issued in March 1983 to health boards about vaccination and immunisation, advised that public health nurses should also endeavour to establish family and medical factors in each individual case and transmit all the relevant information to the vaccinating doctors. Every precaution is taken but the final decision rests with the doctor as to whether the vaccine should be administered or not.
Will the Minister agree that the action taken by doctors in Galway indicates that the tests they undertake and the procedures adopted at present to try to identify contra-indications are not necessarily adequate? If they were adequate members of the medical profession would not be refusing to administer the whooping cough vaccine for fear of being sued as a result of the consequences of administering the vaccine.
The issue rests not so much with the point raised by the Deputy but with the demand that there should be a separate and special indemnification in connection with the 3 in 1 vaccine. The Western Health Board referred the matter to their legal adviser and were also in contact with the Medical Defence Union and the Medical Protection Society. The health board are anxious to resolve what is essentially a local issue. I stress that throughout the country, particularly in the Western Health Board area other than Galway city, the issue has not arisen.
How long has this been going on — has it been the position for some time?
I have not got the exact date on which the dispute occurred. The health board are extremely anxious to have the matter resolved urgently.
Will the Minister accept that all the best medical advice is that parents should have their children vaccinated against whooping cough, diphtheria and tetanus at the one time, unless there are definite contra-indications?
I share the Deputy's view, on the best advice available to the Department and to me; but, as the Deputy is aware, there is a persistent campaign against the 3 in 1 vaccine. The balance of advantage lies strongly with families availing of the vaccine. That is critically important.