Vol. 552 No. 4
25 Mr. O'Shea asked the Minister for Health and Children the steps being taken to reassure the public about the safety of the MMR vaccine, having regard to the decreasing level of take-up and the dangers of a measles epidemic; and if he will make a statement on the matter. [12556/02]
The MMR vaccine is available under the primary childhood immunisation programme. This programme provides for the immunisation of children against a range of potentially serious infectious diseases. Under the programme parents may have their children immunised free of charge by the general practitioner of their choice. The schedule of immunisation is in accordance with the recommendations of the immunisation advisory committee of the Royal College of Physicians of Ireland. The World Health Organisation has indicated that the MMR vaccine does not cause autism and that there has been no new scientific evidence that would suggest impaired safety of the vaccine. The WHO strongly endorses the use of the MMR vaccine on the grounds of its convincing record of safety and efficacy.
The international consensus from professional bodies and international organisations is that MMR is a safe and effective vaccine and that the recently published research does not support a causal link between the MMR vaccine and autism or inflammatory bowel disease. The institutions include the Medical Research Council expert committee in the United Kingdom, the UK Committee on Safety of Medicines, the Centres for Disease Control and Prevention in the USA and the American Academy of Paediatrics. Most recently, the United States Institute of Medicine concluded that there was no link between the vaccine and autism or inflammatory bowel disease. This consensus is based on large scale epidemiological studies and more specific studies done in the laboratory setting. A large Finnish study involving 1.8 million individuals demonstrated that no case of inflammatory bowel disease or autism was linked to the MMR vaccine. A similar Swedish study found no increase in cases of autism in the ten years during which the vaccine was introduced.
The MMR vaccine is in use worldwide. Most countries implement a two dose MMR vaccine programme and this policy has been very success ful in controlling measles where high uptake of the vaccine has been achieved.
The primary concern of the Department concerning immunisation is that the vaccines in use are safe and effective. The Irish Medicines Board and the Royal College of Physicians of Ireland support the use of MMR on the grounds that it has been demonstrated to be a very safe and effective vaccine. There is a sound evidence basis for the use of MMR in the national programme.
Additional InformationThe Irish Medicines Board, IMB, is responsible for the monitoring and safety of all pharmaceutical products in Ireland. The monitoring of vaccine safety is ensured through clinical trials prior to licence and post-licence surveillance by the IMB. The IMB liaises closely with international bodies, including the European Medicines Evaluation Agency and the World Health Organisation.
In addition, the report of the Joint Committee on Health and Children on childhood immunisation, published in July 2001, concluded that there is no evidence of a proven link between the MMR vaccine and autism and that there is no evidence to show that the separate vaccines are any safer than the combined MMR vaccine.
To reassure the public about the safety of the MMR vaccine and to address the negative media coverage on this issue which adds to the confusion of parents in deciding whether to vaccinate their children, I recently launched a document entitled, Measles, Mumps, Rubella Vaccine Discussion Pack – an information guide for health professionals and parents. The pack was produced by the National Disease Surveillance Centre and the department of public health in the Southern Health Board. It was published by the health boards executive on behalf of the health boards. It sets out the facts on the most common concerns about MMR in a way that will help health professionals and parents to explore these concerns together, review the evidence on MMR, and provide the basis for making an informed decision. The pack addresses such issues as the alleged link between MMR and autism, the safety and side-effects of the vaccine, combined versus single doses and contra-indications to the vaccine.
The national uptake rate for MMR in 2001 was 73%. This falls considerably short of the national target of 95% which is required to provide population immunity. I am concerned about the unsatisfactory immunisation uptake rates because of the risk of children who have not been immunised contracting the potentially serious diseases concerned.
In 2001 a national immunisation steering committee was established by the health board chief executive officers to address a wide range of issues relating to the childhood and other immunisation programmes, including the identification of issues that were hampering the achievement of uptake targets. On 22 April 2002 I launched the report of the steering committee. This is the first step towards improving immunisation uptake and enhancing and developing the key systems which underpin the immunisation programmes. A group under the auspices of the health boards executive is examining the report with a view to drawing up a detailed implementation plan.
I urge all parents to have their children immunised against the diseases covered by the childhood immunisation programme to ensure that both their children and the population generally have maximum protection against the diseases concerned. General practitioners are aware of the contra-indications to the recommended childhood immunisations and parents should discuss any concerns they may have with their general practitioner before making a decision about their child's immunisation.
I agree with the points the Minister made and they are important. Does he not accept that the message has not got through, that many parents are deciding not to avail of the option of the MMR vaccine because of fears about side effects, and that he has a responsibility to reassure them and ensure full information is provided, especially about the dangers of measles? I am sure he is aware of the serious situation which has developed in the east. The most recent figures I have concerning the low uptake in the Eastern Regional Health Authority area are 68%. Does the Minister not accept that there is an issue of reassurance in putting across the message he enunciated and of ensuring a proper relationship between general practitioners and health boards, some of which have got their act together in the primary care area?
I have taken every public occasion to endorse the use of the MMR vaccine.
People have not heard it.
I have been reported by every newspaper on the issue. Some of the coverage has been extensive and some not. We asked the National Disease Surveillance Centre to produce a document, which I launched recently, entitled, Measles, Mumps, Rubella Vaccine Discussion Pack. It is a good discussion pack for parents and the public and there is a more substantive booklet of notes for general practitioners which will enable a good interaction to take place between GPs and parents.
I accept that there is concern about the issue. There is no question about that. That is why we decided to go the road of the discussion pack to try to allay the concerns, but more importantly to highlight the dangers of measles, mumps and rubella. Apart from the MMR issue, a certain complacency exists because measles has not been experienced by the mass of the population compared to the 1970s when an average of seven people a year died from it. The dangers of a measles epidemic has not fully been appreciated, which is in stark contrast to the uptake of the meningitis C vaccine, because parents were aware of the potential ravages it could visit on their children. A steering committee has been set up to address this matter.
Does the Minister agree that, notwithstanding what he has said and the evidence he quotes, there is a significant and growing minority who are concerned about the evidence? Would it help if there was a smart card for each child who is vaccinated which generated a computer record of his or her vaccination history which in turn could feed into a national database? This might be a way of communicating with people and assuring them that the information they require is available to them because they would retain the smart card themselves.
I agree that a proper database is the way forward. In fact, we are working towards it in terms of the new PPN number, as it is called, where every person in the country will have a number for access to the public services. The provision of the necessary investment in information technology in general practices across the country will be a further key to making that a reality. Health information is one area where there is currently a deficiency, and while we have made much progress in terms of the HIPE data and so on from acute hospitals and other various databases there is, nonetheless, a clear need for a far more comprehensive set of databases to emerge and the new health information strategy will underpin that.
I accept the basic point that if we had a number that individually identified patients it would significantly aid a programme of vaccination and immunisation. Last week I launched the report of a new group that I established, the national immunisation steering committee, which has specific recommendations in regard to the MMR. Further proactive campaigns on the issue will be seen in the coming months.
Does the Minister accept that there is a particularly low uptake of MMR in disadvantaged urban areas? Does he accept that there is now a problem in regard to the number of family doctors in these areas, which has exacerbated the situation? The Minister himself has been responsible for attracting doctors into better-off areas due to the over-70s scheme. Will he state how he intends to deal with this dilemma?
The scheme of free medical cards for the over-70s has not attracted anybody anywhere.
Of course it has. In what world is the Minister living?
The investment in primary care is the way forward in terms of improving the lives of general practitioners and that is why we have invested substantially this year in the general practice co-operatives. An extra €10 million has been allocated for the development of general practice co-operatives, which will be of benefit to disadvantaged urban areas as well as other parts of the country. I acknowledge that GPs in such areas have an enormous work burden, which has built up over recent years – it did not just happen this year, or last year for that matter.
The Minister should not make it worse.
We are not making it worse. All doctors I spoke to after the introduction of the GP co-operative, including in rural areas, spoke of the key dividend as being an improvement in their quality of life. I am convinced that is one way forward in reducing the burden on GPs. We also need to increase the intake into medical colleges in terms of future needs.
The Minister finally got the message.
We have always had the right message.
In the context of the recent serious measles outbreak in Tuam, County Galway, will the Minister clarify if any other outbreaks have been reported to the Department? What is the current situation in Galway where emergency teams had to carry out vaccinations on Saturday and Sunday last?
The general practitioners and the health board in Galway got off the mark very quickly in terms of containing that particular outbreak. We have not had reports of any similar outbreaks elsewhere but continue to monitor the situation on a daily basis. We urge all parents to have their children vaccinated to ensure that there is widespread immunity throughout the country to protect all children.
