I propose to take Questions Nos. 322, 336, 340, 353 and 359 together.
The immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. It makes recommendations on vaccination policy to my Department. NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time.
In 2009 the NIAC recommended HPV (human papillomavirus) vaccination for all 12-13 year old girls to reduce their risk of developing cervical cancer when they are adults. In September 2010 the HPV vaccination programme was introduced for all girls in first year of secondary school. Gardasil is the vaccine used by the HSE in the School Immunisation Programme and is provided free of charge to girls in first year of secondary school.
During the 2019/20 school year, girls attending secondary school can still join the HPV girls only programme with appointments offered in HSE mop up clinics. It must be noted that vaccinated women and girls may still be at risk from other high risk types of HPV that can cause cervical cancer and will therefore need to continue to have regular cervical smear tests.
As you are aware, NIAC recommended that the HPV vaccine should also be given to boys. On foot of NIAC’s recommendation, my Department asked the Health Information and Quality Authority (HIQA) to undertake a health technology assessment (HTA) to establish the clinical and cost-effectiveness of extending the current immunisation programme, which offers HPV vaccination to all girls in their first year of second level education (generally 12 to 13 year olds), to a programme that also offers the vaccination to boys in their first year of secondary school.
HIQA completed the HTA in December 2018, recommending that the HPV immunisation programme be extended to include boys. A policy decision was made to extend the HPV immunisation programme to include boys starting in September 2019 with the introduction of a 9-valent HPV vaccine. However, the HIQA report published in December 2018 did not recommend an HPV catch-up programme for older boys for several reasons:
- Vaccinating boys in the first year of secondary school provides the best possible protection against HPV infection;
- Boys are already benefitting from the indirect herd protection provided by the girls' HPV vaccination programme which started in 2010.
The ages at which vaccines are recommended in the immunisation schedule are chosen by NIAC in order to give each child the best possible protection against vaccine preventable diseases. As the HPV vaccine is preventative it is intended to be administered, if possible, before a person becomes sexually active, that is, before a person is first exposed to HPV infection. Therefore, the gender neutral HPV vaccination programme targets all girls and boys in first year of secondary school to provide maximum coverage. All vaccines administered through the School Immunisation Programme are provided free of charge.
Extending the HPV vaccine to boys will also provide direct protection to boys against HPV-related disease. It also provides indirect herd protection to girls who have not been vaccinated. Another important factor includes the additional protection provided by a gender neutral programme to vulnerable groups (for example, men who have sex with men) and the potential to improve the resilience of the immunisation programme to fluctuations in vaccine uptake and to the movement of individuals into and out of the country.
For older children who did not receive the vaccine as part of the School Immunisation Programme the HPV vaccine can only be obtained privately from a GP. If your child is 15 years of age or older they will require three doses of the HPV vaccine in order to be fully protected. Those who have a medical card are eligible to have the vaccine administered free of charge by their GP. However, the cost of purchasing the vaccine privately is not covered by the medical card.
My Department will continue to be guided by NIAC's recommendations on any emerging evidence on this issue in the future.