2010 was a record year for Ireland's public vaccination services. PRISCILLA LYNCHreports
BY THE end of this year, the HSE will have administered over four million vaccines to everyone from newborn infants to our oldest citizens.
2010 was one of the busiest years in the history of the State in relation to public vaccination, largely because of the swine flu (H1N1) mass vaccination programme, increased childhood vaccinations and the introduction of the HPV (cervical cancer) vaccine.
Dr Brenda Corcoran, consultant in public health medicine and head of the HSE’s National Immunisation Office, says Ireland’s immunisation services have been extremely busy since autumn 2008. The introduction of the six-in-one and pneumococcal (PCV) vaccines meant an increase in childhood vaccine visits from four to five, and a pneumococcal catch-up campaign for all under the age of two. Then, in April 2009, the HSE conducted an MMR catch-up campaign in secondary schools for over 130,000 pupils.
“The day that campaign started was the day the H1N1 pandemic was announced,” Corcoran says. The HSE then moved straight into preparation for the swine flu vaccination programme. The programme was a huge undertaking, with clinics set up throughout the country. By the end of March over one million (23 per cent of the population) had been vaccinated.
“I think overall it worked extremely well. There were huge challenges though. We thought it would be a two-dose strategy but that changed . . . we had shortages of the vaccine at the beginning and we had . . . to make sure it was given to those who were most at risk and that it was given equitably across the country,” Corcoran says.
There was a large amount of vaccine left over after the campaign. At the end of September, the HSE sent 250,000 (€2 million) doses of expired H1N1 flu (Celvapan) vaccine for destruction; it currently has 900,000 doses of the Pandemrix H1N1 vaccine in stock that does not expire until May, August and September 2011. Corcoran says the HSE has not been advised by the National Immunisation Advisory Committee to administer it to date.
This year’s seasonal flu vaccine already contains the H1N1 strain, which is expected to be the most common strain again this winter. The HSE has distributed 613,000 doses of this vaccine nationwide this year since September, as in other years, though the uptake figures are not yet known as the campaign will run until next spring.
In addition, for those aged over 65, there is a programme for once-off vaccination against pneumococcal disease; the HSE has distributed 64,000 doses of Pneumococcal polysaccharide vaccine (PPV23) already this year.
Ireland’s busiest programme, the childhood vaccination schedule, has had an increased workload in the past few years due to the changes in the schedule and the rising birth rate which means that over 70,000 babies annually are now partaking in the scheme. Currently there is an almost 95 per cent national uptake of all childhood vaccines, except for the MMR vaccine for which it is about 90 per cent. The HSE is trying to improve on this, as Ireland has had some recent outbreaks of measles and mumps.
The cervical cancer vaccination campaign, which began on a phased basis in May, is also a significant undertaking, particularly as there is a double cohort (first and second-year female students) of 58,000 across 575 schools to be vaccinated in its first year.
The vaccine has to be administered in three doses over a six-month period.Corcoran says it had been hoped to have all the vaccines administered before next Easter but the closure of schools due to the cold snap means some will now receive their final dose just before next year’s summer break.
She acknowledges that there have been many challenges as the workload of the immunisation workforce – made up of community health doctors, nurses and GPs – has doubled in the past few years. More nurses are now administering vaccines and working to medicine protocols, so prescriptions aren’t necessary for patients to be vaccinated. It is hoped this will spread the workload and maximise resources.
The vaccines themselves aren’t cheap. The HSE spends €36 million on them annually, not including the swine flu vaccine. While Corcoran explains that it is very careful about the amount of vaccine it orders, there can be significant wastage of seasonal flu vaccine.
HSE figures show it has disposed of €3.06 million worth of expired seasonal flu vaccine in the past six years, though wastage in childhood vaccines is much lower. Figures show that from the start of 2005 until the end of 2009, the HSE bought € 91 million of childhood vaccines, of which €1.2 million worth were returned for destruction.
“Vaccination is one of the most cost effective public health interventions – second only to the introduction of clean water – so, while we know that vaccination is expensive . . . if you had to treat all the diseases the vaccines prevent, it would cost you inordinately more,” Corcoran concludes.
The HSE’s vaccination website, immunisation.ie, provides up-to-date, accessible information on the State’s vaccination programmes. It is the only such site in Ireland that has been accredited as an official vaccine website of the World Health Organisation, according to Corcoran.
