The next item of business is a debate on motion S4M-09446, in the name of Michael Matheson, on Scotland’s immunisation programme.
15:41
I am pleased to open the debate.
The World Health Organization has stated that the two public health interventions that have had the greatest impact on the world’s health are clean water and vaccines. Immunisation is one of the most effective ways of protecting the public against and reducing the spread of serious diseases.
The development of effective vaccines in the past few decades has led to a huge decline in the number of deaths from various diseases, particularly in childhood. Before the introduction of the national vaccination programme, Scottish children were extremely vulnerable to diseases such as whooping cough, polio and measles.
The Scottish routine childhood immunisation programme is one of the cornerstones of our efforts to improve and protect public health. Infants are vaccinated against a wide range of diseases that once posed a serious danger to life but are now condemned to the past. The programme has also dramatically reduced the incidence of once common diseases, such as tetanus, whooping cough, measles, mumps and rubella.
The immunisation programme’s value is very clear. For example, vaccination against measles was introduced in 1968. In 1970, more than 25,000 cases of measles were confirmed in Scotland. By 1994, the figure had fallen to 536 confirmed cases and, by 2012, that figure had declined further to just 28 confirmed cases.
Through the immunisation programme, we also offer important protection against conditions such as meningitis. Since 1999, children have been vaccinated against meningitis C as part of the routine childhood immunisation programme. When the vaccine was introduced, there were 95 cases of meningitis C; between 2008 and 2012 there were only 2 cases.
We have seen the effects of immunising our children against meningitis C, but meningitis B remains a greater threat. A vaccine against meningitis B became licensed for use last year, and the Joint Committee on Vaccination and Immunisation has just recommended its introduction in Scotland and across the rest of the United Kingdom. That is a major step forward in our ability to protect children from the threat of meningitis. I am sure that all members will welcome the decision to introduce the vaccination in the near future.
The importance of childhood immunisation programmes is recognised by the public, and Scotland has an enviably high uptake rate. For the past decade, Scotland has had uptake rates of between 96 per cent and 98 per cent for children completing the vaccination courses for diphtheria, tetanus, whooping cough, polio, meningococcal group C bacteria and pneumococcus by 24 months of age. That is consistently above the 95 per cent target that has been set by the World Health Organization. Uptake figures for other vaccination schedules, including the measles, mumps and rubella vaccination and the pneumococcal conjugate vaccine booster, are continuing to rise, too. The uptake rate for both of those is well above 90 per cent, and this year the uptake rate for the MMR vaccination reached the 95 per cent target.
Nevertheless, we cannot afford to be complacent. In 2013, Wales and England experienced a large outbreak of measles—a disease that has been targeted by the WHO for elimination in Europe by 2015. Unfortunately, MMR vaccine uptake declined to less than 80 per cent in Wales and England after the now-discredited Wakefield study, which resulted in an increased population susceptibility to measles. In Scotland, uptake of the MMR vaccine dropped to 87 per cent in 2003. The Scottish public health effort in response to that decline aimed to maximise uptake of MMR1 by the age of two, ensuring at least 95 per cent uptake of one dose of the MMR vaccine among children before they started school at the age of five. It then aimed to maximise uptake of the second dose of the MMR vaccine among children by the age of six.
The most recent uptake rate of the MMR vaccine in Scotland, for December 2013, was 96 per cent, and the uptake rate for MMR2 was almost 92 per cent. Overall, measles has been well controlled in Scotland, with only a small number of cases occurring sporadically across the country during 2013. Because uptake rates did not fall as sharply in Scotland as they did elsewhere in the UK following the Wakefield study, the effect of last year’s outbreak in Scotland was not as severe as the effect of the outbreak in England and Wales. Nevertheless, the children who were most vulnerable to that outbreak were those who would have been vaccinated in the late 1990s. For that reason, a short MMR vaccination catch-up programme was put in place to protect those children who were not vaccinated originally. The outbreak was an important reminder of the value of vaccination programmes and the speed with which a disease can spread if we do not remain vigilant.
Another long-running childhood immunisation programme that is delivering positive public health benefits is the human papillomavirus vaccination that is offered to girls in secondary 2. The programme protects girls against the two types of HPV that cause approximately 70 per cent of cervical cancer and two other types of HPV that cause 90 per cent of cases of genital warts. Since the introduction of the vaccination programme in September 2008, we have seen a consistently high uptake. Although we are only now seeing the results of the programme, research that will be published soon in the British Journal of Cancer will show that the high uptake rates have already led to a reduction in the prevalence of those types of HPV in young women.
There are indeed high uptake rates and we can be confident that there will be success in preventing instances of cervical cancer. HPV is implicated in a number of other cancers—oropharyngeal, penile and anal cancers. In particular, young men who have sex with men do not benefit from the herd immunity that young heterosexual men would benefit from. Is the Government actively considering the extension of the HPV vaccine to boys and young men? When can we expect to hear about some progress on that?
The member may be aware that the advice that Governments receive on the use of vaccination programmes comes from the Joint Committee on Vaccination and Immunisation. It is an issue to which the committee has given some consideration. Given some of the emerging data and information on the matter, the JCVI has set up a specialist sub-group to explore the issue further. Once that sub-group has reported to the committee and its report has been submitted to Government, we will be in a position to make an informed decision on the matter. At this point, we should allow that expert group to consider the existing body of evidence and then to evaluate how to take the matter forward effectively if the recommendation is that there should be changes to the HPV vaccination programme.
I do not have a timeframe that I can give the member, but I assure him that the process for carrying out the evaluation to which he refers is already in place.
It is not only in childhood that we have seen the value of immunisation. Since 2001, the seasonal influenza vaccination programme has offered protection to over-65s and those in at-risk groups. Consistently strong uptake rates since the introduction of the programme have meant that the number of deaths attributable to flu has almost halved; 2,000 fewer annual hospitalisations are caused by flu; and the number of consultations with general practitioners has fallen by a quarter.
Building on the success of the seasonal influenza programme, we have embarked on one of the most ambitious extensions to the immunisation programme. We know that children are vulnerable to the flu so, by extending the influenza programme to all children between the ages of two and 17, we will be able to offer important protection to those who are vaccinated. That is a significant undertaking, and the programme will be phased in over a number of years.
As well as protecting the children who are immunised, the benefits of the programme will extend into the population more generally, with yet further reductions in the number of deaths caused by influenza each year and in the number of hospitalisations and GP consultations that take place.
Last year, there was unprecedented expansion of the immunisation programme—there have been three new programmes over the past year alone. We have successfully implemented a vaccination programme against rotavirus, a disease that causes around 1,200 babies to be hospitalised each year. That comes alongside the introduction of the shingles vaccine and the childhood flu vaccination programme. Those programmes have been introduced in a way that allows the public to be assured about the ability to deliver major immunisation programmes in Scotland.
On the shingles vaccination programme, around 7,000 cases of shingles are recorded each year among people who are 70 years old. Since September 2013, people aged 70 have been offered vaccination against shingles, protecting them against what can be a long-term condition resulting in pain and discomfort.
The benefits of the immunisation programme that I have outlined are a reflection of the professionalism and expertise within the national health service in Scotland. None of it could have happened without the contribution of general practices, school nurses, NHS boards, Health Protection Scotland and other public agencies throughout the country, working together to ensure that Scotland’s vaccination programme functions successfully.
I move,
That the Parliament acknowledges the clear benefits and central importance of immunisation programmes to Scotland’s public health; commends Scotland’s high uptake rates for the adult and childhood programmes and, in particular, the average uptake rates of around 97% annually for routine childhood vaccinations, and supports the Scottish Government, Health Protection Scotland and other national agencies, NHS boards and GP practices in their commitment to these programmes.
15:54
Fourteen routine vaccines are given to people throughout their lives, from two months old to over 70—and the meningitis B vaccine is coming along. Despite periodic concerns about safety, immunisation, whether it is routine or additional, for travel, is one of medicine’s greatest success stories.
Recent additions, such as the shingles and rotavirus vaccines, are quickly finding their place. Rotavirus kills more than 600,000 children worldwide each year. In the UK, our wealth allows us to vaccinate more to prevent admissions than to prevent death, but in sub-Saharan Africa, rotavirus can be fatal when it is combined with bad water and poor sanitation.
All new vaccines, such as the human papillomavirus vaccine, have their critics. New vaccines should be carefully monitored as they enter the mass market.
Smallpox has been eradicated internationally. That is the effect of the first-ever vaccine, which was introduced by Jenner in 1796. Polio has been reduced to a few areas, but health workers who deliver the vaccine in north Pakistan have been murdered, through ignorance and prejudice. We should use this debate to send a message from our Parliament to support and encourage courageous health workers who risk their lives on a daily basis.
Measles cases have been reduced by 74 per cent worldwide. The global vaccine action plan, or GVAP, to which 200 countries have signed up, is a road map for extending the delivery of a basic package of vaccines.
It is estimated that 1.5 million children die each year—one every 20 seconds—from vaccine-preventable diseases. The challenge is to extend vaccines to the poorest countries. Big pharmaceutical companies are beginning to address the issue, through novel funding approaches and research into vaccines for diseases that are prevalent internationally. For example, a vaccine is in development for malaria, which is thought to cause between 1 million and 3 million deaths annually. Incidence of the disease had been reducing, and it is to be hoped that a vaccine will curb its re-emergence.
The biggest vaccine story in the United Kingdom and the western developed world at the end of the previous century and the beginning of this one was the MMR vaccine, to which the minister referred. The consequences should not be lost on politicians who supported the Wakefield fraud. It would have been bad enough if that had been the first time that a single scientist had created a storm around a vaccine, but it was not. In the 1980s, Dr Macfarlane raised concerns about the whooping cough vaccine, and the resultant drop in uptake, which was encouraged by the media, caused a re-emergence of whooping cough and young children were damaged. No proof of a problem with the pertussis vaccine was ever established and the campaign petered out.
The autism link story, which was created out of bad, unethical research, cruelly misled parents into abandoning the MMR. Opposition politicians supported the single vaccine, despite expert opinion and evidence from Japan that single vaccines were not effective. I was personally vilified in this chamber and in the press over my firm support for the triple vaccine, and some politicians berated the Labour Government for following the advice of all the royal colleges.
The result of the scandal was shown in last year’s outbreaks of measles in France and Wales. The Scottish response to the outbreak in Wales, which came on top of a significant outbreak in France and led to a call from the European Union for a significant programme of catch-up, was complacent and slow. There was no national urgency and no national campaign to update people who had missed out on the MMR vaccination. Although letters were sent to parents of children to whom the vaccine had not been administered, without a national campaign we are still at risk. There was no campaign directed at colleges and universities, where there has been an increase in the incidence of mumps as a result of the MMR scandal.
There are to be two new vaccines: the meningitis B vaccine, which is to be made available following last week’s announcement by the Joint Committee on Vaccination and Immunisation; and the HPV vaccine, in its new nine-valent form, which might be made available to boys. Patrick Harvie talked about that.
The influenza vaccine will be administered intranasally to young children. Along with the shingles and rotavirus vaccines, the influenza vaccine should be monitored to see what happens when it is put into the mass market.
Flu immunisation is very important. We made good preparation for the pandemic, and I made my own contribution to that with my report in 2001. I recommended at the time that we should stockpile Tamiflu, but I have to say to the minister that there has subsequently been much debate about how effective Tamiflu is, partly because of the failure by Roche to publish all the research timeously.
There is a big increase in the immunisation budget next year, which I assume is partly due to the new immunisations that are coming in. In reviewing the swine flu pandemic, which was fortunately not very serious, I hope that we will consider again the pandemic programme for the future and make some decisions about whether we should restock with Tamiflu.
The evidence of pressures, which we mention in our amendment, is important. It is based on the NHS Scotland staff survey, which revealed that only a third of nurses and midwives said that they could meet all the conflicting demands on their time at work and only a quarter think that there is enough staff for them to do their job properly
I have been told that midwives have refused to administer vaccines recommended for pregnant women. Such opportunistic vaccine is important, so midwives should be required to administer whooping cough vaccine in pregnancy and MMR before women leave hospital in particular. Are such practices even being monitored?
New vaccines are being introduced, with new pressures on staff. Health visitors play an important role in supporting parents—if not administering the vaccine—through an increasingly complex child vaccine programme, but the number of health visitors is determined by individual health boards. Our recent freedom of information inquiry showed that to be inadequate.
The combination of new vaccines and the demands of family-nurse partnerships and having a named person for every child means that when the Government publishes its workforce plans in June, it will have to display a degree of leadership on health visitors. Scotland has done very well with our immunisation programme.
I move amendment S4M-09446.1, to insert at end:
“; welcomes the recent additions of rotavirus and shingles vaccines and the announcement of adding meningitis B vaccine, but recognises the pressures that administering these additional vaccines and the need for the catch-up programme for the MMR vaccine place on staff”.
16:02
This is a welcome and timely debate as it comes just a month before this year’s world immunisation week and a few days after the recommendation by the Joint Committee on Vaccination and Immunisation that the meningitis B vaccine be introduced into the childhood immunisation programme.
I think we sometimes forget just how valuable immunisation has been throughout the world in eradicating or significantly reducing the incidence of what used to be commonplace diseases that led to people right across the globe developing complications and dying. We no longer fear smallpox and we can travel safely in places in which tropical diseases are rife, thanks to the many vaccines that have been developed over the years to give protection from those diseases.
I well remember a student visit that I made to Yugoslavia in the 1960s as part of a public health tour, when I saw several cases of tetanus in which the virus had entered the body through roughened skin on heels that had been in contact with earth tracks. At the time, I had a few painful hacks on my own heels and I was very thankful for the tetanus vaccination that I had had prior to setting out on my travels, because tetanus is not a pleasant disease.
I also recall that I had to have a typhoid vaccination before entering Yugoslavia, to ensure that I was not a carrier, because we had just had a significant outbreak of the disease in Aberdeen as the result of a contaminated batch of corned beef.
Closer to home, I still vividly recall the very painful photophobia I experienced while suffering from measles as a child. My husband had an iron lung on standby for him when he contracted polio during the UK outbreak shortly after the end of the second world war. Fortunately, he experienced no lasting effects of the disease, nor did I suffer the serious complications of measles. However, we were lucky. It concerns me that there have been several cases of measles in Scotland recently, as well as outbreaks of whooping cough, which indicate the continuing need to maintain high levels of immunisation in childhood that, unfortunately, were adversely affected by the MMR scare a few years ago.
To be able to protect the population from the damage caused by common infections such as rubella and the long-term effects of HPV, leading to cervical cancer and increasingly recognised as a causative factor in other malignancies such as oropharyngeal and other cancers, is an enormous benefit resulting from many years of valuable research. Each year we hear of further vaccines being developed that could, in due course, eliminate many of the scourges of modern-day society.
The introduction of the meningitis B vaccine into the childhood immunisation programme, which the Joint Committee on Vaccination and Immunisation recommends, is a case in point, because meningitis B is now the commonest form of meningitis in the UK and accounts for 90 per cent of meningococcal infections. That follows the success of the meningitis C vaccination campaign in all but eliminating that form of the disease, with only two cases of seragroup C reported in Scotland since 2007.
Meningitis B is a devastating illness; babies under a year old are particularly at risk. It can kill within 24 hours of initial symptoms and, indeed, does kill 10 per cent of those infected, while a third of survivors suffer lifelong consequences. The recommendation to include the meningitis B vaccine in the immunisation programme for babies is very much to be welcomed, as is the Scottish Government’s stated intention to work with health departments across the UK to ensure its speedy inclusion in the immunisation programme.
We all know the benefits of the influenza vaccine in keeping vulnerable people safe from influenza’s complications, such as pneumonia and respiratory failure. Many elderly and immunosuppressed people are alive today as a result of the annual vaccination programme in Scotland, while many have also benefited from the pneumococcal vaccine, one application of which gives lifelong protection from the pneumonia caused by the organism.
The extension of the flu vaccination to children is an important development, as is the vaccination against rotavirus. I also very much welcome the herpes zoster vaccine that Labour’s amendment refers to, as I have seen the painful and debilitating effect of the herpes zoster virus, particularly in susceptible elderly people. Shingles was the trigger that led to my mother’s death in her 80s. She lived for a year after developing the illness, but it led to her steady decline, both physically and mentally, and she never regained the quality of life that she had had before she was hit by the virus.
There are many other vaccines that we could discuss, both those available today and those in the pipeline, but time does not allow for that in a short debate. Suffice it to say that I whole-heartedly support the motion, which articulates the clear benefits and crucial importance of immunisation programmes to our public health, and I am encouraged that the annual uptake of childhood vaccination is as high as 97 per cent.
We cannot be complacent, however, because it is extremely important that the high level of uptake is maintained to protect the community. It follows that we must support health boards, and primary care staff in particular, to maintain their commitment to immunisation, despite the pressures that that will put on their workforce, as Richard Simpson’s amendment highlights. We will undoubtedly see more and more life-saving vaccines coming on stream as a result of cutting-edge research being carried out in the UK and elsewhere.
I move amendment S4M-09446.2, to insert at end:
“; welcomes the announcement by the Joint Committee on Vaccination and Immunisation that the meningitis B vaccine is to be introduced into the routine childhood immunisation programme at two, four and 12 months of age, and looks forward to the Scottish Government implementing this programme as soon as possible”.
We move to the open debate.
16:07
I am delighted to speak in this debate on the Scottish immunisation programme. I echo the minister’s remarks that vaccination is one of the most effective and valuable public health interventions that we can deploy to protect people against serious diseases and to prevent the spread of disease.
In the short time that I have I will focus on some of the newer developments in Scotland’s vaccination programmes and the contribution that they will make to improving and protecting the country’s public health. We know that the comparatively recent vaccine against meningitis C has shown significant benefits, so I very much welcome the Joint Committee on Vaccination and Immunisation’s decision last Friday to recommend the introduction of a vaccine against meningitis B for children at two, four and 12 months of age, and the Scottish Government’s commitment to work with the health department to ensure that the vaccine can be introduced as quickly as possible into Scotland’s routine childhood immunisation programme.
I was approached some time ago by a constituent in Dumfries and Galloway whose teenage son has a rare immune system disorder called mannose-binding lectin deficiency, one of the characteristics of which is an extreme susceptibility to a range of serious diseases including pneumonia and meningitis. The joint committee’s decision on a meningitis B vaccine was of vital importance to my constituent and her son and, as members can imagine, is very welcome for not just this family in particular but, I am sure, other families across Scotland.
The HPV vaccination programme was introduced back in August 2008 under the previous health secretary, Nicola Sturgeon, for 12 to 13-year-old girls in S2. It protects them from two types of human papilloma virus that can cause 70 per cent of instances of cervical cancer. Since its introduction, uptake in Scotland has exceeded 90 per cent and we now see significant decreases in the prevalence of HPV among young women as a result.
The public health benefits that the vaccine is delivering are worth highlighting. Last year, I met members of NHS Dumfries and Galloway’s research and development team at the Dumfries and Galloway royal infirmary, who have been working on a programme to tackle the problem of cervical smear test defaulters. The national audit of invasive cervical cancer found that approximately 71 per cent of women who developed cervical cancer had not had a smear test in the preceding three years. In March 2012, the number of women in Dumfries and Galloway who were unscreened or underscreened stood at 6,100.
The team tackled the problem using a variety of approaches, including sending out self-sampling kits to women who regularly failed to attend smear test appointments. The overwhelming majority of women who undertook self-testing said that they would participate regularly in the screening programme if they could use that method in future.
Cervical cancer is the only form of cancer against which we can effectively vaccinate and we know through the work of various health boards—including NHS Dumfries and Galloway—that many women are not being regularly screened. As with all cancers, early detection is crucial, but prevention is far better than cure, which is why the HPV vaccine is such a significant step forward.
The Scottish Government immunisation programme makes a vital contribution to the promotion of good public health in Scotland. Ultimately, we owe our thanks to the NHS staff who promote and deliver the vaccination programmes, as their efforts have kept vaccination uptake levels in Scotland very high indeed. Although we cannot be complacent, I put on record my thanks to those staff for helping us to keep the killer diseases of the past at bay and making us a healthier country for the future.
16:11
I am grateful for the chance to contribute to the debate and I support the motion as amended by my colleague Richard Simpson.
The vaccination immunisation programme was first introduced to the United Kingdom in the 18th century from Turkey, and Louis Pasteur’s work on cholera, anthrax and rabies no doubt went a long way towards establishing immunisation and vaccination as important principles in health. Indeed, vaccination has been described as one of the great health achievements of the 20th century.
In that context, it is excellent news that the current Government is achieving a 97 per cent average annual take-up rate, and we should be happy to applaud it. That achievement presents Governments of all hues with the giant challenge of not only maintaining a 97 per cent take-up rate annually, but improving on that figure. At the same time, the introduction of new vaccines for rotavirus, shingles and meningitis adds to the pressure on Government to respond by ensuring that high levels of immunisation are maintained.
Three elements need particular attention if we are to continue our progress. One issue, which has been mentioned, is the workload that staff face. Staff reported workload concerns through NHS Scotland staff surveys last year. A third of nurses and midwives say that conflicting demands make it difficult for them to meet the challenges that they face, and a quarter say that there are not enough staff to enable them to do their job properly. It would be worth while for the minister to comment on that in summing up.
The second element, which was also touched on earlier, is fear. There is no doubt that the controversy over the MMR vaccine resulted in a huge drop in uptake and it has taken officials a great deal of time to try to repair the damage. However, in the context of the 97 per cent take-up rate, a relatively high proportion of 10 to 17-year-olds in Scotland, some of whom are about to enter university, need to be immunised in the Government’s catch-up programmes.
The third challenge that Government in Scotland faces is population movement, to which we need to become attuned. People are moving around the world for economic and social reasons and there is no doubt that other places do not have the luxury that we enjoy here in Scotland in our access to immunisation on an on-going basis.
The draft budget reports indicate a see-sawing of year-on-year figures. For example, £8.8 million will be spent in 2013-14, rising to £16.3 million in 2014-15, but thereafter there will be a fall in some elements, such as immunisation for pandemic flu. I understand that that see-sawing is about the rolling programme of purchasing the necessary medicines that are required, but it would be good to hear from the minister that, in spite of the rises and falls in the budgets, the same numbers of targets are achieved every year and will not be affected.
My final comment is about the shingles vaccine. I have received approaches from a number of constituents who seem to think that if they are not in the 79 or over age group, they cannot access a vaccination. In a number of cases, the constituents were 71 or 72 years of age and felt that they would be exempted for a serious number of years. It would be nice to have clarification on that point.
16:16
I begin by thanking the minister for his letter of 21 March, informing me of the JCVI decision to recommend the introduction of meningitis B vaccine. I have raised the issue with him on behalf of constituents on a number of occasions.
I immediately forwarded Mr Matheson’s letter to my constituent, Mr Michael Pattie, who has been campaigning and fundraising on the issue since he lost his 13-year-old son, David, to that terrible disease in 1999. I first encountered Mr Pattie last July, when he wrote to me to express his bitter disappointment when the JCVI failed to recommend the introduction of the vaccine because it was not cost effective. In that letter, he wrote:
“After years of efforts, campaigning and fundraising we finally have the Holy Grail, a vaccine for the B strain of the disease which was passed by the European Health Governing Body as safe and effective earlier this year and I personally am devastated that this decision by JCVI not to implement has been taken in the UK.”
I am very pleased that that decision that has now been reversed.
The meningitis B vaccine will give a 73 per cent protection level, but the catch 22 is that cost effectiveness cannot be ascertained unless it is implemented. However, the B strain, which accounts for half of all meningitis deaths, can lead to lifelong disability and we cannot put a price on a life, particularly that of a child. It is surely significant and persuasive that the estimated lifetime cost of looking after someone who is severely disabled by meningitis is £3 million.
Today we have heard about the increase in the immunisation budget of a considerable 85.2 per cent in a year. That will increase further in 2015-16 to almost £21 million, which will be a cumulative increase of 137.5 per cent in just three years. Even by the standards of NHS inflation, that is a considerable rise, but it is very clear from what we have learned during the debate so far that, in the long run, much more money will be saved.
Given the Government’s preventative agenda, I would be interested to know if any work is being done to quantify how much money is being saved, particularly through the most recent immunisations. It has already been mentioned that, from May last year, all babies born in Scotland were offered a rotavirus vaccine for the first time. That will protect thousands of children and reduce costly hospital admissions.
Until recently, I was not aware of the term “rotavirus”, but as a mother of two, I certainly had plenty experience of it. My children are now aged 16 and 24, so they did not receive that protection, and I remember how frightening severe vomiting and diarrhoea in babies and young children can be. I remember several GP calls and waits in Yorkhill. On one occasion, my daughter became severely dehydrated and had a hospital stay of several days. Apart from the parental distress, the time that it takes clinical staff to deal with that must cost a fortune. As has been said, every year 1,200 babies have to go to hospital because of the symptoms of rotavirus, and it is estimated that all children will become infected at least once before the age of five, although I should perhaps put that in the past tense. That is a huge amount of staff time and NHS money that is being saved.
One could say exactly the same thing about the other vaccines that we have heard about that have been more recently introduced, such as the HPV vaccine, which protects against 70 per cent of cervical cancer cases. Although it has only been in place since 2008, we are already seeing evidence of its effectiveness. One cannot put a price on that. It must be extremely expensive to treat a young mother with cervical cancer, but there is also the human cost and the cost to society more generally. The programmes that the minister mentioned, such as the shingles and influenza programmes, tell us a lot about how much money we could save through the immunisation programme.
I will finish with the words of my constituent Michael Pattie, who has said that, although he does not see an immediate end to meningitis B, the vaccine is
“a massive and significant step.”
In 1999, when he lost his son, he vowed that he would do all that he could to prevent other families from going through what he went through. Needless to say, he says that he feels “delighted” at the news. That is a positive note to end on.
16:21
I welcome the debate. As we have heard, immunisation can be life-saving. Members have talked about the devastation that can be caused by the implications of diseases that we can now vaccinate against. Richard Simpson talked about 14 vaccinations, not including the recently announced one for meningitis B. Most immunisations are accepted and welcomed and people take them up, but we have seen issues in the past. Richard Simpson also mentioned that smallpox has been eradicated because of immunisation, and we could perhaps achieve that with many other diseases, such as polio.
We have had scares about immunisations such as the whooping cough vaccine, but the worst was the MMR scare. We should not forget the impact of measles, mumps and rubella. Measles can have really dangerous complications—it can cause brain damage or death and, in some cases, a fatal degenerative brain condition can develop after the infection, which is a worrying symptom. We are well aware of the problems that are caused by mumps, which can cause deafness and infertility in men and miscarriage in pregnant women. Similarly, we are well aware of the problems that are caused by rubella. It is at its worst when a woman catches it in early pregnancy, which can result in devastating impacts on the baby. That is why people cannot receive the MMR vaccine when they are pregnant or planning to get pregnant.
Before the MMR vaccine was introduced, meningitis that was caused through mumps was one of the biggest killers of children. The fall in uptake of the vaccine that resulted from Andrew Wakefield’s discredited paper on MMR safety decreased herd immunity, and that is still the case among certain age groups. That puts babies at risk. As we saw in the Welsh outbreak, early immunisation is not possible. Therefore, although babies were immunised as early as possible, it could not be done for those who were under six months, so they were in danger.
Teenagers going to university are also in danger. The fewest children were immunised between 1998 and 2002, and those groups are now going to university, where they will come into contact with other young people. The diseases are highly contagious so, if one is contracted, the chances are that it will spread quickly through a university. Given that the symptoms are very much like a cold, the diseases can be passed on before they are identified as dangerous.
We see the impact. In 1998, there were 56 confirmed cases of measles in the UK. By 2006, that was 13 times greater, and we had the first death since 1992. In Ireland, the same thing happened, with 1,500 cases reported because of the decreased vaccination rates following the MMR scare.
It is really important that we have herd immunity and work to improve on the figures for those who missed out on immunisation because of the MMR scare. We need to consider those age groups, so I would be pleased to hear what the Scottish Government is doing to contact and immunise those groups who were missed because of the scare.
We must also learn lessons from the scare. Specialists kept trying to reassure the public regarding the safety of the MMR vaccine. Dr Richard Simpson was quite right to say that he was vilified. Anyone who tried to persuade people that there were real dangers to falling MMR immunisation was vilified. The matter became hugely politicised and a real difficulty within our system.
I ask the Government to determine how it can ensure that the health service is open and transparent about Government advice. That is paramount to people trusting it. We need to build trust in immunisation—especially MMR—to ensure that the same does not happen again.
16:26
As previous speakers outlined, immunisation has played, and continues to play, a vital role in protecting and improving the health of the people of Scotland.
Richard Simpson put the debate into its proper international context. Globally, according to the World Health Organization, immunisation prevents an estimated 2 million to 3 million deaths from diseases such as diphtheria, polio, tetanus, whooping cough and measles every year. The Minister for Public Health reminded us that, in Scotland, those diseases are now largely confined to the past. That is the extent of the contribution that vaccination and immunisation programmes make to public health at home and abroad.
It is to be welcomed that the Scottish Government has introduced a number of additions to Scotland’s immunisation programme over the past year and has committed significant additional resources to implementing those changes. Notwithstanding the questions that Graeme Pearson posed in his speech, the fact remains that the immunisation budget will have increased by 85 per cent—almost 82 per cent in real terms—in the past year from £8.8 million to £16.3 million.
The additions to Scotland’s immunisation programme include: the introduction of the rotavirus vaccine; changes to the meningitis C vaccine; the introduction of a shingles vaccine for people aged 70 and a phased catch-up for those aged between 71 and 79; and a phased roll-out of the childhood flu programme. In all those areas, the Scottish Government has acted to strengthen further the immunisation programme and deliver benefits of public health.
Implementing those new additions to the programme still presents a challenge to the NHS. It will be necessary to ensure that Health Protection Scotland, the Scottish Government and NHS boards work together to implement the changes—a point that is made in the Labour amendment and, I think, accepted by the Scottish Government. Without the willingness to work together, we will not be able to take forward the additions to the programme without impacting on existing vaccination programmes. We must also recognise the challenges that the additional duties place on NHS staff.
In addition, the Scottish Government has made a clear commitment that it will ensure that the meningitis B vaccine will be introduced as quickly as possible in line with the recommendations of the Joint Committee on Vaccination and Immunisation—a point that is welcomed in the Conservative amendment.
Since the mid-1990s, rates for routine childhood vaccinations at two years of age have consistently stood at around 97 per cent annually. The childhood immunisation statistics for 2012 acknowledge that overall rates of childhood immunisation in Scotland are high and exceed the 95 per cent target rate. However, there is a social gradient whereby rates are lowest among children in the most deprived areas and highest in the least deprived areas, as measured by the Scottish index of multiple deprivation.
That important finding from the childhood immunisation statistics underlines the important point that, with the right approach and focused effort, it is surely possible to narrow and overcome the inequalities that are associated with deprivation in childhood immunisation. More needs to be done to close the health inequalities gap, so I urge the minister and his officials to explore what further work needs to be undertaken by the Government and the NHS to identify what more can be done on immunisation.
From May last year, for the first time, all babies in Scotland were offered the rotavirus vaccine, protecting tens of thousands of children from its effects and reducing costly hospital admissions—a point that was effectively made by my colleague, Joan McAlpine. That example brings together a number of important factors, such as timely and cost-effective intervention, preventative spending and an early-years approach, all of which will deliver tangible benefits to the children and families who are affected.
Patrick Harvie talked about gender-neutral human papillomavirus vaccination. Last year, the Public Petitions Committee heard compelling evidence on that issue from Jamie Rae, of the Throat Cancer Foundation, who made the point that there is no protection at all for men who have sex with men, which is discriminatory. The issue is worthy of further consideration by the Joint Committee on Vaccination and Immunisation.
The development and implementation of national programmes and multi-agency working, with appropriate action plans, are key to success in public health. The extended immunisation programme is a clear, cost-effective and efficacious exemplar of this approach, and the Scottish Government is to be commended for it.
16:30
I am pleased to take part in today’s debate. As a father of six children, four of whom are still at school, I am very aware of the immunisations that our young people receive to protect them from illness and infection.
I should also declare an interest, in that I had a number of childhood illnesses, including whooping cough—which I contracted again as an adult—measles and German measles, which children are now routinely vaccinated against. As a sufferer from some respiratory problems now, I also take advantage of the yearly flu jab, which is important for many of our elderly and vulnerable constituents.
All of us today would wish to pay tribute to all the Scottish NHS staff who are involved in delivering our immunisation programme, which is, without doubt, one of the biggest health successes of the past 100 years. We should also today express our gratitude to the scientists whose research has allowed us to have the vaccinations that we often take for granted. We are fortunate to live in the modern world, in which, thanks to immunisation, smallpox and polio, which were formerly so common and did so much damage, are no longer things to be feared. Indeed, the World Health Organization declared smallpox wiped out in December 1979, and Europe was declared free from polio in 2002.
We must never be complacent. We know that it is vital that, in order to maintain progress, uptake rates remain as high as possible. It is reassuring that, for the past decade, uptake rates in children under 24 months for primary courses of immunisation against diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type B and meningitis C, and for PCV, have exceeded the 95 per cent target. Let us hope that that continues and, indeed, let us aim for the highest possible uptakes.
Having said that, I have sympathy with parents who may be concerned that a small percentage of children might be severely affected by types of immunisation, such as that for whooping cough. That concern was brought about by a lot of speculation in the press about MMR and whooping cough vaccines. However, it is important to make the case that some sacrifice must be made, sometimes, for the benefit of the huge majority. Of course, that sacrifice should be kept to an absolute minimum and, if possible, eliminated altogether.
As medical technology becomes ever more advanced, and as new health challenges emerge, it is right and proper that health experts consider what additional immunisations might benefit our people. Therefore, as other members have done, I welcome the recent news that the meningitis B vaccine that is mentioned in Nanette Milne’s amendment is to be introduced into the routine childhood immunisation programme at two, four and 12 months of age. Meningitis B occurs mostly in infants and children under five and is fatal in around 10 per cent of cases, with one in eight cases experiencing serious long-term health problems such as amputation, deafness or epilepsy. It is a real boost to parents’ confidence that children will be protected in future from that terrible disease.
As a farmer, I would like to say a word about the immunisations in the agriculture industry, which have made a great difference with regard to the loss of animals. That is an important measure, and it should be remembered.
16:34
I am delighted to speak in the debate. I was unaware until I joined the Health and Sport Committee, which I did just before Christmas, of how effective the immunisation programme is, as the minister and Richard Simpson pointed out.
I am delighted also to hear that, given the programme’s record of success, the Scottish Government has identified a need to increase the funding for the immunisation budget. As Jim Eadie said, it rose last year from £8.8 million to £16.3 million. In addition, there are welcome proposals for future rises in the budget.
As I was listening to other members’ speeches, it crossed my mind that we are commemorating the great war this year and that many of those who fought in the terrible conditions of the trenches and thought that they had survived were unfortunately afflicted after the war by a particularly virulent type of flu that ravaged worldwide between 20 million and 40 million people. It was a particularly bad kick in the teeth. However, that demonstrates the type of fight that we have against such viruses.
The improved set-up that we have for virus protection is absolutely important. Some of the very fine speeches during the debate have shown how important it is. I suspect that not many in the chamber have seen the effects of full-blown flu. It is not the sort of flu that people phone into work about; it is very close to having pneumonia. It is not the sort of thing that people live with and get through very quickly before heading back to work. I was therefore delighted that in 2013 the flu vaccine was offered for the first time to children between two and 17, as well as to those who are vulnerable and at risk of suffering serious consequences from flu.
The childhood flu programme is offered to 120,000 two and three-year-olds, and to around 100,000 primary school-aged children. That might help the fight against one of the constant scourges of young children’s health. My father used to refer to children as walking Petri dishes, because everybody in the family got an infection from them when the schools returned after a break and all the kids infected each other. My father could be a little bit sarcastic like that.
For me, the remarkable finding in the recent research to which members have referred is the level of uptake in the Scottish childhood immunisation programme. As has been said, 97 per cent is a phenomenal level of uptake. For those of us who are not up to speed on the research, it would be interesting to know why the other 3 per cent do not take up the immunisation. I know that there are bound to be reasons to do with health, for example.
I welcome the changes that have occurred in the programme over the past year and which have been mentioned in the debate: the introduction of the rotavirus vaccine in May 2013, the changes to the meningitis C vaccine last June and the introduction of the shingles vaccine for those between 70 and 79. I also welcome the speedy introduction of the meningitis B vaccine, which has also been mentioned. I remember the worry that my parents had when a member of my family was diagnosed with meningitis back in the 1960s, when less was known about it. There can be serious consequences for anyone contracting it.
I am aware that I am running out of time. I would love to say more, but I can honestly say that, having researched the subject of immunisation, probably one of the most important things that the Parliament and Government can do is to keep the research going and try to find the answers to some of these horrible problems.
16:38
It has been a short but well-informed debate. I do not mean to sound patronising when I say that it was clear to me that nearly every contributor to the debate was contributing because they wished to contribute rather than because they had been asked to contribute and did not necessarily volunteer to do so, which is the impression that we sometimes get from one or two speakers in a debate. It was therefore no surprise that there was no disagreement among members on the issue. However, we heard a collection of anecdotes about different experiences, all of which underpinned the importance of the vaccination and immunisation programme.
I thought that the three principal speeches—those by the minister, in which he detailed the public health benefits of the various immunisation programmes and Scotland’s record on all the key vaccines, by Richard Simpson and by Nanette Milne—gave a rounded picture of the history of immunisation and the success that Scotland has had in it.
Without repeating what has already been said, it seems to me as someone who is not a doctor—several doctors have taken part in the debate—that the key thing is that politicians are not generally experts and that, although public scepticism towards experts has been a growing modern phenomenon, given the rather curious specialisms in which people can claim to be experts, we must mount a vigorous campaign to ensure that the public suspend any scepticism towards clinical and pharmaceutical experts, because we must trust their judgment on the introduction, the sustainment or the withdrawal of individual vaccination programmes.
The minister and others were right to highlight just how quickly a disease can take root. The MMR crisis of a few years ago gave us a sharp reminder of what can happen if we allow those who are sceptical about the advice that we receive and act on to enable that scepticism to take root in operational practice.
The human papilloma virus has been mentioned several times. The vaccination for HPV, which was introduced relatively recently, is an extremely important one. In some detail and at some length, Aileen McLeod spelled out just what its benefits are and how successful it has been. However, several members will have attended meetings at which representations have been made and concerns have been expressed to them about the vaccine’s introduction. Even today, some of us have been emailed with evidence from Japan on the issue.
The important point that I make to them echoes the comments with which I opened my speech. It is the duty and the responsibility of Parliament not to react to that, but to trust the judgment of those who give ministers the evidence and advice on which they must act, and to exemplify—as Aileen McLeod did—the benefits and advantages that the introduction of such vaccines has brought.
I listened to Patrick Harvie’s intervention on the extension of the provision of the HPV vaccination to young men; Jim Eadie touched on that, too. As a member of the Public Petitions Committee, I heard representations on that issue, and I hope that evidence is gathered and advice is given that allows a fresh recommendation to follow.
Richard Simpson mentioned that 14 vaccines are given to people throughout their lives. He also introduced the subject of smallpox. I commend the recent BBC 4 series that showed just how astonishing the progress has been in eliminating that disease, which ravaged various parts of the world recently enough for the contemporary footage to be in graphic colour. Watching the programme, I realised that, although I might have seen one or two sensationalised photographs, to see not those in this country, to whom we have paid tribute, but those who in the 1960s and 1970s volunteered to go and eradicate that disease in other parts of the world, and to recognise just how unassuming and ordinary the individuals who made that commitment and achieved that success were, is—given how devastating and damaging smallpox had been—to be confronted with a redefinition of the concept of heroism.
The big challenge will be not just the current situations but the enormous clinical, surgical and pharmaceutical progress that we are seeing—to which I have referred in other debates—and the challenges that we will face in keeping pace with the opportunities that future vaccinations will provide. That is the challenge that the Government must address in the future, but I think that we all support and commend it for the work that it has done to date and the response that it has made to the challenges that exist.
16:44
I commend Jackson Carlaw for his speech, which identified some of the political issues in an exemplary way.
The greatest public health achievements have been the provision of clean water and sanitation and cleaner air, and the recognition—only four centuries after James VI of Scotland and I of England recognised it—of tobacco as a hazard. However, as the minister, Graeme Pearson and many others said, vaccines are one of the greatest of all the achievements, and there is no doubt that there is more to come. Jamie McGrigor was right to praise our scientists for their innovation in not only human vaccines but in veterinary science, where vaccines are also important.
Successive Governments have delivered a world-class vaccination programme and lives have been saved. We can prevent cervical cancer with the HPV vaccine rather than rely solely on cervical screening, with its shortcomings, as illustrated by Aileen McLeod. The new rotavirus vaccines, the phasing in of the intranasal influenza vaccine for children and the shingles vaccine for the over-70s will all further enhance the quality of many lives. They are worthwhile investments, as will be the meningitis B vaccine.
Patrick Harvie referred to the potential to extend the HPV vaccine to boys to achieve herd immunity. That would mirror the switch from giving the rubella vaccine only to girls—that was a difficult programme to try to eliminate rubella and prevent problems in pregnancy, as Rhoda Grant said—to having the MMR vaccine for all.
We should not forget that the international picture is different. The success in eradicating smallpox, which Jackson Carlaw referred to; the near eradication of polio; the substantial reduction in measles; the progress on addressing yellow fever; the prospect of a useful vaccine to tackle a resurgent malaria—all are welcome. As Jim Eadie said, the international programmes might be saving 2 million to 3 million lives a year.
Colin Keir was right to remind us of the deaths from Spanish flu after the first world war. Further pandemics are inevitable and we need to be prepared for them. I hope that their effect will be as soft as that of the swine flu pandemic was.
If it is validated, the new tuberculosis vaccine that is being developed in India to replace or add to the BCG will be welcome. In the meantime, we need to scrutinise our TB detection programme in at-risk groups. The rates of TB and resistant TB have risen significantly, and I am not convinced that our detection programmes are adequate.
At home, we have had the measles outbreak, although it was at nothing like the levels of the 1960s, as the minister and Nanette Milne graphically reminded us. Mumps rates have also increased because of the MMR problem, although—fortunately—not in Scotland. That suggests that the decline in uptake left by the MMR debacle has not been fully repaired.
Along with my colleague Rhoda Grant, I still have concerns that the decision not to have a national advertising campaign on MMR may yet expose some older children to all three diseases. I hope that I am wrong.
I ask for the media failures in the 1980s on pertussis and in the 1990s on MMR to be taught in college journalism courses—Joan McAlpine might be able to help us with that.
General uptake of all vaccines is good, but the degree to which uptake differs among socioeconomic groups is unclear from the routinely published data, and we should look at that as part of standard publications. Jim Eadie made a plea for us to look closely at health inequalities. The vaccines for which uptake does not meet the required percentages need to be looked at carefully to understand why that is happening, what the barriers are and whether we can improve the figures. The vaccination programme is otherwise excellent.
Like me, Graeme Pearson referred to pressures on staff, which we mention in our motion. As he said, those pressures are significant. The efforts of our staff should be applauded again—they do a fantastic job—but we need to acknowledge the pressures. I hope that midwives’ input during and post-pregnancy will be monitored, because their involvement in the vaccination programme through not only giving advice but giving vaccines merits attention.
UK’s Joint Committee on Vaccination and Immunisation may recommend more new vaccines, such as the most recent meningitis B vaccine. Joan McAlpine was right to remind us of the excellent campaign that has been run. We often rely on individuals who have suffered from our regimes’ failures to bring fully to our attention the need to undertake new measures. The recent campaign has been successful and helped the joint committee to take the step of introducing the meningitis B vaccine. Joan McAlpine also reminded us of not only the costs but the benefits from prevention in children and from reduced hospital costs and reduced time spent in hospital.
I recognise that the debate has been consensual, as it should be. We will support the Government motion and its immunisation programmes, but continue to be critical where that is appropriate.
My one concern is that we have managed to get through the whole debate without mentioning the referendum in September. The JCVI has served us well, and I wonder what our approach would be after 18 September, were we to be independent. Would we accept JCVI determinations without any Scottish representation—Scottish representatives have made a huge input—or set up our own vaccination and immunisation advisory committee, as Eire has done with its national immunisation advisory committee? What plans does the Government have in the—I hope—unlikely event of its winning that referendum?
16:50
The debate has been very useful, and I am happy to say that we are happy to accept both the Labour and the Conservative Party amendments. The debate has been very helpful for the reasons that Nanette Milne outlined in her speech. Our national vaccination programmes are largely taken for granted, in that they happen and are very effective. They are programmes in which, if one element ever went wrong, that would very quickly become a major public health challenge and concern. That staff, particularly in our public health sector and primary care sector, have managed our vaccination programmes so successfully over many years is to their tremendous credit. We can rightfully be very proud of that.
As members have highlighted, the vaccination programmes extend from newborn babies right through to older members of our community. However, as a number of members said, they do not stand still. As a result of national and global vaccination programmes, we have seen the effective eradication of some conditions, such as smallpox, to which Richard Simpson referred, and polio, which has been eradicated in Europe since 2002. All those things are the result of good, effective immunisation and vaccination programmes. We are very lucky to have very safe and reliable vaccination programmes in Scotland that ensure that we can have confidence in how the process operates.
I want to pick up in particular the issue that Richard Simpson and Graeme Pearson highlighted: the concern about pressure on staff and the demands that the vaccination programmes place on them. I am acutely aware of the pressure that our staff are under in delivering the vaccination programmes, because I am extremely conscious that, in order to maintain public confidence in our immunisation programmes, we need to ensure that those programmes are robust and that they apply effectively the science for which they have been developed right across the country.
I will give members an illustration of the nature of some of the challenges that we face. An ever-increasing number of vaccinations have been introduced. A significant number of those vaccinations and immunisations are one-offs, or perhaps one, two or three immunisations are required at given times in a young person’s or older person’s life, but the flu vaccination programme must take place every single year. The introduction and extension of that programme to those between the ages of two and 17 almost overnight doubles the numbers in our childhood immunisation programme. That is a significant logistical challenge.
In order to deal with that challenge, in the first year we have used a number of different pilots in different health board areas to test out different approaches and to get staff feedback on which is the most appropriate. The pilots cover different age groups to find out what is the best approach for particular groups. For example, older kids can, under supervision, self-immunise in class. Other approaches are being taken with different age groups in primary schools, too. We are working with staff to identify the best way to proceed.
Another challenge is that we very often require the staff to undertake immunisation and vaccination programmes only for a short time over a given period during the year and not throughout the year. We will therefore introduce the programmes over a number of years. I know that some people want that to happen much quicker, but we should take our time to get it right and to work with the staff to ensure that we have a robust system and that the public can have confidence in the processes that we have in place.
Jackson Carlaw made an extremely important point. The approaches that we often take to different immunisation programmes are not a consequence of Government choice; rather, they are led by expert advice that is presented to Government. We react and respond to the expert advice that we receive, whether from the Joint Committee on Vaccination and Immunisation or from Health Protection Scotland. I am certainly not an expert in any shape or form, and in this area we are very much led by experts.
Richard Simpson mentioned a catch-up programme for kids who may have lost out by not having the MMR vaccine in the 1990s. Our approach is based on expert advice provided to ministers by Health Protection Scotland. If Health Protection Scotland believed that a different approach should be taken, I would be more than happy to take that approach. I reassure members that no complacency exists whatsoever. We are led by experts on the issue, and if the advice changes we will respond to that positively, for the very good reason that that is what we should do.
Graeme Pearson mentioned the shingles vaccination and the concerns expressed by some older people about whether they are entitled to that vaccination because of their age, and when they will be vaccinated. The introduction of that vaccination programme is based on JCVI advice. We will start off with people who have turned 70 and those who are 79, to catch them before they turn 80. Over the next three to four years, we will run a catch-up programme for those in between. I recognise that people may be concerned that they have not been vaccinated yet, but we are taking what the experts have recommended to us as the most robust approach. It is fair to say that there is limited availability of the shingles vaccine because only one manufacturer makes the vaccine. That is part of the reason for our roll-out programme.
I am also conscious that our vaccination programmes must be placed in the context of the international health agenda. Some members may be aware that the wild poliovirus was identified recently in Syria, which immediately resulted in advice from the World Health Organization: if a single case is identified in Europe, where polio has been eradicated, that will result in the release of oral polio vaccination stockpiles in Scotland.
We must take forward our vaccination and immunisation programmes in that global context. We must ensure that we have a robust system in place, so that can respond—in a safe and informed way—when new vaccines come along.
All members who spoke in the debate recognise that Scotland is well placed to build on the success of its vaccination programmes over recent years. This Government intends to build on that success, so that we gain the public health benefits that have come from having vaccination programmes in Scotland over the past several decades.