Meeting of the Parliament 25 March 2014
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.