I raised an issue on Tuesday last and I do so again today because of its importance. I refer to the increase in the number of cases of meningitis that is causing huge worry for parents, particularly because a number of children have unfortunately passed away as a result of meningitis in recent weeks. I am sure that I speak for everybody in this House when I say that we send our deepest sympathy to the families affected at this very difficult time. We know that meningitis is a horrible condition and is one that all parents fear, myself included, as the father of young children.

I am sure the Tánaiste is no different.

It is a cause of major justified concern and distress that the meningitis B vaccine is not available for children. The programme for Government commits to extending the childhood vaccination programme to include vaccination against meningitis B, which was done but only for children born after October 2016. For children born before that date, availing of the vaccine costs up to €450. The vaccination is not available for free for parents whose children have medical cards. The Tánaiste knows as well as I that the cost of the vaccine is a considerable sum which most parents simply cannot afford, particularly if they have more than one child. This means that the vast majority of children over the age of three are not vaccinated against meningitis B, which is worrying for those of us who want to eradicate the strain.

It is also worrying for parents that general practitioners, GPs, have stated that they have been inundated with calls about the vaccine in recent days and weeks. Dr. Maitiú Ó Tuathail, the president of the National Association of General Practitioners, went as far as to stated that this amounted to medical apartheid. He is spot on in that regard. The situation is such that those whose parents can afford to pay are vaccinated and protected whereas those whose parents cannot afford the cost are left vulnerable to the disease. This leads to significant stress and anxiety on the part of parents because of the choices they face. I appreciate that meningitis B has not been identified as the cause of the reported deaths but it has been identified among the cases notified to the HSE.

If making the vaccine available to all children can be done, then this should and must happen. Is consideration being given to what the tens of thousands of parents, as well as thousands of GPs, across the State are calling for, namely, to ensure that a catch-up programme for meningitis B vaccination is put in place for all children up to the age of 18 in order to ensure that our children are protected from the strain? This was done in respect of meningitis C and, therefore, surely there can be no reason, except lack of political will, that we cannot do it for meningitis B.

I am also a father of young children, as are many other Members. To outline how the system works, the primary childhood immunisation scheme was amended in 2016 to include the introduction to the meningitis B vaccine for all babies born on or after 1 October of that year. This change to the immunisation scheme took effect from 1 December 2016. The three doses of the vaccine are administered to children when they reach the ages of two months, four months and 12 months, respectively. Meningitis B disease is most common in babies under the age of one year, and the timing of the administration of the vaccine under the immunisation programme is provided on this basis. All vaccines administered through the primary childhood immunisation scheme are provided free of charge.

There are no plans to introduce a catch-up programme for older children at this stage, which is what the Deputy inquired about. Ireland is the second country in Europe to make the vaccine available free of charge as part of its national immunisation programme. It is important to reassure parents that to our knowledge no deaths that can be attributed to meningitis B have occurred. The Deputy has also confirmed this and he is not suggesting otherwise. However, parents are asking the question and it is important to clarify matters for them.

The national immunisation advisory committee makes recommendations for at-risk groups but not all of these are included in the current immunisation scheme. That committee's recommendations are based on the epidemiology of the relevant vaccine-preventable disease in Ireland, as determined by the Health Protection Surveillance Centre and international best practice in immunisation. In plain English, this means that we are proceeding with caution and taking the advice of medical experts and the committee in charge of making recommendations to Government in this area. If we felt that extending the scheme was the right thing to do for healthcare, as the Deputy suggests, that is what we would do but that is not the recommendation at this stage.

The Tánaiste mentioned, as did I, that none of the deaths has presented as a result of the meningitis B strain, but he must acknowledge that cases of children with meningitis B have been reported to the HSE. Thankfully, there have been no deaths thus far but we want to ensure that remains the case in the future.

The Tánaiste referred to the national immunisation advisory committee, which wrote to the Department in June 2018. It is carrying out a review of the matter but still the Department has not received the recommendations. Meanwhile, there has been an outbreak in which up to 20 cases have been identified, while the National Association of General Practitioners is calling for a catch-up programme to be rolled out. Tens of thousands of parents have signed online petitions, crèches and schools are warning parents and families to consider the issue and parents are sitting at home wondering what they should do. It is a case that Jack has been immunised because Jack is only two years old but Mary has not been because she is four years old. Parents wonder what they should do because they may not have the €450 to protect their children. God forbid anything would happen.

There is a review of the issue under way but the advisory committee has not reported. When does the Tánaiste expect that review to be completed? As a State, can we not involve ourselves in a catch-up programme? Why is the political will not there? Does the Tánaiste dispute the advice of the medical professionals in the National Association of General Practitioners when they say the policy is medical apartheid? Does he not accept this and that the Government is forcing parents to choose which children to protect and which to leave vulnerable?

I assure the Deputy that there is no issue with political will in this regard. It is about doing the right thing on the basis of medical advice and the recommendations of experts - in this case from the committee responsible for making recommendations for immunisation schemes. It is important to try to assure parents that meningitis B is most common in babies under the age of one, all of whom are covered by the current immunisation programme. That said, as the Deputy noted, the issue is under review. Once that review has been completed, the Minister and the Department will be able to provide further clarification.