2026-03-04

Gabhaim buíochas le hOifig an Cheann Comhairle as ucht an ábhar seo a roghnú ar maidin. Mar a dúirt an Cathaoirleach Gníomhach, I wish to ask the Minister to discuss the availability of the shingles vaccine for those aged over 65 or those with compromised immune systems. Shingles affects approximately one in three people during their lifetime, with the risk of contraction increasing significantly with age. I think also the risk of impact increases significantly with age. The condition can cause severe and prolonged pain. I discussed the matter with my colleague, Deputy Martin Daly, who was in a position to advise me of some of the impacts of the shingles virus when contracted. It causes a very significant rash and the pain can be extremely debilitating. Should the rash affect one's face, it can cause serious vision problems, including potential risk of permanent vision loss. It can cause chronic pain. Some 30% of patients described feeling the pain some years after initially contracting the illness. In some cases it can lead to a syndrome known as post-herpetic neuralgia, PHN, where nerve pain continues for months or even years after the shingles rash is healed. One can imagine such an illness could have a very lasting impact on mobility, independence and quality of life. A range of international studies have shown that the shingles vaccine may reduce the risk of Alzheimer's disease and other dementias. It can also slow the progression of dementia. In Ireland, unfortunately, access to the shingles vaccination currently depends largely on ability to pay, with the vaccine costing up to €500 per person, which places it out of the reach of many older people living on the State pension and creates inexorable health outcomes based on income. In February 2024, the national immunisation advisory committee recommended the recombinant herpes zoster vaccine for all adults aged 65 and over but following this the Health Information and Quality Authority conducted a health technology assessment, which was published in 2024. It concluded that the vaccination of all adults aged over 50 was not cost-effective. One of the queries I have is that when the national immunisation advisory committee recommended the vaccine for those aged 65, why did HIQA conduct an assessment on providing it for all adults over the age of 50? It seems that the threat of contracting shingles and the impact of it increases significantly for those aged over 65. The assessment did not specifically model a targeted programme for those aged over 65, despite the recommendation of the national immunisation advisory committee. Many countries, including our neighbours in the UK, and other European countries such as Germany, Italy, Belgium and the Netherlands already provide the shingles vaccination free of charge to older adults, so there is a trend across Europe of this being provided but Ireland is yet to introduce such a scheme. I met recently with a group from the active retirement association in Galway, which put forward a very good argument for a targeted, age-focused vaccination programme for adults aged 65 and over, as advised by the national immunisation advisory committee. We owe it to the people of the country to formally assess the provision of the vaccine to those over the age of 65. I ask that the Minister would give it every consideration.

I thank Deputy Connolly for raising this matter in the House. Varicella is a common and highly infectious disease caused by the varicella zoster virus. This virus is associated with two distinct clinical syndromes, varicella, commonly known as chickenpox, and herpes zoster, commonly known as shingles. Primary infection with the varicella zoster virus results in varicella, after which the virus becomes latent in the body's nervous system. The virus may reactivate after a period, sometimes several decades later, resulting in herpes zoster or shingles, as we know it. Currently, a non-live, recombinant shingles vaccine called Shingrix is available in Ireland and is administered as a two-dose vaccine. The national immunisation advisory committee guidelines state that the Shingrix vaccine may be considered in those aged 65 years and older, due to the greater burden and severity of disease and post-herpetic neuralgia in this age group and in those aged 18 years and older at increased risk of shingles. It should be noted that in advance of any change in policy, the Minister can request that the Health Information and Quality Authority, HIQA, carry out an evaluation of the impacts of a potential policy change. HIQA has a statutory remit, under the Health Act 2007, to evaluate the clinical and cost-effectiveness of health technologies, providing advice to the Minister for Health on budget impact, organisational and social aspects and ethical and legal issues. These evaluations take the form of health technology assessments or HTAs. A HTA is a multidisciplinary research process that collects and summarises information about a health technology in a systematic, unbiased and transparent manner. The use of the HTA facility assists decision-makers in assessing the merits and potential shortcomings of a new health technology, policy or service based on accurate and reliable evidence. The Minister for Health advises that following a request from her Department, HIQA carried out a HTA on the herpes zoster vaccine which protects against shingles. The HTA examined the evidence on the safety and clinical effectiveness of shingles vaccines. The cost-effectiveness and budget impact were also reviewed, in addition to the ethical, social and organisational implications of including the vaccine in the adult immunisation schedule. This is an area I know quite a bit about because I was Minister of State with responsibility for older people for four and a half years and I can remember dealing with it at the time. HIQA's HTA was published on 19 July 2024. The HTA found that including the shingles vaccine in the routine immunisation schedule, at the vaccine price at the time, for all adults aged 65 years and over would not be cost-effective and would have a substantial budget impact. While the HTA found that the introduction of the shingles vaccine was not cost-effective based on the cost of the vaccine, it found that it could be cost-effective for vaccination of those at 75 years and 80 years if the price of the vaccine was reduced by 80%. The healthcare budget is finite and this year alone we will spend €4 billion of the €28 billion health budget on medicines. Decisions regarding increased spending relating to a change in one area could impact the provision of other health technologies and treatments within the healthcare system, the cost-effectiveness must be considered in any decision-making process. The Department considered the findings of the HTA in 2024 and determined that the introduction of the vaccine could be reconsidered when the cost-effectiveness of the vaccine was confirmed as being more favourable. I will come back to the Deputy with more information.

I understand the vaccine is available, as the Minister of State outlined. I also understand that when the process of assessing whether it would be provided through the immunisation programme was undertaken, there was a period of public consultation and a substantial number of submissions were made in the public consultation that highlighted that the cost of the vaccine - at that time between €480 and €500 - would be prohibitive for many older people, especially those on fixed incomes and those who rely in particular on the State's old age pension as their only income. The public consultation also highlighted the potential long-term chronic impact of contracting the shingles virus. The impact it would have on quality of life is significant. While I understand everything the Minister of State said, I am not sure it is fully captured in the standard cost-effectiveness modelling. The Minister of State provided one piece of information that differs from the information I have been provided with. In her response she said that: "The HTA found that including the shingles vaccine in the routine immunisation schedule, at the vaccine price at the time, for all adults aged 65 years and over would not be cost-effective" but the information I received is that the assessment was done for all adults aged 50 and over, and that is what was found not to be cost-effective. Clearly, it would be more cost-effective if it was done for the lower number of people who are over the age of 65. There is no argument being put forward by anybody that it should be made freely available to those over the age of 50 but the argument has been strongly made that it would have considerable benefits, including long-term benefits for people over the age of 65. I recognise fully the limits on the State coffers and on the Department in terms of expenditure in this area but I feel the appropriateness and the benefits would outweigh that.

I understand the points the Deputy makes. I agree with many of them but we must stop and think. He says the vaccine would cost €500 per person. We have an ageing population. We actually have more than a million people over 65. The Deputy can quickly do the maths to see what that would cost. Following detailed consideration of the findings of the HTA in 2024, it was determined that the introduction of the shingles vaccine to the immunisation schedule in Ireland could be considered if and when the cost-effectiveness of the vaccine is confirmed as being more favourable. I think there is an onus, too, on the companies that provide the vaccine to come to the table. That is an important element of it. In line with this, the introduction of the shingles vaccine to the immunisation programme in Ireland is again being actively considered for a cohort of immunocompromised individuals in line with NIAC advice and cognisant of the cost-effectiveness of market pricing and available funding, so that is welcome. The Deputy will also be aware that the immunisation programme in Ireland is based on the advice of NIAC. The information I have, and I have no doubt they looked at it for those aged 50 and the whole way up, is that the HTA found that vaccinations could be cost effective for those aged 75 and 80 if the price of the vaccine was reduced by 80%. I will certainly raise this again with the Minister for Health. It is kept under constant review. As I said, €4 billion, which is a huge proportion of the overall spend of our health budget, is spent on medicines. We will keep the situation under constant review and I will speak to the Minister on the Deputy's behalf.