2026-01-27

I thank the Minister of State for coming this evening to take this Topical Issue matter. Over recent months, there has been ongoing debate about the merits of providing enhanced influenza vaccines such as high-dose or adjuvanted formulations for people aged 65 years and older. The Health Information and Quality Authority, HIQA, conducted a health technology assessment, HTA, which found that enhanced vaccines are likely to provide greater protection than standard influenza vaccines in older adults, with the potential to reduce severe illness, hospitalisation and influenza-related mortality in this high-risk group. Despite these findings, the HSE did not proceed with a tender for enhanced influenza vaccines last year, citing cost-effectiveness concerns. However, the scale and severity of the influenza outbreak in recent weeks, characterised by high levels of community transmission, significant pressure on hospitals and a disproportionate impact on older people, raises questions about whether the current approach adequately reflects the true cost of influenza to the health system. Hospital admissions, bed occupancy and delayed discharges during peak flu periods carry substantial financial and operational consequences. Preventing even a modest proportion of these admissions through improved vaccine effectiveness could offset the higher upfront cost of enhanced vaccines. In addition, vaccine uptake among older adults remains suboptimal in some communities, suggesting that availability alone is not sufficient. Public awareness, confidence and timely access all play critical roles in determining vaccination rates. Clear public messaging, earlier seasonal campaigns and stronger engagement through GPs, pharmacists and community organisations may help to improve uptake, particularly among those at risk of severe outcomes. In light of this year's flu cases and associated hospitalisations, what consideration has been given to funding an enhanced flu vaccination programme for older adults ahead of the next flu season? What measures are being considered to improve public awareness, confidence and uptake of the flu vaccine among older people to maximise the impact of the vaccination programme and reduce preventable illness and hospital pressure? We are not a million miles off the vaccination target for the age cohort of 65 and older. However, another concern I have is for those aged between two and 17. The HSE has a target that 50% of children in that cohort will be vaccinated, but we are way below that, at below 20%. Will the Minister of State give consideration to improving uptake of the flu vaccine among children?

I thank the Deputy for raising this matter in the House this evening. The Minister for Health shares his concerns about the protection of older adults against influenza. For those in recommended groups, the influenza vaccine reduces the risk of serious illness and death from flu. Ensuring high vaccine coverage is a priority in order to reduce severe illness from influenza, RSV and Covid-19 over the winter period. Ireland’s immunisation programme is based on the advice of the National Immunisation Advisory Committee, NIAC. The committee's recommendations are based on the prevalence of a disease in Ireland and international best practice. NIAC routinely revises recommendations to facilitate the introduction of new vaccines and to keep on top of changing patterns of disease. Therefore, the immunisation schedule will continue to change over time. The vaccination programme provides a free flu vaccine to those most vulnerable to the impact of flu. Every year, the WHO reviews global surveillance data and recommends the specific strains that manufacturers should include in the season's vaccines based on the flu strains that are considered most likely to circulate. All licensed influenza vaccines included for the 2025-26 season comply with WHO and NIAC recommendations. In 2024, HIQA carried out an enhanced flu vaccine health technology assessment, which found there were limited studies on the effectiveness of enhanced flu vaccines, along with a lack of data over multiple seasons. Due to the variability of seasonal influenza, a single study may misrepresent average vaccine effectiveness. Based on the limited data, the HTA determined that switching from a standard to an enhanced flu vaccine for those aged 65 and older was likely to reduce the burden of flu. However, whether such a switch would represent a good use of public money would depend on the price of enhanced vaccines when compared with the standard flu vaccine. The European Centre for Disease Prevention and Control, ECDC, reported overall low to moderate relative vaccine effectiveness for the enhanced influenza vaccine against laboratory-confirmed influenza-related hospitalisations. It concluded that evidence specific to the relative effectiveness of enhanced influenza vaccines when compared with standard vaccines was still limited and that further studies were necessary to allow more substantial conclusions on the potential benefits of enhanced influenza vaccines. The HSE is responsible for the procurement of vaccines in line with EU and national procurement rules. It was asked to commence a tender process to determine if enhanced flu vaccines could be purchased at a cost-effective price and within its existing budget. It carried out an analysis of the tenders received and on 4 February 2025 advised the Department of Health that neither of the available enhanced vaccines for older people met the criteria set out in the HTA for net monetary benefit compared with the standard flu vaccine. The HIQA HTA estimates that procurement of the enhanced influenza vaccines would cost between €4 million and €19 million per year. However, the actual costs remain commercially confidential and are not known until tenders are evaluated each year. Decisions regarding increased spending in one area could impact the provision of other technologies and treatments in the healthcare system. Therefore, cost-effectiveness must be considered in any decision-making process. It is important that the Department and the HSE adhere to the value-for-money obligation set out by the Department of public expenditure in relation to the efficient and effective use of public funds and resources.

I thank the Minister of State, who is here instead of the Minister, Deputy Carroll MacNeill. She has probably heard me in parliamentary party meetings in recent years talking about access to drugs in general in the round. It does not surprise me that the response from the Department is that we need to do more research because that is generally what it does when it comes to expanding and rolling out drugs right across the board for patients. There is one thing that annoys me. As a Government, we have made a political decision to expand the RSV programme. It is a commitment in the programme for Government. While my question does not directly relate to RSV, it is on the spectrum when it comes to flu vaccinations. RSV vaccination is right in there. We have made a political decision as a Government to expand that. NIAC has recommended that the RSV vaccine be expanded. However, we have not done that yet. I am not discounting the fact we might do it in the future, and I hope to God we do, because it will prevent some of the chaotic scenes we see in our emergency departments over the winter months in particular. I would lay down the gauntlet to the Department of Health that it is time it got off its chair and made these decisions and big calls. NIAC has recommended that the RSV vaccination be expanded to older people. We already do it for children. It has recommended this. The Minister of State has said that it will cost between €4 million and €19 million for flu. Obviously, there are many caveats in that. I assume it involves many different age cohorts and whatever. I ask the Minister of State to consider rolling it out to people in nursing homes who may be vulnerable, to see if that is effective and cost efficient to begin with. Obviously, cost effectiveness is more important that people's health; that is what I keep being in told here when I raise these questions. As regards cost effectiveness, has the Department estimated to the Minister of State, or would she be able to find out in writing afterwards, what the cost of people who present with flu or RSV, for example, is during every winter period? I guarantee it is far less than the €4 million to €19 million range given to us this evening.

Certainly, I will get those answers for the Deputy. I am pleased to note that in this flu season, the uptake rate for the vaccine among adults aged 60 and older was 66%, and for fair deal residents it was 83%, which is high. This is very positive and has been a factor in ensuring hospital and trolley numbers for flu this year are lower than previous years. It is important that we protect ourselves and each other from infection during the winter season by availing of the flu vaccine when it is offered. The introduction of an enhanced vaccine can be reconsidered when the cost effectiveness is more favourable. I will get the Deputy those answers. I urge all those who are eligible for any vaccine under the national immunisation programme, at all stages of life, to take the opportunity to be vaccinated. It is important that we tell anyone who needs to get their vaccine that they need to get that as soon as possible. Again, I thank the Deputy for highlighting this matter. I will certainly bring his questions back to the Minister and get answers, particularly with regard to children. It is important we look at that again. I thank him for raising this very important topic tonight.