Oireachtas Joint and Select Committees
Wednesday, 22 April 2026
Joint Oireachtas Committee on Health
Vaccine Policy, Availability and Uptake: Discussion (Resumed)
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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Apologies have been received from Senator Nicole Ryan, who is on maternity leave, and Senator Boyle.
I remind members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate where he or she is not adhering to that constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask members participating via Microsoft Teams to confirm, prior to making their contribution to the meeting, that they are on the grounds of the Leinster House complex.
The minutes for the meetings of 24 and 25 March and 15 April have been circulated. Are they agreed? Agreed.
Today, we will continue our consideration of vaccine policy, availability and uptake. Last week, we heard from Professor Ronan Collins and Active Retirement Ireland. During that meeting, it became clear that while great strides have been made in childhood vaccines, we still have some way to go in terms of older adults. The State's approach to the vaccination of adults was described as "reactive at times", in stark contrast to the much more proactive approach to childhood vaccination. Unlike the childhood vaccination programme, the committee was told that there is no set vaccine schedule for older adults. This means that many vaccines which would benefit older adults are simply out of reach. Active Retirement Ireland outlined that this is because many older members are on fixed incomes and cannot afford to pay privately. For example, the shingles vaccine costs the equivalent of 1.5 weeks' income for somebody who relies on the State pension. A strong case was made for a publicly available shingles vaccine by all witnesses. The issue of equitable access and the benefits of vaccination, particularly for older adults, will be considered again at today's meeting.
To assist the committee today, from the HSE, I welcome: Dr. Colm Henry, chief clinical officer; Ms Kate Killeen White, the regional executive officer, REO, for Dublin and the midlands; Dr. Éamonn O'Moore, director of national health protection; Dr. Lucy Jessop, consultant in public health medicine and national immunisation lead; and Dr. Anne Sheahan, regional director of public health. From the Department of Health, we are joined by Professor Mary Horgan, chief medical officer; Dr. Ellen Crushell, deputy chief medical officer; and Ms Rachel Murray, principal officer, immunisation and infectious disease policy.
Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of that person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses, or an official either by name or in such a way as to make him or her identifiable.
To commence today's proceedings, I invite Dr. Colm Henry to make the opening statement on behalf of the HSE.
Dr. Colm Henry:
I thank the Chair for inviting me to discuss vaccine issues with the committee, including their role in public health, our immunisation programmes, system management and current progress and challenges. My colleagues joining me are Ms Kate Killeen White, regional executive officer; Dr. Éamonn O’Moore, director of national health protection; Dr. Lucy Jessop, consultant in public health; and Dr. Anne Sheahan, consultant in public health medicine in the HSE South West.
Vaccination is one of the most effective public health interventions, protecting individuals and communities from serious infectious diseases. The Covid-19 pandemic highlighted the vital role of vaccines in protecting public health. Across Ireland and Europe, immunisation programmes protect people at all stages of life, from routine childhood vaccines to those recommended during pregnancy, older age and for at-risk groups. Maintaining high uptake is essential to sustaining this protection and preventing outbreaks.
This committee meeting coincides with European Immunisation Week, 19 to 25 April, and World Immunisation Week, 24 to 30 April, themed, "For every generation, vaccines work." The HSE strongly supports the value and importance of vaccination and immunisation programmes. We offer a wide range of vaccination programmes across the life course, ensuring protection against vaccine-preventable diseases and working with GPs, pharmacists, hospitals and dedicated teams for accessibility and effectiveness. Through our primary childhood immunisation programme, we protect infants from 12 diseases across five visits for children aged two to 13 months, including chickenpox since October 2024. Vaccination programmes are also delivered in primary and secondary schools, protecting our children and young people from infections including meningitis and human papillomavirus, HPV.
We deliver evidence-based vaccines in line with Department of Health policy for pregnant women, older people, people in risk groups due to age or underlying medical conditions and healthcare workers, and in response to outbreaks of infectious diseases. The HSE delivers its vaccination and immunisation programmes in line with national immunisation policy, and with funding from the Department of Health. The national immunisation advisory committee, NIAC, provides independent evidence-informed guidance to the Department to guide its policy decisions. The Department may also request the Health Information and Quality Authority, HIQA, to undertake a health technology assessment, HTA, to assess cost-effectiveness and refine target groups for any national programme.
Through its national immunisation office, the HSE procures and distributes vaccines in line with national policy, also supporting training and communication to both healthcare professionals and the target population. Regional directors of public health lead work on implementation of vaccination and immunisation programmes, working closely with GPs, pharmacists, schools and mobile vaccination teams. Within the HSE, national governance and oversight is provided through the integrated immunisation oversight group, which I co-chair alongside Ms Martina Queally, the lead regional executive officer for vaccination and immunisation.
Ireland stands out internationally for its extensive range of funded national immunisation programmes. These programmes cover the entire life course, ensuring protection for individuals at various stages of life. The country consistently achieves high uptake rates, reflecting strong public engagement and confidence in the immunisation system. For example, Ireland achieved one of the highest uptake rates globally for the primary Covid-19 vaccine programme, with 92% coverage and almost 10 million doses of vaccine given in 2021. This past winter, through our winter vaccine programme, we protected over 1 million people from serious complications of seasonal flu infection, protecting almost 50,000 more children than the previous year and achieving above-target levels of vaccination coverage for our most vulnerable older adults, those aged 80 and over, and those in long-term care facilities, at 91% and 83% coverage, respectively. Through a second pathfinder programme, we protected newborn and infants under six months of age from complications of RSV infection through immunisation with nirsevimab, reaching 88% of newborns and 52% in the catch-up cohort. This programme contributes to reduced RSV-related paediatric hospital admissions, with a 60% reduction in presentations to emergency departments and a 71% reduction in paediatric intensive care unit admissions seen in our first RSV pathfinder programme the previous year. Evaluation of this recent programme is ongoing.
Through our HPV vaccine programme, introduced in 2010, we are delivering on our ambition to eliminate cervical cancer. Ireland was an early adopter of gender-neutral HPV vaccine, offering to both boys and girls, and has consistently achieved high coverage, among the highest performing programmes in Europe. In the academic year 2023 to 2024, national uptake of one dose of HPV was 74.9% among first-year students in second level schools. Furthermore, as part of the HSE national tuberculosis strategy, plans are under way to introduce a selective BCG programme in line with NIAC guidance, commencing with infants under 12 months of age in high-risk groups.
In line with other countries in Europe and worldwide, immunisation uptake across a range of vaccination programmes has decreased, leading to outbreaks like measles and pertussis in Ireland, Europe and worldwide. Rates of uptake of vaccines within the primary childhood immunisation programme have been decreasing and continue to be below the 95% World Health Organization, WHO, target required for herd immunity. For example, uptake measured at 24 months of age for the MMR vaccine was 87.6% in quarter 2 of 2025 and for the six in one vaccine, it was 90.4% for the same period. Causes for this decline in Ireland and worldwide are manifold and complex but may include the impact of misinformation, especially on social media; a lack of perception of risk by people who may not understand how serious some infectious diseases can be as they have been rare until recently due to previous high rates of vaccination, for example, measles; and issues such as access to vaccines and trust in health systems.
The field of immunisation is rapidly evolving, with a growing number of vaccines and innovative vaccine technologies being licensed on a regular basis. In Ireland, several new immunisation programmes have been launched in recent years, including nasal influenza vaccines, Covid-19 vaccines, MenACWY vaccines, chickenpox and mpox vaccines, as well as the extension of HPV vaccination to boys. Given the constraints on our healthcare budgets, it is essential to carefully assess both the costs and benefits prior to implementing new or expanded national immunisation initiatives. Even vaccines for which there exists strong evidence of clinical effectiveness need to be judged against wider considerations on best use of public health resources. For example, health technology assessments conducted by HIQA currently indicate that introducing shingles and RSV vaccines for older adults would not represent an efficient allocation of healthcare resources at present, considering current product cost estimates. Such assessments inform national policy as decided by the Department of Health. The HSE works to secure and procure vaccines mandated by national policy for the best price and at the right quantity to meet the current and predicted vaccine requirements for our population.
The HSE strives to achieve equity and excellence in our public immunisation programmes. We work to ensure that everybody has access to clear information they can trust, so that nobody is left behind. The HSE continues to monitor and evaluate existing immunisation programmes, along with the implementation of new programmes in line with Department of Health policy, to add to the scientific evidence-base and to ensure we identify challenges in access or equity.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Dr. Henry. I call Professor Horgan to make the opening statement on behalf of the Department.
Professor Mary Horgan:
I thank members for the opportunity to update the committee on matters relating to vaccines, including policy, availability and uptake. It is fitting that the invitation to attend today falls during European Immunisation Week 2026, which has the theme, "For every generation, vaccines work". I am joined by deputy chief medical officer, Ellen Crushell, and the head of immunisation and infectious diseases policy unit, Rachel Murray.
Vaccination is one of the most impactful public health interventions available to us and it has led to many lives being saved in Ireland, dramatically reducing the impact of infectious diseases such as measles, whooping cough and meningitis over the course of the past century. Vaccination is a particularly important intervention as it can protect the most vulnerable members of our society and it directly contributes to a key aim of Sláintecare by addressing health inequalities within Irish society. In using vaccinations to prevent disease we can also avoid additional pressures on our healthcare service via reduced attendances at GP practices or emergency departments and lower admissions to hospital, which is particularly important during times of increased healthcare demand.
Vaccinations are administered across the country on a daily basis in primary care, community pharmacies and via the HSE, as part of routine vaccination programmes like the primary childhood immunisation programme, and via annual vaccination campaigns like the flu and RSV programmes. It is testament to the combined efforts of all involved in the use of vaccines in Ireland, including the public, that this past winter, more than 1 million people across Ireland were given a flu vaccine. At times, special vaccination programmes are also stood up in response to specific disease outbreaks, for example, during the mpox outbreak in 2022 when more than 11,000 doses of vaccine were administered over a short period of time.
Ireland takes a comprehensive, structured, multi-layered, life-course and evidence-based approach to the development and delivery of national vaccination programmes. For the benefit of the committee, and to support our discussions here, I will briefly outline the steps involved. Key to the approach taken in Ireland is the provision of advice from the national immunisation advisory committee. NIAC provides independent, evidence-based recommendations and advice to the Minister for Health on immunisation and related health matters to inform health policy in Ireland. In advance of any change in vaccination policy, the Minister may request that the Health Information and Quality Authority carry out an evaluation of the impacts of the potential policy change. These evaluations take the form of health technology assessments. As the committee will be aware, a HTA is a multidisciplinary research process that collects and summarises information about a technology, including vaccinations, in a systematic, unbiased and transparent manner. HTAs can assist decision-making in assessing the merits and potential shortcomings of a new vaccine programme. A key piece of the HTA is the cost-effectiveness analysis. This can help to guide the allocation of finite resources within a health service, which faces multiple demands at any given time. When NIAC submits recommendations on immunisation to the Department of Health, these are considered alongside other relevant evidence, such as findings of the HTA, and a determination will subsequently be made by the Minister.
Ireland's approach to its vaccination policy is dynamic, whereby standing guidance is updated as evidence changes and assessments are re-evaluated. Following any policy decision, the HSE then has responsibility for the implementation of immunisation programmes, including procurement and administration to eligible individuals via a range of means including primary care. The HSE also reports on vaccination uptake across national immunisation programmes. In line with the commitments in the programme for Government, I will highlight some recent expansions in the immunisation programmes offered in Ireland. Last year, the primary childhood immunisation programme was expanded to include the varicella vaccine for infants. This vaccination gives children important protection against chickenpox infection and helps protect the wider community.
This vaccination gives children important protection against chickenpox infection and helps the wider community. A highly successful RSV infant immunisation pathfinder programme in winter 2024 saw 83% of newborns covered and led to significant reductions in RSV cases, hospitalisations and ICU admissions. Building on the success of the first season, an expanded RSV immunisation programme was put in place in winter 2025. Earlier this year, the Minister also announced that the Laura Brennan HPV catch-up programme will offer unvaccinated fifth- and sixth-year school students another opportunity to receive the HPV vaccine to protect them from some types of cancers.
Every year, the WHO reviews global surveillance data and recommends the specific influenza strains that manufacturers should include in that season's vaccine, based on the flu strains that are considered most likely to circulate. The HSE is in the process of carrying out a procurement process in relation to the flu vaccine specific to the 2026-27 flu season. It is expected that NIAC-recommended enhanced flu vaccines will be included in this procurement process. Only when that process is complete will it be known what vaccines will be available for the coming flu season. With the HSE's multichannel approach to delivery, Ireland has one of the highest flu vaccine uptake rates for older adults in Europe, reaching nearly 75% in the 2024-25 flu season, which is the target set for this group by the WHO. The corresponding median uptake in this older age group among 22 other European countries is much lower, at 47%. Last season also saw the highest uptake to date of the nasal flu vaccine, with over 270,000 children in Ireland directly protected from the effects of flu and with the risk of onward transmission in the community also lowered.
At this point, I will take the opportunity to recognise the dedication of the healthcare professionals who worked tirelessly throughout the pressures our health service experienced this past winter. However, as the committee is aware, uptake of other key vaccinations, such as the MMR vaccine, is not at the level we need it to be to protect the population. I know my HSE colleagues are actively focused on addressing and increasing the uptake of these key vaccines.
Turning to priority work that is under way, the Department of Health and the HSE are actively examining the potential to offer the shingles vaccine to at-risk groups in a phased manner, guided by NIAC advice and focused on achieving the greatest health impact with available resources. As Chief Medical Officer, I share the concerns about the impact of shingles on vulnerable people in terms of post-herpetic neuralgia, the associated discomfort and pain experienced, and the significant societal costs. Any decision on whether to introduce a specific immunisation programme must take a population health approach and consider many factors, including the burden of disease on individuals and the health service, the future demographics of our population, the clinical effectiveness and safety of the vaccine, and the cost-effectiveness and budgetary impact of the programme. A huge amount of work goes into the assessment, planning and delivery of our vaccination programmes and I want to extend our gratitude to all those involved in the various aspects and, of course, to all those who come forward to avail of the vaccines offered, which goes a long way towards protecting the health of our population.
I again thank the committee for its invitation to facilitate discussion on the important work being done to protect the health of the nation through the use of vaccines. I reiterate the Department's commitment to working collaboratively to protect the population at large and particularly the most vulnerable members of our community.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Professor Horgan. We will now move to questions from members. Each member will be afforded eight minutes. We will move through the agreed rotation and will take a break in about an hour's time, once we get through the first round of questions.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank Professor Mary Horgan and her team from the Department of Health and Dr. Colm Henry and his team from the HSE for coming here this morning. Following on from last week's information meeting, it is really important to tease out a few issues.
There is an emerging divergence in this country. We are a small country and the population is sensitised to the advantages of a shingles vaccine. In my surgery, people with means are coming in and paying €400 to have a shingles vaccine while people with the least resources, who may be immunocompromised or older, do not have access to that vaccine. We know this connection is not just present in respect of shingles, which is a nasty disease. As Professor Horgan pointed out, the problem is not just post-herpetic neuralgia. Many older people's lives are materially affected in many ways after having a shingles infection. They can become more frail and more open to other illnesses. It appears that infection also affects their cognitive ability.
I will ask some specific questions. My first question is to Professor Horgan. Has the fact that the HIQA evaluations included those over 50 rather than an older cohort of people skewed the cost-effectiveness case for the shingles vaccine?
Professor Mary Horgan:
I fully appreciate the safety and effectiveness of the shingles vaccine. The big issue here is one of cost. When HIQA did the analysis, the cost analysis was done for those over 65 rather than for those over 50. When the cost analysis was done for that particular group of patients, it was found that it would cost nearly €218 million to vaccinate everyone aged 65 or older, which is the cohort the analysis looked at, over a five-year period.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I have read that. I just wanted Professor Horgan to say it. I am sorry but I have limited time. I accept that part. Has the effect of the reduction in the prevalence in dementia suggested by the Cardiff study and others been factored in? We know it is not just the antiviral portion of it. It may have to do with the adjuvant in the vaccine.
Professor Mary Horgan:
It is really important that we understand that the licence for the shingles vaccine is to prevent that particular disease and post-herpetic neuralgia. Work is ongoing. There is a big study under way in the UK to look at the impact of the shingles vaccine on dementia and other inflammatory conditions. That is a four-year study that began last year. It is important to think of this as a possible secondary benefit rather the primary reason for vaccination. As the Deputy knows well, there are many factors that influence dementia. There are loads of types of inflammation, one of which is in sections that-----
Martin Daly (Roscommon-Galway, Fianna Fail)
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I accept that. There is vascular dementia and then there is Alzheimer's. This is what is concerning people. It seems a pattern is emerging. It is not clear whether it is the vaccine or the adjuvant. That brings me on to my next question. Either Dr. Henry or Professor Horgan may answer. The enhanced or adjuvanted flu vaccine and the adjuvanted RSV vaccine are also emerging as factors in reducing the prevalence of the onset of Alzheimer's but we are not using either adjuvanted vaccine. I accept the success of the vaccination programme. I support vaccination. In a world of vaccine scepticism at the highest levels of the American Government, I am glad the witnesses are here to restate the value of vaccination because it is really important. Will they address those points?
Dr. Colm Henry:
Given the fact that the vaccine programme has been so successful among older people, it is really important to restate in a public forum - I am sure the Deputy will allow me to do this - how important it is for older people to take up that vaccine at the level they have thus far. The rates are extraordinary. Some 81% of people in long-term care facilities, 91% of those aged over 80 years and 66% of those over 60 trusted their healthcare professionals when they advised them to take the flu vaccine. Not only do they take it up but, based on the epidemiological curve of flu-related hospitalisation this year, we have good evidence to show that this had a real impact. If there is time, I will ask my colleagues to come in on this. From the beginning of December, the impact of the vaccine kicked in among the most vulnerable. It is really important to say that.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I certainly agree. Before Dr. Henry goes further, healthcare workers present a major challenge. There is very low uptake among such workers. I know I am going off on a tangent here but that is one of my questions.
Dr. Colm Henry:
To go back to the Deputy's question on the enhanced flu vaccine, the most critical factor for people in a population-based programme is the uptake of the vaccine. We learned that during the pandemic. There were differences between vaccines but we recommended that people take the vaccine they were offered and the impact was huge in the Irish setting.
The immune systems of older people vary. That is my specialty, and I understand that. There are potential advantages to adjuvanted vaccines over standard vaccines. That is the subject of procurement for this year. We do not discuss that in public because it is commercially sensitive but clearly that is part of our discussion at that procurement period which is now ongoing when we consider the range of vaccines and the one best-suited for the Irish population next year.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I accept what Dr. Henry has said to me about that. It appears that the adjuvant might be the factor in reducing the onset of Alzheimer's, rather than the actual viral piece of the vaccine. That is what some of the evidence suggests. I am not suggesting that we have an answer for that at this point-----
Dr. Colm Henry:
I am sorry for cutting across. I restate that the single most important thing when you look at the factors that influence dementia is that they include any acute illness and recurrent delirium. Certainly, prevention of influenza and hospital-based influenza is for me the single most important indirect factor. That is the prevention of flu through the current high-uptake levels of the current vaccine programme.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I accept that but I also ask if that is being deliberated on-----
Martin Daly (Roscommon-Galway, Fianna Fail)
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With regard to healthcare workers, when people go into healthcare settings they expect that they will be made better. Unfortunately, in any health system anywhere there are unintended consequences with hospital-communicated infections. However, the uptake of the flu vaccine among healthcare workers is comparatively low. What is Dr. Henry's view on that?
Dr. Colm Henry:
I will answer that and then bring in my colleagues. It is low. It was extraordinarily high during the pandemic. We saw healthcare workers queue to not only be vaccinated but to volunteer to be part of vaccine teams in an extraordinary example of the nation coming together. It is at 34.9% in the past season. My colleague, Dr. O'Moore, has done extensive work to look at how we address the factors that have led to a drop in uptake, not just in Ireland, but abroad. We have seen examples of great practice. I ask Dr. Sheahan to describe Mallow hospital, where the uptake is now over 60%, and why it is higher in some areas.
David Cullinane (Waterford, Sinn Fein)
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I turn to Dr. Henry first. If all the clinical and cost-effectiveness measurements or thresholds were met, how quickly would it take to set up a shingles vaccination programme? Is it something that could be done fairly quickly? If the decision was made that we were going to do this and the cost-effectiveness issues were resolved and we were going to plough ahead, is that something that could be done quickly?
David Cullinane (Waterford, Sinn Fein)
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So, it can be done.
David Cullinane (Waterford, Sinn Fein)
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I will get to the gap.
David Cullinane (Waterford, Sinn Fein)
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I will get to that. I want to put a number of things on the record from my perspective. It can be done, and we can put it in place quickly. In his opening statement, some of which he has responded to, Dr. Henry stated that they have to look at the clinical effectiveness and the cost-effectiveness. I start with the clinical effectiveness. Does he believe the shingles vaccine is clinically effective?
David Cullinane (Waterford, Sinn Fein)
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Those thresholds have been met.
David Cullinane (Waterford, Sinn Fein)
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Therefore, the only issue here is cost-effectiveness.
David Cullinane (Waterford, Sinn Fein)
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I accept all of that.
David Cullinane (Waterford, Sinn Fein)
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I want to get to the crunch here. We can have a programme up and running quickly. The clinical effectiveness is not disputed. The issue at play here is the cost-effectiveness. I want to get to the cost. I assume the HSE and the Department have costed it. What would an immunisation programme for 75 year olds to 80 year olds cost?
David Cullinane (Waterford, Sinn Fein)
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I do not need to know the negotiations; I just need to know what the estimated cost is.
David Cullinane (Waterford, Sinn Fein)
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Let us break that down because those are not the figures we have been given. I am not saying they are not accurate but we have to tease it out. Is Dr. Henry it is €218 million for over 75s?
David Cullinane (Waterford, Sinn Fein)
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I am asking about over 75s.
David Cullinane (Waterford, Sinn Fein)
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I think the manufacturer is proposing that we will have programme for over 75s.
David Cullinane (Waterford, Sinn Fein)
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Will Dr. Henry stick to the question I am asking? I asked if there was a cost for over 75s.
David Cullinane (Waterford, Sinn Fein)
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Why not?
David Cullinane (Waterford, Sinn Fein)
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I know but then they would scenario paint and look at the different options-----
David Cullinane (Waterford, Sinn Fein)
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-----for over 65s and over 75s. Are they telling me they have not costed that?
David Cullinane (Waterford, Sinn Fein)
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I was coming back to the Department. I am asking if it is costed because Dr. Jessop said they have to look at the different options. Has the Department or the HSE costed the roll-out of a programme for over 75s?
David Cullinane (Waterford, Sinn Fein)
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They have not done it.
David Cullinane (Waterford, Sinn Fein)
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I go back to Dr. Henry. Is what they costed over one year, five years or how many years is that €218 million?
David Cullinane (Waterford, Sinn Fein)
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What is the yearly cost?
David Cullinane (Waterford, Sinn Fein)
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When we do budgets we look at the annual cost. We do not look at what it is over five years.
David Cullinane (Waterford, Sinn Fein)
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How can we not have these figures? We had a lengthy discussion on this last week. We invited the HSE and the Department, so we could have a discussion about whether we could roll out a programme. Dr. Henry has accepted there are no clinical issues. He has accepted that it can be done quickly. The issue is cost-effectiveness. I would have hoped the Department would have looked at what a programme for over 65s would look like, what a programme for over 75s would look like, what a programme for immuno-compromised patients would look like, what the different cost scenarios would be and what the annual cost would be. If we are making an allocation in a budget, it is for one year. That is factored in. That is in the base. Is Dr. Henry telling me there is no figure for what it would be in the base for one year?
Dr. Colm Henry:
In the negotiations the CMO and I are currently looking at sub-groups of immuno-compromised individuals, which are the other risk groups not covered in the question, to see which groups would receive maximum benefit based on the other groups identified in the HTA and NIAC advise, namely those with stem cell transplantation, solid organ transplants and haematological malignancies. We are looking at sub-groups to see where we can get the maximum benefit-----
David Cullinane (Waterford, Sinn Fein)
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That is great but that is not what I have asked. I was given a cumulative figure for five years. What is the annual figure? In year one, what would the figure be if it had to be put into a budget?
David Cullinane (Waterford, Sinn Fein)
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It is €173 million. How could that be the case if it is over five years?
David Cullinane (Waterford, Sinn Fein)
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Is that because the vaccine effectiveness lasts for a number of years?
David Cullinane (Waterford, Sinn Fein)
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That cost is for people over 65.
David Cullinane (Waterford, Sinn Fein)
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If you break it down, how much of that is the cost of the drug versus administration costs and so on?
David Cullinane (Waterford, Sinn Fein)
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As a rough percentage, is it the majority of it?
David Cullinane (Waterford, Sinn Fein)
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Why not?
David Cullinane (Waterford, Sinn Fein)
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How can we make a decision that there is a cost effectiveness issue here if we do not have a breakdown in that total figure of how much is for the drug, for administration and for other issues?
David Cullinane (Waterford, Sinn Fein)
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They have been given a cost. Is Dr. Henry telling me they have been given a cost which is just the headline cost but have not had a breakdown of what that would mean? All they have been given is a cumulative cost over five years of €218 million and that is it. They have no breakdown of what that would entail.
David Cullinane (Waterford, Sinn Fein)
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There is a cost. That is €150 per dose but for how many?
David Cullinane (Waterford, Sinn Fein)
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How many patients are we looking at?
David Cullinane (Waterford, Sinn Fein)
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If we had a calculator, we could probably work it out. There is a figure. That is what I was getting at.
I want to finish on a positive note because I am not here to quarrel with anyone. I desperately want this to be put in place. I have family members who have had shingles. It is a nasty illness to get. We should have a national immunisation programme for older people to make sure they are properly protected, whether it is against the flu, RSV or shingles, as well as possible. No one on this committee is making any arguments for any individual company. I certainly would not do that, but vaccines work. We all know that. I have seen people in my family and circle of friends pay huge amounts of money privately to get a shingles vaccine and it is not right.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Deputy.
David Cullinane (Waterford, Sinn Fein)
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It is one of the areas in healthcare that we should be making available to as many people as possible. I will finish on this. The preventative advantages in this are massive. I appeal to people to take what we are saying on board. I hope we can get to a point where we have a programme. I thank the witnesses.
Pádraig Rice (Cork South-Central, Social Democrats)
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The next slot is for Fine Gael.
Peter Roche (Galway East, Fine Gael)
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First, I acknowledge and thank Dr. Henry and Professor Horgan for their comprehensive statements. I welcome the professional team and thank them for being with us. I assure them I will not give them a hard time.
I was taken by the fact that in any immunisation programme, such as that for Covid-19, misinformation and social media can be a blocker. I consider some of those things nearly an epidemic in themselves because social media has a huge impact on anything happening right now. Will the witnesses touch on how that can be overcome?
Dr. Colm Henry:
I welcome that remark. We are very concerned about it. We saw the harm that could be done through our HPV programme initially. It has recovered following social information. I will use this public forum to acknowledge the work of the late Laura Brennan and her family in reinforcing trust and confidence in that programme. In the interest of using expertise, I ask Dr. O'Moore to talk about that specific issue, which is a huge focus for us in the HSE.
Dr. Éamonn O'Moore:
I thank Dr. Henry and Deputy Roche. It is important that the Deputy raised this issue. As we said, we are sitting here during European Immunization Week and right across the globe, we have seen confidence in vaccine programmes impacted by negative statements by influencers in a range of places, some high, some low, which have influenced a dialogue about vaccination and immunisation. This is unfortunate because, as we heard from the CMO, Professor Horgan, and the CCO of the HSE, Dr. Henry, the absolute evidence of the benefit of vaccination is very clear for everyone to see. It is great to have in this forum people talking about the need for more vaccination and recognising that there may be additional benefits from a vaccination beyond primary prevention. This is an innovative area of science and it is important that we continue to advance our scientific knowledge on it.
These programmes work if people take them up. The things that influence people to take up the offer of vaccination are manifold, but they include knowledge about and attitudes to vaccination, which are accessed through a whole range of channels. The HSE, through our national immunisation office, seeks to be the trusted voice for information on vaccination and immunisation. We have put a lot of work into communication and particularly tailoring our information and advice to different parts of the population, working with advocacy and representative groups to make sure the information makes sense in the way it lands, that it addresses people's needs and that it is accessible to them.
We are also aware that when people talk about vaccine hesitancy, which is a phrase that arose during the Covid-19 pandemic, it is a blanket phrase covering quite a number of complex issues that may be at play. Sometimes it may be less about people's lack of acceptance and more about their ability to accept or access a vaccine. Therefore, part of the work includes looking at how to enable people who are motivated to be vaccinated to have access to vaccines. We might talk later about how that played out among healthcare workers, but for many people access to vaccines is a challenge.
There is a twin-track approach, which is to ensure our target populations for vaccine programmes have the information they need to make a decision for themselves, their loved ones or the people they care for, and when they are motivated to take up the offer of vaccination, to ensure we enable it to be done easily and in a way that is accessible to them. We are spending a lot of time, in partnership with colleagues in other public health agencies in Europe and in the World Health Organization, WHO, thinking about the best ways to tackle misinformation, disinformation and malinformation.
We all have a role in this and I am pleased to hear Deputies in this forum strongly advocate for the value of vaccination because we know from the evidence that that sort of system leadership role is very important. People who are being asked to take up vaccinations need to know this is important and that there is strong belief in it. That is the work we are doing. We have lots of examples of how we have communicated, engaged and promoted vaccination in a way that has allowed us to turn some of the issues around. However, we are mindful there is a mountain to climb with some of our vaccination programmes in this regard.
Professor Mary Horgan:
We have previous experience, as the CCO, Dr. Henry, outlined. There was a particularly difficult time around 2016 with the HPV vaccine when a focused social media misinformation campaign took place. What really worked was people coming together - healthcare professionals, researchers, advocacy groups like the Irish Cancer Society - and, most important, hearing the voice of the patient. We all remember the impact Laura Brennan had on reversing what was a downward trend. I was involved with it at the time, as president of the Royal College of Physicians of Ireland. This is work her parents, Larry and Bernie Brennan, continue to this day. We are able to reverse the trend. However, as Dr. O'Moore said, we have to be vigilant. We have to listen to people and have a forum where people can voice concerns, but healthcare workers are trusted voices. We need to listen to people. We need to make it convenient to get vaccines and to make sure there is not complacency.
Vaccines are so successful that we sometimes forget how good they are. Having practised infectious disease medicine for more than 30 years, I have seen the huge positive impact vaccinations have, such as for meningitis. There used to be approximately 500 cases per year in the early 2000s. I dealt with the unfortunate consequences of them. Now, there are about 60 per year. That is the real story of the success of vaccine programmes and it is a plea to everyone, whether they are healthcare workers, parents, children or older people, to take the vaccines they are offered. They are safe and effective and we have robust processes in place in this country to make sure they are safe and effective and good value for money for our taxpayer. The vaccines work across the whole life course.
Peter Roche (Galway East, Fine Gael)
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I have 36 seconds left. It behoves us to maybe try harder to mitigate the negativity that comes from social media and other platforms against the goodwill of what the witnesses are trying to do, to protect against and prevent such conditions. Those people feel they represent a community or cohort of people who can bang stuff up on social media and it is sometimes a message that gets out and loses people who are willing to avail of a vaccination. It is criminal that they do that and, particularly so for the most vulnerable, that they would decline a vaccine on foot of nonsense and rhetoric.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions. This is an important discussion we are having. Particularly in the middle of European Immunization Week, it is important that we have this awareness raising and that we get out the message about the effectiveness of vaccines.
We do not realise the effectiveness of vaccines sometimes until there is an outbreak or we do not see the full impact because so much has been prevented in terms of what we have saved, illness and cost wise. It is important that we highlight and put a spotlight on the importance of vaccines and their effectiveness. It is also about looking to the future and seeing how we can improve things, where we can go and how we can develop programmes and continue to expand on them as well.
I want to start there because last week at the committee we had a really interesting discussion with Professor Ronan Collins around older adults. He made the point quite effectively that there is a set schedule for children but not for older adults. The schedule for children is paid for by the State and has been quite successful. Professor Collins said:
If we look at childhood vaccination, it is very much a set schedule ... It is laid out like almost a formal policy and every adult is aware about the vaccine schedule for their child and their GP teaches them if they are not. I am not aware of a similar approach in older adults ... People are not empowered and then they are not sure whether they are paying for it or if it is free.
Why has the State not adopted a set vaccination programme for older adults? Is the Department of Health looking at this? If so, what vaccinations would the witnesses include in such a programme?
Professor Mary Horgan:
The Department really takes a life-course approach to vaccines. The vaccines we give people in childhood protect them right through to adulthood and old age. Vaccines we give to older people also have protection against children. The reason we give vaccines for particular diseases at an early age is that infants and children are more prone to those infections at that period of time, but many of the vaccines we give those children have lifelong benefit.
There is an adult vaccination programme. The Department gives influenza, Pneumovax and Covid-19 vaccinations, not only to older people but also to those who are immunocompromised. The approach is really that life-course approach. It is very dynamic. The Department continues to assess and reassess, evaluate and re-evaluate the infections that are problematic in adulthood and that includes pregnant women, at-risk groups, immunocompromised groups and also older adults. We all recall that with the Covid-19 vaccine, the main initial target was the eldest members of our country. It is that lifespan approach and it is done for a good reason.
I will bring Dr. Henry, who is a geriatrician, in to comment on this but it is a life-course approach to vaccination and that is what works.
Pádraig Rice (Cork South-Central, Social Democrats)
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Does Dr. Henry accept the point made by Professor Collins about the need for a more set schedule and more awareness around it, as well as a set number of vaccines laid out for older adults in the same way as we do for children. Does Dr. Henry take the points he made?
Pádraig Rice (Cork South-Central, Social Democrats)
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I take that point.
Dr. Colm Henry:
-----but are illnesses that have been forgotten by our clinical community today because they have been virtually eradicated. Unfortunately, we are seeing a resurgence in measles because of a drop in vaccine uptakes. We have not seen cases of polio in many years. I think that there has not been an outbreak in this country since 1955.
With older people, we do have a programme. As Professor Horgan outlined, we have a strong age-related bias towards the provision of free vaccines. We push our vaccination teams into long-term care facilities where there is an uptake of 81%.
Not only that, I would contend that much of what we do in encouraging the uptake of vaccinations in younger groups has the secondary intent to protect older people. If we look at two 17-year-olds, of course we are trying to prevent influenza in children, but one of the other reasons we are doing that is because we are trying to reduce what is a reservoir for influenza infection among children to impact on older adults. Arguably, our seasonal vaccination programmes are designed to protect older people and the most vulnerable, and that includes the way we provide vaccines to healthcare workers and to younger people.
Pádraig Rice (Cork South-Central, Social Democrats)
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I want to move on to the shingles vaccine because there was a really important discussion on that at the last meeting as well. There is emerging evidence that was referred to as well and the Department provided the committee with a briefing note on this back in February. It said that HIQA was aware of new studies that have been published since it published its health technology assessment, HTA, in 2024, and that HIQA was considering the implications, if any, for the advice provided in relation to the cost-effectiveness of the shingles vaccine. More studies have been published since it did that HTA and that may have an impact in terms of its determination and cost-effectiveness.
Does the Department and the HSE know the status of HIQA's consideration of these new studies? Has any timeline been provided? Do the witnesses think that the view may change based on these studies that have come out since 2024?
Professor Mary Horgan:
The work with HIQA is ongoing at my request. I wanted to see if there is new evidence that would influence any policy decisions. The work is ongoing. One of studies that I think will be really important is the UK study that I mentioned to Deputy Daly. It is looking at real-life outcomes of the shingles vaccine in the UK, but it is a four-year study. Looking at outcomes like dementia can be complicated because there are other factors that influence that, such as chronic disease and other infections, as well as the potential benefits of other vaccinations to dampen down the inflammation that we know is associated with dementia. We do not have a randomised control trial which is the pinnacle or the gold-standard way of testing this hypothesis, but real-life experience will really help with that because dementia-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Is there an indicative timetable for when HIQA will finish its consideration?
Pádraig Rice (Cork South-Central, Social Democrats)
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Will it hopefully be this year?
Pádraig Rice (Cork South-Central, Social Democrats)
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Could that then change the determination in terms of the cost-effectiveness?
Pádraig Rice (Cork South-Central, Social Democrats)
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Professor Horgan mentioned the mpox vaccination campaign in her opening statement and it was a really effective campaign.
Pádraig Rice (Cork South-Central, Social Democrats)
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There was a huge uptake and great demand. What lessons were learned from that? What went well? What can we do in future for similar cases? We prevented an outbreak.
Professor Mary Horgan:
It brings up some really good things that the Department of Health does. We have to be reactive with some things and that is due to a lot of the surveillance work that is done by Dr. O'Moore and his group which looks at what is out there and how we can intervene as quickly as possible. It worked. There was really good uptake. The clinics that were rolled out reached the most at risk, so we know that concept works, but we have to be reactive. We have to survey diseases all the time. This is what we do in our weekly meeting. We survey the epidemiology of what is happening in Ireland, Europe and beyond because what happens there, affects us. When there is any flag, we intervene quickly. We get the message out to those who may be at risk but also intervene with a vaccine should they be available, safe and effective.
Pádraig Rice (Cork South-Central, Social Democrats)
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One of the lessons learned and one of the things that was most effective was the communications from community organisations-----
Pádraig Rice (Cork South-Central, Social Democrats)
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-----NGOs and trusted people within the community who shared information about it in a really accessible way that people understood. I understand that the demand for the vaccine was higher here than in other countries, particularly based on some of the community communications.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the witnesses very much.
Marie Sherlock (Dublin Central, Labour)
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I thank the witnesses for being here. When we look at health budgeting, it is a very difficult thing because there are so many variables. However, when we look at health prevention and the very clear efficacy of vaccination programmes in terms of reducing those medium- and long-term costs for our healthcare system, it is really welcome that we are having this conversation on vaccines.
I just want to ask about shingles to start with. There have been a lot of conversations about shingles but there seems to be a clear consensus about the clinical effectiveness of the shingles vaccine both for older people and for immunocompromised people as well. However, the cost is the argument that keeps coming back. There were two deals done in March this year with regard to the pharmaceutical framework for this country. Was the shingles vaccine part of those negotiations? To what extent was it pushed in those negotiations and what was the outcome?
Marie Sherlock (Dublin Central, Labour)
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Dr. Henry might want to answer that.
Dr. Colm Henry:
We covered much of the issue relating to Shingrix already. There is no doubting its effectiveness, and there is emerging evidence regarding secondary benefits. We have had discussions in this forum previously about medications and how we approve them. In many cases, there is no doubting the effectiveness. In deciding on provision, whether it is a drug or a vaccine for a population, we have to consider the cost-effectiveness.
Marie Sherlock (Dublin Central, Labour)
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Of course.
Dr. Colm Henry:
As was addressed earlier, that is the level at which we are having those discussions at the moment. At the request of the CMO, we are looking at subgroups that may particularly benefit from this vaccine and that are immunocompromised. They would include: individuals with stem cell transplantation; individuals with solid organ transplants; and other individuals whose immune systems are not up to scratch who would benefit particularly from this. Those discussions are under way. As I said earlier, we cannot conduct those discussions or engage with the public because they need to come to a conclusion where we want to see access as wide as possible regarding a vaccine that clearly has clinical benefits.
Marie Sherlock (Dublin Central, Labour)
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I hear Dr. Henry on that. We have not had sight of the deal with the pharmaceutical companies. We were told that there are lots of good things in it, and yet we are still talking about the shingles vaccine. We have been talking about this for a number of years. I am not in any way clear as to the priority that the Department places on it. That is not in any way to cast aspersions on the individuals involved. From the Department or the HSE, I am not hearing about a deal. This is an issue that did not develop yesterday or today. It has been going on for a number of years. When a deal is done, why are we not seeing an outcome?
Professor Mary Horgan:
I can speak from the point of view of the shingles vaccine. I reiterate that it is safe and effective. It is about affordability. Certainly, from the Department's point of view, we have engaged the HSE to engage with the pharma company to see what price it can get.
Marie Sherlock (Dublin Central, Labour)
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Is there nothing over the line?
Marie Sherlock (Dublin Central, Labour)
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I hear Professor Horgan. We are told that we have an agreement with the pharmaceutical companies, but we still have no progress on the shingles vaccine. Is the HSE currently purchasing shingles vaccines for any of its patients at present?
Marie Sherlock (Dublin Central, Labour)
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Is anywhere else in the HSE?
Marie Sherlock (Dublin Central, Labour)
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I hear what Dr. Henry is saying about the vaccination programme. I am referring to it being acquired for specific patients. Obviously, there are certain groups of patients who would be particularly vulnerable if they were to get shingles. I want to understand whether the HSE has made any purchasing decisions.
Dr. Colm Henry:
I cannot speak for every clinic or interaction, and the Deputy would not expect me to do so. I am sure that at the level of oncology departments or nephrology departments, there are consultants who are in discussions with patients and who may - in the context of advice tailored to them - advise them of the benefits of a vaccine . That does not fall within the remit of the national immunisation office because it is not a public vaccination programme.
Marie Sherlock (Dublin Central, Labour)
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In the context of the flu vaccine, I understand that approximately 40% of hospital admissions last year involved those under the age of 15. Obviously, we have just come through a particularly bad winter with regard to flu. The target for children, as I understand it, is 50%. It has been stated that this has gone up. That is to be welcomed, but less than half is what was achieved this past winter. Something more surely needs to be done. I came across pharmacists last winter who had supplies and who reached out individually to schools. There does not seem to be as comprehensive or as joined-up an approach across schools and local pharmacists or through the national immunisation office with regard to getting the vaccine out to children.
Dr. Colm Henry:
This is a cause of concern for us. The situation is improving. It began low, but we needed it to be more for two reasons: for primary protection of children; and, as I said earlier, recognising that younger people can be a reservoir for infection that will impact on vulnerable older people or those who are immunocompromised. I might ask Dr. Jessop and, perhaps, Dr. Sheahan to address what measures we are talking specifically to address children.
Dr. Lucy Jessop:
It is important to remember that the nasal flu vaccine has been an evolving programme. It started as a community-based programme in GPs and pharmacies when we introduced it during the Covid times when schools were closed. We then did some pilot programmes that involved HSE teams going into a few schools. We had a much better uptake going into schools, and that is something we have been evolving. More of our HSE teams are partnering with schools. We are also allowing our GP and pharmacy colleagues, as the Deputy said, to partner with primary schools, particularly because of those younger children that we want to target. We are starting our planning early this year for the coming season in order to try to increase participation with schools between GPs and pharmacists. We are facilitating that as best we can.
Obviously, it is for parents to decide if they wish their children to have the vaccine. It is for schools to decide if they wish to be part of the programme but, for example, if a child is in a school that is not participating, it is still available in community pharmacy and GPs. It is readily available throughout the country. We also did some HSE catch-all clinics as well.
Ms Kate Killeen White:
The ongoing development of the regional structures is helping in the context of the joined-up and integrated governance around vaccinations. The regional directors of public health who are on the executive management teams are responsible for the roll-out of the vaccination programmes within each of the regions. They work closely with the GPs and primary care teams in the schools to enhance that integrated governance. Each health region also has established a regional immunisation committee. They are chaired by the regional directors of public health and support and operate in the context of monitoring uptake locally and implementing targeted improvement programmes. The enhanced governance in each of the regions will support that critical opportunity to stabilise the workforce, integrate governance and strengthen accountability and data, in this area and also in the context of rebuilding immunisation uptake post the Covid-19 pandemic.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Killeen White. The next slot is an Independent slot. I call Senator Clonan.
Tom Clonan (Independent)
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I thank the witnesses for being here. I want to apologise. I am on the disability matters committee, which sits at the same time as this committee, and I had to hop out for a quorum. Related to that, I apologise if I ask questions that have already been answered. The witnesses will have to forgive me for that.
On the subject of vaccination, given the various witnesses who are here, as the parent of a vulnerable adult who is compromised from a respiratory perspective and immunocompromised, I want to put it on record that during Covid, we were absolutely terrified. I commend the HSE and all of the relevant stakeholders on what was an extraordinary collective effort on a social basis and in terms of medical innovation, etc. When my son got his vaccination, there was a queue of hundreds of people going into the RDS. In the small cubicle inside the venue, the person who administered that vaccine could see his situation. It was a very emotional moment. It was extraordinary. Notwithstanding all of the criticisms of how Covid was handled and the necessary lessons that we must learn as a result, I want to put that on the record.
At a previous session, I asked questions about the efficacy and quality of the flu and Covid jabs last winter. I imagine lessons have been learnt from that. Who makes the decision on which particular vaccine to roll out? Is it a clinician who takes clinical responsibility for that decision or is it, for want of a better expression, an administrator? I have three quick questions if anyone wants to come in on that.
My second question is from an anecdotal point of view and is totally subjective. I have been told by a couple of pharmacists who are friends of mine that there has been quite an increase in the number of people contracting shingles.
Is there any reason for that? Has a study been done in that regard? Is there any truth to what I have been told? If there is, it adds to the argument for introducing the vaccine on a general basis.
My final question relates to a matter that has come up at previous meetings of the committee. We had a presentation from the National Centre for Pharmacoeconomics last year. It was quite clear during that presentation that the manner in which the centre reaches its decisions is, by definition, unethical. Those who work at the centre are statisticians. It has people with pharmacological qualifications - I looked at its staff outline - but it does not have any ethicists. Its methodological approach is quantitative and highly deterministic and positivistic. It does not consider the qualitative or life impact of the intervention that might be made possible by introducing something, so there is a big bit missing from its determinations. Last week, we had a geriatrician before us who said that sometimes he is quite surprised by the decisions the centre makes because when he looks at the literature, the conclusions it reaches are not supported by the statistical analyses it puts forward.
There are no ethicists in the National Centre for Pharmacoeconomics. There is nobody from the human sciences who would consider the sociological or phenomenological impact of a vaccine and so on. It is, by definition, an unethical calculus for arriving at a conclusion as to whether or not we should introduce something. We are all aware of the shortcomings in that regard. We have had so many presentations in the audiovisual room from groups of people who are in extremisand who, for quite small sums of money, could benefit from life-changing impacts. The geriatrician who was here last week gave a commitment to the committee that he would, through the RCPI, lobby, advocate and engage with the National Centre for Pharmacoeconomics on that. Is that something that the witnesses have considered in the context of vaccines? Is it a concern? Do they have any plans to engage with the National Centre for Pharmacoeconomics on that? When I challenged the CEO of the National Centre for Pharmacoeconomics on this, he said he would review it to see if he would change it. However, I do not know if anything has happened since.
Dr. Colm Henry:
First, on the decisions, I thank the Senator for his kind comments. To be fair, the pandemic response was a truly societal effort. Maybe I will touch on that final point in that context, because what the response highlighted was how ethically principled our vaccination programmes are. The programmes we deliver are fundamentally underpinned by principles of equity, access and fairness. One of our slogans during the pandemic - it remains our slogan - is that nobody gets left behind. We make every effort to seek out those populations that can be characterised as marginalised and that have difficulty accessing healthcare. We make huge efforts nationally and locally to reach out to those populations.
Tom Clonan (Independent)
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I do not want to conflate two issues. I understand that once something is funded, there is an ethical approach regarding its implementation. What I am talking about is the methodological approach the National Centre for Pharmacoeconomics uses to arrive at decisions as to whether or not vaccines should be made available in the first place.
Dr. Colm Henry:
For the purposes of today's discussion, that function relates to the HTA, which is carried out by HIQA, and the criteria it uses, which include effectiveness, safety and cost-effectiveness. In addition, if you read its submissions, it includes ethical principles as well as organisational change and so on. I have to trust that in carrying out its assessments and advising the CMO that it is adhering to those principles.
In terms of the Senator's first question about the vaccine, we touched on this earlier. The committee will forgive me for repeating myself. We know that the flu vaccine we used for this season was very effective. The uptake was extraordinary, at 91% of people over the age of 80, 80% of people in long-term care and 66% of people over the age of 60. We also know from looking-----
Tom Clonan (Independent)
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Was it a medical clinician who made the decision to choose that particular vaccine or was it an administrator?
Tom Clonan (Independent)
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Is it a clinical decision for which somebody takes clinical responsibility or is it done by a committee? Is it a clinician who takes clinical responsibility for the decision to choose the particular vaccine or who takes responsibility?
Tom Clonan (Independent)
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Is it the Chief Medical Officer who is clinically responsible for such decisions? Which clinician is responsible?
Tom Clonan (Independent)
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On the choice as to which vaccine is used.
Tom Clonan (Independent)
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Yes, I know that but-----
Tom Clonan (Independent)
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I have only seven seconds. I am really sorry.
Tom Clonan (Independent)
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I do not mean to be rude or brusque, but is it a clinician-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Senator.
Tom Clonan (Independent)
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I am very reassured by that answer.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Senator is are over time.
Tom Clonan (Independent)
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If it is a clinician like Professor Horgan, I am very reassured.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Senator is out of order. Deputy Burke has asked to go next. He has to leave soon. With the agreement of the committee, the Senator will take the next slot. Is that agreed? Agreed.
Colm Burke (Cork North-Central, Fine Gael)
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I thank the witnesses for the work they are doing in this whole area. A lot of progress has been made over recent years in relation to vaccines. Professor Horgan set out that about 83% of newborns were covered, which led to significant reductions in the number of RSV cases. There is another 17% where it was not taken up. Is there a particular group of people where there is a reluctance to take up the vaccine? How do the witnesses work to try to increase the figure beyond 83%?
Professor Mary Horgan:
The good news is that it has increased further this year to 88% from the first year of the programme, so, clearly, that has been well received by mothers of newborns and families. We do a lot of work, and it is a particular focus of mine in the Department of Health, to target and support those people who do not wish to have it in order that there is open discussion and dialogue. I might ask my colleague Professor Crushell, who is a paediatrician, and Dr. O'Moore, to speak on how we target to increase that uptake, given the huge positive impact that this vaccine-----
Colm Burke (Cork North-Central, Fine Gael)
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Before the reply is given, the witnesses might take account of the following. I was just cross-checking data. The childhood vaccination rate in Ireland stands at 91%, the second lowest across Europe. The target is 95%. How do we now increase it to 95%? There is a gap there of 9% in the context of our not succeeding 100%.
Dr. Ellen Crushell:
I am a paediatrician at CHI as well as being a deputy CMO. The RSV immunisation programme, the pathfinder programme, was brought in two years ago. It has been revolutionary. I do not know if members remember the winter of 2023-24. It was a very heavy season in terms of RSV infections. Most babies contract RSV in the first few months of life and many of them become very sick. They get a chest infection from it called bronchiolitis. That ends up with them being off their food and being feverish and sick for a few days. Many children need to be hospitalised. About 10% of babies who are hospitalised end up needing intensive care and all that the latter entails in the context of prolonged admissions. The winter before we did this pathfinder, there were about 1,600 admissions of babies with RSV bronchiolitis.
That collapsed within the first year. Hospitalisations reduced by 75% in that cohort. We are very happy with that. The programme was expanded last year to include babies born who were under six months at the start of the season. It has been really helpful, especially in the context of those winters when people got the flu and RSV at the same time. Children’s services were impacted by that as well. That is aside from the whole stress and trauma of having a sick child-----
Colm Burke (Cork North-Central, Fine Gael)
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We are doing a follow-up. As well as that, we have a larger migrant community now too. Is there a particular focus as regards selling the message about the importance of vaccines?
Dr. Éamonn O'Moore:
I thank Deputy Burke. I am pleased he has raised this important issue about health equity within our primary vaccination programmes and in relation to the recent RSV programme. In fact, I chaired a steering group of the current RSV pathfinder 2 programme yesterday. We are in the middle of conducting a detailed evaluation of the impact of that programme. It includes looking at areas, either geographically or by location, where there was less good coverage than there might have been in other areas. We are also trying to understand what issues might have been barriers to people accepting the offer.
As Professor Horgan said, we have certainly seen a significant year-on-year increase in the uptake of nirsevimab, the RSV immunisation, compared to pathfinder 1 and 2. Generally, the level is increasing but the Deputy is right to point out that it is not a universal phenomenon and there are areas where there is less coverage. Our ability to understand the reasons for this is also impacted by the level of data we have, particularly some detailed data on a whole range of sociodemographic factors.
Colm Burke (Cork North-Central, Fine Gael)
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In relation to vaccinations, can we get detailed figures for 2025 regarding the uptake of various vaccines? The issue of the uptake of vaccines was raised already. The uptake of the flu vaccine, for example, by HSE staff was extremely low. We need to make sure we can get a message out there and we all have a part to play in getting that message out there. It would be helpful if we got a detailed breakdown of the take-up of vaccines so that people are giving accurate information.
To go back to one issue raised earlier, about the Mercy Hospital in Cork, it purchased and provided a vaccine for immunocompromised patients. My understanding is that the hospital took the cost for those vaccinations out of its own funding. Other hospitals are doing the same. The hospitals are looking at this approach as one that brings savings for them, in the sense that patients will be in the hospital less, but the problem is that the hospitals are now taking this money out of their own budgets. Is it not a case of trying to make sure this issue is dealt with, particularly where we have immunocompromised patients?
Dr. Éamonn O'Moore:
To answer the Deputy’s first question on the publication of vaccine uptake data, I am pleased to say that we do it. The Health Protection Surveillance Centre website provides data on vaccine coverage for our national vaccine programmes. For example, data on the primary childhood immunisation programme up to the second quarter of 2025 is available there, and we will soon be publishing the information for the third quarter of last year.
On the Deputy's latter point, as Dr. Henry said, the varicella zoster vaccine programme is not a national programme. We are aware that decisions are made at hospital level, and comments have been made already in this committee about the process to take us to review some of the factors within decisions around that but we are aware that is happening.
Colm Burke (Cork North-Central, Fine Gael)
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In fairness to the Mercy Hospital for taking on this initiative, it got a HSE innovation award. This is an institution being proactive in dealing with an issue in a context where it feels that if it did not do so, then it would only prolong the lengths of stay for people in hospital.
Colm Burke (Cork North-Central, Fine Gael)
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We can also have the situation, however, where a GP might look for a particular case and may not have the same power to deal with it.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Deputy. At this point, I suggest we take a break and resume at 11 a.m. Is that agreed? Agreed.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will continue the committee's consideration of issues related to vaccines. Our next slot is for Fianna Fáil and I call Senator Costello.
Teresa Costello (Fianna Fail)
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I will start off by acknowledging the work Laura Brennan and her family have done. It is just phenomenal to think of what that girl sacrificed and how much awareness she raised. I really hope that uptake increases and continues, given the actual factual benefits that have been seen in Sweden, the UK and Australia, if you want to turn to those places for how effective the HPV vaccine is. I hope that vaccine goes from strength to strength by whatever means possible.
I have a couple of questions. On the shingles vaccine, it is funded in 16 other European countries, including Greece, which has a relatively poor economy, and the UK. Why did it see the value and return on investment but we do not see it in Ireland? Did its health technology assessments, HTAs, find it to be cost effective?
Professor Mary Horgan:
The review by HIQA into this highlighted the number of European countries which do this. It suggested nine but sometimes, there are different models, such as a co-sharing arrangement. It may come down to the cost of the vaccine and what they negotiated. I do not know what the reason for that was but it may have come down to cost. We have all agreed it is very safe and it is very effective.
Teresa Costello (Fianna Fail)
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Those countries see the value in investment but in Ireland, it is coming in too high for us to see the value.
Teresa Costello (Fianna Fail)
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Is it less expensive in the UK?
Teresa Costello (Fianna Fail)
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Can I ask if there is a plan for an RSV vaccination programme for older people, given the benefits?
Teresa Costello (Fianna Fail)
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How long has that been ongoing?
Teresa Costello (Fianna Fail)
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Today, people spoke about vaccines and the fear people have around vaccines. I was thinking that there might be an education piece that is needed. Realistically, people do not know what is in a vaccine or what a vaccine is made up of. Misinformation finds a way through when people do not have the knowledge themselves. An easy to understand communication that says what a vaccine is compiled of might help eliminate a lot of the fear.
We have to look at polio. It is unheard of now. That is absolutely unbelievable. Now, it is not even a worry in our minds as opposed to going back many years ago. An aunt of mine had it. People need to have a clearer understanding, in that we are telling people to get vaccinated but they are asking what is in it. A bit of clear communication and education around that could be beneficial.
With the assessments finding shingles and RSV vaccines for older adults not cost effective, how does the HSE plan for future demand if costs fall or evidence changes? What preparations are under way for a policy shift?
Dr. Colm Henry:
I might outline what happens once a vaccine is approved and we then have to plan for its delivery and administration, which is a very complex exercise. On the earlier point, it is important to underline, as I am sure the Senator would agree, the huge level of trust the Irish public has in the people who give vaccines, such as GPs and practice nurses. We learned that during the pandemic and saw the huge trust it has, and in midwives too, with the RSVP programme provided to 88% of newborn babies. That is down to trust and the relationship between mothers and midwives. There is an extraordinary level of trust we should be very proud of.
Dr. Jessop might outline what happens once a vaccine is approved, the steps we take in training our workforce and putting it into operation.
Dr. Lucy Jessop:
There are several steps we take. The first thing is to ensure supplies of the vaccine. Once we know who is eligible, we model and forecast over a several year period as to how much vaccine we would need. We then work with our procurement colleagues in HSE procurement. We have to follow EU procurement regulations, which is obviously extremely important. We then procure the vaccine. It takes the vaccine manufacturers some time to make vaccines. Usually, we put that order in a year before we are due to start the programme to make sure we have security of supply in the country before we start the programme. We then have to decide which healthcare workers will be administering the vaccine. If it is general practitioners or pharmacists, there needs to be some discussions with their representative bodies to agree a fee or if it is some of the HSE teams, we need to determine which HSE teams to ensure they are fully available to deliver that programme if it is in schools, etc.
We then run a comprehensive training programme for all of our healthcare professionals and the Senator touched on that. What is very important is the trust an individual healthcare professional has with those parents or patients. We run a comprehensive programme so they can explain one-to-one to that person about the vaccine. There would be leaflets available and we would target these at some of our more harder to reach groups, in different languages and with translations, etc. We also have a training programme for healthcare professionals on how to speak to people who have questions about vaccines because it is very important we address their actual questions, not what we think they believe. We need to answer what they actually believe and think about how we address that, so that is what we would do.
We would then have a comprehensive communications campaign on the launch date and launch the vaccine. We then monitor uptake, as Dr. O'Moore said. The Health Protection Surveillance Centre, HPSC, monitors the uptake and then does an evaluation. There are comprehensive evaluations for the RSV programme, for example.
Teresa Costello (Fianna Fail)
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I thank Dr. Jessop. I have one more question. With regard to the MMR uptake, what specific barriers has the Department identified and what new measures are being considered to increase uptake to projected levels?
Dr. Éamonn O'Moore:
I thank Professor Horgan and I thank the Senator for her question. I really appreciate that she is spotlighting some of the challenges within our primary childhood immunisation programme because I was struck by commentary made earlier about how polio is no longer seen but we live in a world where no certainties now exist. Polio-containing vaccines and how we administer them are part of our primary childhood immunisation programme.
As the Health Protection Surveillance Centre, we collect and collate data from all over the country and everywhere that is giving vaccinations. We publish that data. We provide breakdowns on regional and sub-regional levels, so that people can see the performance of their local region. As my colleague said from an REO perspective and regional director of public health perspective, that data is used at a regional and local level to look at factors that may be associated with low uptake. That could be about specific population setting, access and so on.
The local work done at regional level includes engaging with target communities and includes the education programmes Dr. Jessop mentioned and all form a comprehensive approach to addressing undercoverage.
Teresa Costello (Fianna Fail)
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I thank the witnesses.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank our guests. I want to ask some questions specifically the HPV vaccine and the catch-up programme but also the school-based vaccination programme. In terms of the school-based vaccination programme, we know there are a number of gaps there. I cannot recall who it was - it might have been Ms White or Dr. Jessop - who spoke about pilot schemes earlier that were being rolled out in certain areas for certain vaccines in schools. In terms of the school-based programme, what is the level of uptake among students?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Yes.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Brilliant. I want to ask a very specific question because this is something that came into my office yesterday.
In a school that is being offered the catch-up programme, which is brilliant and fantastic and I am a huge fan of it, some of the children had already received the vaccination. They received it during Covid before the restrictions kicked in fully. How are these children reconciled? How do we know we are not offering an excellent vaccine a second time to children? Yesterday, a parent informed me that both HPV jabs had been given, as had a meningitis booster and a tetanus booster, at the start of Covid. How do we reconcile this?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will have to push back on this because I was that parent yesterday, with an 18-year-old in sixth year with a form in front of him asking whether he had these vaccinations. I can show Dr. Jessop the WhatsApp messages, which are quite entertaining as 18-year-olds and forms are not a good combination at the best of times. I rang the school vaccination programme team because I am one of these people who never deletes a phone number. I remembered it specifically because he was offered his Covid vaccine on the same day in a different town as he had his appointment for the HPV vaccine and we were not going to get to both - geographically it was impossible - so it sticks out very clearly in my memory.
After I had that conversation with the schools vaccination programme, I had parents in his class ringing to ask for the number because they could not remember whether or not their children had the vaccination. This has me concerned not because the vaccine was being offered but because it is another small level of eroding trust in our system. It is very important that we get a handle on this. As I do not delete phone numbers, I knew who to ring. The phone was answered within 30 seconds and the answer was received then and there. It should not be up to young people in school to ring their parents and for those parents, because they happen to know one of their classmates' mother is TD, to get from her a phone number to double check whether their child has received the vaccine. Do the witnesses agree?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How common is it?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I do not mind because I am a big girl and I know who to contact but a lot of other people do not. How common are experiences like this?
Dr. Éamonn O'Moore:
I do not think it is very common but I agree that we have a fractured data system. Work is going on as we speak to address this through the roll-out of the new national immunisation intelligence system, which is designed to address exactly these issues. We will have a centralised single database that will allow us to have oversight of the vaccine record of everyone in our country. This roll-out has begun with the inclusion of the Covid vaccination programmes, the pneumococcal vaccination programme and the primary childhood immunisation programmes.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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On this issue, I remember having a conversation with the HSE almost 12 years ago and I was told this was in the pipeline. Do we have a delivery date as opposed to a pipeline?
Dr. Éamonn O'Moore:
It is in play now. The vaccine products I have just mentioned are included in this and this is available now. It is being rolled out this year. We have a timeline for implementation of the whole project, which will conclude by the end of next year all being well, in 2027. This is a really comprehensive broad-based programme that is addressing exactly these-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Long-running.
Dr. Éamonn O'Moore:
It is long running and we agree with this. We would all prefer to be in a different place. It is now delivering detailed data that will inform all of the discussions we have had today on vaccine coverage and impact assessment. It will inform things like economic evaluations in the future. This will improve the governance around vaccination to enable us to be able to have a high degree of confidence in the vaccine record of the people who are coming before us for vaccination. This is being delivered and it will be completed as a programme in the next-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I have one eye on the clock.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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My final question is about school-based vaccination programmes. How many schools offer the flu jab every year? What percentage of schools do so?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Perhaps we can speak in general terms.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I appreciate that an accurate figure would be helpful. In general terms, how does the conversation start? How does it work? Does the school approach the HSE? Does the HSE approach the school? Who makes the decision as to which schools will have the flu vaccination available, whether it is the injection or the sniffer?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Just for clarity, what is Dr Sheahan's area?
Dr. Anne Sheahan:
I am a regional director for public health and I cover Cork and Kerry. One of my responsibilities is that I chair the regional integrated immunisation committee. This year in particular we are moving towards looking at who is delivering what vaccine in what schools. We are working with pharmacies, GPs and our mobile vaccination teams to ensure two teams are not going into the same school. This had started with one class and then another class but now we are offering a comprehensive programme to each school. There will be very clear guidance for each group, and each school will be well aware of what team is coming in to offer vaccines.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Does this conversation start with the school speaking to the HSE, chemist or GP or is it the other way around?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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This is with regard to schools. How does Dr Sheahan manage or interact in her area, which is Cork and Kerry, with children who are home schooled or who may be out of the formal educational setting such as in Youthreach?
Dr. Anne Sheahan:
We work very closely with the social inclusion team regionally. Under the umbrella of the regional integrated immunisation team, we work to identify those children who are being home schooled through the Department of education. Our mobile vaccination team gets the names and we offer the vaccination to them. In the same way, we go into congregated settings to make sure children who might miss vaccines in schools, perhaps with issues around language, are also targeted. We work very closely with these agencies to target the Roma community and other communities who may not access it through the formal setting of schools.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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On Dr. Henry's offer to come back with the exact information, will he give us a county-by-county breakdown, including children who are home schooled and those children who may be out of formal education settings, in terms of the percentage offered and the percentage who took up the offer?
Pádraig Rice (Cork South-Central, Social Democrats)
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Dr. Henry is happy to do that.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I welcome the witnesses. I want to ask a broad question because I have tried to get this detail through parliamentary questions and I have not received a definitive response. Can anybody tell me how much we spend on immunisation or vaccination per annum as part of the HSE budget overall?
Dr. Colm Henry:
There are certain definitive costs, such as administering the vaccine. In 2025, for example, the total cost of vaccines was €87.9 million. The administration fees to GPs and community pharmacists paid by the primary care reimbursement service amounted to €57.9 million. There are other costs for the workforce in terms of the members of the school vaccination teams and public health staff who are not occupied completely with vaccination. The two most fixed costs are the total cost of vaccines and the cost of the administration fees to GPs and community pharmacists.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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In the round it is €150 million plus other workforce costs.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Professor Horgan mentioned vaccination being the most impactful intervention we can undertake. I was looking at a European Commission study, which estimated that Ireland spends 0.27% of its total healthcare budget on immunisation and vaccination. This does not put us at the bottom of the pile in the EU but we are somewhere to the lower end of the middle of the pack. At the top are countries such as Luxembourg, which spends 2.6% of its total healthcare budget on vaccination. Is there an ambition in the HSE to grow this figure from 0.27% in the short, medium or long term? Where does Professor Horgan hope we will be in the next decade?
Professor Mary Horgan:
With my extensive experience in fighting infectious diseases for 30 years, screening for them, preventing them through screening programmes and vaccination and treating them once they come is very important to me.
I have seen the impact of immunisation programmes. If we look at the trajectory of adding immunisation vaccination programmes to our national programme, it has increased steadily over the past decade.There was meningococcal B and RSV more recently. There were shorter programmes like Mpox. I am a huge advocate for vaccinations. We have processes in place. We horizon scan what is coming up-----
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I apologise for interrupting, but the clock is against us. Where does Professor Horgan hope we will be in ten years' time? Does that point to her hoping that it will be doubled?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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To be fair, it is universally agreed here that vaccinations are good. The more we do, the better and the more money the HSE affords to get it rolled out, the better. We are all in agreement of that. It was the same EU Commission study that showed for every euro spent on vaccination, there is a €23 benefit to wider society in terms of health outcomes and whatever else. We are all on the same hymn sheet there. I am listening in for the past few hours about the difficulty around RSV, shingles and so on. There is information in the public domain that I have read. It goes back to Deputy Cullinane's question earlier. In the patient cohorts of 70- and 80-year-old plus immunocompromised, I have read that the pharma company involved has estimated that it would be €5.4 million per annum to provide it just specifically for those cohorts.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I wish to ask a question about cost effectiveness. I have done a good bit of research on rare diseases. Cost effectiveness is important, but it is not necessarily the single determinant of whether something is approved or not. Am I right in saying that?
Professor Mary Horgan:
That is correct. What is important in reassuring the public when it comes to the debate about shingles, there is treatment for shingles. There are effective antiviral agents that are accessible in every pharmacy in Ireland with the guidance of general practice. The earlier one gets treatment for shingles, the less likely he or she is to have severe neuralgia. It is an important message to get out. When it comes to shingles vaccines, as we have all agreed, it is safe effective. The affordability is an important area. The reason that I am saying that is that are other aspects of healthcare that may be needed. We have a finite pot of money.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I understand that. I am not trying to be unfair here. I was listening in to Deputy Cullinane earlier. The exchange was that the overall cost for the 65-year-old plus was in the region of €200 million over five years.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Was it over five years?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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It was at 50% uptake.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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What I am hearing in the public domain and part of the HTAs that for €5.4 million per annum, we could vaccinate 70- and 80-year-olds and immunocompromised people. Again, I do not expect Professor Horgan to negotiate the cost effectiveness of a drug on the floor of the committee. Looking from the outside and listening in here this morning, €5.4 million sounds a lot smaller of a number than €218 million. I am not accusing anybody of obfuscation or anything. If we could be more upfront about the different cohorts, maybe we could do it incrementally and build it in over time, that would be a far more beneficial conversation to have. That is something that the committee should write to the HSE about afterwards to see if it can look in greater detail at how it can implement that in the various age cohorts.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Specifically, into this area, how many interventions or interactions have we had with that pharma company in the past 12 months?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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It can be in writing, a phone call or conversation. How many interactions have there been in general?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Yes. We will stick with the shingles one.
Dr. Lucy Jessop:
We have not been able to go into a formal procurement process because there is not a formal policy. We have talked about the age groups. It would depend on the age groups. We have had three or four interactions with it around a fact-finding exercise regarding some of the costs of the vaccine. The cost that the Deputy is quoting may only be for the vaccine cost. Obviously, as we have said, we need the administration cost and the other ancillary costs. It may not be significantly more than that.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Nonetheless, there is still a big disparity between €5 million and a figure when it thrown out at €218 million. I am not saying that the €218 million is not accurate, but there is a cavern there between the two figures. If we can get the appropriate people in the room, the benefits of the shingles vaccine are undisputed here. Can we please get together in time for next winter? We have all acknowledged the benefits of it. I am over my time.
Martin Conway (Fine Gael)
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I commend the witnesses for their great work. It is one of the areas in spite of the difficulties and challenges that we can be immensely proud of. I am very much supportive of what has been proposed by this committee in terms of the whole area of a shingles vaccine.
I wish to focus on two areas. The first area is the HPV. I have the great privilege of knowing Larry and Bernie Brennan and I acknowledge the work that they have done and the work their daughter, Laura, did before she passed away. The vaccine at one stage was almost at 90%. While 74.9% is very high and much higher than the European average - it is probably the best in Europe - we still did a lot better if my memory serves me correctly. I ask Dr. Henry for a comment on that.
Regarding the catch-up programme, how successful has the catch-up programme been in terms of catching the people it is designed to catch?
Dr. Colm Henry:
I will hand this over to Dr. Jessop. Yes, it is 74.9%. It had fallen to a much lower level precisely because of the issue that was raised by one of the Senator's colleagues earlier in relation to disinformation. I ask Dr. Jessop to comment on current performance, particularly on the catch-up campaign.
Dr. Lucy Jessop:
It is an extremely important programme. We deliver HPV with two other very important vaccines, which are a tetanus booster and meningitis vaccine in the first year of second level school. We are very committed to trying to increase the uptake. The Senator is right. It was higher. It did fall. We have gone back, but not to those original levels. We are working with our colleagues in regions to try to improve that and look at how we can improve the uptake of the vaccine in first year. It is very important that people are vaccinated before the age of 15. That is our WHO target. We know it is most effective at that point. That is what we need to particularly look at. The Senator is right that we have a catch-up programme. That is being offered this year for those in fifth and sixth year. It is still ongoing. We do not have final figures on that. The teams will be offering that over the summer holidays. Our sixth years have exams to be contending with, so they may not wish to be vaccinated until after their exams. That offer will be available to them. Next year, we will be extending the catch-up------
Martin Conway (Fine Gael)
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Dr. Jessop does not have the figures on that yet. I ask her to provide them to the committee when she does.
If parents had missed the vaccine for whatever reason and decided to do it privately, is that possible without a cost?
Martin Conway (Fine Gael)
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Does it have been to be done through the schools or can it be done through a GP? Is there another way that a parent who might have missed out because of misinformation and other reasons can catch up without doing it through the schools?
Dr. Lucy Jessop:
The catch-up programme is being run through the schools and through community clinics. As I was explaining, over the summer holidays they would be able to phone up the community clinics and get an appointment. For home-schooled children, their parents are able to be vaccinated by the HSE teams.
Martin Conway (Fine Gael)
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My next question is about the flu vaccine, specifically for healthcare workers. I was very concerned at the low level of the take up of the flu vaccine over a number of years by healthcare workers who are, let us face it, on the front line. There is a legitimate expectation that they would have the highest uptake in terms of profiles of people.
Do the witnesses have any information on that or any thoughts on it that they would like to share with the committee because this is an area of particular concern?
Dr. Colm Henry:
Yes. It is a huge concern to us for a number of reasons. First, primarily to afford protection to healthcare workers who are uniquely exposed to the flu; to protect members of their family who may be vulnerable; and of course to protect the patients under their care. It is under these three banners that we appeal very strongly - it is in bold font and underlined - to healthcare workers nationally and locally. Members will have heard the media campaigns and there is work locally.
If we break down the 34.9% uptake of the flu vaccine, which is indicated for healthcare workers, we see variation between professions. We also see variations between regions and between locations. There are some hospitals, for example - I mentioned Mallow hospital earlier - where we have a very high uptake. Éamonn O'Moore and his colleagues have looked into the reasons we see a very high uptake in some areas. The themes that come through are, first, access. It is clear that it helps if people work in a setting that lends itself to collecting people in one area, such as a hospital. The second is peer leadership - strong leadership from either the hospital CEO, clinical director or the director of nursing who visibly get their vaccines, bring the vaccines or sponsor it themselves. The third reason is communication of the message of why this is important for them and their colleagues.
It is more difficult in the community setting because then, rather than people going to a vaccination day where they work in a hospital, they must get into their car to drive to a setting where there is a designated vaccine.
Martin Conway (Fine Gael)
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That would be the case for the general public as well, so I do not really accept that as a reason. Less than 40% of the people who should be advocating and promoting it are getting vaccinated. That is a problem and it has not been addressed and dealt with appropriately by the HSE. If I had my way it would be part of their contract but, obviously, that is at the absolute end of the scale. I do not believe the HSE has dealt with this appropriately or rather in a focused way. If the people who should be the advocates are only at 34%, it is very hard then for the general population to buy into it.
Ms Kate Killeen White:
I will reiterate a lot of what Dr. Henry has said. At a regional level and across all of the regions we are adopting a values-based approach to supporting healthcare workers to take up the vaccine. That has proven to be more sustainable in the long term. Access, local leadership and building workforce strategy that builds trust has been pivotal in the context of trying to support healthcare workers to take up the vaccine. The key priority areas of focus have been removing any and all access barriers to the uptake of the vaccine. We support healthcare workers to receive vaccines in acute and community settings and via peer support workers so that it is a much more flexible approach. We do lots of things like strengthening visible clinical and managerial leadership in terms of the promotion around the uptake of the vaccine, ensuring that there is clear, consistent and accessible messaging around uptake of the vaccination and, where we can, offering personalised vaccine invitations and reminders for healthcare workers.
Martin Conway (Fine Gael)
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Which is what is being done in the general workforce. In the Houses here, there is an option for people to get their vaccination. It is very conveniently available in the medical room. I still cannot get my head around the situation with healthcare workers.
I want to finish on a positive. Dr. Henry has always been very accessible. I have been advocating on vaccines for a long time. Because of that, I have been reprimanded on the train and on the street - I presume he has as well, because I know he travels by train - by people who choose to misinform. It is very difficult. It is a challenge - especially when the health secretary of the United States is a sceptic and a cynic - when we are trying to persuade people that medicine has improved for a good reason.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Senator Conway.
Martin Conway (Fine Gael)
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I urge the witnesses to keep up the good work. I thank them.
Pádraig Rice (Cork South-Central, Social Democrats)
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That concludes the list of questions from members. I am quite conscious that it is really important to get accurate information here and to get full answers. Sometimes that is not possible in the short eight minutes available going over and back between members and witnesses. We have a couple of minutes if Dr. Henry or Professor Horgan wan to add anything or clarify.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have a copy of that and we will circulate it to members as well.
Professor Mary Horgan:
As a big advocate of vaccines, I have really seen the positive impact they have had on patients, and the lives of people and families in communities and my message is that if people are offered a vaccine, or one for their children or parents, they should get it. They really protect people from serious illness. As Chief Medical Officer, along with Professor Crushell, we will continue to ensure that vaccination and immunisation policy is front and centre of the office of the CMO.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is a really important message about vaccines being effective and safe and encouraging people to take them up.
Peter Roche (Galway East, Fine Gael)
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I want to make a point, purely out of curiosity. Two things occurred to me. In the last couple of years, many thousands have chosen Ireland as a place to come to live and stay because of economic reasons, as well as war and otherwise. I am conscious that a lot of those came with very young children who obviously would have to be vaccinated. That is just one part of the question.
The second part is that those very same people, and some of our own, cannot get access to a GP because surgeries do not have capacity to take on additional patients. In that scheme of things, how do people who require vaccines but who do not have a GP manage? I also refer to those who may not yet have been identified who are living here.
Dr. Colm Henry:
We mentioned today the mobile vaccination teams and school vaccination teams. The backbone of our childhood vaccination programme in Ireland is our GP workforce and the unique relationship they have with patients, which is one of trust. We look at the extraordinary levels we have talked about in terms of shortfalls and ambition and where we need to improve but what we have not talked about are the extraordinary levels of uptake that are testament to that trust that exists between patients and GPs. We are heavily reliant on a stable, even, standardised GP workforce. We are underprovided for in terms of our GP workforce in Ireland today. We have a ratio of approximately between six and seven per 10,000. It is not geographically equally distributed. There is some correlation when we look at the areas of relatively low GP provision and some of the more challenging areas we have in terms of childhood vaccination uptake, such as in Border areas. The work we are doing in terms of enhancing and bringing greater resilience to the GP workforce is increasing the trainees to 350 per year. It involves looking at international GP graduates from other countries who we bring into areas of low GP provision, such as counties Meath and Donegal, and making it a more attractive career option. Without GPs, we will not be able to deliver vaccination programmes to the required level.
Peter Roche (Galway East, Fine Gael)
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I thank Dr. Henry very much.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the representatives from the HSE and the Department of Health for their consideration of these matters. We will adjourn until we meet in private session at 3.30 p.m. on Tuesday, 28 April. The select committee will meet tomorrow to consider Committee Stage of the Health (Amendment) (Home Support Providers) Bill 2025.