Noel Grealish (Galway West, Independent)

Gabhaim buíochas leis an Teachta Burke for raising this matter, which I am taking on behalf of the Minister for Health. Varicella is a common and highly infectious disease caused by the varicella zoster virus. This virus is associated with two distinct clinical syndromes, namely, varicella, commonly known as chickenpox, and herpes zoster, commonly known as shingles. Primary infection with the varicella zoster virus results in varicella, after which the virus becomes latent in the body’s nervous system. The virus may reactivate after a period, sometimes several decades later, resulting in herpes zoster or shingles. Morbidity associated with herpes zoster increases with age. The most common complication is neuralgia, which is a persistent pain in the area of the rash. This has the potential to cause significant reductions in quality of life, activity, mood and sleep. It is estimated that one third of people who have had a varicella infection will develop a shingles infection at some point during their lifetime due to reactivation of the virus. Two thirds of cases occur in those aged 50 years and older.

Currently, a non-live, recombinant shingles vaccine called Shingrix is available in Ireland and is administered as a two-dose vaccine. Shingrix is more effective than the previously available live vaccine, Zostavax, and can be safely administered to immunocompromised patients. Internationally, Shingrix has also replaced Zostavax as the preferred vaccine against shingles. The National Immunisation Advisory Committee guidelines state that the Shingrix vaccine may be considered in those aged 65 years and older, due to the greater burden and severity of disease and neuralgia in this age group, and in those aged 18 years and older at an increased risk of shingles.

It should be noted that in advance of any change in policy, the Minister can request that HIQA carry out an evaluation of the impacts of a potential policy change. HIQA has a statutory remit under the Health Act 2007 to evaluate the clinical and cost-effectiveness of health technologies, providing advice to the Minister for Health on budget impact, organisational and social aspects, and ethical and legal issues. These evaluations take the form of health technology assessments, HTAs. A HTA is a multidisciplinary research process that collects and summarises information about a health technology in a systematic, unbiased and transparent manner. The use of the HTA facility assists decision-makers in assessing the merits and potential shortcomings of a new health technology, policy or service, based on accurate and reliable evidence. The Minister for Health advises that following a request from her Department, HIQA carried out a HTA on the herpes zoster vaccine which protects against shingles. The HTA examined the evidence on the safety and clinical effectiveness of shingles vaccines. The cost effectiveness and budget impact were also reviewed, in addition to the ethical, social and organisational implications of including the vaccine in the adult immunisation scheme.

HIQA's HTA was published on 19 July 2024. The HTA found that including the shingles vaccine in the routine immunisation schedule, at the vaccine price at the time, for all adults aged 65 years and over would not be cost-effective and would have a substantial budgetary impact. While the HTA found that the introduction of the shingles vaccine was not cost-effective based on the cost of the vaccine, it found that it could be cost-effective for vaccination of those at 75 years and 80 years if the cost of the vaccine was reduced by 80%.

Given that the healthcare budget is finite and decisions regarding increased spending relating to a change in one area could impact the provision of other health technologies and treatments within the healthcare system, the cost-effectiveness must be considered in any decision-making process. The Department has considered the findings of this HTA and determined that the introduction of the vaccine could be reconsidered when the cost-effectiveness of the vaccine is confirmed as being more favourable.

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