Colm Burke (Cork North-Central, Fine Gael)
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The issue I am raising is the shingles vaccine. As the Minister of State knows, shingles causes quite a lot of difficulty for people who get it. Herpes zoster is the other name for it. It is very painful. It can affect people really badly, especially when they get it close to the eye. I have come across people who have suffered long-term damage to their eyes from getting it in that area and I am sure the Minister of State has too. Over 30% of people who get shingles develop nerve pain and can suffer that for quite a long period. Anyone who has suffered chicken pox is more likely to get shingles at some stage in their lives. There is a high risk for people over 50 years of age. There is a high risk for people who have had Covid infection and also where people have chronic respiratory problems.

This is one area where a lot of work and moneys could be saved if there was a comprehensive vaccination programme, especially for people over 65. There is a recommendation there would be five vaccines for older people available. We currently have three. It was recommended that a vaccine be introduced for this medical condition, particularly for people over 65. I believe 13 countries around Europe have a vaccine in place. It varies from country to country but it shows there is a real benefit not only from a health point of view but from a financial one. A study carried out by the Office of Health Economics has shown that for every euro spent on providing a vaccine there is €23 saved.

This is important. As I said, some people can suffer long term damage and health problems. People will end up in hospital with complications and once a person ends up hospital there is a huge cost in real terms to the health service, whereas a vaccine could save a lot of the costs currently being incurred.

It is about being proactive. The age group over 65 is increasing every year. The good point is people are living longer and the number aged over 65 has increased from over 600,000 ten or 12 years ago to more than 800,000 now. By 2030, we will have more than 1 million people over 65 years of age. People over 65 or even people over 50 are more prone to getting shingles. Now is the time for planning as regards the ageing population and putting in place a vaccine programme to deal with this issue.

Jerry Buttimer (Cork South-Central, Fine Gael)
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I thank Deputy Burke for raising this matter in the House this evening. I am taking the matter on behalf of the Minister for Health, who shares Deputy Burke's concerns in relation to the current cost of shingles vaccination in Ireland. Varicella is a common, highly infectious disease caused by the varicella zoster virus. The virus is associated with two distinct clinical syndromes, varicella, 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. Approximately 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.

Morbidity associated with herpes zoster increases with age. The most common complication is post-herpetic neuralgia, 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. Two thirds of cases occur in those aged 50 and older. The risk of developing the disease in those aged 85 and over is 50%. A non-live, recombinant shingles vaccine called Shingrix is available in Ireland and is given as a two-dose vaccine. Shingrix is more effective than the previously available live vaccine Zostavax and can be safely administered to immunocompromised patients. Shingrix has also replaced Zostavax as the preferred vaccine against shingles internationally. The national immunisation advisory committee guidelines state that the Shingrix vaccine may be considered in those aged 65 and older due to the greater burden and severity of disease and post-herpetic neuralgia in this age group and in those aged 18 years and older at increased risk of shingles. The shingles vaccine is not currently provided as part of the national immunisation programme.

The Minister for Health advises that following a request from her Department, HIQA carried out a health technology assessment, HTA, on the herpes zoster vaccine which protects against shingles. This assessment examined the evidence on the clinical effectiveness and safety of shingles vaccines. The cost-effectiveness and budget impact were also reviewed, along with the ethical, social and organisational implications of including the vaccine in the adult immunisation schedule. HIQA published this HTA on 19 July last year. The HTA found that adding the shingles vaccine to the routine immunisation schedule at the vaccine price at the time for all adults aged 65 and over would not be cost-effective and would be associated with a substantial budget impact. While the HTA found that the introduction of the shingles vaccine was not cost-effective based on the cost of the vaccine, it found that it could be cost-effective for vaccination of those aged 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 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 more favourable.

On the question of the shingles vaccine being included in the drugs payment scheme and the medical card scheme, it is the Health Service Executive which has statutory responsibility for decisions on pricing and reimbursement of medicines in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The Minister for Health has no role in decisions relating to approving which medical products are covered under these schemes.

Colm Burke (Cork North-Central, Fine Gael)
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I accept what the Minister of State said; obviously, there is an issue regarding the negotiated price for the medication. Surely, we must look at the long-term challenges with an increasing older population. As the Minister of State outlined, those in the older age group are more prone to getting shingles. The number of people having to go into hospital will increase, as will the number who require treatment. The cost to the HSE and health service will increase. Even if we started by only providing it to people over 70, that would at least be a start on the programme. We are going nowhere at present.

People require support. There are long-term effects that people do not recover from. I am aware of several people who suffered long-term eye damage from shingles and cannot regain their previous vision. Their eyesight is not the same as it was previously as a result of the damage caused by shingles. We should give careful consideration to this matter and take it step by step. If we cannot afford to provide the vaccine to everyone over 65, we must at least start with some age group so we can then work back to include people aged 65 and, long term, down to 50.

I ask the Department to give serious consideration to this matter to see how it can be progressed. There is a cost to the State. It is a substantial cost every year with hospital admissions and people having to attend their GPs, most of whom have medical cards and will have to attend more often if they contract the infection. I ask that careful consideration be given to the proposal.

Jerry Buttimer (Cork South-Central, Fine Gael)
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Deputy Burke made some very valid points. He is right about the long-term effects of shingles and the ageing population. I thank him again for raising this important matter. He is right that we should be forward thinking. Vaccination is regarded as one of the most effective, cost-effective and successful public health interventions that exist, saving many lives every year. As has been highlighted, shingles can impact anyone who has been infected with chickenpox during their life, leaving a significant proportion of the general population vulnerable. Up to one in three people who have had chickenpox will go on to have shingles. That is why the Department requested that HIQA carry out a HTA to review the evidence for adding the shingles vaccination to the adult immunisation schedule in Ireland. It is hoped that the introduction of the shingles vaccine to the immunisation schedule in Ireland can be reconsidered if and when the cost-effectiveness of the vaccine is confirmed as more favourable. Members will be aware that the immunisation programme in Ireland is based on the advice of the national immunisation advisory committee. The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation.

To protect the public from serious outcomes of diseases, vaccines included in the national immunisation programme are administered free of charge to those in eligible at-risk groups. More generally, the Minister asked that I take this opportunity to urge all those eligible for any vaccine under the national immunisation programme, at all stages of life, to avail of the opportunity to be vaccinated. In particular, the Minister encourages all parents to bring their young infants, in line with the vaccination schedule, to the GP for their important childhood immunisations. This will help us to reach the shared objective of protecting public health by preventing the spread of disease in our community.

I will take the Deputy's remarks back to the Department and the Minister. He made valid points that should be listened to.