Colm Burke (Cork North-Central, Fine Gael)
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This comes issue under the Department of Health. My question on whether consideration will be given to putting in place a shingles vaccination programme to be made available to people over 65 or to immunocompromised patients in view of the fact that shingles vaccination is recommended by NIAC for those over 65 and for those who are immunocompromised and aged between 18 and 65. Shingles vaccination is currently not available on the national immunisation programme. While the drug for shingles is approved, it is not available under the medical card scheme or under the present health programme. We must remember that when a person gets shingles, especially those over 65, up to 30% of people end up with long-term nerve pain. Anything up to 25% of people are adversely affected in the area around the eye. Shingles is also associated with increased risk of stroke and neurological conditions.

As the Minister of State will be aware, the age profile of the population of this country is changing dramatically. Since 2011, the number of people over 65 has increased from 600,000 to 860,000 and within the next four years, it will be over 1 million. It is also important to note that at any one time, 50% of all hospital beds in our hospitals are occupied by people over 65. I am disappointed that we have not put in place or even started this programme. Even if we decided to go for people over 75, we could easily put in place a programme that would cost us less than €10 million in real terms. In real terms, however, it would probably be a cost saving because if you have people who end up in hospital as a result of getting shingles, due to the knock-on adverse effect it can have on their health, then there is a real saving there. As the Minister of State will be aware, the average cost to the State is €8,000 per week for each week a person is in hospital.

I ask that the Government give serious consideration to putting in place a vaccination programme. While my request is for people over 65, if we cannot do it for over 65s, we should at least put it in place for people over 75. A number of other European countries already have it in place. The UK is putting in place a programme for over 75s. It is recognised that there would be a real saving to the State in the long term. This is particularly true for those over 65 but also for those who are immunocompromised. If they get shingles, if they already have a medical complication, this will add further to their problems, add to the occupancy of hospital beds, and add in real terms to the overall medical cost. That is the reason I am bringing forward this Topical Issue this evening.

Noel Grealish (Galway West, Independent)
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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.

Colm Burke (Cork North-Central, Fine Gael)
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I fully accept the answer the Minister of State has given in the sense that cost-effectiveness is also an important issue in relation to any new medicine that is made available under the drugs payment scheme. What I am saying, however, is that I understand that after the decision of July 2024, there were further negotiations but, again, no progress was made. While there was a considerable cost reduction made by the pharmaceutical company, my understanding is that a decision was taken following the HTA not to approve this.

I am concerned about the fact that other countries in Europe now have this in place. We must look carefully at it as well, even if we are to start off with the age group comprising those over 75, and even setting aside some money to deal with that age group. As already stated, the age profile is changing and the demand for hospital services will increase dramatically over the next few years. Therefore, the more people we can keep out of hospital and away from the medical services, the better. One of the ways of doing that is vaccination programmes, whether it is the flu vaccine, the shingles vaccination or other vaccines. Vaccines help to keep people from having to require hospital care. Therefore, this is a programme we should carefully look at, particularly now in relation to over-75s, and review to see if we can get that slot in there to at least start some element of it, in the same way other European countries have done.

Noel Grealish (Galway West, Independent)
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I thank the Deputy once again for raising this important matter. Vaccination is recognised as one of the most impactful and cost-effective public health interventions that can be employed, promoting good health and saving many lives year on year. As has already been highlighted today, shingles can impact anyone who has been infected with chicken pox during their life, leaving a significant proportion of the general population vulnerable. Up to one in three people who have had chicken pox will go on to have shingles. It is for this reason that the Department requested that HIQA carry out a HTA to review the evidence for adding shingles vaccination to the adult immunisation schedule in Ireland. It is hoped that the introduction of the shingles vaccination to the immunisation schedule can be reconsidered if and when the cost-effectiveness of the vaccine is confirmed as being more favourable.

The Deputy will be aware that the immunisation programme in Ireland is based on the advice of NIAC. 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 which are included in the national immunisation programme are administered free of charge to those who are in eligible at-risk groups.

More generally, I urge all those who are eligible for any vaccine under the national immunisation programme at all stages of life to avail of the opportunity to be vaccinated. The discussion here today is timely as the HSE launched flu and Covid-19 vaccination programmes earlier this month. All who are eligible for the free vaccine should make their appointment to receive it. In addition, I encourage all parents to bring their young infants, in line with the primary childhood immunisation schedule, to the GP for their important childhood immunisations. Babies born during the RSV season are eligible for RSV immunisation and will be offered immunisation at the relevant maternity hospital. These measures will help us reach the shared objective of protecting public health by preventing the spread of disease in our community.