Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)

I thank the Senator for highlighting this very important issue. I am taking this matter on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill.

Varicella is a common, highly infectious disease caused by the varicella zoster virus. This virus is associated with chickenpox and shingles. Primary infection results in chickenpox, after which the virus becomes latent in the body’s nervous system. The virus may reactivate, sometimes decades later, resulting in shingles. Approximately one third of people who have chickenpox will develop a shingles infection at some point during their lifetime. Two thirds of cases occur in those aged 50 years and older.

Morbidity increases with age and the most common complication is persistent pain in the area of the rash. As the Senator has said, this condition can be very painful. I know people who have had shingles and they had a lot of pain. This has the potential to cause significant reductions in quality of life, activity, mood and sleep.

Currently, a vaccine called Shingrix is available in Ireland and is administered as a two-dose vaccine. Shingrix is more effective than the previously available vaccine, Zostavax, and can be safely administered to immunocompromised patients. Internationally, Shingrix has replaced Zostavax as the preferred vaccine against shingles. I am learning a lot of new words today. The national immunisation advisory committee, NIAC, guidelines state that the Shingrix vaccine may be considered in those aged 65 years and older, due to the greater burden and severity of the disease in this age group and in those aged 18 years and older who are at increased risk of shingles.

In advance of any change in policy, and this is what we need to address, the Minister can request that the Health Information and Quality Authority, HIQA, carry out an evaluation of the impacts of a potential policy change. These evaluations take the form of health technology assessments or 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 can advise that, following a request from her Department, HIQA carried out a HTA on the vaccine which protects against shingles. This 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 and organisational consequences of including the vaccine in the adult immunisation schedule. 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 budget impact. However, it found that it could be cost-effective for vaccination of those at 75 years and 80 years if the cost of the vaccination was reduced by 80%. This is what we need to address.

Given that the healthcare budget is finite and decisions regarding spending 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. This is the answer given to me by the Department.