Gerry Horkan (Fianna Fail)
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It is a little bit disappointing for myself and Senators Kyne and Conway, who all have health related topics, that despite the fact there are four Ministers in the Department of Health, none of is here today. However, I do not doubt the Minister of State and his extensive knowledge of the health portfolio. We were joint rather than fellow councillors on the south Dublin-mid Leinster regional forum of the HSE a long time ago. We will do our best. I know he will have a response for me and will relay back my points.

Gerry Horkan (Fianna Fail)
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We were on the same local authority but that is about as far as it goes.

Gerry Horkan (Fianna Fail)
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I am sure the Acting Chair will give me extra time if I need it.

Aidan Davitt (Fianna Fail)
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"Cutting" being the operative word.

Gerry Horkan (Fianna Fail)
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This is shingles awareness week. Shingles is a painful condition that is estimated to affect one in three people during their lifetime. It generally presents as a painful rash on one side of the body, a kind of a belt across the torso, but it can also be on the face and sometimes affect the eyes. Up to 30% of people who experience shingles develop nerve pain known as post-herpetic neuralgia that can last for months or, in rare cases, longer, which needs treatment with pharmaceutical drugs and so on. Around 10% to 25% of those have symptoms that affect the area around the eye, potentially leading to scarring and vision problems. Shingles is also associated with an increased risk of stroke and neurological conditions. It is important to diagnose and treat shingles early to reduce the risk of complications.

Anyone who has ever had chickenpox, which is many of us, can get shingles. It is basically caused by the successful reactivation of the VZV, or varicella zoster virus, that causes chickenpox. Some 90% of people are infected with that during the first three decades of life as chickenpox and already have the virus lying dormant, if you like. It generally reactivates itself primarily due to age-related decline in immunity or because an individual has a weakened immune system. Generally speaking, those who have it are over the age of 50. However, there are other factors associated with an increased risk, including Covid-19 infections, comorbidities such as COPD, asthma, diabetes, chronic renal disease, immunosuppression associated with an underlying disease such as cancer or arthritis or use of an immunosuppressive treatment. It can be prevented by vaccination.

The reason I bring this up is that it is shingles awareness week but, equally, because I got shingles in the Bank Holiday weekend of August 2020, right in the middle of lockdown and Covid. I think I may have had Covid very early on when we did not realise Covid was there and that may have helped. It is quite vicious in that it affects people mostly who are already immunosuppressed and not very well. I ask the Minister of State and obviously the Minister for Health, particularly, if we can bring in shingles vaccines, which are very successful. That will vastly reduce the number of people who might get shingles. I had to log on for the drug payment scheme and first pay €140 and then get the drugs. The drugs the State is paying for to treat shingles are expensive. I was also on, which is quite topical, pregabalin, or Lyrica, which is being talked about now as very dangerous drug, to deal with the post-herpetic neuralgia. I took it for a number of months and tried to get off it as fast as I could. I found it a horrible drug to use.

There is a real value in providing the vaccine. I am not saying to make it compulsory, but for people who are vulnerable and for people who would like to take it, it would be useful to give them that immunity and keep them safe, healthy and in the workforce. It would keep them from being sick, being off work, getting sick benefit and so on. Equally, they would not need to take the drugs for shingles and post-herpetic neuralgia. It is an important topic. I am glad to raise it and I hope I will get a positive response from the Minister of State on behalf of the Minister.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Senator Horkan for raising this important issue. I too know people close to me who have suffered from shingles. It can have a debilitating impact. As is outlined in the response I have, which I will deliver on behalf of the Minister for Health who is unable to make it today, it can have serious implications, particularly for older people.

Varicella is a common, highly infectious disease caused by the varicella zoster virus. This virus is associated with two distinct clinical syndromes: 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. 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, which is a persistent pain in the area around 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 years and older. The risk of developing the disease in those aged 85 years and over is 50%.Older adults are most likely to have post-herpetic neuralgia and to have longer lasting and more severe pain.

There are two shingles vaccines currently available in Ireland. One is a recombinant vaccine called Shingrix, which is given as a two-dose vaccine. The other is a live vaccine called Zostavax, which is given as single dose. The national immunisation advisory committee, NIAC, guidelines state that the Shingrix vaccine may be considered for those aged 50 years and older due to the greater burden and severity of disease and post-herpetic neuralgia in this age group and for those aged 18 years and older who are at increased risk of contracting shingles. The NIAC guidelines also state that the Zostavax vaccine may be considered for those aged 50 years and older as a result of the greater burden and severity of disease in this age group. The shingles vaccine is not currently provided as part of the national immunisation programme. It is open to those aged 50 years and older who wish to receive the vaccine to consult with their GP or pharmacist in order to arrange to receive the vaccine privately for a fee.

Following a request from the Minister for Health, HIQA is carrying out a health technology assessment on the herpes zoster vaccine, which protects against shingles. This assessment will examine the evidence on the clinical effectiveness and safety of shingles vaccines. The cost-effectiveness and budgetary impact will also be reviewed, along with the ethical, social and organisational implications of including the vaccine in the adult immunisation schedule. It is anticipated that this assessment will be completed by July 2024. The outcome will inform future decision-making in the context of whether any amendments are required to the national immunisation programme. I again thank Senator Horkan for raising this timely issue, particularly this week.

Gerry Horkan (Fianna Fail)
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Unfortunately, the Minister of State has told me much that I already knew. I asked him to indicate the likely funding that would be required to do this on an annual basis, and to make a statement in that regard. The vaccine is available for free from the NHS in the UK, so it is free in Northern Ireland. It is free on part of this island, but not down here. The assessment is due to be completed by July. I ask that it not be delayed in any way. The sooner it happens, the better. Cost-effectiveness obviously needs to be taken into account, but a person cannot know the unbelievable level of pain that goes with shingles until he or she contracts it. Three and a half years later, I still get twinges and pains in places where I had shingles. I got off the medication. Sometimes, people cannot come off the medication. I found my experience with the pain medication almost worse than the pain. I got off it as fast as I could. I was still on it probably from August until November. We should do anything we can to stop people getting it. We are talking about how morbidity is a potential outcome of shingles too. Anything we can do to reduce the number of people getting shingles and experiencing the pain involved is important. I ask the Minister of State to really impress on the Minister for Health how useful it would be to make the vaccine available, in particular to vulnerable over-50s and so on. I got the vaccine before I turned 50, so it is not only the over-50s who can get it.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Senator. As already stated, I am responding on behalf of the Minister for Health. Unfortunately, the funding details Senator Horkan requested have not been provided. However, I am led to believe that funding is not the key consideration here. We obviously have a national immunisation programme that is well funded. If the strong opinion NIAC comes to at the end of its review comes to that point, I do not expect that funding to be a key element of that decision-making process.

There are other elements, as outlined in the response, which show the importance of the vaccine and of making sure that it is fit for purpose. It is important that this issue has been raised today because vaccination is recognised as one of the most cost-effective and successful public interventions that exists. Vaccines save many lives every year, so there is always a strong financial case to why a vaccine would work if it is proven not to have negative impacts. This vaccine should be subject to the same rigorous process we use when analysing all other vaccines.

The Senator will be aware that the immunisation programme is operated on the basis of advice from NIAC. The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in the context of immunisation. As already stated, the Minister has requested that HIQA carry out a health technology assessment to review the case. We look forward to seeing the result of that assessment as soon as possible.