Gabhaim buíochas leis an Aire Stáit as ucht a bheith anseo le déileáil leis an gceist an-tábhachtach seo faoi shingles agus an shingles vaccine. The population of the Republic aged 65 or over is approximately 850,000. If they are unvaccinated, one in three of those are likely to get shingles. Around 90% of adults carry the varicella zoster shingles virus and the incidence of infection increases incrementally after the age of 50. Estimates indicate that approximately 40,000 of the cohort have paid the approximate €500 it costs for private vaccination. This leaves approximately 800,000 over-65s unvaccinated. Nearly all of these are at risk.

If these were to be given the vaccination over the remaining four planned years of this Administration, it would cost approximately €50 million a year for each of those four years. International and Irish data suggest that approximately 7,000 older shingles patients are likely to be hospitalised due to ophthalmic shingles, risk of vision loss, neurological complications such as meningitis and encephalitis, disseminated shingles in immunocompromised patients and severe or uncontrolled pain, usually due to postherpetic neuralgia, which regularly impacts long-term mobility, mental well-being and social and independent living.

The Shingrix vaccine is free, subsidised or reimbursed in so many developed countries like ours. Those countries include the United Kingdom and, significantly, Northern Ireland, as well as Australia, Luxembourg, New Zealand, many provinces of Canada, the United States of America, France, Germany and Spain. Alas, Ireland is a complete outlier for all of the wrong reasons. I have had personal close encounters in my own family with shingles. A dear old uncle of mine contracted it early in his 70s. It went hard on him as he became more and more immunocompromised.

In the end, shingles was the death of him. It was one thing after another until he died about three years later. It did not need to be that way. In my Commencement matter, I simply ask the Government and the HSE to review forthwith funding the vaccine for people aged 65 and over. Internationally, this is the status quo and widespread, so why does Ireland persist in being so obstinate as an outlier?

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.

I will say a couple of things about the response provided by the Minister. First, HIQA, which published its findings in 2024, examined two contradictory cohorts, so the evidence it has given is not pertinent to the argument. I do not doubt for a moment the sincerity of the Minister but I do doubt the Government's ability to do sums. Over four years, 200,000 vaccines per year will cost €50 million a year, or €200 million. There will be 7,000 probable hospitalisations from shingles over four years. Including maintenance, specialists, pathology and pharmacy, stepdown and aftercare, these will cost an approximate €68 million a year for four years, and counting. In the lifetime of this Government, the Minister for Health and the Government could save us upwards of €70 million over the next four years if a vaccine were introduced for people aged 65 and over, as opposed to blithely throwing €700 million to clubs and pubs, Domino's and McDonald's. It is an awful cliché but a no-brainer. Into the bargain, the Government would end the scandal of brazenly expecting the poorest pensioners in this State to fund a €500 bill to keep themselves free from the scourge of shingles.

I wish to say a special thanks to Active Retirement Ireland for its input in working with me on this Commencement matter.

This is something we need to look at. As the Senator said, we are talking about elderly people who are our most vulnerable people.

I assure the Senator that I will speak to the Minister for Health about this. The Department has indicated that the introduction of the single vaccine to the immunisation schedule in Ireland can be reconsidered if and when the cost-effectiveness of the vaccine is confirmed as being more favourable. I give the Senator my word that I will go back to the Minister because this matter is important. Over the years, I have known people who got shingles. They were very sick and suffered a lot of pain so I understand the importance of a vaccine.

Senators 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 a disease in Ireland and international best practice. 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, I 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. This discussion is timely as the flu and Covid-19 vaccination programmes are under way for the winter season. All those who are eligible for a free vaccine should make an appointment to receive it. I also encourage all parents to bring their young infants to their GP for their important childhood immunisations. These measures will help us reach the shared objective of protecting public health by preventing the spread of disease in our community.

Again, Senator Conway has my full commitment that I will highlight the urgency of considering this matter with the Minister.

Many pensioners do not have €500 in their bank account.

Yes, I agree. As the Senator said, Active Retirement Ireland does great work. Well done to it.

I thank the Minister of State for her time.