I welcome Senator Joe Conway's wife, Sandra; Ross Mac Mathúna, family and guests and the group from Active Retirement Ireland. They are all very welcome and I hope they enjoy their visit to Leinster House today. They are in very capable hands with Senator Conway. I also want to welcome Sviatoslav who is on transition year work experience with the Independent Group.

I move:

That Seanad Éireann: acknowledges that:

- shingles affects one in three people in their lifetime;

- adults aged 50+, especially those with weakened immune systems, are much more likely to develop severe disease;

- post-herpetic neuralgia (PHN), a complication causing severe nerve pain lasting months or years, can significantly undermine mobility, sleep, mental well-being, social participation and independent living;

- the Health Information and Quality Authority (HIQA) 2024 public consultation on the addition of the shingles vaccination to the adult vaccination programme included multiple testimonies from older adults living with life-limiting pain due to PHN;

- the Shingrix vaccine substantially reduces the risk of shingles and PHN; however, in Ireland it costs €480-€500, making it inaccessible for many older people, particularly those living on the State pension;

- older people with weakened immune systems, such as those receiving cancer treatment, are particularly predisposed to shingles and, as a result, can live out the remainder of their lives in extreme pain from PHN, as raised by a number of respondents to HIQA’s public consultation;

notes that:

- in February 2024, the National Immunisation Advisory Committee (NIAC) recommended the shingles vaccination for all adults aged 65 and over;

- in July 2024, HIQA concluded that extending the programme to adults aged 50+ would not be an efficient use of HSE resources;

- as no publicly funded programme has been implemented, older people must pay privately;

- many countries, including the UK, Germany, Italy, Belgium, the Netherlands and Australia, already provide shingles vaccinations free of charge to older adults; Ireland is becoming an outlier in the prevention of this avoidable illness;

- while the NIAC has recommended vaccination for those aged 65+, HIQA’s Health Technology Assessment modelled a much broader cohort of adults aged 50+;

- a targeted age-focused vaccination programme for adults aged 65 and over, the specific group NIAC identified, has not been formally assessed;

- this creates a clear evidence gap as the Department of Health cannot state that the NIAC recommended 65+ programme is not cost effective when it has not been individually modelled;

- the public consultation response also highlighted that the €480-€500 vaccine cost is prohibitive for many older people, especially those on fixed incomes;

- the public consultation also highlighted PHN’s impact on mobility, social engagement, mental well-being, independence, and quality of life as significant and not fully captured in standard cost-effectiveness modelling;

calls on the Government to:

- urgently reconsider the determination that the shingles vaccination is not an efficient use of HSE resources;

- include the shingles vaccination for adults aged 65 and over in the National Immunisation Programme, in line with NIAC recommendations and international best practice; and

- requests that the Department of Health revisit the Health Technology Assessment with a specific 65+ model.

I second the motion.

We are sharing time. Senator Boyhan is not greedy. Ar an gcéad dul síos, gabhaim buíochas le Active Retirement Ireland, go háirithe Alison Bough, agus mé ag eagrú an rúin seo don Seanad. Gabhaim buíochas leis na Comhaltaí a chuir a gcomhshínithe síos chun tacú leis an rún atá faoinár mbráid inniu.

The full wording of the motion is substantial so I am presuming that all will be familiar with it or with the substance of it at least. For that reason I am going to move ahead with the actual debate points.

All the Senators present will be very knowledgeable about shingles, medically known as herpes zoster. Shingles is caused by the same virus that causes chickenpox. Anyone who has had chickenpox can develop shingles and that is estimated at roughly 60,000 people annually. So, it does present frequently and very frequently in people as they get older.

In itself, the infection symptoms can range from negligible to severe. In the latter cases it is described as a stabbing or burning sensation of continuous pain that can last for weeks or, indeed, months. However, it is in the aftermath that the real damage often presents in a well recognised condition, namely, post-herpetic neuralgia, PHN, which can last for a year or more and impacts the physical, psychological, functional and social dimensions of the affected person. Worrying also are recent studies which show raised protein levels in PHN sufferers' cerebral spinal fluids, which is frequently a pointer to increased risk of forms of dementia.

Before I go on I will briefly digress. I was working on this motion at home last week and the question struck me, and I struggled to find out, why is it called shingles? I was searching around and poking around. After a lot of this poking around I latterly found the answer in my late mother-in-law's copy of Harmsworth's Home Doctor and Encyclopedia of Good Health, published in 1924, which says that shingles comes from the Latin word cingulum, meaning a girdle or belt. I imagine this is testament to the frequency of the infection attacking right around the trunk, belt-like.

However, not at all by digression, I want to record my gratitude to Active Retirement Ireland and give special thanks to their team, headed by Alison Bough, who is here with her team in the Gallery. Active Retirement Ireland represents 850,000 of our people aged 65 years or over who very robustly signalled their support for our motion.

Because of two close encounters in my own families, I got the Shingrix vaccine last August and it cost me, as the bookies would say, a full monkey, that is, €500. If I resided in Tandragee, County Armagh, instead of Tramore, County Waterford, it would have cost me nothing. It is totally free in the North of Ireland, it is free all over the NHS, in much of the EU, the USA, Australia and Canada. Sadly in Ireland, the Republic that is, we are an uncomfortable outlier. As for our oldest citizens, those 850,000 of them, most of whom are reliable voters with 85 Dáil quotas between them, the message to them is that yes, of course, a good vaccine is available but it will cost them €500 out of their weekly pension of €278.

With its increased prevalence in our older aged cohort, shingles results in a significant rise in doctor consultations. As well as that, hospitalisations can and do occur often with herpes zoster ophthalmicus, which can leave the patient with deteriorated vision or, in extremis, blindness.

This leads us to the key question. Taking all that is known about how pernicious this complaint is, why not consider vaccinating freely against it? Twenty years ago, a vaccine called Zostavax was introduced but it had very limited success in protecting older people, that is, those most prone to serious infections. Now we have here in Ireland and in the free world, much of the western world, Shingrix, a vaccine that has about 90% efficacy, even in older people. The manufacturers of Shingrix, GlaxoSmithKline, GSK, that is much prevalent in the Irish economy, like all pharmaceutical companies are about people, yes of course, and about profit. However, they are cognisant of the small market Ireland represents in the greater scheme of things. More on that anon.

Vaccination is indisputably an ironclad investment in individuals, the health system, the economy and society in general. Every euro invested generates a significant return. In 2024, a report was commissioned by GSK Ireland from the Office of Health Economics. The report estimated that the full implementation of the current national immunisation advisory committee recommendations for older adult vaccination against influenza, pneumococcal disease, shingles and respiratory syncytial virus, RSV, would together generate a return of up to €23 in socioeconomic benefit for every €1 invested by the State. They would also prevent approximately 375,000 cases of disease, 74,000 hospitalisations and 1,400 deaths. Specifically for shingles, the return on investment was between 1.8 and fivefold for every euro invested.

In our neighbouring democracy, there is under way a great debate within and outside Parliament about assisted dying. Conversely, in this country and in many other democracies, a changing emphasis is becoming evident in health policies internationally that aims for good health for the duration of life. As never before, and concomitant with this, there are now over 200 vaccines in the development pipeline in Europe alone and 80% of those vaccines target illnesses affecting adults including cancer, neurological diseases and infections.

So, as our population increases and ages, we pressingly need to find ways to decrease the demands on our health system and signally, vaccination is a key tool. Such an initiative has four levers for Ireland, namely, bolstering the actual trust in vaccinations; ensuring equitable access, which is the main thrust today; leveraging data and technology, and positioning Ireland for future innovation in our pharma industries. Of these, I would rate equitable access as the most important. By definition, a vaccine cannot work unless it is accessed.

If it is a very expensive vaccine to access, that access will be confined to the wealthiest cohorts, which surely, for all us people who live in a republic, is the very antithesis of what constitutes our Republic in Article 41, which guarantees the equality of all citizens before the law.

I will go back and reiterate where a shingles national immunisation programme is already funded. It is funded now in 15 national programmes across Europe: Germany, Spain, Italy, the UK, the Netherlands, Belgium, Austria, Switzerland, Greece, Israel, Luxembourg, Poland, Slovenia, Cyprus and Croatia. It is 65% funded in France, and we expect other countries to come on board in 2026, Finland being one of them. A shingles programme is widely funded in the US, totally in Australia, and in some provinces of Canada for older citizens. As can be seen from all of the above, the vaccine is available in both older and newer European countries and older and newer democracies. It is not just a vaccine for wealthy countries.

A few years ago, the Minister for Health at the time asked HIQA to perform a health technology assessment on the shingles vaccination. It concluded, with advice to the Minister, that vaccination at the current price would not be a good use of resources. Since the health technology assessment was published, the vaccine developer has engaged - this is very important - in good faith with the National Immunisation Office to deliver a programme which represents true value for this State. That engagement concluded with the company submitting a best and final offer through the Department of Health which was at least as good as that offered to the larger European markets. Currently, this offer has not been accepted but we are very hopeful. Ireland, as we stand, is now an outlier when compared with our neighbours in the UK and Europe. One could reasonably ask how other European countries that have assessed the vaccine have decided that it represents a good use of resources and Ireland has not. Are they looking in truth and comprehensively at the value in a wider context, including the growing cost of caregivers' time, time off work, hospitalisations, of which there are many, the propensity down the road for dementia and so on?

I am asserting in the strongest way I can in this House that Ireland should not remain an outlier in Europe when it comes to the protection of its older and immunocompromised citizens from the increased risk of shingles infection and its serious associated health complications. There is a real inequality issue on our island between those who can afford to buy the vaccine privately and those who cannot and between those living in the Six Counties and those in the Twenty-six Counties.

My uncle contracted shingles when he was in his early 70s. This is just a case in point. It heralded a catalogue of health reversals. He was a charming old guy, an inoffensive bachelor uncle, but after shingles he suffered two strokes, multiple falls involving fractures, and serious loss of speech and communication until, finally, his body was invaded with hideous melanoma, which at length saw his demise. He is just one of the hundreds annually, and it need not be like this.

The stealthy, insidious onslaught of shingles was summed up to me recently by one person infected:

I was fit and healthy...I never saw it as ... [something that would happen] to me. The pain was the worst ever, 24/7 and nothing eased it. It was six weeks before it got bearable, but two years on, it still comes back. At this stage, I doubt if I'll ever get rid of it completely.

Molaim an rún seo. I commend this motion to our House.

I welcome the Minister of State to the House and thank her for coming to take this matter. I know she is not the lead Minister but I appreciate her coming and I know we on this side of the House, as do all our Members, appreciate her coming here and hearing what is to be said. I commend my colleague Senator Conway on the excellent way he has presented this Private Members' business. I thank his team and his supporters who have worked with him because I know he has widely collaborated on this.

The question has to be asked. It makes eminent sense that we should have a roll-out of a full scheme. It is worth stating that the national immunisation advisory committee, NIAC, recommends the vaccine for all adults 65 years or older, adults aged 50 years or older who may be immunocompromised and a cohort of specific high-risk groups aged 18 or over. That is what NIAC is doing. The HSE, of course, has the issue about the funding. What is quite disturbing is that following the health technological assessment carried out by the HSE in July 2024, the Health Information and Quality Authority, HIQA, advised that adding the vaccine to the routine schedule, as it was currently priced, would not be cost-effective. That is what it bounces down to. Basically, the Government is sitting on its hands because the HSE has said it cannot afford this. That does not make sense. We have listened to Senator Conway set out all the good reasons for the vaccine. This is being decided on cost. The key element of what Senator Conway said is about equitable access, equal access for all, to avail of our health services. We cannot come into these Houses and spout about equality and accessibility to our health services if we cannot see to putting in place real, tangible measures in relation to this vaccine.

The Minister of State will be aware of GSK. I certainly am very aware of it and have spoken about it many times in these Houses. It operates and provides certain vaccines under the national immunisation programme. A deal can be cut, given the numbers involved, and I suggest that, hopefully, out of all this, this matter will be revisited. As regards the vaccine's effectiveness, we know from expert advice that a 90% protection rate has been proven. That is the track record. The issue seems to be about cost and availability. We know that in the private sector any one of us can walk into a private facility and for between €450 and €500, or in some cases if we have special cover under our private health insurance, for those who are lucky to have it, and fewer people have it now because of the problem of cost, we can have this. We therefore have a two-tiered system.

This motion asks the Government to look at this again and to make this vaccine available for those who need it. The Minister of State and I know former colleagues in this House who suffered terribly from shingles. It is an awful condition. We can do something about it. The rally call from my colleague, supported by Independent Senators from the Seanad Independent Group, is that we need to do something. I look forward to hearing what the Minister of State has to say and the message she brings on behalf of the Minister for Heath, who has overall responsibility. I really do not want to hear today - and I mean this with full respect to the Minister of State - that this is a matter for the HSE. The HSE is a big organisation but it is a beast of the politicians. We created the HSE and we cannot keep saying to the people that we have no control over the HSE. We control its budgets, we control policy and, therefore, we must influence change to bring about the change Senator Conway has espoused here today.

Before I move to the next speaker, I apologise, Minister, for never having welcomed you to the Chamber. I welcome the Minister of State, Deputy Murnane O'Connor, and her officials from the Department.

I thank the Minister of State for being here and thank Senator Conway, who spoke brilliantly. I welcome the opportunity to speak on this motion and about the shingles vaccination programme. Fianna Fáil welcomes the debate and we note that the Government is not opposing the motion. That reflects a shared understanding across this House of the seriousness of shingles and its impact, particularly on older people and those who are immunocompromised. It is not a minor condition. It is caused by the same virus, as was said, that is responsible for chickenpox. Following a primary infection, the virus remains dormant in the nervous system and can reactivate years and even decades later as shingles. Around one third of people who have had chickenpox will develop shingles at some point in their lifetime, with two thirds of cases occurring in those aged 50 and over. The consequences can be severe. Morbidity increases significantly with age, and the most common complication of this condition causes persistent and often debilitating pain long after the rash is resolved. It can lead to a marked reduction in quality of life, limiting mobility, daily activity and overall well-being, while also increasing the need for medical care and support.

The data is stark. GP surveillance between 2013 and 2022 shows that shingles rates rise sharply with age. The highest mean rates are among those aged 75 to 79. Hospital data over the same period shows an average of 285 related discharges and more than 2,600 bed days per year, with almost three quarters of discharges and nearly 90% of bed days occurring in people over 50. There were 54 deaths in acute hospitals during that period, and the vast majority occurred among those aged 75 and over. These figures do not capture those who may have died in the community. International evidence also demonstrates that people who are immunocompromised experience higher incidence and more severe disease. While overall mortality from shingles is low, the burden on individuals is clear.

Ireland's immunisation programme, guided by the national immunisation advisory committee, NIAC, currently advises that shingles vaccination may be considered in those aged 65 and over and recommends vaccination for adults aged 50 and over with immunocompromised conditions. At present, the non-live recombinant vaccine, Shingrix, is available in Ireland. It is administered as a two-dose course and is more effective than the older vaccine, Zostavax - my pronunciation is terrible - and can safely be given to immunocompromised patients. In 2024, HIQA published a comprehensive health technology assessment, HTA, and there were issues around the pricing. Some of the costing was that to roll out vaccination for everybody aged 65 and over would cost €218 million. I will have to check if I am correct on that. It did conclude at that time that it could be cost-effective at certain ages but that the price of the vaccine was quite high. I am told it is consistent with some international experiences, and HTAs in other European countries reached similar conclusions. In 2025, the HSE entered some negotiations with the manufacturer and, again, the price quoted was still high. Despite that, progress is being made on this. I am told the Department is committed to examining the introduction of a shingles vaccine for a cohort of immunocompromised individuals in the first instance. HIQA has also been asked to consider whether new scientific evidence has emerged since 2024. When this work is completed, the Minister for Health will be able to make a more informed decision. This debate is timely and necessary, however.

The way Senator Conway spoke of his uncle really struck me. It is a very real burden. I too have family members who have had shingles. It is not there for people to see; it is a very privately borne and lonely illness. The pain just does not seem to end with it. Fianna Fáil supports continued evidence-based progress towards a shingles vaccination programme.

I welcome to the Distinguished Visitors Gallery David, Eva and Philip West. They are guests of Lorraine West from the Office of the Secretary General. I hope they enjoy their visit to Leinster House today.

Senators Ahearn and Duffy are sharing time. Is that agreed? Agreed.

The Minister of State is very welcome to the Chamber. I thank her for being here.

To follow on from Senator Costello, the Government is not opposing this motion. Fine Gael is not opposing it and there is good reason for that other than it being the right thing to do. The presentation of it and the balanced approach that Senator Conway has put towards this Private Members' motion outlines very well why this should be taken seriously by Government. When we speak of how it affects one in three people right across the country and particularly vulnerable people more so, the Government needs to find a way to make sure it is possible to fund it. There are two very strong arguments or issues that need to be overcome. One, obviously, is the cost; €218 million is not a small amount of money that the Government needs to find to be able to fund this. That has to be found from the resources we have. Luckily, at the moment, as a country and as a Government, we have funding and the economy is strong and we are able to consider these things. However, it should not be a reason we do not do it. Sometimes there are things that are the right thing to do, and cost should not be a factor in determining whether we do it or not.

These are people who have lived their lives and done everything right. They have paid their taxes and are good decent people who need support. We cannot expect a pensioner to have to spend two weeks of his or her pension in the year just to get a vaccine when people in almost every other country in the EU and further abroad are able to receive that. As Senator Conway said, we do not want to be an outlier. We want to be a country where people look at our health service and decisions we make, particularly for people over the age of 65, in terms of protecting them. We want to be seen to be ahead of other countries rather than as an outlier. This proposal by Senator Conway is a very good one. It affects people and families in communities right across the country. It is something we need to support and that we need to do. I am looking forward to the Minister of State's response but I ask that he treat this with as much priority as possible, as I know he will, to make sure we can support these people so that they are not left in limbo where they have to make a decision on whether they spend €500 to get a vaccine. Unfortunately, it is just a reality that some people cannot afford it and cannot get it and then suffer on the back of it and have a very traumatic and challenging time with shingles. I am looking forward to the Minister of State's response. I thank Senator Conway for tabling the motion.

I thank the Minister of State for being here for this Private Members' motion. In particular, I thank Senator Conway for leading on it. I welcome all the guests in the Gallery who are here to listen to the debate.

I raised this issue on the floor of the Seanad last year. Unbeknown to me, a day previous, Senator Conway had a Commencement matter on it. I raised it having been contacted by the Bonniconlon Irish Countrywomen's Association, ICA, group in my home county of Mayo whose members are very passionate about seeing this brought to pass. It is only since I spoke on it and discussed it with Senator Conway and members of the community who have contacted me about it or people I have met who have unfortunately had shingles and experienced the debilitating nature of it that it has really brought home to me how important it is that we find a way to help realise this, especially for those who are vulnerable in our community and in our society.

We have to think about the opportunity cost of not doing it. Can we afford not to do it considering how Senator Conway has outlined that every €1 invested is actually worth €23? I understand that from the point of view of the impact it has on health services in the State, especially at this time of year when we have high waiting lists and a lot of our medical practices or hospitals are overcrowded. This is something that can help mitigate that in certain ways. It has a cost on the quality of life of people. The impact for families cannot be overstated. I would like to lend my support to it and thank Senator Conway for his advocacy on it. We should not have a situation where people, because of their social background or perhaps deprivation in certain parts of society, are potentially on a more negative health course in their lives because they are unable to afford a vital option of a vaccine like this. It is that option for people to avail of. I would really welcome as much support from my own party and the Government generally to hopefully try to get a resolution on this. It is very worthwhile and will improve health outcomes and the quality of life for all our citizens, especially our most vulnerable. I hope we can collectively achieve that.

I welcome the Minister of State to the House. Senator Conway not only spoke; he was really fantastic. We thank him for bringing this motion forward because Sinn Féin supports it.

We know shingles is not a rare condition. It affects one in three people during their lifetime. For many adults, especially older adults with a weakened immune system, it is not a short-term illness. It has a lot of side-effects that continue as they age. Despite this, we have been told, as Senator Conway pointed out, that the cost of the vaccine is up to €500, which is quite expensive. For many older people who may be in receipt of the State pension or on a fixed income, it is simply not tenable to pay that. That is a real barrier to healthcare at an older age. It should not be that way.

We have been told that HIQA concluded its report and that vaccinations for adults aged 50 and over would not be an efficient use of HSE resources. As clearly outlined in the motion, HIQA modelled a broader cohort than NIAC recommended. The Department cannot credibly claim that NIAC recommended a programme that is not cost-effective when it has never been individually modelled.

We in Sinn Féin have called for action on this issue since last summer, alongside calls for progress on shingles, RSV and broader adult immunisation. We welcomed the introduction of the free chickenpox vaccination. We were clear then, and are clear again now, that the Minister must also act on shingles and RSV because prevention saves money. More importantly, it saves people's lives from pain, loss of independence and a declining quality of life.

People have given so much. The did the right thing, paid their taxes and hoped to retire and have fulfilling lives. It is not fair, at that point in their lives, to then have to worry about choosing between a vaccine and developing shingles, which could potentially end their lives, among other things. We should make it as easy as possible for people as they go into the final stages of their lives and beyond.

What the motion is calling for is not impossible. It calls for something reasonable, targeted and evidence-based. It is about fairness, listening to expert advice and ensuring that older people in our State are not left to suffer preventable pain simply because they cannot afford protection. We are glad to hear that the Government is supporting Senator Conway and his group. We are delighted that he brought this forward and thank him for giving us the opportunity to discuss the matter. Long may support last across the Houses for Opposition Bills and motions.

Somehow or other, the Minister of State and I always seem to finish up together in this House when difficult questions come up. Her follow-up on recent topics I have discussed with her has been commendable. She does a good job and I am grateful to her for what she does.

I thank the Senator.

The weekend Pope John Paul II died will never leave my mind. It was not because I had any great affinity for His Holiness. Rather, it was because it was after a week's conference when I was in Rosslare as president of the Teachers' Union of Ireland. I had a pain in my back all week. On the night I arrived in Rosslare, His Holiness was dying and I sat in a chair in absolute agony. Nothing I could do would ease the pain. I spent the entire night awake and the following morning I left Rosslare at about 6.30 a.m. By the time I got to St. Columcille's Hospital, Loughlinstown, I was unable to be in any way cognisant of what was going on around me.

I spent two days in the hospital under complete sedation. The level of pain I experienced was something I have never experienced before or since. Half of my torso was covered in shingles front to back. The pain was so excruciating that I moved into one bedroom in the house and after three days in it I thought I was going mad. I finished up lying on the floor of my sitting room for six weeks trying to find a position that would be comfortable. Nothing I could do would make the pain go away. More importantly, I still get a twinge every now and then and I think it is coming back. If it ever comes back, I do know not know what I will do. It is absolutely horrendous. I have never known anything like it.

The virus follows nerve lines. I was told at the time that if I got it in the face, it could cost me my sight. It is an horrendous condition. As all my colleagues pointed out, there is a relationship between it and chickenpox. I now have three beautiful granddaughters and if I hear of any of them having chickenpox, I will not go near them until they are well and truly clear of it.

Senator Conway has done a lot of work on this and his presentation was fantastic. It is worth restating that the UK, Germany, Greece, Italy, Luxembourg, Spain, Cyprus, Australia and New Zealand have all adopted the vaccine. It is also worth stating that there is some correlation between Alzheimer's, dementia more generally and shingles. There has been a reduction of up to 20% in the risk of dementia, including Alzheimer's, as a result of vaccination against shingles. When one gets to the latter stage of life where I am now, the thoughts of dementia, including Alzheimer's, scares the living hell out of me. If there was anything out there that would help reduce that risk, dear God, please give it to me.

The Minister of State is frequently put in the firing line over decisions made by the HSE. One of my asks today is that she get the HSE to publish its research on this and give an explanation as to why the vaccine was deemed to not be cost effective. I do not know why we always end up throwing Ministers under the bus for decisions made by bureaucrats. It was not a bureaucrat in the Department of Health but rather a HSE decision. Let it publish the information.

We had this debate over the RSV vaccine, another vital vaccine for people aged in their late 60s and early 70s. It has resulted in a massive reduction in the number of hospitalisations of people suffering from the respiratory diseases that come with RSV. From that point of view, it is something we need to do. But for Senator Conway bringing this forward, it would have gone under the radar and nobody would have taken much notice of it. I congratulate my colleague for bringing forward the motion and the amount of work he has done on it.

I do not think it is fair to blame the Department of Health, the Minister or, indeed, the office of the Minister of State. I do not think that was ever intended by Senator Conway. I congratulate Senator Ahearn for pointing out that the Government is behind the motion. We seem to have a unanimity in here and everybody seems to be singing from the same hymn sheet.

I do not want to delay this any longer. Let us see what GSK, the manufacturers of the vaccine, and the HSE are saying. Let us see the research that went into deciding whether the vaccine was cost effective. If that research stands up, we may have to examine another way around this problem. When the HSE makes statements to the effect that something is not cost effective, it needs to be able to back that up by publishing its research. It is not fair to ask Ministers to come to the House and defend something in which they have no hand, act or part.

I am particularly concerned about over-50s. I was in my 50s when I got it and my father was in his 60s. I am also concerned about those who are immunocompromised. The Minister of State knows from a debate we had here that my daughter is immunocompromised due to head and neck cancer. People who had breast, prostate or bowel cancer are immunocompromised for the rest of their lives. If we can do something to make their lives more certain, then we should do that.

I do not think there will be a need for votes or anything else on this. There is total support for it. I thank the Minister of State for being here. Once again, I am sorry she is one who gets to carry the can. I thank her for her time.

I welcome the Minister of State and thank her for being here. I commend Senator Joe Conway on bringing forward the motion. We have heard all the evidence to support both the sense of and the absolute ethical imperative for doing this.

I just want to add to the lived experience component of the debate. My father, who passed away a long time ago, was a garda in Dublin. Unusually for a garda in Dublin, he was from Dublin. He was a very tall man. Before he joined the Garda, he was a carpenter. That was something he kept up, I think slightly controversially, for the entirety of his career in An Garda Síochána. For me, as his family, he was a big, kind of indestructible and larger-than-life individual, but he got shingles. I saw both my mum and my dad grow older, suffer various health crises and become more debilitated and infirm. Eventually they passed away. The word I would use to describe the impact shingles had on my father is "frightening". Senator Craughwell described that agonising, excruciating pain. It was really shocking for us to see him so stricken by it. He ended up, unfortunately and tragically, with permanent damage to one of his eyes. That meant that he could not use his tools, and for him, that was such a blow to his quality of life and enjoyment of life and how he felt about himself, as a retired person, being a useful member of society. I used to go down to his workshop and see all of his tools sitting there, and he was up in the house. I remember the words he used. He said, "I am fed up". That was because of shingles.

There is an issue around how we see and value older people in our society. If this was a condition that impacted, let us say, infants or small children, there would be no question of it becoming a compulsory free vaccine for all families around the country. We would not tolerate even the prospect of such suffering among one in three junior or senior infants or babies. There is a little blurring of the absolute requirement in respect of this matter because it relates to older people. In the minds of some, it is probably assumed that people experience suffering as part and parcel of ageing. As our parents used to say, offer it up for the holy souls. We are beyond that now.

I will conclude with a few observations. I am a member of the Joint Committee on Health. Last year, representatives from the National Centre for Pharmacoeconomics, NCPE, appeared before the committee. I got the opportunity to interrogate them about the point Senator Craughwell made about how the NCPE calculates its cost-benefit analysis regarding the viability of drugs and treatments. It became very clear from that discussion that it only uses quantitative analysis, statistical analysis and mathematical computations, which are very deterministic and mechanical. It does not take into account either the ethical or social impact of certain illnesses and diseases. The impression we formed at the committee was that the system which the NCPE used to make its calculations is not fit for purpose. If we look at health economic units in other jurisdictions, we can see that they factor in the sociological elements and, in particular, the ethical components relating to decisions. It is simply not good enough to say that because something costs a particular amount, we are not going to alleviate someone's suffering. That goes against everything that makes us human. I query the deterministic nature of the process used and note that the centre does not carry out a qualitative analysis or look at the phenomenological outcomes of particular conditions.

I will declare a conflict of interest shortly. We tend to move very slowly on things. Can we progress this matter with some urgency? My conflict of interest is that I will turn 60 in August, so I would like to get that free vaccine. I would rather spend €500 on something else. I just wanted to be totally upfront with people. I commend the motion to the House.

I welcome the Minister of State. It is good to see her again. I commend Senator Joe Conway on moving the motion on this very important topic. I speak as someone who has campaigned over the past number of years with regard to vaccines in general. I was front and centre during the Covid pandemic in encouraging people to avail of vaccines. I have always supported and spoken out very strongly on the need for people to take the flu vaccine, especially those who are vulnerable but also people in general. Vaccines work and have been proven to work.

The late Laura Brennan campaigned in respect of the human papillomavirus, HPV, vaccine. She spoke here many times. She encouraged and lobbied the Government and welcomed its decision to expand the availability of the HPV vaccine. There was a catch-up programme where if somebody did not avail of it, for whatever reason, in their early days at second level and parents subsequently wanted their children to avail of it, the cost was something like €800. After much lobbying by Laura Brennan's family, the Irish Cancer Society and others, the Government agreed that it be made available free of charge.

I see the motion as an extension of that good health practice. We in Ireland are lucky that cynicism and people being sceptical about vaccines is very low in comparison with other countries. When we look at what is happening across the pond in America regarding vaccines, where they are absolutely not being encouraged at all, we can see that we are very fortunate that our citizens believe the science and the word of the experts and that they take vaccines. Against that backdrop, it makes absolute sense that we should be making this vaccine available free of charge and encouraging as many people as possible to avail of it.

If HIQA is given terms of reference and comes back with a report to the effect that doing this does not represent value for money and that the money could be spent better in other areas, we can point out that this argument can be made in respect of so many aspects of life. A couple of years ago, we eliminated the €80-a-day charge for the first ten days people are in hospital. It could be argued that some people can afford to pay that charge, some people should pay it and so on. I really do not believe that is an argument for not doing something. The greater good, as Senators Clonan, Ahearn and others stated, needs to be taken into consideration. We are a first world country. We aspire to having a top-class health service. In many areas, we do have a top-class health service. However, access to a vaccine should not be denied because of money. Certainly, access to something that will prevent an illness from happening should not be determined because of money.

Not only should we be providing what Senator Conway is looking for - and I am glad the Government is not opposing the motion, because that is a very important first step in this process - we should also be looking at making other vaccines available.

We should be a country where, if people are prepared to take a vaccine, we would move heaven and earth to give them as many vaccines as we possibly can. I have known people who have suffered greatly from shingles. I know older people who have suffered a lot and then get shingles and suffer a whole lot more. It is protracted and lasts a long time. I put it to the Minister of State that as a society we should be engaging in preventative mechanisms in every way we can. I often talk about people going and getting their eyes checked on a regular basis. For four out of every five people who suffer sight loss in this country it is preventable if it is caught in time. We need to really embrace preventative medicine and ways of preventing sickness and illness. Vaccines is a no-brainer. As I said, when we have a population who are not sceptical about vaccines we should be embracing that and we should be making them available.

I thank Senator Joe Conway. I thought his opening statement was absolutely excellent. I welcome the Senator's friends who are here today. I felt everybody who spoke on the motion was really passionate about it. I have a family member who had shingles and I have friends who had shingles. I saw what they went through. I realise how important this motion is. As previous speakers have said, we are not going to oppose the motion. I felt the opening statements were excellent. The Government has noted the motion. There was a meeting on Wednesday and I am pleased to say that the motion will not be opposed as the immunisation commitments outlined in our programme for Government broadly align with this motion we are debating today. This was spoken about on Wednesday. It is broadly aligned with what we have in the programme for Government.

Vaccination is considered to be one of the most impactful public health interventions we have at our disposal, and it is an integral part of a modern and well-functioning health system. The Government is committed to continuing to implement the recommendations on the potential expansion of the national immunisation programme as set out in the programme for Government and in line with NIAC advice.

In fulfilling this commitment I can confirm that the Department of Health is actively examining the potential to offer the shingles vaccine in the first instance to a cohort of immunocompromised individuals, with a view to a potential phasing of an additional group at a later time, in line with the advice of NIAC and mindful of the cost-effectiveness of the market price. I am representing the Minister for Health, Deputy Jennifer Carroll MacNeill, today. Unfortunately the Minister cannot be here but I am delighted to be here to address the Senators on this.

I can confirm that the Government shares the Senators' concerns on the impact of shingles, especially on vulnerable people and cases of post-herpetic neuralgia, PHN, and the associated discomfort and pain as well as the added stress of requiring additional medical care. The probability of PHN increases with age, increasing from a one in ten chance in 50- to 59-year-olds to a one in five chance in those aged over 80. The risk of shingles and complications from shingles increase after the age of 50, which the Senator spoke on, and among individuals who are more vulnerable due to certain health conditions.

I welcome this opportunity to update the House on the current status of shingles vaccinations in Ireland, and on the formal processes which underpin the delivery of the national immunisation programme today in Ireland. Our national immunisation programme is based on the advice of NIAC. The committee's recommendations are, in turn, based on the prevalence of the relevant disease in Ireland, international best practice in relation to immunisation, and evidence-based analysis and expert medical advice. NIAC submits its recommendations on immunisation matters to the Department of Health for consideration. Determination is subsequently made by the Minister, Deputy Jennifer Carroll MacNeill, which will then take the form of a policy decision. In advance of any change in policy the Minister can request that HIQA carry out an evaluation of the impacts of potential policy changes. HIQA has a statutory remit under the Health Act 2007 to evaluate the clinical cost-effectiveness of health technologies and to provide independent advice to the Minister for Health on the budget impact, organisational and social aspects, and ethical and legal issues. These evaluations take the form of a health technology assessment. The 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-making in assessing the merits and potential shortcomings of a new health technology, policy or service based on accurate and reliable evidence. NIAC guidelines state that the shingles vaccine may be considered in those aged 65 years and older due to the greater burden and severity of the disease in this particular age group and in those aged 18 years and older at risk of shingles.

Following a request from the Minister, HIQA published a health technology assessment in 2024 which found that including the shingles vaccine in the routine immunisation schedule at the vaccine price at that time for all adults aged 65 years, and others, would not be cost-effective and would have a substantial budgetary impact. In 2025 the Department requested the HSE, which retains full responsibility for the vaccine procurement process, to enter non-binding negotiations with the manufacturer of Shingrix to determine if the HSE could procure the vaccine at a cost-effective price. The HSE advise that the price quoted by the manufacturer was greatly in excess of the price noted by HIQA as a good use of healthcare resources in its 2024 HTA.

It is important to note that as the Department is committed to exploring whether it is possible to offer the shingles vaccine to a cohort of immunocompromised individuals in the first instance in line with NIAC advice, the Chief Medical Officer has asked the HSE to conduct a new follow-on assessment of cost of delivery of a vaccine programme. This is being looked at now. It is hoped that it will be possible to implement a potential phasing-in approach of additional groups at a later time in line with NIAC advice and available funding. If the HSE can negotiate a more affordable price, it will be submitted in a costing to the Department, which will necessarily include other anticipated costs such as vaccine administration, training, ICT and communications.

As we can all appreciate, it is important that the Department and the HSE adhere to value-for-money obligations set out by the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation, specific to efficient and effective use of public funds and resources. Furthermore, the Department of Health has recently written to HIQA asking it to conduct a scoping exercise to establish whether there is any relevant additional scientific information available after the 2024 HTA that may be pertinent to the review to inform the new matters. I will go back to the Minister on this for the Senator. Once this information is available the Minister for Health will make a decision in relation to the introduction of a targeted shingles vaccination programme. This would require seeking additional funding via the annual budget and Estimates process for 2027. I can confirm that the Government is supportive of the introduction of a targeted shingles vaccination programme for eligible people should the HSE be able to negotiate a price that is deemed to be a fitting and appropriate use of healthcare resources, which will ease the burden of shingles on most vulnerable people in our community. That is exactly where we are today.

It is important to note that adding a shingles vaccination to the routine immunisation schedule for all adults aged 65 and over was not deemed to be an efficient use of resources, even after considering potential savings as a result of fewer people presenting to their GP or being admitted to hospital. This is what they were looking at. HIQA's health technology assessment found that the introduction of a shingles vaccine was not cost-effective based on the cost of the vaccine. It was determined to be cost-effective for the vaccination of those at age 75 years and 80 years. This is what came from that assessment. If the cost of the vaccine was reduced by 80%, the HTA further outlined the cost estimate of providing the vaccine to people turning 50, 60 and 70 years of age, respectively.

I know this is all the Department, but I am trying to explain as best I can through the Department and the HSE.

The HTA noted a decision to fund the shingles vaccine as part of the adult programme could have significant financial and logistical implications, depending on the population group for whom the vaccine is funded. It also found there was uncertainty surrounding the potential uptake of the vaccine given the wide range of uptake estimated for other vaccines in the adult immunisation programme and for shingles vaccine uptake internationally. In addition, the HTA advised that if a decision were made to fund the shingles vaccination, consideration would need to be given to defining priority groups. You would have to define the priority groups for vaccination in the event that demand exceeds supply.

It is important to acknowledge that a decision on whether to introduce a specific immunisation programme must be based on many factors, including the burden of disease on individuals and health services, the clinical effectiveness and safety of the vaccine and the cost-effectiveness and budget impact of the programme. As I stated earlier, the Department of Health is actively examining the possibility of offering the shingles vaccine to a cohort of immunocompromised individuals, with a view to a potential phasing in of additional groups at a later time, in line with NIAC advice and mindful of the cost effectiveness of market pricing.

Ireland’s national immunisation programme is vitally important for protecting the health of the population and ensuring the effective functioning of the health system. It is notable that immunisation uptake rates are generally high across the various immunisations provided as part of the national programme. Many Senators spoke today on a particular example which relates to the influenza vaccination programme. I am pleased to note Ireland has one of the highest flu vaccine uptake rates for older adults in Europe. Uptake in those aged 65 years and older was nearly 75% in the 2024-25 influenza season, which aligns with the target set for this group by the World Health Organization.

This contributes to the broad goal of safeguarding the health of the population through immunisation, which confers benefits to both individuals and the general public by way of herd immunity. Another notable example is the RSV infant immunisation pathfinder programme, which has achieved high uptake rates. Again, this season it has contributed significantly to the improvement of health outcomes over the winter period due to the resultant reduction in the circulation of RSV disease and hospital attendance for children. The considerable positive impact of our national immunisation programme is easily identifiable in this instance. It is critical, however, that high uptake rates are achieved in both the long established and the more recently introduced immunisation programmes, such as the flu vaccine for children, to ensure these life-saving interventions are as impactful as possible and represent the best return on investment for the health service.

I wish to take this opportunity to put on the record of the House our thanks to all the healthcare professionals working tirelessly throughout the winter season. I extend our gratitude not only to those working in the hospitals ensuring those in need of quality healthcare get it, but also to those out in the community ensuring all those who are eligible to receive the free flu vaccine get the vaccine early, ensuring those who are most vulnerable to the effects of the flu are protected. Again, I thank Senator Conway for the opportunity to discuss this matter today. As I said, this is very important. Like him, I have known people who have had the shingles, so this is very important. The Senator and this House have my commitment to go back to the Minister, Deputy Carroll MacNeill, to explain the passion here today and the need for this vaccine. It is important for people, particularly older people, who have shingles. I will definitely go back to the Minister on that.

The Senator was very passionate and I thank him. I am delighted to take this instead of the Minister.

Some months ago, we had a Commencement motion down about shingles and coincidentally, on that occasion it was the Minister of State, Deputy Murnane O'Connor.

It was me.

I recall at the end of it, she definitively said to me she would go back to the Minister and gave me her word that she would put her points to her. I have no doubt that she did because I can see we have come a good way from that Commencement motion some months ago.

I did.

People will ask what is the purpose of the Seanad, and this is a wonderful example of the efficacy of the House, that people who are lowly backbenchers like myself can work with the Government Senators. It was a very enlightened approach by the Government and I am immensely thankful to Government and the Minister, Deputy Carroll MacNeill, because I know she has an almost impossible job to do, as does the Minister of State. I am in great admiration of her can-do attitude in her work and I have no doubt her efforts will be crowned with success.

To Senators Costello and Ahearn and all the other Government Senators, the constancy of their support has been very gratifying for me and my colleagues in the Seanad Independent Group. I also thank the civic group, Sinn Féin and the Labour Party and all the people who co-signed the motion. It was very uplifting to get that level of support when you are putting down a Private Members' motion. There are other people, of course. Last week, when I was trying to work through the mechanics of the Private Members' motion - because I still have a big L plate up here - the support I got from Martin Hughes and Carmel Considine, as well as the level of support and inclusiveness in this House, was mind-blowing. The Minister of State also contributed to that today in coming here to make her replies. Often, we have been told that when rising to reply, you should contain a couple of punchy things to say back at Ministers because you know you are the last person on his or her feet, so nobody can come back at you.

I want to indicate a couple of things. I thank Active Retirement Ireland, my PA, Niamh, who did huge work on this and of course, my wife Sandra, for being here today. Pharma companies are sometimes portrayed as being venal and out for profit but I have to say the inclusive and supportive way GlaxoSmithKline helped me with the figures and perspectives on this was immense. I also thank Ross Mac Mathúna and Marguerite - who was in here last week - from the bottom of my heart. They mentioned that someone they knew had done a heat map on the uptake of the private shingles vaccination and not surprisingly, the deep red areas were in places like Cork city south, the Dunmore Road area of Waterford city and Dún Laoghaire-Rathdown in greater Dublin, to mention a few. The pale yellows and white areas were predominantly in rural Ireland and areas with high levels of social housing. That tells its own poignant story about the accessibility to the shingles vaccinations.

I have no doubt the people who have co-signed the motion will move might and main. This is naked politics but I know Active Retirement Ireland, its 850,000 members and the people who co-signed this motion want to put this issue front and centre in the two by-elections coming up in Gaillimh Thiar and Dublin Central. Those people - the over 65s - are voters, as I reminded the Minister of State when she was here at the outset. Their voice will carry sway. I am glad this House has taken the opportunity to say there is not the same trenchant opposition to this proposal as there was a while back and that people are viewing this positively. People say in politics you should hasten slowly but the Government and all of us should drive on resolutely on this issue. I would not be one to tell the Minister of State her own business but it is not just important to do the right thing but also, very obviously, to be seen to be doing the right thing. There is no point in bringing in progressive initiatives like this if you are not shouting it from the rooftops.

Sin mo cheannsa. I thank the Leas-Chathaoirleach for, as always, the very inclusive way she conducts her debates and for all the people who spoke in support of the motion. If it got a little personal and emotional at one stage, my apologies but sin an rud.

When is it proposed to sit again?

Next Tuesday, at 2.30 p.m.

Is that agreed? Agreed.