The Minister of State is very welcome. Senator Gallagher was waiting in anticipation.

I never doubted the Minister of State, she will be glad to hear.

Indeed. He was backing the Minister of State.

Cuirim fáilte mór roimh an Aire Stáit go dtí an Teach. She is very welcome back to the Chamber this afternoon. I thank her for taking the time out to be here.

They say a stitch in time saves nine and the evidence that the shingles vaccination not only protects people from what can be a very painful illness and its possible complications, but also helps prevent cardiovascular disease, stroke and dementia is surely a case in point.

Shingles is an infection that causes a painful rash caused by the chickenpox virus and can lead to many complications. It is estimated that every one in ten adults could develop shingles every year. Keeping older people healthy and active for as long as possible in their lives is a vitally important goal, not just for their quality of life, but also with regard to the costs and pressures on the health system. Consultant geriatrician and stroke physician at the Royal College of Physicians of Ireland, Professor Rónán Collins, has said vaccination is the greatest single medical advance in modern history. There are many calls for the shingles vaccine to be made available for free to those over 65 years of age, similar to what our nearest neighbour in the UK has done.

However, the vaccine is only available privately at a cost of around €480 for the two doses. The vaccine is very effective, and several countries provide for it, including the UK, Australia, Luxembourg and Canada. Clearly, they see the extra benefit in the evidence of the drug's effectiveness in protecting not just against shingles, but also against Alzheimer's disease and heart disease.

Professor Luke O'Neill, whom I am sure the Minister of State is aware of, has said that assuming a 70% uptake on the vaccine and overall instance of around 10,000 cases a year, the vaccine could result in a saving to the State of up to €8 million per annum. Active Retirement Ireland has recommended the vaccine for all adults aged 65 and over, as well as for certain immunocompromised groups.

I call on the Government to actively examine ways to enable the vaccine to be publicly funded or for State-supported access, including engagement with the makers on the actual pricing of it. Right now, access depends on ability to pay only and that is not equitable. Shingles is not simply an acute condition. It can have everlasting and significant consequences, and there should be recognition that the vaccination for older people is an issue of prevention, equity and healthy aeging. I look forward to the Minister of State's response.

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

Varicella is a common highly infectious disease caused by varicella-zoster virus. The virus is associated with chickenpox and shingles. This virus becomes latent in a body's nervous system and may reactivate after a period, resulting in shingles. Approximately one third of people who have had varicella infection will develop shingles infection at some point, but two thirds occur in those aged 50 years and older.

Morbidity associated with shingles increases with age, and the most common complication is postherpetic neuralgia, which is a persistent pain in the area of the rash. This has potential to significantly affect 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 Zostavax, and can be safely administered to immunocompromised patients. Internationally, it has become the preferred vaccine against shingles.

The national immunisation advisory committee, NIAC, guidelines state that the vaccine may be considered in those aged 65 and older due to the greater burden and severity of the disease on the postherpetic neuralgia in this age group, and in those aged 18 and older at increased risk of shingles. It should be noted that in advance of any change in policy, the Minister can request that HIQA carries out an evaluation of the impacts of a potential policy change. These evaluations take the form of the health technology assessment, HTAs.

A HTA is a multidisciplinary research process that collects and summarises information about the health technology in a systematic, unbiased and transparent manner.

The Minister for Health can advise that following a request from the Department, HIQA carried out a HTA on the vaccine, which examined safety and clinical effectiveness. 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 schedule. The HTA was published on 19 July 2024. It 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 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 aged 75 years and 80 years if the cost of the vaccine were reduced by 80%.

In 2025, the Department of Health requested the HSE, which retains full responsibility for the vaccine procurement process, to enter a non-binding negotiation with the manufacturer of Shingrix to determine if the HSE could procure the vaccine at a cost-effective price. The HSE advised 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 their 2024 HTA. The Minister for Health and the Chief Medical Officer are 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. Earlier this year, the CMO again asked the HSE to conduct a new follow-on assessment of the cost of delivering a vaccine programme. If the HSE can negotiate a more affordable price, it will submit costings to the Department of Health. Furthermore, HIQA has also been asked by the Department of Health to conduct a scoping exercise to establish whether there is any relevant additional scientific information available subsequent to the 2024 HTA. When all this information is available, the Minister for Health will make a decision in relation to the introduction of a targeted shingles vaccination programme. This will require seeking additional funding via the annual budget and Estimates process for 2027.

I welcome students from Coláiste Dún Iascaigh in Cahir, County Tipperary. They are guests of Deputy Mattie McGrath, whose daughter is here somewhere hiding in the back. They are all very welcome. As is tradition, they do not have homework for the rest of the week when they visit the Seanad. That is according to Deputy McGrath.

I thank the Minister of State for that comprehensive response. I know she is taking this on behalf of the Minister, Deputy Carroll MacNeill. I welcome the fact that the HSE is in negotiations with the provider of the vaccine. It is a welcome development and hopefully positive news might flow from that. We all agree that shingles is a very debilitating disease. Unfortunately, when someone gets it at a certain age, it is very hard for them to get rid of it and it has negative consequences on the quality of their life going forward. It is worthwhile. Professor Luke O'Neill reckons we could save €8 million per annum by having this. I very much welcome the news that it is being looked at and look forward to it progressing in the not-too-distant future.

I thank the Senator for raising this. We are all aware that vaccination is recognised as one of the most cost-effective and successful public health interventions that exists saving many lives each year. As discussed here today, shingles can impact anyone who has been infected with chickenpox during their life, leaving a significant proportion of the population vulnerable. Up to one in three people who have had chickenpox will go on to have shingles. This is why the Department requested that HIQA carry out a health technology assessment to review the evidence for adding shingles vaccination to the adult immunisation schedule in Ireland.

As I advised, the Minister for Health and Chief Medical Officer are 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's advice. The Senator will be aware that the HSE has responsibility for implementation of the national immunisation programme in Ireland, which 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 disease, vaccines which are included in the national immunisation programme are administered free of charge to those who are eligible and at risk.

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. In addition, I encourage all parents to bring their infants into line with the primary childhood immunisation schedule through their GPs for their important childhood immunisations. These measures will help us protect public health by preventing the spread of disease in our community.

I was thinking Senator Gallagher should have declared a self-interest in that debate given he is closing in on 65, the magic age, like the rest of us. I thank the Minister of State.