A recent meeting of the Oireachtas Health Committee heard calls for the introduction of a vaccination programme for adults. On 15 and 22 April the Committee heard presentations related to vaccines policy, availability and uptake, with a particular focus on adult vaccination, which Committee Chair Pádraig Rice TD (Social Democrats, Cork South-Central) said, “has not received the attention it deserves”.

Presentations at the hearing on 15 April were heard from Prof. Rónán Collins, Consultant Geriatrician and Stroke Physician, and RCPI National Clinical Lead for Stroke; Prof. Luke O’Neill from the School of Biochemistry and Immunology at Trinity Biomedical Sciences Institute; and Alison Bough, Head of Policy and Advocacy at Active Retirement Ireland.

In his statement to the Committee, Prof. Collins said; “Vaccination is the greatest single medical advance in modern history, saving hundreds of millions of lives”, but while programmes for childhood vaccination “are the norm . . . our approach to adult vaccination has been less robust”. He said; “Many common viral illnesses such as influenza, respiratory syncytial virus (RSV), shingles and others cause seasonal surges in acute hospital activity . . . Less appreciated is the effect of these illnesses in causing cardiovascular disease such as stroke and heart failure and their association with dementia.” He called for, “a national programme for older adult vaccination analogous to that we have for children”, citing it as “a vital component to any national health strategy that seeks to be age-friendly, promote healthy ageing (‘adding life to years’) and address the challenge of rising rates of stroke and dementia”.

In a written statement to the Committee, Prof. O’Neill said that around one in ten older adults could develop shingles every year. He said the vaccine is very effective and is already provided for under free healthcare programmes in several countries. He also said there was evidence of the drug’s effectiveness in protecting against Alzheimer’s disease and heart disease.

Ms Bough also called for a vaccination programme and said, more than 20,000 people, primarily older people, have signed a petition from her organisation calling for “fair, state-supported access to the shingles vaccine”. Outlining that current access depends on the ability to pay, she said the cost of the two-dose course is approximately €480, and the maximum contributory State Pension is currently just under €300 per week, making the cost prohibitive for many.

The following week at the Oireachtas Health Committee the discussion continued with a large delegation from the HSE and the Department of Health. When asked about the call for an adult vaccination programme, Professor Mary Horgan, Chief Medical Officer, said; “There is an adult vaccination programme. The Department gives influenza, Pneumovax and COVID-19 vaccinations, not only to older people but also to those who are immunocompromised.”

Dr Colm Henry then explained how the vaccination programmes operate: “The national immunisation advisory committee, NIAC, provides independent evidence-informed guidance to the Department to guide its policy decisions. The Department may also request the Health Information and Quality Authority (HIQA), to undertake a health technology assessment (HTA) to assess cost-effectiveness and refine target groups for any national programme.”

Dr Henry said; “Health technology assessments conducted by HIQA currently indicate that introducing shingles and RSV vaccines for older adults would not represent an efficient allocation of healthcare resources at present, considering current product cost estimates.”

A HIQA study found that the vaccine was safe and effective, but at the price sought it was not considered cost effective. Professor Horgan provided the estimated cost for rollout of the shingles vaccine as €218 million for full rollout for those over 65 years of age for a five-year period.

The Department of Health said that in February, it had requested the HSE to enter into negotiations with manufacturers of the shingles vaccine to determine if it can be procured at a cost-effective price. Engagement is ongoing. The Department said that should an affordable option be identified, the HSE will submit a proposal to the Department of Health for consideration and decision.