Martin Daly: Calls for Shingles Vaccine Equity for Older Adults

Thanks to Professor Ronan Collins and Professor Luke O'Neill, we got his statement so that was important and to Miss Alison Baugh for coming here today and presenting to us in relation to this. I just want to note that I'm delighted that Professor Collins has reflected on the powerful role of vaccination in the reduction of both morbidity and mortality right across the population and across all age groups and I think we need to restate that because in an age of vaccine hesitancy and and false messaging by people in very powerful positions in governments right across the western hemisphere which should know better and I think we know what we're talking about but I mean when it's driven at the heart of one of the most powerful governments in the world, the US government, vaccine hesitancy, it is difficult to get that message out and we have to reach beyond the public understanding of simple prevention of a disease process rather than the wider benefits that are going on that appeal and I also have to note that the shingles vaccine issue is a matter of equity. As a GP, I have people who have means and will fund their own vaccination so the poorest and the sickest and the people who needed most who will be most at risk are unable to afford this vaccine and it is really regrettable about this and that's why I'll just ask the question. We had a HICU report in 2024 into the cost effectiveness of the vaccine. The study was set up for over 50s vaccinating the population. I wonder if there would be increased cost effectiveness in your view if we targeted maybe an older population either over 65 or over 70 with significant benefit, not just for those people but also for our health service. That's a very interesting, the short answer to that is yes and the longer answer is that all these vaccines are not just if you like the same in some respects. In shingles is a particularly interesting illness because if you you're unlikely to get shingles when you're younger you know you can get it but most people do not get it when they're younger but even younger people who get shingles get cardiovascular events after it so that's the first thing to state and so the reason 50 was probably picked is because some of the evidence that was produced for shingles cohorted the population to older than 18 and older than 50 and it was a very blunt study in that regard but almost all the other vaccine schedules for example if we took if we deviated slightly and looked at enhanced flu vaccine which again was a NIAC recommendation and which again the state stopped the tender on. The evidence on that and the recommendations on that is that that vaccine should really be focused on a cohort that are older and they drew the line at 65 and as I was telling Senator Clunan which that age of 65 which has stuck with us all our lives came from Bismarck's pension age but in any case I think you're right I think the most at risk group are probably over the 65s and other cohorts people of chronic respiratory disease and immunodeficiency so I think in that model you're probably going to get much more cost effectiveness. I think one of the things thank you for that answer firstly just a very quick answer on this for the first time ever that Cardiff study with Stanford that showed this connection between viral infection and the onset of Alzheimer's that is an extremely important discovery I don't think that has been fully factored in people's understanding. No I think I would agree with you I think again from a health I'm not a health economist Deputy Daly but I suppose if you it's easier for health economists to cost discrete episodes like heart attack like stroke it's much more difficult for health economists to factor in the lifetime cost of dementia I think you know and that's the problem I think in that type of model but I agree with you listen I nobody did a health economic model you know for example with immunizing children against diphtheria or even or whooping cough but all of us would agree it's a good idea because it gives the child a healthier life you know a healthier life as a child and less risk of mortality and so health economics has to be borne in mind as one criterion at which you're looking at the whole issue and I think the issue of prevention of stroke I mean who's not going to vote for prevention of stroke who's not going to vote for prevention of dementia yes it has to be costed and reasonably but I think the focus should be on that we want people to have healthier active later life but I suppose one of the things is that people's understanding and I would say many medical and nursing professionals understanding of vaccination is very much isolated to the prevention of a specific disease a chest infection a onset of flu or pneumonia but the case you've laid out here is for a much wider the need for a much wider promotion of vaccine to prevent heart disease and stroke which are the biggest killers in our society yes and there needs to be a refocusing of the education of both medical nursing professionals and and health care professionals and the prevention of many other diseases because I don't think there's a connection in the public's mind between the flu vaccine and heart disease flu vaccine and stroke or RSV vaccine and and dementia so do you think that there needs to be a refocusing of that maybe yourself what you think about that yeah I just just to absolutely agree that you know looking at cost effectiveness and qualities as their quality adjusted life years in a in a hta and health economics assessment of a vaccine you know just to absolutely agree with professor collins does not take into account the the potential need for long-term care for example the removal of individuals really from community and and all of the other activities that older people in particular take part in you know a lot of grandparents now are primary caregivers for for their grandchildren while their parents are at work so um so I just wanted to say that about the cost effectiveness issue um but in in terms of um public understanding it's been our experience certainly in in recent months that this is really an issue being driven by older people so our members you know mandated this at their national agm they wanted this they wanted us to lobby for this vaccination in particular because they are aware of the impact on their health and and and the long-term impact on their health no thanks very much I I'm on the clock so I just want to reflect on this is that on the HICWA report it was suggested that there's it would take an 80 reduction in the price of the vaccine even if you targeted over 65 I suppose that's the health economics part of it and I have to say I would be urging government but I would also urge the pharma companies to look at the at recalibrating their negotiations with government in order to provide this really useful vaccine to our older people thank you thanks