Martin Daly raises shingles vaccine inequality in Dáil

Thanks very much and thank you to the witnesses, thank you to Professor Mary Horgan and her team from the Department of Health and Dr Colm Henry and his team from the HSE for coming here this morning and following on from last week's information meeting, it's really important to tease out a few issues. There's an emerging divergence in this country, in a small country where we have the population sensitised to the advantage of having a shingles vaccine and what we're having is in my surgery we're having people with means coming in and paying 400 euros to have their shingles vaccine and we're having people with the least resources who are maybe immunocompromised and who are older and not having access to the shingles vaccine and we know that the connection isn't just with shingles which is a nasty disease and Professor Horgan pointed out, it's not just post-hepatic neuralgia, the problem is we see with many older people that their lives are materially affected after having a shingles infection in many, many ways and becoming more frail, more open to other illnesses and also affecting and it would appear affecting their cognitive ability. Now I'm going to ask specific questions. Firstly, a question to Professor Horgan, do you think the HICWA evaluation, including over 50s rather than an older cohort of people, skewed the cost effectiveness case for the shingles vaccine? Thank you, Deputy. I suppose just to acknowledge that I fully appreciate the safety and effectiveness of the shingles vaccine and I think the big issues here is about cost and when HICWA did the analysis, the cost analysis was done for those over 65 and not for over 50. When the cost analysis was done for that particular group of patients, if you were to vaccinate everyone from 65 older and that's what they looked at, would be nearly 218 million over a five-year period. I've read that and I just wanted you to say that I'm sorry because I'm on a time clock here. So I accept that part. Has it been factored in the effect of the reduction in the prevalence of dementia in say the Cardiff study and others? It's not specifically, we know just with the antiviral portion of it, it may be to do with the adjuvant in the vaccine. Yeah. So just to, I suppose it's really important that we understand that the license for shingles is to prevent that particular disease and post-herpetic neuralgia. There is work ongoing and there's a big study underway at the moment in the UK looking at the impact of the shingles vaccine on dementia and other inflammatory conditions, which you'll take. It's a four-year study that began last year. But I do think it's important that that may be a secondary benefit rather than the primary reason for it. And as you well know, Deputy, there are many factors that influence dementia and loads of types of inflammation, one of which is infections. Yeah, we accept that like this vascular dementia and then there's Alzheimer's, but this is what's concerning people. But it would seem there's an emerging pattern and it's not clear whether it's the vaccine or whether it may be the adjuvant. And that comes on to my next question, either Dr. Henry or yourself can answer this, is for example, enhanced flu vaccine or adjuvanted flu vaccine and RSV vaccine adjuvanted are also emerging as factors in reducing the prevalence of the onset of Alzheimer's. And yet we're not using either the adjuvanted flu vaccine or an adjuvanted RSV vaccine. I accept the success of the vaccination program. Look, I'm a supporter of vaccination in a world of vaccine skepticism at the highest levels of the American government. I'm glad you're here restating the value of vaccination because it's really important, but you might address those. Yeah, I think it's really important as a public forum, Deputy, I'm sure you'd allow me to do this, that given the fact that the vaccine program for flu has been so successful among older people that we restate in this public forum, how important it is for older people to continue to take that up at the level they have at extraordinary rates, 81% of people in long-term care facilities, 91% of those age over eight years of age, 66% of those over 60 trust their healthcare professionals when they advise them to take the flu vaccine. Not only do they take it up, we have good evidence based on the epidemiological curve of hospitalized flu this year to show that there was a real impact kicking in at the beginning of December. I can ask my colleagues to comment on this if you have time, demonstrating a kick-in of that vaccine in the most vulnerable group. So that's really important to say. I said that just before you go further, healthcare workers. Yes. That's a major challenge. Yes. There's a very low uptake of healthcare workers. I know we're going off on a tangent, but it was one of my questions. To go back to your question on the enhanced flu vaccine, what is the most critical factor for people in a population-based program is the uptake of the vaccine. I mean, we learned that during the pandemic. There were differences between vaccines, but we said to people, take the vaccine you're offered, and the impact was huge in an Irish setting. There are, with older people, their immune system varies. It's my own specialty, and I understand that it varies, and there are advantages to adjuvanted vaccines that are presented over standard vaccines, and that's the subject of our procurement for this year. We don't discuss that in public, obviously, because it's commercially sensitive, but clearly that's part of the process. So I think it's important for people to be aware of that. I think it's important for people We don't discuss that in public, obviously, because it's commercially sensitive, but clearly that's part of our discussion at that procurement period, which is ongoing now when we consider the whole range of vaccines, and the one best suited for the Irish population next year. Okay, and just coming back to the healthcare, I accept what you said to me about that, because it would appear that the adjuvant might be the factor in reducing the onset of Alzheimer's, rather than the actual viral piece of the vaccine. That's what some of the evidence suggests. I'm not suggesting we have an answer for that at this point in time. What I would say, I'm sorry to cut the question up very quickly, but to restate the single most important, when you look at the factors that influence dementia, any acute illness, recurrent delirium, but certainly the prevention of influenza and hospitalised influenza is the single most important indirect factor for me, and that is the prevention of flu through the high uptake levels of the current vaccine program. I accept that, but I'm also asking if that is being deliberated on. That's the question. In relation to healthcare workers, when people do go into healthcare settings, they expect that they're going to be made better, and unfortunately in our health system, in any health system anywhere, there are unintended consequences, hospital communicated infections, but the uptake of flu vaccine amongst healthcare workers is low, comparably speaking. What would your view be on that? I might come in, Mary, if that's okay, on that one too, and I'll bring it on to my colleague. It is low. It's lower than me. It was extraordinarily high during the pandemic when we saw healthcare workers queue, not only to get vaccinated, but queue to voluntarily be part of vaccine teams, an extraordinary example of the nation coming together. It is now 34.9% in the last season. My colleague here, Eamon O'Meara-Wright, has done extensive work looking at how we address the factors that have led to a dropped uptake, not just here in Ireland, but abroad. We've seen examples of great practice, and I might ask Anne to describe, for example, Mallow Hospital, where the uptake is now over 60%, and why it's high in some areas. A lot of that is probably down to the fact that you actually have the, within the hospital, such as promoted by the leadership team within the hospital and people, and it's a relatively small hospital, but the uptake was very good. Thanks. Thanks very much.