Ireland’s parliament has issued a sharp challenge to the government over its failure to fund a recommended shingles vaccine for older people, with lawmakers and medical experts united in calling for a state-backed adult immunisation programme – and taking direct aim at both pharmaceutical companies and the bureaucratic machinery used to assess drug value.
Parliament’s Joint Committee on Health convened on April 15th to hear expert testimony on vaccine policy, with the shingles vaccine serving as the central case study for what witnesses described as a structural failure in Ireland’s approach to adult immunisation.
The core grievance: equity
The committee heard that Ireland’s National Immunisation Advisory Committee has recommended the recombinant shingles vaccine for all adults aged 65 and over, yet it remains unavailable on the public health system. The two-dose course costs between €450 and €487 at pharmacies nationwide – equivalent, as Alison Bough of Active Retirement Ireland told the committee, to one and a half weeks of the maximum contributory State pension of €299 per week.
“A recommended vaccine that is available only to those who can afford to pay privately is not equitable access,” Bough said. “The policy pathway is clear. The need is very clear. What is required now is a decision on access.”
The border anomaly drew particular political heat. Residents of counties along the Irish border can drive into Northern Ireland and receive the vaccine for free under the UK’s national immunisation programme, which routinely provides it to adults aged 70 to 79.
Active Retirement Ireland said more than 21,000 people had signed its petition demanding state-supported access in the Republic, a number the organisation said had been driven entirely by older people themselves. Senator Joe Conway, who co-sponsored a Private Members’ motion on the issue in the Senate – passed with unanimous cross-party support – told the committee he was convinced the vaccine would be made available “within the next couple of years”, noting the government had declined to oppose the motion. “That does not signal any entrenched opposition to it,” he said.
The medical case
Professor Rónán Collins, consultant geriatrician and stroke physician at the Royal College of Physicians of Ireland, presented a clinical case that went far beyond shingles prevention.
He told the committee that flu, RSV and shingles infections trigger inflammatory responses – releasing cytokines that destabilise arterial plaques, promote clot formation, cause cardiac arrhythmia and damage the blood-brain barrier – which collectively increase the relative risk of stroke and cardiovascular disease by a factor of between two and eight.
Systematic flu vaccination, he said, reduces stroke risk by up to 25% in vaccinated populations.
On dementia, the evidence was described as “compelling and growing”. Around 50% of patients who experience hospital delirium – frequently triggered by viral infection – are diagnosed with dementia within 12 months.
Vaccination against viral infections reduces dementia risk by as much as 20%, Professor Collins said, adding that the landmark Cardiff-Stanford study establishing the causal link between viral infection and Alzheimer’s onset had not been adequately factored into existing cost-effectiveness models.
“One in four of us in this room will get a stroke, and one in four of us will get dementia,” he told the committee. “Vaccination is an important pillar of healthcare to ensure healthy ageing and the prevention of cardiovascular disease, stroke and dementia.”
Direct challenge to pharmaceutical pricing
Several committee members explicitly called on the drug’s manufacturer to lower its price. Deputy Martin Daly, a GP, told the committee that a HIQA study had suggested the price would need to fall by around 80% for the vaccine to be cost-effective even if targeted solely at over-65s, and urged pharmaceutical companies to “recalibrate their negotiations with the Government”.
Senator Teresa Costello, a member of a government party, was equally direct: “I ask that the pharmaceutical company does not propose a price that is 80% over the cost. I urge people to meet in the middle.”
GSK, the manufacturer, has previously signalled its willingness to negotiate, stating it “could have enabled a national immunisation programme to be implemented” under its existing offer.
Deputy David Cullinane noted that a proposal to cover over-75s and immunocompromised patients had been costed at €5 million – a figure he described as difficult to justify rejecting from within a health budget of €27.4 billion. “The arguments are unassailable,” he said.
The most structurally significant challenge of the session was directed not at the government’s spending priorities but at the methodology of the National Centre for Pharmacoeconomics, the body responsible for health technology assessments.
Deputy Pádraig O’Sullivan called for a bespoke assessment process for vaccines that separates them from the drug reimbursement framework applied to conventional medicines. Professor Collins agreed: “Vaccines are a public health measure, and they probably should not be subject to the same type of process.”
[VA]
Source:
www.euractiv.com