If shingles vaccination reduces dementia risk even modestly, the programme might become not merely compassionate but strategically brilliant, writes Terence Cosgrave<\/p>\n<\/p><\/div>\n
T<\/span>here are many small humiliations in ageing, but few are quite as maliciously designed as shingles. Shingles is what happens when a virus you met briefly as a child \u2013 chickenpox \u2013 decides \u2013 decades later \u2013 to reintroduce itself by setting fire to a strip of your nervous system. It doesn\u2019t politely knock. It doesn\u2019t send a Christmas card. It turns up with a blowtorch and a grudge, like the punk rock of disease.<\/p>\n Independent Senator Joe Conway and his colleagues in the Seanad Independent Group brought forward a motion yesterday calling on the Government to make the shingles vaccine free for everyone over the age of 65, as approximately one-in-three people will develop shingles in their lifetime.<\/p>\n Terence Cosgrave and pup<\/p>\n<\/div>\n In Ireland, shingles is common enough to be almost banal and yet serious enough to be profoundly disruptive. It typically arrives as a rash and pain along a nerve pathway, but the rash is often the least of it. The real villain is nerve pain: sharp, burning, electric, sometimes lingering for months or years as post-herpetic neuralgia. For older adults, this isn\u2019t just an inconvenience; it\u2019s a quality-of-life demolition job.<\/p>\n So let us ask the deceptively simple question: should Ireland introduce shingles vaccination as a free measure for adults over 65 as this motion asks, or even 60?<\/p>\n The short answer is that the case for is medically strong and morally tidy, while the case against is economically anxious and logistically realistic. The longer answer is that Europe offers a useful mirror \u2013 and dementia has wandered into the debate like an unexpected but potentially game-changing guest. (Sid Vicious?)<\/p>\n The case for: preventing suffering that is both common and preventable If you run a health service, shingles has an irritating habit of turning up everywhere you don\u2019t want it: GP consultations, emergency departments, ophthalmology clinics (when it involves the eye), ENT services (when it hits facial nerves), and pain clinics long after the rash has vanished. Preventing shingles prevents those downstream demands. It also reduces medication use \u2013 antivirals upfront, neuropathic pain drugs later \u2013 and lessens the risk of hospitalisation in frailer older adults.<\/p>\n Then there is the fairness argument. Ireland\u2019s current approach is, in effect: if you can afford several hundred euro, you may buy yourself a substantially lower chance of years of nerve pain.<\/em> This is not a policy so much as a price tag attached to suffering. It creates an obvious inequity; those with disposable income can reduce risk; those without must wait and see whether their dormant virus is the sort of lodger that enjoys setting the curtains on fire.<\/p>\n Public health programmes exist precisely to correct this kind of inequity when the intervention is safe, effective, and targeted at a predictable risk group. Shingles risk rises steeply with age \u2013 and so does the likelihood of complications. If there is a sensible cohort to protect, it is people over 60.<\/p>\n Europe as a reality check: Ireland is not alone, but neither is it leading A cross-sectional review of policies across the 27 EU member states (using data available up to July 2025) found shingles vaccination is recommended in 17 countries, but only seven<\/strong> offer it free of charge to the age-based target group<\/strong> through the national healthcare system.<\/p>\n Those seven EU countries are:<\/p>\n Even within that \u2018free\u2019 list, the fine print matters: countries differ in the age at which eligibility begins (60 vs 65, for example), delivery routes, and how aggressively programmes are implemented.<\/p>\n Meanwhile, several other EU countries do not fund shingles vaccination broadly by age but do fund it for specific high-risk groups \u2013 immunocompromised people and those with certain comorbidities. The same review notes that vaccination for risk groups is free in a larger set of countries including Austria and Belgium (but not as a universal age-based free programme).<\/p>\n Ireland sits awkwardly in this picture: it is listed among the countries where vaccination is recommended, but the review explicitly notes that Ireland\u2019s national healthcare system does not offer free shingles vaccination, resulting in out-of-pocket payment.<\/p>\n So the pro-vaccine argument gets a European boost: Ireland wouldn\u2019t be doing something eccentric.<\/em> But the counter-argument also gets one: most of the EU still hasn\u2019t chosen to fund it universally by age.<\/em><\/p>\n The case against: cost, capacity, and the tyranny of the finite budget In a health system already strained by overcrowding, staffing gaps, and waiting lists, every new programme has to answer a blunt question: what do we stop doing, or delay doing, in order to do this?<\/em><\/p>\n It would be an excellent question to ask the Senators.<\/p>\n This is not cynicism; it is arithmetic. If you direct funds into shingles vaccination, you are choosing not to fund other interventions that produce benefits sooner or more visibly \u2013 extra community nursing hours, additional theatre sessions, improved diagnostics capacity, more home-care packages or better chronic disease management in primary care. In a perfect world, we would do all of it. In Ireland, we tend to do some of it while loudly announcing plans to do all of it.<\/p>\n There is also delivery capacity. Rolling out a national programme for everyone over 60 means thousands of appointments, two doses each, records, recalls, stock management, and a workforce to administer it. General practice is already stretched. Pharmacies are busy. If you create a free entitlement without the operational muscle to deliver it smoothly, you risk producing a programme that exists mainly in policy documents \u2013 which are, after all, an area in which Ireland has never lacked capacity.<\/p>\n Finally, adult vaccine uptake is not automatic. The best-funded programme in the world can still underperform if people don\u2019t show up, if communication is poor, or if misinformation fills the vacuum. So the \u2018against\u2019 case is partly: don\u2019t add another obligation until you\u2019re sure you can do it well.<\/p>\n Now the plot twist: dementia In April 2025, a high-profile study exploiting a \u2018natural experiment\u2019 in Wales \u2013 created by a birth-date cut-off for vaccine eligibility \u2013 reported that receiving the shingles vaccine was associated with about a 20 per cent lower risk of dementia diagnosis over roughly seven years of follow-up.<\/p>\n This matters because dementia is not a minor complication. It is among the most feared outcomes of ageing, and a major driver of healthcare and social care costs. If a vaccine already justified by shingles prevention also reduces dementia risk, the economic argument begins to wobble in a new direction.<\/p>\n But \u2013 and this is the part where the responsible adult in the room clears their throat \u2013 we must treat the dementia claim with care.<\/p>\n The Welsh policy design is valuable because it reduces some of the usual bias: it\u2019s not simply comparing \u2018health-conscious vaccine-getters\u2019 with everyone else. The mechanism is also biologically plausible: varicella-zoster virus can affect nerves and blood vessels; shingles is linked with inflammation and vascular events; repeated viral reactivation could contribute to brain injury or neuroinflammation over time.<\/p>\n Even strong observational designs can have residual confounding, and the Welsh programme used the older live vaccine (Zostavax), which has since been withdrawn in Europe in favour of recombinant vaccine strategies. The dementia signal may or may not translate directly to Shingrix, though many scientists consider it plausible and worthy of further study.<\/p>\n In other words, the vaccine is not a magical \u2018anti-dementia injection\u2019. It is, at most, a potential additional benefit that could be enormous if confirmed.<\/p>\n So what should Ireland do? The best argument against is that Ireland\u2019s health system is already triaging crises, the programme is not cheap, and implementation without robust delivery capacity could create a promised service that exists mainly as an aspiration.<\/p>\n The dementia evidence doesn\u2019t settle the question, but it does change the temperature of the room. If shingles vaccination reduces dementia risk even modestly, the programme might become not merely compassionate but strategically brilliant \u2013 the kind of prevention that saves suffering and money on a scale that makes today\u2019s price tag look like small change.<\/p>\n A sensible Irish approach might borrow from Europe\u2019s variety rather than choosing between extremes: start with universal free vaccination at 65 (or 60) and\/or immediate free access for high-risk groups, build delivery through pharmacies and primary care, and evaluate uptake and outcomes. Europe already demonstrates that \u2018recommended but self-paid\u2019 (Ireland\u2019s current position) is common \u2013 but it also demonstrates that \u2018free to the target cohort\u2019 is feasible and established in multiple systems.<\/p>\n The human body is a wonder of biological engineering \u2013 prone to breakdown \u2013 and public policy is an attempt to keep it from doing so, one boring, practical, quietly heroic measure at a time. If Ireland can afford to prevent a great deal of predictable suffering in older adults, it should at least be brave enough to do the maths properly \u2013 including the possibility that the maths might extend beyond rashes and pain, into memory itself. If shingles vaccination reduces dementia risk even modestly, the programme might become not merely compassionate but strategically brilliant, writes Terence Cosgrave There are many small humiliations in ageing, but few are quite as maliciously designed as shingles. Shingles is what happens when a virus you met briefly as a child \u2013 chickenpox \u2013 decides \u2013 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_daextam_enable_autolinks":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2],"tags":[],"class_list":["post-20491","post","type-post","status-publish","format-standard","hentry","category-health"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/20491","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/comments?post=20491"}],"version-history":[{"count":0,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/20491\/revisions"}],"wp:attachment":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media?parent=20491"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/categories?post=20491"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/tags?post=20491"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"terence](\"https:\/\/d1l0gza1nowsqe.cloudfront.net\/wp-content\/uploads\/sites\/4\/2023\/02\/terence_with_dog-500-300x300.jpg\")
<\/p>\n
<\/strong>The most persuasive argument for free shingles vaccination is also the least glamorous: it works. The modern recombinant vaccine (Shingrix) is highly effective at preventing shingles and, crucially, at preventing the long tail of misery that follows in a proportion of cases. In public health terms, shingles vaccination is not about heroics; it is about quietly stopping thousands of people from discovering that nerves can scream.<\/p>\n
<\/strong>This is where it helps to glance across the continent, because Europe shows that adult shingles vaccination policy is both widespread and oddly inconsistent.<\/p>\n\n
<\/strong>If prevention were free, we would all prevent. The chief obstacle here is that shingles vaccination is relatively expensive, particularly because it is a two-dose schedule and because adult vaccination programmes do not always enjoy the same procurement efficiencies and delivery machinery as childhood immunisation.<\/p>\n
<\/strong>This is where shingles vaccination becomes more than a rash prevention story.<\/p>\n
<\/strong>The best argument for free shingles vaccination over 60 in Ireland is that it prevents a common cause of severe pain and disability, reduces healthcare utilisation, and improves equity \u2013 and Europe shows that several countries have already judged it worth paying for.<\/p>\n![\"\"\/](\"https:\/\/d1l0gza1nowsqe.cloudfront.net\/wp-content\/uploads\/sites\/4\/2020\/09\/imt_end6.jpg\" "\\"\\"")
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