Since the first of May this year, the pharmacy counter has been a legitimate place to get the pneumococcal vaccine in Ireland. If you are 65 or over and otherwise healthy, your community pharmacist can now give you the jab out of HSE stock, usually in the same ten minutes as your flu vaccine. It is a genuinely good change, and almost nobody has heard about it.
It also runs into a question that neither you nor the pharmacist can reliably answer. Before giving it, they have to establish whether you have had it before, because this is a once-in-a-lifetime vaccine and a repeat dose inside five years can cause a nasty local reaction. So they ask. And a great many people in their seventies and eighties say some version of the same thing: I think I had that one. Years ago. With the flu, maybe.
The honest answer is that in most of those cases, nobody can check.
TL;DR
- The vaccine Ireland gives over-65s is PPV23 (Pneumovax 23), not the conjugate vaccine used in the childhood programme. One dose, recommended here since 1996, and for most people never repeated.
- From 1 May 2026, community pharmacists can administer it under the national programme (HSE Circular NCO-15-2026), but the administration is only free if you hold a medical card, GP visit card or Health Amendment Act card. Everyone else may be charged a private fee for the injection, even though the vaccine itself is free.
- The HSE’s vaccination history system cannot see anything given before September 2022, or anything given privately by a GP, or in hospital. For the age group most likely to have already had it, the record is blank.
- Ireland’s only published estimate of adult uptake comes from a telephone survey carried out in 2013, which found 36 per cent of over-65s said they had ever been vaccinated. Flu uptake in the same age group is measured and published every single season.
- Chapter 16 of the national immunisation guidelines, which governs this vaccine, is dated July 2018. The influenza chapter beside it was revised in July 2026.
First, the vaccine is probably not the one you think it is
There are two families of pneumococcal vaccine, and the difference matters more than the names suggest.
Conjugate vaccines (PCV13, PCV15, PCV20) are what Irish children receive at two, six and thirteen months. They produce a strong, long-lived immune response, including in people whose immune systems respond poorly to other vaccines, and they reduce the bacteria carried in the nose and throat, which protects people who were never vaccinated at all.
Polysaccharide vaccine (PPV23, sold here as Pneumovax 23) is what adults get. It covers 23 serotypes of Streptococcus pneumoniae, more than any conjugate vaccine, but it produces a weaker and shorter-lived response, particularly in older adults, and it does not reduce carriage. The Health Protection Surveillance Centre puts it plainly in its own annual report: PPV23 “is important to give additional protection despite a lower vaccine efficacy than the PCV”.
The rule in Ireland is simple on paper. One dose of PPV23 for everyone aged 65 and over. If you were given it before the age of 65 and that was more than five years ago, you are due one further dose. If you have had a dose at or after 65, you should not have another, regardless of your immune status. People aged two and over with certain conditions are eligible earlier, and sometimes on a different schedule.
Worth saying clearly, because our own guide to pneumonia after 50 previously described the over-65 vaccine as PCV20: it is not. PCV20 (Prevenar 20) has held a European marketing authorisation since 14 February 2022 and is used in adults in other countries, but it is not part of the Irish adult programme. What you will be offered at 65 in Ireland is PPV23.
What actually changed in May
Under the Community Pharmacy Agreement 2025, HSE Pharmacy Circular NCO-15-2026, dated 23 April 2026, enabled and funded community pharmacists to give the public PPV23 from 1 May 2026. Before that, pharmacies had been giving it since 2015, but as a private service you paid for yourself.
You qualify for the pharmacy route if you are 65 or over, have no Group A or Group B risk factors as defined by the national guidelines, have not had PPV23 after the age of 65 or within the last five years, have not had a conjugate vaccine in the last eight weeks, and have no clinical reason to avoid it. People with those risk conditions are still directed to their GP, because their schedule can be more complicated.
Then comes the part that got no coverage at all. The circular says pharmacies will be reimbursed for administering the vaccine to eligible people “who have GMS/GPVC/HAA eligibility”. In plain terms: a medical card, a GP visit card, or a Health Amendment Act card. For everyone else, the circular continues, the pharmacist “may charge a private fee for administering the vaccine”.
The agreed public fee is €28.50 for giving PPV23 to an eligible cardholder, rising to €42.75 where flu and pneumococcal are given on the same day. If you do not hold a card, what you pay is whatever the pharmacy decides to charge. The same logic applies at the GP surgery, where the HSE’s own patient guidance notes that the consultation is free “if you have a medical card or GP visit card”.
So the vaccine is free to every person over 65 in the country. The act of putting it into your arm is free to some of them.
Flu made this leap six years ago
This is not a hypothetical problem, and we know what fixing it looks like, because Ireland already fixed it once.
Here is the HPSC describing its own flu programme, verbatim: “Between 2004/2005 and 2019/2020 seasons, the HSE provided flu vaccine and administration free of charge for those recommended vaccine if they had medical card or GP visit card. Since the 2020/2021 season the HSE extended access to free vaccination to all individuals in specified age, clinical, and occupational groups regardless of medical/GP visit card status.”
That single change is the dividing line between the two vaccines. Flu is free to administer to everyone eligible. Pneumococcal, in 2026, is still where flu was in 2019.
And the evidence that this matters is Irish. The 2013 national survey that remains our only published source on adult pneumococcal coverage found that people in at-risk groups were twice as likely to be vaccinated if they had free medical care or free vaccination services, and more than three times as likely if a doctor had recommended it. The two strongest predictors of getting vaccinated, in Ireland’s own data, were a recommendation and not being charged.
“I think I had that one”
The pharmacist is legally and clinically obliged to establish your history before vaccinating. The tool for that is the Vaccination History Search in HSE PharmaVax, and the circular is refreshingly honest about what it cannot see.
PharmaVax displays public PPV23 given in general practice since September 2022, and PPV23 given in community pharmacy since September 2022. It does not display any dose given before September 2022. It does not display doses given privately by a GP. It does not display doses given in a hospital or any other setting. It does not display conjugate vaccines at all.
Read that against the eligibility rule and the problem is obvious. The question the system needs answered is whether you had a dose after your 65th birthday. If you turned 65 before autumn 2022, which is to say if you are now 69 or older, the national record is structurally incapable of answering it. The people most likely to have already been vaccinated are precisely the people the database cannot see.
There is also no national HSE medical eligibility and consent form for PPV23. Each pharmacist assesses eligibility and takes consent themselves, using forms produced by their own representative body.
The number nobody has
According to the Central Statistics Office’s April 2026 population estimates, 891,063 people in Ireland are aged 65 or over. Every one of them is recommended a single dose of this vaccine.
Nobody publishes what share of them have had it.
This is not an accusation that the State measures nothing. It measures a great deal, which is what makes the gap visible. The HPSC has collated and published uptake for the childhood programme since 2000, and for school and booster programmes since 2013. Its 2025 pneumococcal report carries a slide headed “National PCV vaccine uptake”, which reports three-dose coverage at 12 and 24 months of age, 83.5 per cent and 81.3 per cent respectively. Every figure on it is about infants.
Adult uptake is measured too, just not for this vaccine. For the 2023/24 flu season the HPSC published uptake for over-65s at 75.7 per cent, 562,601 people out of an estimated 743,087, broken down into five-year bands: 60.1 per cent at 65 to 69, 73.3 per cent at 70 to 74, 88.4 per cent at 75 and over. Ireland can tell you, to a decimal place, how many people in their late seventies took the flu vaccine last winter.
For pneumococcal, the best available figure is from a computer-assisted telephone survey of 1,770 adults carried out in 2013 and published in the journal Vaccine in 2016. Thirty-six per cent of respondents aged 65 and over said they had ever been vaccinated, with a confidence interval running from 30 to 42 per cent. Among at-risk adults aged 18 to 64, it was 16 per cent. The authors, who included HPSC staff, opened by stating that in Ireland “vaccination uptake among at-risk adults is not routinely available”.
Thirteen years later, that is still the number researchers cite. A 2023 paper in Epidemiology and Infection, written by microbiologists at the Royal College of Surgeons in Ireland together with HPSC colleagues, describes adult uptake as 27 to 36 per cent against 81 to 92 per cent in the childhood programme, and attributes the difference to the fact that adult access “is more opportunist and it is not always free”.
Meanwhile, the disease
None of this would matter much if pneumococcal disease had quietly gone away. It has not.
In 2025 Ireland recorded 575 confirmed cases of invasive pneumococcal disease, an incidence of 11.2 per 100,000 and an increase of 17.8 per cent on 2024. Just over half of those cases, 295 of them, were in people aged 65 and over. The rate climbs steeply with age: 25.8 per 100,000 at 65 to 74, 45.8 at 75 to 84, and 77.0 at 85 and over. The median age of everyone who got it was 65.
Of the notifications where an outcome was recorded, 22 people died. That proportion is worth a footnote of its own, because the outcome field was completed for only 42.4 per cent of cases in 2025, against 87.1 per cent in 2018 and 97 per cent in 2017. The surveillance that tells us how serious this is has itself been getting thinner.
One more structural detail. Enhanced surveillance of invasive pneumococcal disease, the kind that records vaccination status alongside the infection, is carried out in Ireland on children and adolescents under 15. For the 295 older adults who were hospitalised with it last year, the national system does not ask whether they had been vaccinated.
Is PPV23 still the right vaccine?
This is where honesty is more useful than a verdict, because the Irish evidence cuts both ways.
PPV23 covers the serotypes that are actually causing disease here. The predominant types in 2025 were 8, 3, 19A, 4 and 9N, followed by 22F and 12F. Serotypes 8, 9N, 22F and 12F are in PPV23 but not in the conjugate vaccine used in Irish children. When the RCSI and HPSC team ran the arithmetic on 2021 data for people aged 65 and over, PPV23 covered 63 per cent of cases, against 57 per cent for PCV20 and 37 per cent for PCV15. On breadth alone, the vaccine Ireland uses wins.
The counter-argument is about quality rather than breadth. Polysaccharide vaccines produce a weaker response in older adults, they wane, and they do little against the non-bacteraemic pneumonia that sends most people to hospital. That same team concluded that “consideration should be given to providing a PCV to this age group”. It is fair to note that two of the authors have declared consultancy fees from the vaccine’s manufacturer, and that the surveillance work was part-funded by the same company, which they disclose in the paper.
There is also a live warning in the Irish data that no vaccine currently fixes. Disease caused by serotypes in no vaccine at all rose significantly in people aged 65 and over in 2025 compared with 2008. Serotype 23B, absent from PCV15 and PCV20, went from 1 per cent of older-adult cases in 2020 to 6 per cent in 2021.
Other countries have moved anyway. The United States recommended a conjugate vaccine for all adults over 65 some years ago, and on 23 October 2024 extended that to everyone aged 50 and over who has never had one. The European regulator authorised Prevenar 20 across the EU in February 2022, with the caveat that for some serotypes the antibody response was lower than with the older conjugate vaccine.
Ireland has not had that argument in public. Chapter 16 of the Immunisation Guidelines for Ireland, which sets out everything above, is dated July 2018 on every page. The chapter sitting next to it on influenza was revised in July 2026. The National Immunisation Advisory Committee’s most recent published advice on pneumococcal vaccines, issued on 25 October 2024, concerns the childhood schedule only, and the word pneumococcal does not appear in the minutes of any of its four published 2025 meetings.
That is not evidence that the committee is wrong. It is evidence that the question has not been taken up, while the disease rate in over-65s climbs.
What to do with all this
If you are 65 or over, the practical version is short.
Ask whether you have had it. Your GP practice is the place to start, not the pharmacy, because the practice record goes back furthest. One phone call usually settles it.
If you have not, get it. One dose, any time of year, and it can be given at the same appointment as flu, COVID-19, RSV or shingles vaccines. Autumn is the practical moment because you are likely to be in for the flu vaccine anyway.
Ask about the fee before you book. If you hold a medical card, GP visit card or Health Amendment Act card, administration is covered at both the GP and the pharmacy. If you do not, ask what you will be charged, and ask both. It is a question that embarrasses people, and it should not.
If you are under 65 with one of the listed conditions, you are eligible now. Diabetes, chronic lung, heart, liver or kidney disease, chronic neurological conditions, coeliac disease, Down syndrome, cochlear implants, a weakened immune system, HIV, spleen problems, cerebrospinal fluid leaks or a brain shunt. Your schedule may involve two doses five years apart, which is a conversation for your GP.
Write it down. Whatever you are given, note the date and the vaccine name somewhere you will find it in ten years. Given what the national record can and cannot see, your own note may end up being the most reliable source anybody has.
At Críonna Health we keep returning to the same shape of story, because Ireland keeps producing it: an entitlement that exists, that works, that costs the State very little, and that nobody is responsible for telling you about. The pneumococcal vaccine is one of the clearest examples. It has been recommended here for thirty years. It became easier to get in May. And the last time anyone counted how many people over 65 had actually received it, the answer was 36 per cent, and that was in 2013.
This article is for general information and is not a substitute for individual medical advice. Talk to your GP or pharmacist about your own circumstances, particularly if you are unsure whether you have been vaccinated before.
Sources: HSE Pharmacy Circular NCO-15-2026 (23 April 2026); HSE patient guidance on the pneumococcal vaccine; NIAC Immunisation Guidelines for Ireland, Chapter 16, July 2018; HPSC Annual Epidemiological Report, Streptococcus pneumoniae (invasive) in Ireland, 2025; HPSC Seasonal Influenza Vaccine Uptake in Ireland, 2023-24; Giese C et al., Vaccine, 2016; Humphreys H et al., Epidemiology and Infection, 2023; CSO Population Estimates, April 2026; MMWR, 9 January 2025; European Medicines Agency, Apexxnar.
📷 Photo by Ángel Nava on Unsplash
