Greater Support Needed For Older Kiwis To Close Gaps In Funded Vaccine Programme

Experts are calling for greater support for the thousands of Kiwis aged 65+ who are most at risk of an intensely painful and debilitating disease.[1]

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Even those who appear healthy but are aged 50+ are at risk of developing shingles.

Almost all adults aged over 50 already have the virus that causes shingles lying dormant in their body due to an initial chickenpox infection. Around a third of these will develop shingles in their lifetime when the virus reactivates.[2]

Shingles can also be intensely painful, and the disease is associated with a range of complications which for some people can include potentially long lasting nerve pain, vision loss, hearing loss, scarring and neurological problems and less common, cardiovascular and stroke events.[3][4][5]

Spokesperson for Grey Power, Jo Millar, says the currently funded vaccine programme has created several gaps that could leave many older Kiwis vulnerable to the disease.

She says there is a very specific window at which funded shingles vaccine doses can be accessed for those aged 65.

A shingles vaccine is free only for the 12-month period after a person’s 65th birthday. Two doses are funded, the first dose must be given in the 65th year. There is a cost for the shingles vaccine outside this time.[6]

“Under current funding guidelines, there is a considerable number of older people who missed out on getting the shingles vaccine, either because they were over 65 when it was funded, or because they didn’t get the vaccine in their 65th year due to them not knowing, or not being able to access a GP due to post COVID-19 measures.

“There is an urgent need for funding for all adults over 65 years of age, who are at increased risk and have a reduced ability to pay for the vaccine privately. Many of our members are pensioners and they simply can’t afford to pay for the vaccine,” says Millar.

The number of Kiwis aged 65+ is expected to grow to 1 million by 2028 and reach 1.5 million by the 2050s.[7]

According to Ministry of Health pre-pandemic figures around 60% of hospitalisations due to shingles occur in adults aged 60+. It is believed that the number of those hospitalised annually (483) is a very small proportion of the total number of shingles cases, as most are managed at a primary care level by GPs.[8]

“What I’m concerned about is the number of our members who develop shingles when they are in their seventies and have ended up in hospital for three or four days unnecessarily.

”In todays society it is sadly not unusual for people to feel like they have become invisible once they turn 65. It should not be forgotten that 65 year olds and older are often still actively working whilst many also volunteer and contribute to society in invaluable ways. As such, it is clear a greater investment is needed when it comes to the health of 65’s and over”.

Geriatrician Dr Tyson Oberndorfer says anyone who has had chickenpox previously is at risk of developing shingles at some stage in the future, as the virus remains with us and is suppressed by our immune system.

“Our immune system is usually very good at keeping the virus in check, but as we age it becomes less effective, allowing the virus to reactivate. This is particularly debilitating in older patients, often with significant and lasting consequences – especially for those who are frail,” he says.[9][10]

Dr Oberndorfer says older Kiwis are more at risk of developing a common complication from shingles known as postherpetic neuralgia (PHN).[11]

PHN is a result of damaged nerve fibres sending confused and exaggerated pain messages from the skin to the brain. This can be in the form of a persistent; stabbing pain that can last for years and can cause depression, anxiety and the reliance on long term pain medications.[12][13]

Age is an important risk factor when it comes to the development of PHN. It is estimated that 20% of patients aged 60 – 65 years and 30% of patients aged over 80 years experience post-herpetic neuralgia.[14]

Dr Oberndorfer says the nerve pain caused by PHN significantly impacts a patient's quality of life and can be ongoing and medications used to manage PHN can often have side effects like cognitive impairment and increased risk of falling.[15]

“By limiting funding for the new vaccine to just those in their 65th year, we are neglecting our older patient populations who are most vulnerable to shingles,” he says.”

Millar agrees saying those in their more advanced years still have much to offer the community and need better access to preventative medicines.

“Older people are valuable members of our society. They have a lot of knowledge and a great deal of life experience that you wouldn’t find in a textbook because it's learned through life’s journey. But they are on a pension and when they have paid for all of their utilities like power and rates there isn’t enough for them to pay for vaccines, even though for some diseases like shingles, they are at increased risk,” says Millar.16

Amanda Southcombe general manager for GSK NZ says prioritising a greater investment in vaccines which protect New Zealanders, can help to reduce the burden on the health system.

“The recent funding announcement is a positive first step to address the extensive prioritised waiting list for standard of care medicines and vaccines and GSK is committed to collaboratively working with Pharmac, the Government and its officials to get vaccines and medicines to patients as quickly and proficiently as possible.”

Notes: 

Dr Tyson Oberndorfer - Tyson Oberndorfer is a Consultant Geriatrician at Taranaki District Health Board. He is medical co-director of the Frailty Initiative, which aims to develop a pathway of care for older people with frailty as they move through the healthcare system. Prior to moving to NZ, he held an Assistant Professor position at the University of Colorado and was the co-founder and medical director of the UCHealth Fall Prevention Clinic.

[1] Turner NM, MacRae J, Nowlan ML, McBain L, Stubbe MH, Dowell A. Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm. BMJ Open. 2018;8(5)

[2] Centers for Disease Control and Prevention. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2008 May;57(RR-5):1-30.

[3] Cohen KR, Salbu RL, Frank J, Israel I. Presentation and management of herpes zoster (shingles) in the geriatric population. P T. 2013;38(4):217-227. Accessible here.

[4] Catron T, Hern HG. Herpes zoster ophthalmicus. West J Emerg Med. 2008;9(3):174-176. Accessible here.

[5] Erskine N, Tran H, Levin L, et al. A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One. 2017;12(7):e0181565. Published 2017 Jul 27. doi:10.1371/journal.pone.0181565. Accessible here.

[6] PHARMAC. Shingles vaccine: Shingrix is funded for people aged 65 years old exactly. September 2023 https://pharmac.govt.nz/medicine-funding-and-supply/medicine-notices/shingrix

[7] Stats New Zealand here

[8] Ministry of Health New Zealand;2024;1-666

[9] Bricout H, Haugh M, Olatunde O, Prieto RG. Herpes zoster-associated mortality in Europe: a systematic review. BMC Public Health. 2015 May 5;15:466. doi: 10.1186/s12889-015-1753-y. PMID: 25940080; PMCID: PMC4435558. Accessible here.

[10] Jiahui Qian et al;The Journal of Infectious Diseases, Volume 220, Issue 1, 1 July 2019, Pages 3–11, https://doi.org/10.1093/infdis/jiy625here

[11] Kawai K et al;BMJ open;2014;4;1-18. Accessible here

[12] Kawai K et al;BMJ open;2014;4;1-18. Accessible here

[13] Sansone RA, Sansone LA. Herpes zoster and postherpetic neuralgia: an examination of psychological antecedents. Innov Clin Neurosci. 2014;11(5-6):31-34. Accessible here.

[14] Fashner J, Bell AL. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician 2011;83(12):1432–7.

[15]John A et al;Infect Dis Clin North Am;2017;31;811–826. Accessible here

16 Kawai K et al;BMJ open;2014;4;1-18. Accessible here

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