Underused, Shingles Vaccine Beset with Problems

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Shingles on the waist, above the eye, and forehead, CDC.

If you talk with people who have had shingles, many will tell you that it took a terrible toll on them and that they wish that they could forget about the entire experience. Some can’t. “Freddy” had shingles three years ago, when he was 61. A decorated Vietnam veteran, he told me that nothing prepared him for the incredible pain, headaches, fever, nausea, and numbness that he had from shingles. Freddy had a painful rash on his left side and fluid filled blisters. His entire left side was affected and he says that he still has numbness. He went to work, but was miserable, and immediately went to bed when he got home. His doctor told him that his symptoms were “classic” signs and symptoms.

In 2006, the shingles vaccine was approved and recommended for people age 60 whose immune system was good. However, the uptake for the vaccine is just 10 percent. If this was the case with uptake of childhood vaccines, people would be in an uproar.

Shingles is caused by the same virus that causes chicken pox, the varicella- or herpes-zoster virus. Once you have chicken pox, the virus remains in your body in a dormant state for the rest of your life. The risk for shingles rises with age.

  • The Shingles Prevention Study found that the vaccine reduced the odds of getting shingles and postherpetic neuralgia (pain along a nerve three months after symptoms begin) by 51 percent;
  • The shingles vaccine is covered under Medicare Part D; however copays vary widely, depending on your plan;
  • About one in three individuals will get shingles in their lifetime;
  • Those individuals who get vaccinated and get shingles will have a less severe case, have decreased likelihood of loss of work, and lower treatment costs;
  • In one study, African Americans got vaccinated less and the risk for shingles was lower; however, researchers maintain that the burden is still considerable and urge all groups to get the vaccine;
  • Because the vaccine was only licensed recently, the duration of its effectiveness remains unclear and is under study.
  • The Advisory Committee for Immunization Practices recommends that people age 60 and over get the vaccine. However, most people don’t know about it, doctors don’t recommend it, and pharmacies often don’t carry it because of storage issues. It is also one of the costliest vaccines available: costing as much as 20 times what the flu vaccine costs, and 4 times as much as the pneumonia vaccine.

Freddy says that he would have definitely gotten the vaccine, but he knew nothing about it. That says something: Freddy works as an analyst for a health agency in the mid-Atlantic.

“This vaccine is a perfect storm,” says Rafael Harpaz, MD, MPH, epidemiologist with the Centers for Disease Control and Prevention, Immunization Services, National Center for Immunization and Respiratory Diseases, Atlanta GA. “It is one of the most expensive vaccines, there are big supply shortages, the manufacturer [Merck] does not promote it, and doctors don’t tell patients about it because it is difficult to get. Added to that are reimbursement issues: it may be unaffordable or require cumbersome paperwork for people to get their money back.”

In New York, one patient told me that she went to several chain drugstores: all told her that they never carry it and her doctor had no idea where to find the vaccine. Finally, a pharmacist at an independent pharmacy told her that the vaccine was on order and that they would have it in four months. That was not all. She’d get a prescription from her doctor, have to pick up the vaccine dose, and have the doctor give her the shot. The pharmacy warned her to check with her health plan on the cost so that she would be sure that she wanted it. She gave up.

Harpaz pointed out that adult vaccines are “an extremely tough sell.” It took decades to get the pneumonia vaccine up front and it took doctors demonstrating that preventing pneumonia was cost effective and pushing it aggressively as a way to stop unnecessary hospitalizations. The pneumonia vaccine is part of Medicare Part B.

Shingles vaccines may not be promoted very much unless more data comes out that demonstrates adverse effects on employee work performance (days out of work, in pain, and discomfort) or high treatment costs linked for people who don’t get vaccinated.

The shingles vaccine is covered under Medicare Part D, but that doesn’t mean it is affordable. Out of pocket expenses for the vaccine are all over the map, very much dependent on who negotiates what contracts with whom.  The Government Accounting Office is exploring ways to make these vaccines more accessible and simplifying payment and reimbursement.

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8 Responses to Underused, Shingles Vaccine Beset with Problems

  1. Thank you for this. Have their been any economic analyses of the benefit of the vaccine?

    AM

  2. I should have searched before commenting! Yes, there have been including this one http://www.resource-allocation.com/content/8/1/7/ which shows that it would be cost-effective in the UK.

  3. jean harrington says:

    Thank you for writing about this little-known vaccine and the horrors of having shingles.
    The severe pain from shingles can last the rest of your life.Anyone who has had chicken-pox can get it.I’ve heard the reason that it’s not promoted by the health departments, is that it’s not ‘contagious’. But, the larger issue is why it’s not promoted by doctors themselves.

  4. Laura Newman says:

    Thank you for your comments. I do think that doctors may not promote it because of all the problems: Americans can find it because of drug shortages, it is relatively unaffordable (priced at $150 by Merck/may be cheaper in health plans), it is difficult to store, and the system is not set up to give it. The healthcare system itself must change for this to be used more widely. I wonder if there could be vaccination days and vans giving the vaccines like mammograms are done. This is not a problem of patient literacy. The system doesn’t work. As for cost effectiveness studies, Merck did one, but because they stand to gain from selling it, it is not likely that it will be taken seriously. I think that people who get shingles often have a terrible time. It is somewhat invisible.

  5. I don’t understand how vaccination programmes work in the US- obviously not in the same way as in the UK, and we don’t yet have a plan to administer it. It seems plans are stalled over negotiations to get it at cheaper cost.
    http://news.bbc.co.uk/1/hi/health/8487987.stm

  6. Alana says:

    Naively, I had no idea the vaccine was so hard or expensive to get. I will be turning 60 next year. My walking partner was diagnosed with shingles earlier this month. An ex-boss is still suffering greatly a year after diagnosis. I was wondering why neither had received the vaccine (both are in their 60’s) – didn’t their doctors recommend it? No, their doctors hadn’t. Mine hasn’t talked to me about it, either. Nor has my husband’s doctor. Why the secrecy about a vaccine that could prevent or mitigate such a horrible illness? Now I know.

  7. Marilyn Mann says:

    I was able to get the shingles vaccine at my local Safeway pharmacy (I live in Maryland). My doctor wrote a script for it. The vaccine just recently got a new indication for people over 50.
    http://www.medscape.com/viewarticle/742867

    • Laura Newman says:

      Thanks for the updated information. Experts tell me that we will see more vaccines dispensed at the pharmacy. I’d love to know how available these are geographically. In NYC, shingles clinics at drugstores do not yet exist, perhaps because the vaccine requires refrigeration and space is at a premium. I have to be careful to not think NYC is representative. Hardly!! Perhaps I should have gotten my shingles vaccine last week: I was in Maryland for a few days.

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