Closing NZ’s vaccine funding gaps could create ‘silver dividend’ - advocate

Experts say more needs to be done to protect thousands of Kiwis aged over 65 years, who are at a higher risk of an excruciating and debilitating disease that can cause severe and long-term complications.^{1 2 16 *}

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox.²

Almost all adults aged over 50 already have the virus lying dormant in their bodies due to an initial chickenpox infection. Around one in three people will develop shingles in their lifetime when the virus reactivates.^[2]

Shingles can be intensely painful, and the disease is associated with a range of complications which can include potentially long-lasting nerve pain, vision loss, hearing loss, scarring and neurological problems and less commonly, cardiovascular and stroke events.^{23 4 5}

Grey Power spokesperson and aged care advocate Jo Millar says the current funding programme is narrow and excludes many older Kiwis who are vulnerable to the disease. So older adults have lost out.

The previous shingles vaccine was funded for people at 65 years, and also for those 66 to 80 years old through a catch-up programme which enabled wider access. When the national immunisation schedule changed vaccines in 2022, funding was approved only for individuals at 65 years.^{8 15}

She says increased support for the health of this demographic could help create a ‘silver dividend’ for the country.

“We need to ensure that older Kiwis have access to essential vaccines and treatments, so we can reduce healthcare costs associated with preventable diseases and empower our seniors to continue contributing actively to society. This approach transforms the challenges of an aging population into a 'silver dividend,' deriving economic benefits for all New Zealanders.

The number of Kiwis aged 65 years or older is expected to grow to 1 million by 2028 and reach 1.5 million by the 2050s.^[6]

According to Ministry of Health pre-COVID-19 pandemic figures, around 60% of hospitalisations due to shingles occur in adults aged 60 years and older. It is believed that the number of those hospitalised is a very small proportion of the total number of shingles cases, as most are managed by their GPs.^[7]

The Shingrix vaccine is funded for the 12 months after a person’s 65th birthday. Two doses are funded, the first dose must be given at age 65 years.^[8]

Millar says this means many older Kiwis are potentially vulnerable to the disease, either because they were already over 65 when funding was introduced or because they missed the small window at that age due to a lack of awareness or difficulty accessing a GP.

“I refer to our generation as the ‘forgotten generation’ or the ‘invisible ones’. Over 65’s play a vital role in keeping the economy going even if it is not always as part of the paid workforce. Older Kiwis give hours of their time volunteering and supporting the more vulnerable community members.

“In addition to this, many are helping to raise grandchildren so their parents and caregivers are able to work, if grandparents are sick in hospital for an extended period this can have a direct economic impact on the already stretched health system and loved ones. We know that those over 65 years have a higher risk of shingles and many simply can’t afford to pay for the vaccine privately.

“Investing in comprehensive healthcare for older New Zealanders not only enhances their quality of life but also yields significant economic benefits,” she says.

Geriatrician Dr. Tyson Oberndorfer says anyone who has previously had chickenpox carries the risk of developing shingles later in life, as the virus stays in the body and is suppressed by the immune system.

"As we age, our immune system becomes less effective at suppressing the virus, increasing the risk of reactivation. For older adults, especially those who are frail, this can lead to severe and long-lasting complications," he says.^{2 910}

Dr Oberndorfer says older Kiwis are more at risk of developing a common complication from shingles known as postherpetic neuralgia (PHN).^{2 11}

PHN is often described as a persistent throbbing, burning or shooting pain that may last for years and can cause depression, anxiety and the reliance on long term pain medications.^{2 12}

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.^[13]

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.^[14]

"The current funding for the 12 months after a person’s 65th birthday excludes those over 65 who have the greatest health need," he says.

Amanda Southcombe, general manager for GSK NZ, says increasing access to innovative vaccines is essential for protecting New Zealanders from preventable diseases like shingles.

"Shingles can have a severe and lasting impact on a person’s health and quality of life, particularly for older adults. Ensuring broader access to vaccination is a crucial step in reducing the burden on individuals, families, and the healthcare system. GSK remains committed to working with health authorities to expand access and raise awareness about the importance of shingles prevention," she says.