Doctors told to prioritise vulnerable patients as stocks of shingles drug dwindle

The $826.8 million free Shingrix vaccination program began on November 1 with Australians aged 65 and over and First Nations people over 50 able to get a free shingles vaccination from their GP.

Immunocompromised people 18 and over at high risk of herpes zoster infection are also eligible.

Patients need to receive two doses for full protection.

However, supplies of the vaccine are limited with the federal government in discussion with drug company GSK on supply. The government is responsible for the management and implementation of the National Immunisation Program and the supply and distribution of vaccines in conjunction with states and territories.

Doctors in NSW have been told they will only receive between five and 20 doses a month (depending on the number of providers at their clinic) and will have to prioritise their highest risk patients for vaccination.

The previous shingles vaccine Zostavax (free for people aged 70 with a catch-up program to 79) was removed from the National Immunisation Program on November 1 meaning anyone who wants that vaccine will have to pay privately if they can obtain it.

In a joint statement with the Royal Australian College of General Practitioners, the Australian Medical Association, the Pharmaceutical Society of Australia and the Pharmacy Guild of Australia, NSW Health told doctors, "In the early stages of the program high demand and limited availability of Shingrix vaccine supply to states and territories is anticipated, requiring NSW Health to restrict supply.

"To manage vaccine supplies in the early stages of the program, it is recommended that providers prioritise their highest risk patients for vaccination. Risk of developing shingles increases with age and is higher in people who are immunocompromised."

The statement said as the recommended scheduling of Shingrix doses is two to six months and one to two months for immunocompromised people, providers should consider their current vaccine stock when booking patients for their second vaccine dose.

Shingrix provides around 10 years of protection and previously cost up to $560 for two injections.

A Department of Health and Aged Care spokesperson said 1.6 million doses of Shingrix are expected to be distributed to providers between now and June 30, 2024 with vaccine stock distributed to providers as it comes into the country. Distribution to local providers such as GPs and Pharmacies is arranged by the individual states or territories to ensure local supply is managed appropriately.

One in three people will develop shingles at least once in their lifetime. The condition is caused by a reactivation of the same virus that causes chickenpox (varicella zoster virus) which lies dormant in the body. Shingles can cause a painful, blistering rash on one side of the face or body that lasts 10-15 days. Shingles on the face can affect the eye and cause vision damage.

Older people are most vulnerable to shingles but it can affect people of any age.

Most older adults in Australia will have been exposed to chickenpox as a child. There is now a vaccine available for children.

One in five people with shingles will develop severe nerve pain known as postherpetic neuralgia that can last months or even years. In some cases, it may be permanent. The risk of developing shingles increases with age and people aged 65 years and over are at highest risk of complications.

There are antiviral drugs which can be effective if taken early in an infection - just after the blisters appear.

A spokesperson for SA Health said supplies of Shingrix are currently limited. "We encourage providers to book appointments after stock has been received to ensure they have enough vaccines for those wanting them."

Unlike influenza and COVID-19, there is no urgent public health need in South Australia to quickly vaccinate as many people as possible with Shingrix.

Last month Health Minister Mark Butler said, "older Australians will now have free access to the best protection against shingles through one of the most comprehensive and widely available vaccination programs in the world."

Other Australian state health departments were contacted for comment.