Free shingles vaccine rollout hits day-one roadblock

Extensive delays have plagued the beginning of the new $800 million shingles vaccine rollout, with GPs left to deliver the bad news to ‘irate’ patients lining up for treatment they cannot access.
 
Doctors across the country are pleading with the Federal Government to sure up the supply chain, with the number of vaccines available to practices falling significantly short of what is needed.
 
As of Wednesday, five million Australians have access to a free recombinant zoster vaccine (RZV, sold as Shingrix), following its addition to the National Immunisation Program (NIP) schedule.
 
The highly-anticipated rollout was announced last month and will see RZV replace the live-attenuated varicella zoster virus vaccine (sold as Zostavax) on the NIP.
 
Dr Martina Gleeson is a GP at the Caringbah Family Practice in New South Wales.
 
She told newsGP the practice was only able to order its vaccines on Tuesday night, the night before the program began, and could only access 30 vaccines for the entire month.
 
‘We have 2500 patients over the age of 65, and a number of patients with transplants and blood cancer,’ Dr Gleeson said.
 
‘We have told all our patients who are eligible on the basis of age that we won’t be able to give it to them until we have prioritised our highly immunosuppressed patients, and we will be actively recalling our people with transplants, and our people with blood cancer, and doing them first.
 
‘It’s like being back in the COVID days where you have to prioritise some people ahead of others because you’ve been given inadequate supplies.’
 
The Department of Health and Aged Care (DoH) did not say how many vaccines it currently has at its disposal but plans to distribute 1.6 million doses to providers between now and 30 June 2024, including 500,000 doses before the end of the year.
 
‘Distribution to local providers such as GPs and pharmacies is arranged by the individual states or territories to ensure local supply is managed appropriately,’ a spokesperson told newsGP.
 
‘The amount of Shingrix vaccines purchased for the NIP is determined using Australian Bureau of Statistics population estimates for the eligible cohorts.
 
‘As this is an ongoing program, there is no urgency for members of the public to be vaccinated. Members of the public are encouraged to call ahead to check vaccine availability for all vaccines on the NIP.’
 
But given patients immunised under the NIP with the older, less effective vaccine need to wait five years before accessing a subsidised dose of RZV, Dr Gleeson said many have decided to wait until 1 November and she is now concerned they could catch shingles before supplies arrive.
 
‘It is a worry because it’s such a debilitating disease and it can have such long-term consequences for some people, which is the whole reason why we want the vaccine,’ she said.
 
‘We are efficient at rolling out our vaccines and my practice nurses were ready to go.
 
‘My admin staff are having to take calls from irate patients who are upset because they can’t get the vaccine even though the Government promised them that they would be able to get it.’
 
Under the NIP, the vaccine is free for every Australian aged over 65, Aboriginal and Torres Strait Islander people aged over 50 years, and immunocompromised people 18 years and over at high risk of herpes zoster infection.
 
It was a move welcomed by the RACGP, with RZV significantly more effective in preventing shingles that its predecessor.
 
GP and Immunisation Coalition Chair Dr Rod Pearce described the new vaccine as ‘fantastic’ and ‘exciting’, but says the lack of access has meant doctors now need to make the difficult decision of who gets it and who misses out.
 
‘There’s this big equity issue in this announcement from the Government which says, “right, we’re going to have these vaccines that everyone aged 65 gets, except for a few”,’ he told newsGP.
 
‘And then it’s the GPs who have to decide whether the healthy 65-year-old has the priority over the 74-year-old with a disease, or the 85-year-old who’s been waiting for a vaccine.
 
‘The way the Government’s organised it onto the shoulders of the GPs … it just seems [like] Australia has a really weak, inequitable system.’
 
According to the Australian Institute of Health and Welfare, one in three people will develop shingles in their lifetime, and 20% of those will suffer severe nerve pain which can become permanent.
 
Federal Health and Aged Care Minister Mark Butler described the virus as ‘a very serious public health menace’ when launching the free vaccine.
 
‘Hospital operators have said to me that shingles and issues associated with shingles among older Australians is presenting in their hospitals with increasing frequency,’ he said.
 
But Dr Pearce said moving forward, there needs to be a more streamlined system and better cooperation between State and Federal Governments to ensure patients have equal access to treatment.
 
‘We’ve just had three years where the Federal Government’s actually been in charge of distribution and now, they’re reverting to states having control of distribution and making up their own rules,’ he said.
 
‘To distribute any new program or any vaccines, the states need to work closely with their providers, whether they’re GPs or pharmacists, so that there’s a predictable rollout.
 
‘There needs to be some transparency about why certain people are getting it before others.’
 
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National Immunisation Program shingles Shingrix vaccination