A patient receives a Prevnar and shingles vaccine at a CVS in Huntington Park in August, 2024. The U.S. offers free shingles vaccinations through its Medicare program.Christina House/Getty Images
One of the most frustrating aspects of Canada’s decentralized health care system is how it results in inconsistent, and often incoherent, public policies.
Take, for example, the largely overlooked issue of shingles infection.
Anyone who has had chickenpox – which is about 90 per cent of people born before 1995 – can develop shingles later in life, and about one-third will do so at some point.
Shingles can cause pustulent sores and, in up to one in five cases, post-herpetic neuralgia, a form of debilitating nerve pain that has been likened to “being wrapped in flaming barbed wire,” and even deafness and blindness.
Yet, these woes are largely preventable because there exists a highly effective vaccine to prevent shingles. In clinical trials, Shingrix was 97 per cent effective in adults between the ages 50 and 69, and 91 per cent effective in those over 70. That protection lasts for at least 7 years.
The National Advisory Committee on Immunization recommends that everyone over the age of 50 get vaccinated, as well as anyone over the age of 18 who is immunocompromised. But only 38.3 per cent of adults over 50 has actually had the shot. (Which requires two doses, two to six months apart.)
One of the principal reasons is the cost, roughly $400.
The other, related issue is spotty public coverage.
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Ontario started covering shingles vaccine for some seniors back in 2016, and other jurisdictions have gradually come on board.
But eligibility rules are all over the map.
Only Newfoundland and Labrador, and Prince Edward Island follow the evidence-based NACI recommendations to the letter, offering shingles vaccine at no cost to everyone over age 50, and younger adults who are immunocompromised.
Aforementioned Ontario covers Shingrix for seniors age 65-70, except those who previously received Zostavax, an earlier version of shingles vaccine.
Nova Scotia offers the shot to anyone over the age of 65, in Quebec you have to be over the age of 71 (or immunocompromised), while in the Yukon only those aged 65-79 are eligible.
Meanwhile, in Alberta and Saskatchewan the shingles vaccine is covered publicly only for organ transplant patients, or those treated with stem cells or CAR-T therapy for cancer.
In Manitoba, New Brunswick, Northwest Territories and Nunavut, people who want to be vaccinated against shingles must pay out-of-pocket or depend on private insurance benefits.
Finally, in B.C., there is no public coverage of shingles vaccine, except for First Nations elders over age 60.
Dan Levitt, the provincial Seniors Advocate, has been highly critical of B.C.’s lack of coverage of shingles vaccine, saying it could reduce physician visits, ER use, and hospitalization.
The National Institute on Ageing has also called out the wildly different coverage rules from province to province, saying they don’t make any sense.
They have a point: Why should someone be eligible for a free shingles vaccine in PEI but not B.C.?
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Canada may not have a national health care system, but that doesn’t preclude having coherent national policies on essential issues like vaccination.
The U.K. offers free shingles vaccination to everyone over 65. The U.S. to everyone on its Medicare program. They do so because it’s cost-effective.
These policies have been bolstered of late by research showing that shingles vaccine is associated with lower rates of heart attack and stroke, and dementia.
According to the Public Health Agency of Canada there are 130,000 shingles cases in Canada annually, including 17,000 cases of post-herpetic neuralgia, and 2,000 hospitalizations. Costs of care are estimated at $67- to $82-million a year.
Surely our health dollars would be better spent on preventing shingles than treating its painful symptoms.
In Canada, we cover varicella vaccination for all children to prevent chickenpox. (Mind you, Canada also lacks a unified, national immunization schedule and centralized digital registry for children, but that’s an issue for another day.)
It makes sense to do the same to prevent the re-activation of a virus – which is essentially what shingles is.
Over time, widespread chickenpox vaccination should greatly reduce the likelihood of shingles but, in the meantime, we should be aiming to protect people at both ends of the age spectrum from the ravages of varicella-zoster virus.
Shingles should serve as a reminder too that vaccination is not just for children, and that we need a life course strategy for protecting Canadians from infectious diseases at all ages.