Patients on immunosuppressive treatments can now access the shingles vaccine for free.
Free access to the expensive shingles vaccination Shingrix has been expanded to include adults with underlying conditions or who are on immunosuppressive treatments.
The news has been welcomed by advocacy and patient groups and comes 10 months after Shingrix was added to the National Immunisation Program for a limited number of patients.
Initially the NIP listing was only for people aged 65 years and over, First Nations people 50 years and over, and immunocompromised people 18 years and over at high risk of herpes zoster infection.
The expanded listing, which took effect on 1 September but was formally announced by Health Minister Mark Butler on Sunday, means people aged 18 years and over “considered at increased risk of herpes zoster due to an underlying condition and/or immunosuppressive treatments” are now eligible to receive the vaccine for free.
The list now includes people who
- have acute or chronic blood cancers
- are HIV-positive with CD4+ cell count < 200/µL
- have inborn errors of immunity with ongoing functional deficits and IgA deficiency
- have stage 5 kidney disease or are on dialysis
- are receiving treatments for cancer, autoimmune or inflammatory conditions including:
- stem cell therapies
- CAR T-cell therapy
- B and T-cell targeted monoclonal antibody therapies
- conventional cancer chemotherapy
- immunosuppressive therapy to prevent organ rejection
- immunosuppressive agents such as high-dose methotrexate, azathioprine, 6-mercaptopurine, mycophenolate, cyclophosphamide, systemic calcineurin inhibitors, mTOR inhibitors, purine analogues
- some biologics, antibodies, immunomodulatory drugs including sphingosine-1-phosphate receptor modulators or oral small molecule targeted therapies
“We think that that will add about 215,000 Australians to the program, again expanding the most comprehensive shingles vaccine program in the world and save every single one of those 215,000 Australians around $560 to get this highly effective protection against a really terrible disease,” Mr Butler said on Sunday.
He said while Shingrix could be administered in pharmacies, “it will really require a discussion between a patient and their GP as to whether or not they qualify and would benefit from this”.
Rheumatology patients on so-called lower-risk biologics are not eligible, including anti-integrins, anti-IgE antibodies, anti-complement antibodies and lower risk IL inhibitors (17, 12/23, 31), the DoHAC listing states.
University of Queensland’s Associate Professor Michael Nissen, an infectious diseases physician, microbiologist and paediatrician, welcomed the expansion.
“Thanks to the government and Department of Health for taking on the advice of specialists and ATAGI for expanding the NIP to protect Australians at increased risk of shingles,” he told GR.
“These risks have been known for a while and the expanded NIP fills a gap for these additional patients and protects a wide group of immunocompromised people from the burden from shingles.”
Better Access Australia Chair Felicity McNeill PSM said the expanded access was an important first step in recognising the value of adult vaccination in patient groups “too long ignored, despite [what] the covid-19 pandemic taught us about the risk of viruses to older Australians, and those with already immunocompromised health”.
She said BAA and AusPIPS, a group which supports Australians with primary and secondary immunodeficiency, had been working together to bring changes to the draft NIP Strategy for 2025-30, which they believe is “almost silent on the priority of medical need in those with immunocompromised health”.
“While we have achieved change for one vaccine, Shingrix, we need reform for all current and future vaccines added to the NIP,” said Ms McNeill.
“The Australian Immunisation Handbook is full of recommendations on administering a vaccine where no funding is available. With another whooping cough season in the community, how many are aware of the recommendation of a booster every 10 years and how many in the community can afford that vaccine?”
AusPIPS president Jackie Murphy said covid had showed the importance of “timely, affordable access to preventive health care for those of us in the community who already spend too much time engaging with the health system.”
“Patients with PID and SID have no immune system to fight infection, so vaccination is a first line protection for all of us, keeping us healthy, and saving the healthcare system thousands of dollars a day in hospital admission costs,” she said.
The NIP has released latest program advice for health professionals that reflect the 1 September change. The Australian Immunisation Handbook (AIH) will be updated in November 2024.
Latest data from the National Centre for Immunisation Research and Surveillance on Shingrix vaccination in Australia shows that as at 6 May this year, almost one in five Australians aged 65 years and over had received at least one Shingrix vaccine dose.
NSW led the way – with 384,208 Shingrix vaccine doses given to people over the age of 18 between 1 November 2023 and 20 April 2024. It was followed by Victoria (294,648), Queensland (275,277), Western Australia (129,118), Tasmania (34,137), the ACT (18,180) and the Northern Territory (4154).
Almost 85% of Shingrix doses during that time were administered in a general practice setting.
Despite this, GPs have struggled to access enough supply of the vaccine to keep up with demand from patients. The RACGP and other peak organisations have repeatedly called on the government to increase supply, while DoHAC has said in a statement it is working with the supplier GSK Australia on a solution.
