Patients don’t experience shingles risk in five-year increments

The gap between shingles risk and funded vaccine access is leaving GPs with some difficult conversations.

---

GPs understand the importance of funding thresholds.

We also know that the clinical risk of any patient in front of us rarely fits neatly within one. It changes with age, comorbidities and individual circumstances, which can often mean recommending interventions to patients who stand to benefit from it before funded access begins. It makes for what can be a difficult conversation for GPs.

That familiar tension in preventative medicine is apparent with shingles. More than 97% of Australians have been exposed to the varicella zoster virus by age 40, meaning almost all of us carry the virus that can reactivate as shingles.^1-3 Risk rises with age, increasing significantly from around 50,^4-6 and ATAGI recommends Shingrix for immunocompetent adults from the age of 50.⁷

Importantly, that risk continues to increase steeply through the years that follow, with incidence increasing in adults aged 60-64.^4-6,8-9 It does not suddenly emerge overnight, or on a particular birthday. It’s somewhat unpredictable, with stress and other variables playing a role. Those aged 60-64 years are approaching the current funded threshold as their clinical risk increases, yet most remain outside NIP-funded access.⁷

With the PBAC currently considering expanded funded access to Shingrix for this age group, general practice has something critical to contribute to the discussion. We see what those five years between recommended prevention and funded eligibility actually mean for these patients who are at increasing risk of shingles. We know that patients don’t experience risk in five-year increments – and the current consultation is an opportunity to consider whether funded access should better reflect this reality.

Consider seeing a 60 something-year-old patient with diabetes. We might be reviewing their cardiovascular risk, medications and screening, and vaccination comes up as part of routine conversation on prevention. Their age and diabetes are both relevant to their shingles risk,^4-6,10-11 and vaccination is already recommended for their age group.⁷

For some patients, privately funding vaccination is an easy decision. For others, it joins the growing list of costs associated with managing their health. I have discussed whether someone might pay for one dose now and then budget for the second. Another may decide to wait until they become eligible for funded vaccination. The decision may be financially rational, but it does not change their underlying risk of developing shingles during that waiting period.

None of these decisions changes the patient’s individual underlying clinical risk. That is the part of this conversation I think is worth bringing to the PBAC. Population-level funding inevitably requires boundaries, but general practice sees what happens on either side of them.

The consequences patients experience are broader than the cost of vaccination itself. Around 62% of Australians aged 60-64 years remain in the workforce,¹² and studies have documented productivity impacts associated with shingles and post-herpetic neuralgia.^13-15 Patients may also be caring for grandchildren, supporting older parents or managing chronic disease.^16-17 When they consider prevention, they are often thinking not just about their likelihood of developing shingles, but what becoming unwell would mean in the context of their lives.

We also see what access can do. In the 12 months before SHINGRIX was added to the NIP, approximately 97,000 doses were administered in Australia. In the program’s first year, over 2.5 million doses were administered.¹⁸ Many factors influence vaccine uptake, but a change of that scale is difficult to ignore.

Funding decisions must consider clinical benefit, cost effectiveness and finite resources, and no eligibility threshold will ever perfectly reflect individual risk.

The more useful consideration is whether a threshold remains in the right place when the population immediately outside it has a recognised and increasing burden of disease, vaccination is already clinically recommended, and access may influence whether patients act on that recommendation.

That is why the current PBAC consultation is an important opportunity for GPs to contribute more than a general endorsement for prevention. We can describe what the gap for patients aged 60-64 years actually looks like in practice.

While our consulting room anecdotes are not substitutes for clinical or economic evidence, they are part of understanding how a funding threshold operates in the real world. General practice can add that part of the picture – what access looks like for the individual patients to whom that ultimately applies.

Professor Charlotte Hespe AM, is Head of General Practice and Primary Care Research at the School of Medicine, The University of Notre Dame Australia and Adjunct Professor Health Faculty, University of Sydney. 

Professor Hespe has received no honorarium in relation to this content. She has previously been part of a GP Advisory Committee regarding shingles vaccinations, for which honorarium was provided.

References:

1. CDC. Shingles. Available at: https://www.cdc.gov/shingles/about/index.html. (accessed August 2026).   
2. Health Direct. Available at: https://www.healthdirect.gov.au/shingles. (accessed August 2026).  
3. Gidding HF, et al. The seroepidemiology and transmission dynamics of varicella in Australia. Epidemiology and Infection 2003;131:1085-9 
4. Johnson et al. BMC Infectious Diseases (2015) 15:502 
5. Centers for Disease Control and Prevention (CDC). Update on Recommendations for Use of Herpes Zoster Vaccine. MMWR. 2014 August;63(33):729-731. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6333a3.htm (accessed [July, 2026]). 
6. Kawai K, et al. BMJ Open 2014;4:e004833. 
7. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook, Australian Government Department of Health and Aged Care, Canberra, 2022, immunisationhandbook.health.gov.au (accessed [July, 2026]). 
8. MacIntyre, R., Stein, A., Harrison, C., Britt, H., Mahimbo, A., & Cunningham, A. (2015). Increasing Trends of Herpes Zoster in Australia. PLOS ONE, 10(4), e0125025. https://doi.org/10.1371/journal.pone.0125025   
9. Qian, J., Macartney, K., Heywood, A. E., Sheridan, S., & Liu, B. (2021). Risk of recurrent herpes zoster in a population-based cohort study of older adults. Journal of the American Academy of Dermatology, 85(3), 611–618. https://doi.org/10.1016/j.jaad.2020.06.1013   
10. Marra F et al. Open Forum Infec Dis 2020;7:ofaa005
11. Steinmann M et al. Infection 2024;52:1009–26. 
12. Australian Bureau of Statistics (ABS). Labour Force Australia Feb 2025 [updated 2025 Mar 20; accessed 2026 Apr 27]. Available at: https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia/feb-2025  
13. Singhal, P. K., Makin, C., Pellissier, J., Sy, L., White, R., & Saddier, P. (2011). Work and productivity loss related to herpes zoster. Journal of Medical Economics. https://doi.org/10.3111/13696998.2011.607482   
14. Drolet, M., Levin, M. J., Schmader, K. E., Johnson, R., Oxman, M. N., Patrick, D., Fournier, S. O., Mansi, J. A., & Brisson, M. (2012). Employment related productivity loss associated with herpes zoster and postherpetic neuralgia: A 6-month prospective study. Vaccine. https://doi.org/10.1016/j.vaccine.2012.01.045   
15. Gater, A., Uhart, M., McCool, R., & Préaud, E. (2015). The humanistic, economic and societal burden of Herpes Zoster in Europe: A critical review. BMC Public Health. https://doi.org/10.1186/s12889-015-1514-y  
16. Australian Bureau of Statistics (ABS): Heart, stroke vascular disease in 2022 [updated 2023 Dec 15; accessed 2026 Apr 27]. Available at: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/heart-stroke-and-vascular-disease/latest-release;  
17. Australian Bureau of Statistics (ABS): Diabetes in 2022 [updated 2023 Dec 15; accessed 2026 Apr 27]. Available at: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/diabetes/latest-release
18. Simpson A et al. (2026) Uptake of Shingrix vaccine in its first year on the National Immunisation Program: an analysis of Australian Immunisation Register data. Public Health Research and Practice 36, PU25044. doi:10.1071/PU25044