But I have mixed feelings. The vaccine is very effective in preventing this painful and sometimes debilitating condition.

So there's an argument the groups it's been shown to work for, and approved for use in (any adult over 50, and those 18 and over with weakened immune systems) would be better off getting the vaccine than not.

But the risk varies with age – younger people don't get shingles as often, and when they do, it is typically milder. So we need to weigh up the high cost against the relatively smaller benefit.

There may also be a timing "sweet spot". Vaccines are most effective in the first few years. Although it seems Shingrix is effective for quite a long time (at least 11 years), if we give the vaccine to younger people, protection may start to wear off as they age – precisely when they're at higher risk of developing shingles.

These factors were considered when the Pharmaceutical Benefits Advisory Committee recommended the Australian government fund the current program (I was a member of an advisory committee which provided advice to PBAC). The cost matters, especially for large programs, because we also need to consider how the benefits stack up against the benefits of other programs we might spend this money on.

---

View Allen's profile

I don't think the shingles vaccine should be free for everyone. But it should be free for those aged 30 years and over.

In Australia, this group is most likely to have had chickenpox before the childhood vaccination program was introduced in 2005 and therefore to carry the dormant virus, which can later reactivate as shingles. Australians under 30 are less likely to have had chickenpox and are therefore less likely to develop shingles.

Getting shingles during your 30s or 40s can have significant consequences, especially if there are complications. This is a life stage when many people focus on raising a family or building a career and financial security. So expanding free vaccination to those likely to carry the dormant virus could lessen this impact.

The vaccine may also have other benefits. Emerging evidence suggests it may reduce the risk of heart disease and stroke, and dementia.

That shingles is prevalent in younger adults is increasingly clear. But the shingles vaccine has not been evaluated in healthy adults under 50. So the next step is to prioritise clinical trials that can establish how safe and effective it is in this age group.

---

View Sarah's profile

No.

We need more evidence to understand the trends.

Anecdotally, we hear about younger people getting shingles, but we still don't understand if this is a real increase or what might underpin it. There may be increased testing or greater awareness, meaning more people see a doctor. Or it could be because numbers of immunocompromised people have increased.

But there's a clear reason why the vaccine targets older people.

Infection risk increases with age and postherpetic neuralgia (the most severe complication causing persistent nerve pain) also becomes more likely. Vaccinating older people means they get the best protection when they are most at risk.

Since the first shingles vaccine was introduced in 2016, rates have declined in older people.

But monitoring the disease remains challenging. One study found an annual 1% increase in hospitalisations for shingles in Australia between 1999 and 2013, across all ages. But only a small proportion of people get hospitalised.

And Australia's notification data is not reliable. For example, New South Wales doesn't routinely report shingles cases.

To better assess if there's a real increase in shingles among younger adults, and whether they'd benefit from a vaccine, we need better monitoring and data.

---

View Meru's profile

When the varicella zoster virus is reactivated and you develop shingles, the virus enters your nerve cells and causes inflammation which can travel to the brain and damage it.

This damage is invisible when you're young. But it increases the risk of developing dementia later in life and accelerates brain ageing.

However, the shingles vaccine has been shown to reduce this risk.

Research from the UK found people who'd had the shingles vaccine were 20% less likely to receive a dementia diagnosis in the following seven years, compared to those who didn't get vaccinated.

Australian research has similarly found the vaccine may prevent or delay dementia, significantly reducing the risk of a diagnosis during the following 7.4 years.

The protection comes from avoiding the infection.

So, funding the shingles vaccine for working-age adults would be expensive but it is a worthwhile investment. The evidence suggests that reducing infections now among younger adults may safeguard their long-term brain health – stopping inflammatory brain damage before it takes hold.

---

View Ibrahim's profile

The shingles vaccine (Shingrix) is not recommended in Australia for adults under 50 years of age unless they are immunocompromised. This reflects the fact that shingles becomes more common and more severe with increasing age.

Younger adults can still develop shingles, but their risk of long-term pain or complications is much lower. Early antiviral medications (started within three days of onset) can also reduce symptoms and speed up recovery.

Providing the vaccine free to all adults in Australia would also be very expensive. The current program already costs A$826.8 million, and expanding it to younger, low-risk adults would mean fewer resources for other important health programs.

When the Pharmaceutical Benefits Advisory Committee (PBAC) reviewed Shingrix back in 2023, it concluded the vaccine was unlikely to be value for money for low-risk populations at the price proposed.

If circumstances change, applications for broader access can be reconsidered by the PBAC, with evidence that supports both benefit and value for money.

---

View Jing's profile