Recently, the Canadian Association of Retired Persons (CARP) met with B.C.Geriatrician Joshua Budlovsky to discuss the importance of shingles vaccination for older Canadians.
Shingles, also known as herpes zoster (HZ), is a painful and often debilitating condition caused by the reactivation of the varicella zoster virus (VZV), the same virus responsible for chickenpox. One in three adults is expected to develop shingles in their lifetime, and the risk increases with age.1 You can read more about shingles here.
The symptoms of shingles include a painful, blistering skin rash that can lead to severe complications such as nerve pain (postherpetic neuralgia) that may persist for months or even years. Other complications can include scarring and vision loss.2
“The only real way to protect ourselves or to increase our protection from shingles is by immunization. The shingles vaccine has well over 90% efficacy and lasts 11 or more years,” says Dr. Budlovsky. “Shingles with chronic pain can really knock people off their game plan and begin a cycle of decline. Anything we can do to prevent that seems like a real no brainer.”
A recent Government of Canada report on vaccination from the Chief Public Health Officer of Canada emphasizes the crucial role of adult vaccination in Canada’s health system and economy. The report underscores how vaccines ease strain on healthcare resources, foster greater health equity, reduce costs to the healthcare system, and contribute to economic productivity” among other benefits to the individual, such as decreased risk of infection and preservation of well-being and independence in older adulthood.3
CARP strongly advocates for equitable access to the best available, expert-recommended vaccines for older Canadians, in particular with respect to: COVID-19, influenza (the flu), pneumococcal disease, respiratory syncytial virus (RSV), and shingles.
When it comes to shingles, while the vaccine is available across the country for those willing to pay out of pocket or fortunate enough to have it covered through private insurance, the risk of shingles to older adults is well established, as is the safety, efficacy and public health benefit of the shingles vaccine. This is why Canada’s National Advisory Committee on Immunization (NACI) recommends public shingles immunization programs for all individuals over age 50 (among others with increased risk such as those who are immunocompromised). Yet, despite this recommendation from 2018, currently only five provinces have implemented shingles vaccination programs, and of those, only one fully aligned to the NACI recommendation by including all those aged 50 and older.
Currently, provincial and territorial governments are in charge of funding vaccination programs. That means that while NACI may make a strong recommendation in support of a public immunization program, the reality is that it is up to each province/territory to decide whether or not to fund it, and which populations or age cohorts to include.
Says Dr. Budlovsky, “Whether a province funds a vaccine has no correlation to the importance of the vaccine. It comes down to funding priorities. There’s a lot of heterogeneity across the country. PEI, for instance, funds shingles for everyone over age 50, whereas some provinces don’t fund it at all.”
In recent focus groups, CARP members were unanimous in their belief that postal code should not determine access to expert-recommended vaccines.
Said one focus group participant, “We keep talking about how the medical system across Canada is universal and fair and free to all. Well, apparently it’s not. It all depends on which province you’re living in, how free and how universal it is.”
“I think it’s outrageous that those who can’t afford it have to go without, given the proven efficacy of these vaccines,” said one participant.
Another noted, “Primary health care means taking whatever steps are necessary in order to prevent further intrusion into the healthcare system, and that starts with vaccinations and healthy living.”
“Vaccines are a vital part of health care,” agreed another participant.
“Somebody should do the math and make it very obvious to the governments that they’re doing themselves a favour by funding all vaccines.”
Dr. Budlovsky believes it’s difficult to get people — and governments — excited about preventative health. “Preventative strategies, particularly easy ones like immunizations, need people to show up and beat the drum. If there isn’t that advocacy, the issue can get sidelined or become a one-liner on a budget that’s easier to cut out.”
“Seniors aren’t making enough noise,” said one concerned participant. “Provincial governments have a limited budget and they’re chasing whatever they’ll get the most political bang out of.”
Agreed another regarding governmental decision-making, “If they think they can get more votes by keeping the budget down and not funding these things, they’ll go in that direction instead of looking at need. We live in a political world rather than in a world of science, and need.”
This is why Bill VanGorder, CARP Officer of Advocacy and Education believes CARP members have an important role to play, “The government listens to input from CARP, but real momentum happens when our members speak up. That’s because elected officials — or those who want to be voted into the government — have a vested interest in keeping their constituents happy.”
Recently, in advance of the provincial election, the Nova Scotia PC party announced their intentions to make shingles vaccines free for older adults. The announcement came after a push from CARP and its members and other advocates. It serves as a reminder that speaking up — whether at election time or not — makes a difference.
“I think, as individuals, we try to do what we can, when we can. But we need a lot more individuals on board with us,” one participant agreed.
In terms of spreading the word and generating engagement in the issue, another participant added, “Don’t dismiss having that conversation in a non-confrontational way within your own smaller circle of friends and acquaintances.”
With ninety-four per cent of CARP members stating they believe the government should be funding all NACI-recommended vaccines, we could create real traction on the issue of immunization: your voice matters.
Tell your elected officials— or those hoping to be elected — that you want to see your province adhere to NACI recommendations for shingles and our other key immunizations: COVID-19, pneumococcal (for which Pneu-C-21 is particularly advised), respiratory syncytial virus, and influenza.
Need help finding contact information for your provincial health minister? Go here.
Want to add your voice to an email campaign about shingles? You can do that here.
Dr. Joshua Budlovsky is a consultant Geriatric Medicine physician in Victoria BC, who also works as a clinical instructor at UBC and provides outreach work to rural communities throughout BC including Haida Gwaii and Prince Rupert.
1 Harpaz, R., I.R. Ortega-Sanchez, and J.F. Seward, Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2008. 57(Rr-5): p. 1-30; quiz CE2-4.
2 Government of Canada. Fact Sheet – Shingles (Herpes Zoster).
3https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2024/report.html#a4.1
