Approximately one in three adults will suffer from shingles once in their lifetime, with adults aged 50 years and older being the most at risk. While rarely fatal, the infection causes a painful rash. This pain can persist for months or even years if a patient develops complications. While the onset of shingles can be unpredictable, anyone who’s had chickenpox may develop shingles since the virus enters the nervous system and lies dormant for years after one has recovered from chickenpox.
In Quebec, shingles affect approximately 27,000 individuals a year, cause 600 hospitalizations, and lead to 10 deaths, mainly in people over 80 years old. The burden of this disease on the province’s health care system is also significant, costing an estimated $25 million a year. This represents at least $926 per shingles case since this estimate excludes costs related to absenteeism, loss of productivity, and other social costs incurred following a case of shingles and its complications.
Luckily, this painful infection can be safely prevented with a vaccine, of which two are presently authorized in Canada. The problem? Due to bureaucratic obstacles, these vaccines are not yet part of Quebec’s provincial vaccination program, despite their proven effectiveness in preventing the occurrence of shingles, their cost-effectiveness, and our ability to rapidly administer the doses across our extensive network of private facilities such as pharmacies.
Indeed, there has been keen interest in including the shingles vaccine in the provincial vaccination program, which would effectively widen access to this medication. Unfortunately, not much progress has been made since the onset of the pandemic. In 2018, the Institut national de la santé publique du Québec (INSQ) completed a nearly decade-long analysis which concluded that including the shingles vaccines in Quebec’s immunization program would be cost-effective since preventing the onset of shingles would cost taxpayers less than treating it once it occurs. Following this study, a unanimous motion was adopted in 2019 by the National Assembly for this vaccine to be included in the Quebec Immunization Program so that it is offered to people aged 65 and over, who are most at risk of suffering from shingles and its consequences. And in early March 2020, Danielle McCann, then Minister of Health and Human Services, announced that work was underway. Since then, however, it has been radio silence.
The positive impacts of improving access to this drug have been evident in other provinces that have added the shingles vaccine to their provincial immunization programs. Ontario, for instance, was the first Canadian province to provide shingles vaccines to all residents between the ages of 65 and 70 through its publicly funded immunization program in 2016. Since then, the province has seen a 19.1 per cent decrease in the monthly incidence of medically attended shingles cases and a 38.2 per cent drop in shingles-related emergency room visits and hospitalizations among those aged 65 to 70. The burden on health care services was thus significantly reduced by expanding access to shingles vaccines, something Quebec’s overwhelmed hospital system could sorely use.
While it may be understandable that the pandemic placed this file at the very bottom of the priority list, the time has come to restart the process of enabling greater access to this vital vaccine, all the more so given its cost-effectiveness. Quebec’s elderly population has been through enough over the past two years. It’s time to offer them some peace of mind regarding their health and finally implement what has been promised – greater access to shingles vaccines.
Maria Lily Shaw is Economist at the Montreal Economic Institute.
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