Should Quebec expand free shingles vaccination to more people?

The shingles vaccine is now freely available in Quebec to seniors 80 and older and to people over 18 who are immunocompromised, which is a "great step in the right direction," according to a leading Montreal infectious diseases specialist.

Dr. Donald Vinh of the McGill University Health Centre (MUHC) said it's appropriate that the health ministry is targeting the most vulnerable people first, but wonders whether more groups of people would benefit from the shot.

Based on previous studies, he said those in high-risk groups have a one-in-three chance of developing shingles. The odds improve to one in nine among the general population.

But the risk increases for everyone starting at about age 50 and so Vinh also said the efficacy of the vaccine dictates that "it should be more widely available."

On Monday, the health ministry said the decision to target certain groups initially was based on budgetary constraints and public health recommendations.

Indeed, at $250 per dose and with two doses required, the vaccine is costly, both for the government and for anyone who has to pay for it themselves.

The government also had to consider the capacity of pharmacies and vaccination centres to offer additional vaccinations, ministry spokesperson Marie-Hélène Émond wrote in an email.

"In subsequent years and after analysis, the program could expand access to an additional age group based on budget capacity and population demand for the vaccine," Emond said.

Anyone who wants to get the shingles vaccine, whether they're eligible for a free shot or not, can make an appointment on Clic Santé.

SHINGLES: CHICKENPOX VIRUS REACTIVATED

Shingles is caused by the varicella-zoster virus. It's the same virus that causes chickenpox, because even after a person recovers from chickenpox, the virus stays in the body, becoming dormant. It can reactivate years later as shingles.

"The virus wakes up in one of these nerve roots, it spreads down the nerve to the skin and it causes shingles. But in the process, as they travel down this nerve root, it damages the nerve and it causes pain," Vinh explained.

Sometimes it's debilitating pain, along with a rash and blisters. The pain can persist long after the rash disappears, a condition called postherpetic neuralgia occurring in about 10 to 20 per cent of shingles cases.

Shingles that develops on the face and near the eyes can even cause scarring and blindness, according to the Public Health Agency of Canada (PHAC).

"In people over the age of 50 the vaccine is more than 95 per cent efficacious in preventing Zoster and for people who are immunocompromised it's about 70 to 90 per cent," Vinh said.

That's why people over the age of 50 who are fortunate to have a family doctor may have been advised to get the Shingrix vaccine series. But the high price tag is prohibitive for many.

"Oh, it definitely does discourage people," Vinh said, but pointed out that at least vulnerable people over 80 who may be on fixed incomes won't be out of pocket.

Since the other important category of immunocompromised people is significant in Quebec, Vinh said he would understand if the government's decisions are part of a strategic plan.

He said once health authorities see how many decide to get the free vaccine and how many additional vaccines they would need to purchase moving forward, he "wouldn't be surprised if they do roll out to the next age or a decade in an age pyramid … one step at a time."