San Francisco Chronicle - (Sunday)
Shingles vaccine shortage spurs fear
Two weeks ago, Paul Perrotta, a retired tech executive, found himself in a predicament now familiar to many Americans older than 50.
His doctor strongly recommended that he get the new shingles vaccine Shingrix, but said his office had run out and he wasn’t sure when the supply would be replenished. He told Perrotta that he’d probably have to drive 30 miles from his Riverside County home of Rancho Mirage to find it, or wait.
“At our age, we have met many people who have had shingles, some of them multiple times,” said Perrotta, 58, whose husband, Curtis Scott, 62, also had problems getting the vaccine last year because it was too new for his health insurer to pay for. “It’s a slam dunk to know we want the vaccine.”
Perrotta had put off getting the shot because he’s heard the side effects leave some people sidelined for a few days, and hasn’t had the time yet.
Months into a nationwide Shingrix shortage, pharmacies and doctors’ offices around the state are no closer to knowing when they will be able to meet patients’ demand for the vaccine, which is more than 90 percent effective in preventing the painful and debilitating rash caused by shingles.
Pharmacies have waiting lists of hundreds of patients. Distribution of the vaccine is sporadic and unpredictable: Some pharmacies are receiving just one or two doses a week, and many don’t know when their next shipment is coming, making it hard to tell patients when to come back.
The vaccine’s manufacturer, GlaxoSmithKline, says it’s planning to ship more doses this year — in the “high teens millions” compared with the 9 million doses it sent out in 2018 — but many pharmacists are expecting the shortage to continue for several more months.
Experts say demand is exceeding supply for a few reasons: Shingrix, which retails for $170 to $250 per dose, is much more effective than the previous shingles vaccine, Merck’s Zostavax, and is recommended for more people — everyone older than 50 instead of everyone older than 60. Shingrix is more than 90 percent effective at preventing shingles, whereas Zostavax reduces the risk of developing shingles by 51 percent, according to the Centers for Disease Control and Prevention.
“I’m frustrated and disappointed,” said Dr. Jeffrey Silvers, medical director of infectious diseases at Sutter Health. “We just have to do the best we can and make sure patients understand just because we say we don’t have it today doesn’t mean they should stop looking for it and give up. It’s a great vaccine, they just have to pay attention and keep in touch.”
GlaxoSmithKline maintains a shingles vaccine locator website where people seeking the shot can enter a ZIP code to find pharmacies that have Shingrix — but the website is not updated every day, and many of the listed pharmacies are actually out of stock.
Silvers recommends that patients call their doctor and pharmacies regularly to ask when their next shipment of Shingrix is coming in.
The vaccine is administered in two doses, with the second being a booster shot. The second shot, ideally, is given two to six months after the first, but Silvers says people should get the second one even if they have surpassed the six-month mark. Amid the shortage, those who have gotten the first shot and are waiting for the second are given priority over those who are seeking to get the first. Those who have had shingles before can also get Shingrix to lower the likelihood of recurrence.
“The bottom line is, work with your provider, try to get on a list, keep checking the news, and you will get it,” Silvers said.
Vaccine shortages and delays
are not unheard of — in the past few years, there have been shortages of vaccines for hepatitis A and the flu — but the Shingrix shortage is particularly acute.
“It happens from time to time,” Silvers said. “This one is out of proportion than what you usually see. That’s partly because this vaccine is such an important improvement over the previous vaccine, which was an improvement over nothing. So this is a major change in what we can offer.”
Vaccines to prevent shingles are relatively new. The older vaccine, Zostavax, was approved by the Food and Drug Administration in 2006. Shingrix was approved in 2017.
The U.S. has about 1 million cases of shingles each year, with most affecting people who are 50 or older. One in 3 people will get it sometime in his life, according to the CDC. Anyone who has had chicken pox has the shingles virus, zoster, dormant in the body, and it tends to be reactivated during times when one’s immune system is weakened. The blistering, painful rash is much more severe than chicken pox and can cause vision loss if the outbreak is near the eyes.
GlaxoSmithKline reported $1 billion in sales of the vaccine in 2018, which surpassed the company’s projections. The unexpectedly high demand for Shingrix helped propel a 14 percent jump in Glaxo’s vaccine sales in 2018, the company reported last week. Shingrix has 98 percent of the shingles vaccine market.
Glaxo says part of the delay in getting more doses out to the public is because it takes six to nine months to make Shingrix. It is not unusual for vaccines, which are more complex than many drugs to manufacture, to take months to produce.
“We are deeply committed to Shingrix and are working to ensure that the vaccine will be available to individuals who need it,” Glaxo spokesman Sean Clements said in a statement.
Patients could ask for Zostavax if they wish to be vaccinated immediately and Shingrix is unavailable, the CDC says. But many pharmacies have stopped buying Zostavax, and experts generally advise against this, saying it is better to wait for Shingrix, which is more effective in the long term.
“Even if you get the old one, you’d presumably still in the near future be looking to get the new one,” said Dr. Lisa Winston, an epidemiologist at San Francisco General Hospital. “In general, we don’t think of being vaccinated for shingles as an emergency. We’d certainly like to get people vaccinated, but we’re mostly thinking about lifetime risk, not immediate risk . ... In general for most people, it probably makes more sense to wait.”
Shingrix costs $170 to $250 per dose at pharmacies, but patients’ out-of-pocket costs depend on their insurance. Most commercial insurance plans and Medicare cover Shingrix. Glaxo estimates that the average out-of-pocket cost for those on commercial plans is $5 or less per dose, and the average cost for Medicare recipients is $50 per dose. Glaxo offers financial assistance for some people who earn less than $30,000 a year, but it’s unclear how much that assistance might be.
A prescription is not needed, except for those younger than 50 who may want it because their immune systems are compromised. Shingrix has more pronounced side effects, including sore arm, fatigue and muscle aches, usually lasting no more than a few days, Winston said.
It was those potential side effects that made Perrotta, the retired Southern California executive, delay seeking the vaccine. Last week, though, a nearby grocery store posted a promising sign: “We have Shingrix.”