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GPs raise doubts over shingles vaccination programme

The rationale for the shingles vaccination programme has been questioned by leading GPs who say the benefits may not outweigh the costs.

The whole programme is at risk of ‘going off the boil’ says one GPC prescribing lead after continuing shortages in the supply of the Zostavax vaccine.

The much-trailed national shingles vaccination programme got underway in September, starting with all people aged 70 alongside a catch-up programme in 79-year-olds.

But the programme got off to a shaky start as supplies of the vaccine ran out within a few weeks, and practices faced restrictions on ordering as Public Health England warned vaccine stocks were likely to remain scarce for the time being.

Dr Bill Beeby, deputy chair of the GPC prescribing subcommittee and a GP in Middlesborough, said the questions over the value of the programme and problems with vaccine supplies will mean practices putting the vaccinations ‘to the back of the queue’.

Dr Beeby told Pulse: ‘My understanding is the risk of shingles is 4% and the shingles vaccine cuts it to 2%, so it’s 50% effective and 98% of people that we give it to won’t need it and don’t get any benefit from it.

‘An awful lot of effort has gone into it and it’s a very expensive vaccine, when [the Government] chooses to ignore other things that are on the agenda. It’s questionable whether in our current health economy this is the wisest use of resources.’

He added: ‘There’s only a limited amount of effort a practice can ever put into that sort of programme, particularly if they don’t buy into it and they’re not convinced by the arguments they’re being offered.

‘It just goes off the boil - if you can’t get the vaccine, you can’t send the appointments out and it goes to the back of the queue. It takes its place but it’s not going to be prioritised.’

Dr Beeby’s comments came after the Daily Telegraph reported the programme was costing £250 million but would ‘save fewer than 200 lives’.

Dr Klaus Green, a GP in Godalming, whose research led to the Telegraph report, told Pulse his concerns were not about whether or not the vaccine saved lives – which was never the intention of the programme – but over the marginal quality-of-life benefits for patients and shaky evidence regarding the cost-benefit ratio.

Dr Green questioned the cost-effectiveness analysis carried out by the Joint Committee on Vaccinations and Immunisations, which he said did not directly compare the costs of the programme with savings from reductions in shingles-related referrals and treatments – and only showed a benefit to each person of 0.003 QALYs, or one day.

Dr Green said: ‘It is a tiny benefit per patient for what is a cost of hundreds of millions of pounds to the NHS. For me, that raises concerns in a year A&E is in crisis and funding for everything is getting worse.’

He added: ‘In terms of painful shingles, it reduces the risk from about one in 1,000 to one in 2,000. True that is a halving of risk but it doesn’t remove the risk, as most vaccines do, and it’s reducing it from a very low baseline anyway.’

A spokesperson from Public Health England said: ‘This programme is not considered cost-effective because it saves lives or generates a net saving for the health service; it is considered cost-effective because it will, assuming reasonable uptake, prevent many thousands of cases of shingles each year, along with the associated pain, debilitation and morbidity. This intervention can result in substantial QALY gain in the population aged 70 and above.’