Minister for Health and Aged Care - press conference - 8 October 2023

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER:  Thank you for coming out to the new Royal Adelaide Hospital this morning to discuss an important announcement in our commitment to deliver cheaper medicines and a stronger Medicare.

 

Shingles affects about one in three Australians at some point in their life and at the very least, it can be a very painful episode for someone who receives that disease. I for one can urge against using Dencorub on it, which is what I did when I had shingles. It's a very painful thing to do so don't do that. But at the very least for a short term, shingles is a very painful condition. For many, particularly older Australians, there is a high risk of longer term very severe impacts in particular, a condition called post herpetic neuralgia which is intense debilitating pain that can last for months or even years, or even the rest of a person's life. I'm told by hospital operators that increasingly there are presentations by older Australians to hospital because of complications driven by shingles. This is a very serious public health menace that we confront in Australia.

 

Up until now, there's been a shingles vaccine on the National Immunisation Program (NIP), which is only moderately effective. More recently, a new vaccine has come onto the market known as Shingrix. It is much more effective, about 90 per cent effective for older Australians in preventing shingles compared to 40 per cent for older Australians with the existing vaccine. It's also much longer lasting, and unsurprisingly, older Australians in particular, are widely seeking access to this vaccine. The challenge is that it cost them about $560 for a course of this new cutting-edge vaccine, called Shingrix. I'm delighted to announce that from the 1st of November this year, that vaccine will be available free of charge to all Australians aged 65 years and over, as well as a number of other vulnerable groups, particularly a number of groups with immunocompromised health and Aboriginal and Torres Strait Islander people aged over 50. This amounts to about 5 million Australians now getting access to this cutting-edge vaccine from the 1st of November. This $800 million investment by the Albanese Government is part of our commitment to cheaper medicines and a stronger Medicare by putting in place one of the most comprehensive shingles vaccine programs anywhere in the world. I'd like now to hand to the Professor who's been very involved in this area to say a few words and answer any technical questions about this vaccine. Thank you.

 

ASSOCIATE PROFESSOR PRAVIN HISSARIA, SENIOR CLINICAL IMMUNOLOGIST AT THE ROYAL ADELAIDE HOSPITAL: Thank you, Minister. I'm really excited to be here on a Sunday morning to announce the funding for this very effective vaccine for shingles. It is Shingrix, as the Minister said, it usually consists of two doses and has an efficacy of about 90 per cent. Now we know that there has been another vaccine that that has been approved on the NIP for people who are 70 years and older but this vaccine has been lot more effective and possibly the uptake should be a lot higher because it does not have lots of precautions that needs to be taken with the previously available vaccine. As I said it needs to be taken into doses, preferably two months apart, but can be taken from two to six months apart. It is known to prevent not just shingles, we think about vaccines and think that what if it prevents a viral infection, which lasts only for five days, maybe a bit of pain for seven days, but that's not what shingles is, it can last for a very long. And also in elderly people when they get any sort of medical illness, it can have a flow on effect in terms of causing other health issues. There has been some associations with stroke and ischemic heart disease and so forth. I would definitely urge all elderly Australians after 1st of November to talk with their GPs or health practitioners. And I'd definitely try to get this jab as soon as possible. Thank you.

 

ROBERT WARD: I'm Robert Ward. I suffered from shingles some time back. It's quite a painful illness. It started off basically from my spine. I just saw this red ring sort of come around to my chest, and it's all just opened up, spread like tentacles. I got a lot of pain, blistering. I had follow up medication but I still was quite severe with it. I was out of action for a couple of weeks. The way it felt was like, I had been shot in the back, and the bullet had blown out the front. That's the pain I had from it. For the next three months, I would have shooting pains at any time it didn’t matter what I was doing it felt like someone stuck a knife in my back. I would urge anyone to get the vaccine. Thank you.

 

JOURNALIST: Robert, you had shingles, I think it was in your late 30s. Can you imagine people having it in their 60s?

 

WARD: I would dread. I know what they would be going through. It was bad for me. It would be worse for someone that's older. So yes.

 

JOURNALIST: Are you urging then Australians aged over 65 to go and get this vaccine?

 

WARD: Oh, absolutely. It’s not worth getting shingles when it can be prevented.

 

JOURNALIST: What do you think it means for people be able to do it the cost of living crisis at the moment? You mentioned $560 for a course, now it's going to be free. What do you think it would do for people who are suffering, you know, with the cost of living crisis?

 

WARD: It will free them up. If they're working, they'll be able to continue working. Because it's such a long term illness, then they wouldn't be able to work so their financial situation would be worse. That would have a throw on effect, especially at the moment, you know, they want more elderly working these days.

 

JOURNALIST: Robert sounds like you can track this in either 97 or 98. Have you had any long-term consequences still to this day?

 

WARD: Well, after I had that, I did develop guttate psoriasis and now turned out to have like a full on psoriasis. Whether it's a relationship between having shingles I'm not sure. I have had some health issues since that time. I think in some ways, you know, I did have ongoing issues.

 

JOURNALIST: And when you contracted it, you said you were quite healthy. Did it catch you off guard that you developed shingle?

 

WARD: Oh, yeah, because I was fit, healthy, busy. It was very unexpected.

 

JOURNALIST: Have you obviously had the vaccine and how much did it cost you back then?

 

WARD: I've had I had one of the Shingrix vaccines. I'm prettye sure I paid around $400 then that was probably about two or three years ago. But now, if it's going to be free, I'll wait until I can get it for nothing.

 

JOURNALIST: Professor, I guess from your perspective, who is recommended this vaccine is it only people that have had chickenpox before, that's been a discussion for us who is susceptible to getting shingles?

 

HISSARIA: The single most risk factor for getting shingles is age. As people have said, the incidence goes up that increases rapidly after 50 years of age. The current approval on the NIP is anyone aged 65 years and above. It is for prevention of shingles. It is not only if you're had shingles, you need to take it, it is for people who have not had shingles. Anyone who turns 65 can go and have this vaccine so that they don't get shingles.

 

If you have had chickenpox in the past, most of us had by the age of 10, I think 95 per cent of us have had chickenpox either symptomatic or not, this vaccine works differently as compared to other vaccines in that it prevents the virus from becoming reactivated. After you had chickenpox in your early childhood by the age of five, or 10, the virus just goes and resides into your nerve cells in your spinal cord. It stays there, because the immune system keeps it in check. As we age and the immune system ages, it somehow escapes that and that's how it's associated with stress and lots of conditions and immunosuppressive medications. That's when you get shingles, and then the post herpetic neuralgia.

 

If you have had shingles we wouldn't want to take vaccine straight away because it is not recommended for treatment, we have to wait at least about a year before you get the vaccine. But if you've turned 65, you should get the shingles vaccine anyway, even if you don't have shingles, or you don't have history of chickenpox.

 

JOURNALIST: So does the increase of risk start from the age of 50?

 

HISSARIA: Yeah, it starts going up after 50. But it exponentially increases after the age of 65.

 

JOURNALIST: From your perspective, how much of a burden does the shingles virus have on the healthcare system?

 

HISSARIA: It has a significant burden. You have to put into perspective that you know, there is a cost involved with treating of these with antivirals anyway. As I said, at an elderly age, what happens is with any health condition at that age, can have a cascading effect in terms of accumulating lots of other health events as well. Now, there are no long-term e studies to show that the association, but that is what can be prevented. We are seeing increasing number because as we are having healthy ageing, as we've been calling it, people ageing, you do tend to see lots of these patients coming in. I can't put a dollar figure because no one has done formal economic analysis on it as to the dollar burden of this disease but from about the age of 70 about one in two people will get shingles.

 

JOURNALIST: This is a virus that stays in your body and it affects a lot of people. I read somewhere like 99 per cent of people have these actually in their in their system and it can just re-emerge is that right?

 

HISSARIA: That’s right.

 

JOURNALIST: It's a quite a lot of people have this and don't realize it?

 

HISSARIA: Viruses are in all of us, most of us anyway, about 99 per cent as I said, but the immune system keeps it in check. That's how this vaccine is different from let's say other vaccines, which prevents you from getting an infection while this virus is already there residing, and this vaccine prevents the re-emergence of it - either it is related to ageing or immunosuppressive medications or anything.

 

JOURNALIST: Can you explain why this vaccine is so effective than the previous one?

 

HISSARIA: I think we have to give this to COVID actually. One good thing, if any, that came out of COVID era was this intense interest in vaccines and because there was so much research happening into increasing the efficacy. For example, comparison with the previously available vaccine, the efficacy was only about 60-65 per cent and it waned very rapidly with age falling to about 50 per cent when you are about 60. What's happened in last 10 years is that the adjuvant system, which is you know, what you use along with the part of the virus or the bacteria, whatever you're using to stimulate the immune system, there is lots of work that has gone in in terms of platforms that are used to prepare this vaccines. This contains a novel adjuvant which actually stimulates your immune response even better, and that's how you get the efficacy. Talking about efficacy in excess of 90 per cent was never the case before COVID came in. You know, we were happy with 60 per cent and that's what, if you remember, the CDC came out with the figure when COVID vaccines were initially being licensed, that if you got anything which was closer to about 50-60 per cent, that would have an emergency use authorisation. Now we are seeing most of the vaccines in excess of 90 per cent. I think that's where the research has to be applauded in terms of the results that we are seeing.

 

JOURNALIST: The vaccine is free for those over 65 but those listening at home tonight, would you recommend actually get this vaccine? Is there a broader group than that?

 

HISSARIA: Yeah, so the TGA currently has approved a vaccine for everyone aged 50 years and above because that is when the incidence starts increasing of getting shingles and reactivation of the virus. It increases very rapidly after 65 years of age and hence the ATAGI and an NIP recommendation now that it will be free from 1st of November. If you're younger and immunosuppressed, so currently it is recommended for use in certain select immunosuppressed conditions like hematopoietic stem cell transplant or you know, solid organ transplant like kidney or lung also in people who have had cancers, if you are on other immunosuppressive, strong immunosuppressive medications, aged 18 years and above you should go and have this vaccine and First Nations aged over 50.

 

JOURNALIST: That’s regardless of whether you've had chickenpox you in your life previously?

 

HISSARIA: That’s regardless, yes. As I said, most of us have it. Some of us remember it. Some of us it manifests some of us, the immune system just looks after it. But yes, the virus is there.

 

JOURNALIST: Minister, I think the most obvious one is why we've chosen to make it free for those over 65 when the risk starts at age 50?

 

BUTLER: As the Professor said, the risk starts at 50, but accelerates dramatically after the age of 65. What we're announcing today is the acceptance of advice from the independent Pharmaceutical Benefits Advisory Committee, which has examined this new vaccine Shingrix very closely over the last 12 months and issued two separate pieces of pieces of advice to me over the last several months. This body, which has been in place for decades, not only looks at the clinical effectiveness of a vaccine or medicine. It also looks at the cost effectiveness of it. On the basis of its statutory charter, these independent experts have recommended that it be available free of charge to people aged 65 and over as well as those other vulnerable groups the Professor mentioned.

 

JOURNALIST: Is there scope in the future to bring it down to include 50? I know Rob actually wouldn't still be eligible for the vaccine yet?

 

BUTLER: The Advisory Committee, in many cases, vaccines and medicines, does continue to monitor new evidence about products and various advice from time to time. The company involved or anyone else is always able to make an application to the Advisory Committee for a change in their advice, and we'd consider that change. But right now, I just want to emphasise other than Germany, this will be the most comprehensive shingles vaccination program anywhere on the planet, following the announcement I've made today.

 

JOURNALIST: Just touching on hospital admissions as well. Do you have any data about the burden on the health system caused by shingles?

 

BUTLER: As the professor has said, there's not been a systematic analysis of the impact on hospital systems. I can say anecdotally, hospital operators have said to me that shingles and issues associated with shingles among older Australians is presenting in their hospitals with increasing frequency. In addition to the burden on hospital systems, though, I also want to emphasise the impact on patient wellbeing that this condition has. I think it's about one in five older Australians will experience what the professor described as post herpetic neuralgia, which is very long lasting, so for over three months intense debilitating pain, Robert talked about this. Some people have this for many months, some even four years or the rest of their life. Even if people don't end up in hospital, because of some of the complications that Professor talked about, this can have an intense impact on people's quality of life at a time, frankly, as they're moving into retirement when they should be enjoying life instead of dealing with what might be very long lasting, or even permanent symptoms of intense and debilitating pain.

 

JOURNALIST: Just from your own personal experience. How old were you when you contracted shingles?

 

BUTLER: I think in my mid-30s and there wasn't much awareness of the condition as I remember it back then. It was in nothing quite like Rob experienced nothing like I hear from older Australians. You'll find that MPs from across the political spectrum are increasingly being contacted by older Australians in their community because they've become aware of this new cutting-edge vaccine being on the market. For many older Australians, if they're on fixed incomes, if they're on the pension $560 is a big hit to their household budget at a time of a global cost of living shock, which is why we're so determined to make this medicine cheaper as we have so many other medicines over the past 15 months.

 

JOURNALIST: If you can sort of eliminate the shingles situation, does it free up the healthcare system at all? Like how much has it impacted?

 

BUTLER: As I say, there's not been a system wide analysis of the impact on the hospital system. As the professor said, if you present to your GP with shingles, you will be prescribed antiviral medicines, a number of which are already on the PBS. If you can prevent shingles in the first place through this vaccine, not only do impact prevent that sort of impact on a patient's wellbeing you will save costs on the PBS for those antiviral medicines, as well as the impact on hospital systems and the healthcare system more broadly of patients who have debilitating ongoing systems presenting to the healthcare system time and time again.

 

JOURNALIST: Are you pleased that out of COVID we’ve got better vaccines like this one for shingles?

 

BUTLER: As the professor said, COVID was just a dreadful, terrible experience for the entire global community. But what we did learn was the power of research and the power of innovation and discovery in the area of medicines and vaccines. I think all Australians, people across the globe now, are literate about vaccine technology in a way we weren't three and a half years ago. There's been a big lift in I think all of our literacy and our support for the incredible work that health and medical researchers do here in Australia, and right across the world, and we are seeing through this vaccine and we will through many others besides a whole bunch of new ways in which we can treat conditions which only a few years ago was seen as not untreatable, necessary, but very, very challenging. Thanks, everyone.