“Why the Dutch Government’s Decision to Delay Shingles Vaccination is Costing Patients Pain and Money”

As if you were burned: that’s how 61-year-old Ellis Minnesma experiences it. She got shingles a year ago and to this day she is in a lot of pain. “It ruins my enjoyment of life. My nerves are damaged from the shingles. I have shooting pains, sometimes cramps. Like I have a bruised rib.”

Shingles is an infection that causes skin rashes. People get it from the same virus that gave them chickenpox before. It causes itching, a stinging sensation and burning or stabbing pain. Some people experience long-term nerve pain from the condition. This is especially true for people over the age of 60 (more explanation: see gray box below).

Vaccinating ‘extremely useful’

Every year, 88,000 patients, mostly women, see their doctor because of shingles. There is a vaccine against it. As early as 2019, the Health Council said that it is ‘extremely useful’ to vaccinate everyone from the age of 60 against shingles. The vaccine would prevent around 90 percent of shingles cases. In 2020, a parliamentary motion called on the government to do this as soon as possible.

Still, that vaccination round will not happen, says State Secretary Maarten van Ooijen (Public Health). “There is no money for extra expenses at the moment,” he says. “And shingles vaccination is a costly extra investment, with amounts of 80 to 200 million euros per year in the first years and 40 million per year structurally thereafter.”

Van Ooijen says: “I stand by the choice we have made and at the same time I am disappointed.” The State Secretary says that he will continue to work on this in the coming years.

Unexpected decision

“This decision comes unexpectedly,” says Jolanda Hoefnagel, infectious disease control physician and chair of the Vaccination Working Group. “Four years ago, the Health Council recommended that all people over 60 be vaccinated against shingles. Earlier this year, the State Secretary was also positive about the vaccination campaign. So we assumed it was coming.”

Hoefnagel is disappointed by the decision. “Many people can be spared suffering with a vaccination. Shingles can be associated with nerve pain that can last for months in some people. They are pain complaints that are not so easy to treat and therefore it can have a major impact on your life.”

Research shows that the vaccine prevents 9 out of 10 cases of shingles. “So it is a well-functioning and safe vaccine,” says Hoefnagel.

Precious affair

Patient Ellis Minnesma also regrets that the vaccination campaign will not be launched for the time being. Paying for the vaccination yourself – it involves two injections that together cost around 350 euros – is a costly affair. “For many people that is a threshold. So it would have been very nice if it had been reimbursed by the government.”

The question is whether she will ever get rid of it. “I’m still in a lot of pain, but I’m trying to live my life as much as possible as I did before. Even if it goes better one day than the other.”

What is shingles?

One in four people will get shingles at some point. Of the 88,000 annual visits to the doctor for shingles, 5 percent have been in pain for more than three months. The older you get, the more likely you are to have long-term pain. Every year 500 people are hospitalized, it is estimated that 20 people die from it every year.

Shingles is caused by the chickenpox virus. Most people are infected with this in childhood, which leads to chickenpox. The virus remains in the body. As we get older, the immune system works less well. The chickenpox virus can then resurface and cause shingles. Painful and itchy red spots and blisters often appear on the skin, usually on one side of the body in the form of a ‘belt’.

The new Shingrix vaccine prevents around 90 percent of shingles cases.