Thoughts on the New Shingles Vaccine

For the last two decades, our practice has observed what appears to be a marked increase in the number of cases of shingles.  Not only has this condition apparently become more common, it would also seem to be affecting younger people than in the past.  Of course, clinical impressions do not always accurately reflect the broader national picture.  In this case, however, data from the National Institutes of Health confirm that the number of patients experiencing acute episodes of herpes zoster has dramatically risen as much as 50% in just three decades.

Some medical authorities have attempted to explain the explosion in herpes zoster cases with the theory that our success in vaccinating against chickenpox in children has, ironically, resulted in more cases of shingles in adults.  Like the popular hypothesis that the thimerosal in vaccines causes autism, however, the current studies have found no clear correlation between changes in vaccination protocols or formulation that correlate with changes in the prevalence of disease.  To date, no other compelling theory has been offered to explain the increase.

For British pharmaceutical giant GlaxoSmithKline, however, the present shingles epidemic is less of a mystery than it is a lucrative opportunity.  At the cost of $280 for the two requisite injections, GSK is salivating at the estimate that Shingrix will bring in over $1 billion dollars in revenue by 2022.  The vaccine, a blend of antigen derived from hamster ovaries, fats from salmonella, and herbal extract from soap tree bark, has performed well in clinical trials.  The adverse affects of muscle pain, fatigue, and headache in about half of vaccine recipients notwithstanding, Shingrix not only reduces the risk of getting shingles but also prevents the chronic pain of post-herpetic neuralgia. 

But, rewinding a bit, what of the elephant in the room?  While the manufacturer of Shingrix stands to benefit from the failure of medical scientists to identify a clear cause for the increase in the number of shingle cases, it may turn out to be critical for our public health and wellness to get to the bottom of this conundrum.  There are several important questions to ask.  For example, does the recent success of shingles indicate a widespread decline in the immunity of older Americans?  If a lack of immunity is to blame, then what factors are impairing our bodily defenses?  Or perhaps the problem lies not so much in our immune systems failing to keep the herpes virus in check as it does in as of yet unknown factors catalyzing the dormant pathogen. 

Unfortunately, the new vaccine threatens to lull both the public and healthcare workers into a false sense of complacency.  Disease, as uncomfortable and frightening as it may be, often has a silver lining: illness can be a tap on the shoulder - or slap in the face - from mother nature encouraging us to examine our lifestyles and devise better ways to live.  These "wake up calls" not only help us to make healthier personal choices but can also act as a referendum on societal trends.  Driven by the motivation of enormous profits, however, humanity today seems more inclined to hit the snooze button than learn a valuable lesson.  We do so at our own peril.