NHS eligibility criteria for shingles vaccination is ageist

Klein and colleagues provide valuable information about the duration of effectiveness of the live herpes zoster vaccination in a Californian population aged over 50, extending to those aged over 80.1 The incidence of severe complications of shingles in unvaccinated people was 113 per 100 000 per year, half being postherpetic neuralgia, which can cause substantial long term distress. Protection against postherpetic neuralgia was higher and waned less than protection against all shingles cases.

There are now two available vaccines, the other being a recombinant adjuvanted subunit vaccine given as two doses, two to six months apart. Licensing studies gave the overall efficacy of the live vaccine as 51.3% compared with 97.2% for the subunit vaccine, and the United States Advisory Committee on Immunization Practices recommended use of the subunit vaccine for immunocompetent adults aged 50 and over in 2018.2

By comparison, in 2023 the NHS is offering the subunit vaccine to people turning 65 after 1 September (my wife) and either the live or subunit vaccine to those aged 70-79; those between 65 and 69 on 1 September (me) have to wait until their 70th birthday. People aged 80 and over are not eligible.3

How can the NHS justify these ageist eligibility criteria whereby the less effective vaccine is being used up on the over 70s, while those over 80 are ignored, and there is a “hole” in eligibility for 65-69 year-olds?