Kathy Hershey, pharmacist manager at the Giant in Pikesville,… (Kenneth K. Lam, Baltimore…)
My fellow mothers used to tease me about being first in line for any new childhood vaccination: hepatitis, meningitis, HPV. If it came in a syringe and it promised to protect my kids from some terrible disease, I was all in.
So it should come as no surprise that as the sun came up on my 60th birthday, I could be found in line for the shingles vaccine for which I was now officially eligible.
The one-time shot should protect me from the painful — and often debilitating — eruption of the dormant chicken pox virus lurking in the nerve endings of everyone who ever had that childhood disease.
When the virus awakens in those of us with immune systems weakened by age or stress, it doesn't simply present itself as a low-grade fever and some itchy blisters.
Instead, it arrives as blistered nerve endings — often on the head, face or in the midsection — so inflamed that sometimes even the most powerful painkillers provide no relief. If it appears on the face and attacks the eye, the pain can be unrelenting and the result can be blindness.
"We serve an older population," said Kathy Hershey, pharmacist at Giant Foods in Pikesville, "and they are well aware of shingles. They might have had loved ones go through this, and they want the shot. It is in high demand. We have a waiting list, and we have physicians we call when we have a supply."
This waiting list is not the result of a public health awareness campaign. Though between 1 million and 3 million Americans contract shingles each year — and the number will only increase as boomers age — less than 10 percent of the those 60 and older have had the vaccination, which has been available for more than five years.
"There hasn't been the major push the way we see with new vaccines where care providers are given information and the public is alerted," said Dr. Myron Levin of the University of Colorado School of Medicine, who has been involved in the experiments that demonstrated the effectiveness of the vaccine. "That's because the manufacturers don't want the demand to outstrip the supply."
The shingles vaccine is made from the same virus used to create the chickenpox vaccine now routinely given to babies. However, 14 times the amount of virus is required, and it takes time to grow in a lab.
A request for more information from Merck, the manufacturer of the drug known as Zostavax, received no response.
The U.S. Food and Drug Administration has also approved the vaccine for 50-year-olds based on research by Levin and his colleagues that demonstrated it is even more effective for that age group. "It is 70 percent effective for this younger group, compared to 51 percent for the 60-year-olds," Levin said.
But Levin said the Centers for Disease Control has delayed its approval in order to protect the limited supply of the drug for the most vulnerable age group.
"The older you are, the more severe the disease and the less you are able to cope with it," said Levin. "If you have seen the disease in an 85-year-old, it is quite profound. People can end up in nursing homes because of the pain."
Cost is a second reason why the vaccine has not penetrated the elderly population the way, say, flu shots have. Instead of costing $5 to $20 as a flu shot does, the shingles vaccine costs between $200 and $300.
And while it is covered by some health insurance policies, it is not covered by Medicare's Plan B, which provides preventive care for those 65 and older. For someone on Social Security or a fixed income, a $250 shot can be prohibitive. (If you subscribe to Medicare Plan D, the vaccine is covered, but the amount of cost-sharing varies with the policy level.)
"If you have ever known anyone who has had this disease, you will do anything you can to prevent it," said Francis Phillips, Maryland's deputy secretary of health and mental hygiene, who is among those pushing for it to be included in Plan B.
While there are no state programs to provide the vaccine, Phillips said, some county health departments in Maryland will administer the shot for a small fee.
In Congress, Rep. Mazie Hirono, a Democrat from Hawaii, has proposed legislation to move the vaccine under Medicare Plan B, where seniors would not even be required to come up with a co-pay. But such an expensive health benefit is probably doomed in the current economic climate.
Those younger than 60 can ask their physician for the vaccine, said Levin, but without CDC approval it will not be covered by insurance.
"The importance of the 50-year-olds is that they are still working and at the top of their game," said Levin. "Getting shingles puts some people out of action for roughly 30 to 35 hours of work. It is expensive, but especially for this group, it would be cost beneficial."