South Africa currently has no registered shingles vaccine available after the only vaccine on the market was discontinued last year. Although a newer, more effective vaccine is used in other countries, it has yet to be approved in South Africa. Those who want it can only get it by navigating a costly and complex approval process, reports Catherine Tomlinson for Spotlight.
Shingles is a painful skin condition caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. It usually affects older adults and people with weakened immune systems. The illness begins with a red rash and clusters of blisters, often appearing on one side of the body in a band-like pattern.
“Infections like shingles can cause severe pain and serious complications, such as strokes, vision loss, and deafness,” said infectious disease expert Professor Jeremy Nel. “It’s something best avoided if possible.”
Two vaccines have been developed to prevent shingles. The first, Zostavax, was introduced in the US in 2006 and approved in South Africa in 2011. It offers about 51% protection for adults over 60. However, Zostavax was discontinued globally in March 2024, including in South Africa’s private healthcare sector, where it was never widely available in public clinics.
The newer vaccine, Shingrix, provides over 90% protection and has become the preferred option worldwide since its US introduction in 2016. South African regulator SAHPRA is still reviewing the application for Shingrix, and the vaccine is not yet registered locally. GSK, the manufacturer, has submitted the paperwork, but approval is pending.
With no registered vaccines available, South Africans must apply for a Section 21 authorisation from SAHPRA to import Shingrix. This process is costly and requires a doctor’s approval. The two-dose vaccine costs around R15,600 when imported this way, and insurance companies typically do not cover it because it is unregistered.
Dr Leon Geffen, director of the Samson Institute for Ageing Research, explained, “Only those who can afford the time and expense of Section 21 approval can access the vaccine.”
Equity Pharmaceuticals imports Shingrix for patients with Section 21 approval but cannot publicly disclose pricing details due to various factors like currency rates and shipping costs.
Globally, health experts recommend the shingles vaccine for adults over 50 and for younger people with weakened immune systems, such as those with HIV or organ transplants. Shingrix is considered safer for immunocompromised individuals because it does not contain live virus, unlike Zostavax, which can pose risks for these patients.
In March 2025, the World Health Organization advised countries with a significant shingles burden to consider vaccinating older adults and those with chronic illnesses using the two-dose vaccine.
Shingles affects about 20% to 30% of people in their lifetime, rising to nearly 50% by age 80. It can cause chronic pain that impacts sleep, mood, and daily life.
Beyond preventing shingles, recent studies show vaccination may lower risks of dementia and heart disease. A Welsh study found that people vaccinated with Zostavax had a 20% lower chance of developing dementia over seven years. Similarly, research from South Korea reported a 23% reduction in cardiovascular events among vaccinated individuals for up to eight years.
Until Shingrix is registered and made widely available in South Africa, many vulnerable patients remain at risk. The high cost and complex approval process limit access, underscoring the need for faster regulatory action and affordable pricing to protect those most at risk of shingles and its complications.
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