What is fair when there’s not enough to go around?

The limited global supply of the shingles vaccine Zostavax has raised an interesting new question on access and equity: how should the NHS share when there is not enough to go around?

In other situations of limited vaccine supply, forward planning by the DH has meant that the UK has been able to secure supply ahead of other countries. But, as GP reveals today, that has not been the case for shingles.

The DH has insisted that, before any national shingles immunisation scheme is launched, there needs to be sufficient supply of vaccine for everyone who is likely to want it. This position has been welcomed by RCGP immunisation lead Dr George Kassianos. ‘We achieve higher vaccination rates when we target age rather than conditions. I, therefore, agree with the JCVI defining an age rather than specific groups,’ he told me.

But would the public really support a position where no one is being given NHS access until everyone can have access?

The JCVI has recommended shingles vaccination for everyone aged 70-79, so the government has a legal duty under the The NHS Constitution to investigate whether a cost-effective vaccination programme can be developed.

It seems hard to believe that the DH would not be able to negotiate a cost-effective price. Sanofi Pasteur MSD is currently making the vaccine available privately for £99.96. The Health Protection Agency calculates that a shingles vaccine would be cost-effective if priced under £90 a dose, and DH figures show that buying vaccines as part of a national programmes achieves discounts of 30%-40%.

It may be easier to run a national campaign for all patients, and it may be difficult to develop appropriate sub-groups to target for vaccination. But is it really fairer to have no one receiving a vaccine on the NHS?

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