Shingles may not kill you, but it can derail you
A vaccine of remarkable efficacy against one of aging's most punishing afflictions has arrived in South Africa, yet its presence may illuminate absence more than progress. Shingrix, capable of preventing more than nine in ten shingles cases, enters a healthcare landscape where the distance between regulatory approval and genuine access has long been measured in rands rather than kilometres. The story of this vaccine is, in many ways, the story of modern medicine's oldest tension: the gap between what science can offer and what society chooses to distribute.
- Shingrix arrives in South African pharmacies in 2026 carrying a 91% efficacy rate — but its price is expected to far exceed what most South Africans can afford, echoing a pattern of innovation that serves the privileged first.
- Shingles is not merely uncomfortable — it can ignite years of chronic nerve pain and strip older adults of their independence, making the stakes of unequal vaccine access deeply personal and physical.
- Regulators approved the vaccine but hold no power to compel supply or control pricing, leaving the terms of access largely in the hands of a single pharmaceutical company operating in a small, fragmented private market.
- Medical aid schemes may eventually fund Shingrix for their members, but coverage will depend on individual plan generosity, leaving the uninsured majority without a clear path to protection.
- South Africa's limited purchasing power and the pricing floors set by international procurement bodies make meaningful price reductions unlikely, trapping the country in a familiar cycle of late and unequal access.
A vaccine capable of sparing hundreds of thousands of South Africans from one of aging's most brutal conditions is arriving this year — but its price may ensure it remains a privilege of the already privileged.
Shingrix, developed by GlaxoSmithKline, received regulatory approval from South Africa's Health Products Regulatory Authority in mid-2025 and is expected in local pharmacies before year's end. The condition it targets — shingles — is caused by the varicella-zoster virus, which lies dormant in nerve cells for decades after childhood chickenpox before reactivating as immunity wanes. The consequences can be severe: a burning rash followed, in many cases, by postherpetic neuralgia, a chronic nerve pain lasting months or years that is considered among the most debilitating forms of pain in medicine. Even a single episode can permanently diminish an older adult's independence.
What distinguishes Shingrix from its predecessor, Zostavax, is both its effectiveness and its safety profile. Using inactivated rather than live virus components, it is suitable for immunocompromised patients — including those undergoing cancer treatment — and prevents more than 91% of shingles cases in older adults. Zostavax, by comparison, offered protection as low as 18% in the most vulnerable age groups.
Yet South Africa's history with vaccine access offers a sobering lens. Shabir Madhi of Wits University names the problem plainly: unequal access. Regulators can approve a vaccine but cannot compel a company to supply it or set its price. Shingrix is expected to cost significantly more than Zostavax, which already stood beyond reach for most South Africans at around R2,300. International pricing floors — shaped by large procurement bodies — limit how far prices can fall in smaller markets like South Africa's private sector.
Medical aid schemes may ease access for some once the vaccine is fully registered, but coverage will vary by plan. For geriatrician India Butler, the broader point stands regardless: science can now prevent many of the quiet erosions that accompany aging. The true measure of progress, however, will be whether that prevention reaches everyone — not only those who can already afford to age well.
A vaccine that could spare hundreds of thousands of South Africans from one of the most painful conditions of aging is arriving this year—but the price tag may ensure it reaches only those who can already afford good healthcare.
Shingrix, made by GlaxoSmithKline, received regulatory approval from South Africa's Health Products Regulatory Authority in July 2025 and is expected in local pharmacies before year's end. For doctors who treat older patients, its arrival feels overdue. The virus that causes shingles—varicella-zoster, the same pathogen behind chickenpox—lies dormant in nerve cells for decades after childhood infection, then reactivates when immunity weakens, usually after age 50. When it does, the results can be devastating. The initial burning pain and rash are only the beginning. For some patients, a condition called postherpetic neuralgia sets in, a chronic nerve pain that can persist for months or years and is widely considered one of the most debilitating forms of chronic pain medicine knows. In older adults, even a single episode can trigger sharp declines in physical function and independence that prove difficult to reverse.
What makes Shingrix different is its effectiveness and safety profile. Unlike Zostavax, the vaccine it replaces, Shingrix is not a live vaccine—it uses inactivated virus components instead. This matters enormously for people with compromised immune systems, including those undergoing cancer treatment or taking immunosuppressive drugs. According to data from the U.S. Centers for Disease Control and Prevention, Shingrix prevents more than 91 percent of shingles cases in older adults. Zostavax, by contrast, offered protection ranging from just 18 to 64 percent, and performed especially poorly in the very age group most vulnerable to severe disease. Some research also suggests that shingles vaccination may reduce dementia risk, though experts caution this link remains incompletely understood and the vaccine is not approved for that purpose.
Yet South Africa's experience with vaccine access tells a cautionary tale. The country has consistently lagged wealthy nations in receiving new immunizations, a pattern that reflects both regulatory timelines and commercial calculations. Shabir Madhi, dean of health sciences at Wits University, frames it plainly: unequal access. From the manufacturer's perspective, the delay reflects practical realities—public health priorities, expected demand, infrastructure readiness, and commercial viability must align before a product enters a new market. Boitumelo Semete, CEO of Sahpra, notes that regulators can approve a vaccine but cannot compel companies to supply it. The decision to bring Shingrix to market rests with GSK.
Price, however, is the steeper barrier. Zostavax cost around R2,300 in the private sector—already beyond reach for most South Africans. Shingrix is expected to cost significantly more. The manufacturer sets the price and submits a cost analysis to regulators, who then establish a single exit price capping what pharmacies may charge. Currently, the unlicensed version available locally costs far more than in the United States or United Kingdom. Part of this reflects the extra oversight responsibilities unlicensed access places on manufacturers. But even once Shingrix is fully registered, Madhi does not expect prices to drop substantially.
South Africa has limited bargaining power. Private market volumes are small. In the public sector, pricing is shaped by global agreements and benchmark rates set by large international procurement bodies like the Pan American Health Organization. Pharmaceutical companies resist offering prices below those negotiated through these channels, effectively setting a floor that limits how far prices can fall. The result is familiar: a highly effective intervention that may remain inaccessible to those who need it most.
Medical aid schemes may offer some relief. Noluthando Nematswerani, chief clinical officer at Discovery Health, notes that vaccines approved by Sahpra are typically funded from members' medical savings accounts, depending on their plan. Once Shingrix is fully registered, access may improve for those with adequate coverage. But affordability will still hinge on individual plan generosity and whether schemes choose to fund it more broadly over time.
For geriatrician India Butler, the case for Shingrix stands on its own merits. Shingles may not kill, but it can derail—triggering cascading losses of independence and resilience in people already navigating the vulnerabilities of age. Prevention should be part of how we age well, alongside flu, Covid-19, and pneumococcal vaccination. The arrival of Shingrix signals a broader shift: science increasingly can prevent the quiet erosions of quality of life that accompany aging. The real breakthrough, though, will come only when that prevention is within reach for everyone, not merely those with means.
Citas Notables
It's not a question of if you'll get shingles, but rather when— Milton Raff, Cape Town pain specialist
Shingles may not kill you, but it can derail you. In older adults, even one episode can trigger a sharp decline in physical and cognitive resilience— India Butler, geriatrician
La Conversación del Hearth Otra perspectiva de la historia
Why has South Africa taken so long to get this vaccine when it's been available in wealthy countries for nearly a decade?
It's not just bureaucratic slowness. Regulators can approve a product, but they can't force manufacturers to supply it. GSK has to decide whether bringing it here makes commercial sense—whether the market is big enough, the infrastructure is ready, the price they can charge will work. Those calculations take time.
So it's about profit, not public health?
It's both. The company has legitimate costs. But yes, profit shapes the decision. And once it arrives, the price will reflect what they can negotiate globally. South Africa doesn't have the bargaining power of larger markets, so we end up paying more.
What happens to someone who gets shingles and can't afford the vaccine?
If they're lucky, they catch it early and antiviral treatment works—they recover in a week. But many don't. The pain can linger for months or years. In older people, it can trigger a sharp decline in physical function they never fully recover from. It's not just pain. It's independence lost.
Could medical aid schemes help close the gap?
They might, for their members. But that only helps people with good coverage. For the majority without adequate medical aid, Shingrix will likely remain out of reach, even though they're the ones most vulnerable to severe shingles.
Is there any chance the price will come down?
Not dramatically. International procurement agreements set a floor. Companies won't price below what they've negotiated with larger bodies. South Africa's small private market gives us little leverage. The public sector could negotiate differently, but that would require political will and budget allocation we haven't seen yet.
So what's the real barrier—is it the vaccine or the system?
Both. But the system is the harder problem to fix.