Doubts About Widespread Use
As promising as the vaccine is, Dworkin points out that we don't really know how many people will wind up getting it. Many things could get in the way.
First of all, a lot of people don't know much about shingles. It doesn't have the fearful reputation of other illnesses. So it's unlikely that the average person will be clamoring for the vaccine as soon as he or she hits 60, says Dworkin.
"A lot of people have heard of shingles," says Gilden, "but they have no idea how devastating an illness it can be."
Adults can also be tough to vaccinate, says Dworkin. While shots in childhood are routine, adult vaccinations are harder to implement. Adults may not see their doctor regularly. They may put off getting a shot. And while the shingles vaccine could prevent hundreds of thousands of cases each year, an average person might be unimpressed that Zostavax only prevents the disease 50% of the time. People might expect a vaccine to protect them from a disease more or less completely, not just reduce the odds to 50/50.
A great deal is resting on doctors and nurses to explain the benefits of the vaccine and the risks of shingles. "But we all know the enormous time pressures that are put on health care providers these days," says Dworkin. "Will they be able to spare the 20 minutes to explain everything? We don't know."
Who Will Pay?
Another unresolved issue is the vaccine's price. Experts believe that the vaccine will cost about $100 to $150. While it's plausible that private insurance companies will cover it, no one knows for sure.
"I know several groups are running cost-benefit analyses on the vaccine now," says Dworkin. "The insurance companies will look carefully at those numbers."
Most people over 65 will probably get some coverage from MedicareMedicare for the vaccine. Right now, Zostavax is expected to be covered by Medicare's prescription drug plan, called Medicare Part D. But as millions of Americans have recently discovered, understanding the details of their Medicare drug coverage can be complicated, to say the least.