Unprecedented demand — and a tedious production process — are still limiting the availability of the shingles vaccine on Long Island and beyond despite the maker of Shingrix declaring manufacturing has been ramped up in recent weeks.
The Centers for Disease Control and Prevention has strongly recommended that people 50 and older get vaccinated with the two-dose Shingrix shot, which provides protection at a rate greater than 90 percent. The two shots boost immunity against an infectious disorder that some people say causes an indescribable degree of pain.
The trouble with Shingrix is there hasn’t been enough of it to meet the demand since its approval by the Food and Drug Administration in November 2017. The nationwide shortage has resulted in waiting lists and frantic phone calls to pharmacies and doctors’ offices.
A few local pharmacies say they’ve had an ample supply within the past week or so.
“In my three pharmacies, we have plenty of doses right now,” said Howard Jacobson, board chairman of the Long Island Pharmacists Society. He owns Rockville Centre Pharmacy, Ryan Medical Pharmacy on the campus of Mercy Medical Center in Rockville Centre and West Hempstead Pharmacy.
One of his pharmacists, Mary Vukadin, said: “We’ve been able to keep up with the number of people who contact us to get the shingles vaccine.”
Jacobson credited the warehouse that supplies his pharmacies: “When shipments come into the warehouse, our orders get populated,” he said.
Shingles is caused by the re-emergence of the chickenpox virus — varicella zoster — which remains in the body decades after the childhood infection is forgotten. But as immunity wanes later in life, varicella zoster rebounds as shingles and brings with it excruciating pain and misery. Varicella zoster is a herpes virus.
The CDC estimates that 99 percent of the U.S. population 40 and older has had chickenpox, even if people don’t remember the infection. That puts tens of millions of individuals at risk of shingles as they age. Younger generations have had the benefit of chickenpox vaccination.
GlaxoSmithKline, the Shingrix's maker, acknowledged that while production has been stepped up since late December, supply still is not on par with requests.
“The unprecedented demand continues to outpace supply,” Sean Clements, a GSK spokesman said in an email, noting that significantly more doses will be produced in 2019 compared with last year. Over the next two to three years, the company plans to grow its manufacturing capacity to the “high teens of millions,” Clements said.
In January, the FDA approved an additional GSK manufacturing facility in France, which will add to the amount of vaccine that can be produced. One reason for the shortage, Clements explained, is that production is tedious.
“The vaccine typically takes six to nine months to produce, but we produced some of the critical elements of the vaccine before we received FDA approval in order to shorten the production cycle so that we could respond quickly to the demand,” Clements said.
Despite improved efforts to meet demand, pharmacists and doctors are still scrambling to stock their shelves and don’t expect to have a full supply any time soon.
“Not much has changed. It’s about the same as it was last year,” said Julio Viola, director of centralized pharmacy services for the Northwell Health system.
Viola said a rationing strategy put in place last year at Northwell’s physician practices is still in force. To help doctors cope with the shortage, boxes of Shingrix, which contain 10 vaccine vials, are reserved for five patients. This enables five people to be fully vaccinated.
“They cannot physically produce enough vaccine to supply the market,” Viola said. “From March of 2018 to the end of the year they produced 7 million doses, and that wasn’t enough.”
Even large chain pharmacies are not receiving sufficient amounts of the vaccine.
“The situation is the same regarding Shingrix supply across all of our pharmacies nationwide,” said Amy Lanctot, spokeswoman for CVS Health in Woonsocket, Rhode Island. The company owns more than 9,800 CVS pharmacies across the country and 1,100 MinuteClinic outlets.
Her assessment had not changed much from December when she told Newsday that it had “become challenging” to keep an ample supply of the vaccine in stock.
Doctors at major public health agencies, such as American Public Health Association and the CDC, have voiced surprise at how quickly the public embraced vaccination against shingles with Shingrix vaccine. The CDC recommended the doses in January 2018, a couple of months after FDA approval.
Shingrix joined another shingles vaccine, Zostavax, which is manufactured by Merck, but has never been in short supply. Zostavax, which is only 51 percent effective, was approved by the FDA in 2006. It is composed of a weakened virus. Some people developed rashes after vaccination.
GSK’s vaccine has no live components and has been deemed the preferred vaccine by the CDC. Both Shingrix and Zostavax can prevent post-herpetic neuralgia, a severe side effect of shingles. After the rash and blisters of shingles have subsided, some people are affected by the neuralgia, which affects nerve fibers and the skin, causing an excruciating burning sensation.