Ain’t got time to fix the shingles

Just as I thought the NHS had finished chasing me up over vaccinations, I got another letter today.

As I explain here, my decision not to get a COVID booster, for the reasons outlined here, led to the NHS totally ignoring my legally registered right not to have my medical records uploaded to the Matrix from my GP. Consequently I received several reminders from a central unit and, in the end, a rather dubious “research” phone call.

Now, as every critic of mRNA technology seems required to say, I am not now, and have never been, a member of the anti-Vaxxer Party. That denial goes along with every death having to be carefully lamented before one discusses IFRs and so on (“After the Chicxulub impact, 75% of species sadly passed, and of course every death is a tragedy…”). No, I did the whole pincushion thing throughout my childhood, foreign travel and subsequent career, got Hep B when it became an NHS rule, started flu-jabs with only a shrug of the shoulders when my partners suggested it (I seldom got flu and it made for a few days away from GP stress, but why rock the boat?), and tut-tutted duly at the parents who wanted to get their kids injected with the components of MMR separately.

But I latched on early to the complete novelty, incomplete safety research, and potential problems of the COVID vaccines, which led me to become more acutely aware of the execrable ethical track record of Big Pharma. Since then matters have got worse, of course, and more and more lines of evidence suggest that the vaccines are all pain and little or no gain.

That conclusion actually led me to look a little more closely at the rather poor results, and massive commercial lobbying, relating to flu vaccinations, and I decided last year to take my chances and let my immune system, if not already compromised, cope with future flu epidemics as it did before I started annual inoculations, treating it face to face daily. It does truly appear that with the market for therapeutic agents saturated, Big Pharma started creating vaccines for every routine disease they could, and bigging up the market for them, as a perennial money spinner. The cost-benefit equation for routine flu vaccines, to my eyes, is not that good.

Having neither been struck off by my doctor, nor had my bank account blocked, I thought I’d got away with declining both vaccines. But yesterday, having reached the magic age of 70, I got a letter inviting me for a shingles vaccination. This is yet another of the proliferating crowd of “essential” inoculations that have appeared since my retirement, only a dozen years ago, and I was unaware we were supposed to get it. I have big questions in general about the long-term advisability of vaccinating against every infection one can think of, given how many quirky reactions immune systems can produce, and the poorly researched safety of introducing cocktails of adjuvants to the body over a whole lifetime. I’ve even heard vaccinologists raise concerns about this at conferences. And, of course, the fact that God gave me a pretty decent immune system should be remembered.

But my initial reaction (after, “Not again!”) was that shingles is an unpleasant condition – at least in later life: one day I’ll have to tell you the story of how my twin daughters got it in infancy and I became an expert on it for about a week. Dad had it during his final disease, though not badly. But maybe, I thought, I’ll scotch any suspicions of my paranoid Anti-Vaxxer status and get jabbed. But not blindly this time round: COVID has proved that one can’t rely on “the system” to weigh up costs and benefits fairly, since everyone from the GP to the government stands to benefit significantly from the cost. So I decided to look beyond “safe and effective” (Yes, that tired phrase is there on the NHS website on shingles vaccination!), and beyond the high percentage reduction in shingles stated, knowing that relative risks can be deceptive.

The vaccine, I discovered, is pretty ineffective over the age of 80, so I stand to benefit from it for no more than ten years. Over the age of 65 the overall incidence of shingles is said to be from 3.9 to 11.8 per 1,000 person-years. At that rate this means that over the ten years from 70-80, the higher end of the risk to me of getting shingles is 0.118%, and the lower end 0.038%, which is not exactly a huge risk.

The NHS still uses a single-dose attenuated live vaccine routinely, Zostavax by Merck (you know, the guys who dissed ivermectin for COVID because their patent had expired). Research shows that it reduces the risk of shingles by 38% over the age of 70, which would reduce my risk to between about 0.08% and 0.03% over the ten years. No great gain, in my book.

However, the big problem with shingles is the risk of post-herpetic neuralgia, which is certainly a very unpleasant, and persistent, condition. Zostavax is said to decrease post-herpetic neuralgia by 66% in those it hasn’t properly protected and who get shingles anyway.

Yet only 1:5 shingles patients gets neuralgia, which makes my absolute risk of neuralgia something less than 0.02% (2:10,000) over the next 10 years. This might be reduced by the vaccine to a bit less than 0.01% (1:10,000). That’s taking the higher level for the incidence of shingles: the figures are 1/3 of these if one takes the lower risk estimate – that is, 30,000 people have to get vaccinated to prevent one case of neuralgia, if my maths is correct. I won’t lose much sleep worrying about those odds.

In older people, post-herpetic neuralgia is certainly worse than in the under-50s, “but even in people over 70, 85% were free from pain a year after their shingles outbreak.” So all in all, the benefit of vaccination appears rather marginal. So what about the costs?

The financial cost to the NHS is not inconsiderable: the NHS price for Zostavax into MSD’s coffers is around £100. Add to that the GP’s administration and dispensing fees, and it seems every case of neuralgia prevented costs the taxpayer in excess of a million quid. The newer two-dose vaccine Shingrix, alleged to be more effective, benefits GSK (and Patrick Vallance’s remaining shares) £360, but is only given to particular vulnerable patients on the NHS, though standard in the US. Zostavax is only effective for 6 years, so I ought to have decreased all my previous percentages for benefit by 40%.

Medical costs are certainly lower than for the appalling COVID vaccines, but they are not trivial given the relative rarity of the problem they are preventing. The worst, and least common, listed adverse reaction is that the vaccine can cause shingles in around (officially less than) 0.01% or 1:10,000. It’s a low risk, but still only 4-10 times lower than my risk of getting the condition naturally. The risk of less serious side effects is significantly higher, and over 10% get at least local pain and irritation, and a good number some constitutional upset, which in my professional experience is uncommon in shingles itself.

The question, then, (feel free to answer it in the comments!) is whether these figures make a very convincing case for shingles vaccination. Very few of the general public will delve into these statistics, but even so, according to Wikipedia, “by August 2017, just under half of eligible 70–78 year olds had been vaccinated.” That would make one suspect that shingles is not considered by a majority of septuagenarians (with many decades of experience in mixing with the elderly) to be a big problem. Does MSD and the GAVI-shareholder government know better, or do they just stand to profit from promoting exaggerated anxiety?

Let me know – should I make an appointment, or once again tear off and return the “No Thanks” slip?