Brazil Denies Free Shingles Vaccine for Elderly

The Ministry of Health has determined that the shingles vaccine will not be added to the public Unified Health System (SUS) at this time. The decision was officially published on Monday, December 12, following an evaluation by the National Commission for the Incorporation of Technologies (Conitec).

The analysis focused on the recombinant adjuvant vaccine, which is currently the only version available in Brazil. While Conitec recognized the clinical importance of the immunizer, the evaluation concluded that the cost of incorporation would be too high for the current public budget. The estimated impact on the budget is projected to exceed R$ 5.2 billion over a five-year period.

The vaccine is designed to prevent the reactivation of the varicella-zoster virus, which causes chickenpox and can reappear decades later as shingles. Although the door remains open for future re-evaluation if new facts emerge, the vaccine is currently available only through private healthcare networks in Brazil.

The Sistema Único de Saúde (SUS) officially decided not to incorporate the vaccine against herpes-zóster, commonly known as shingles. The refusal specifically applies to the recombinant adjuvant vaccine evaluated for use in seniors aged 80 or older and immunocompromised individuals starting at age 18.

The determination was made after Conitec reviewed scientific evidence, budgetary impact, and cost-effectiveness. According to the Ministry of Health, Conitec issued a final unfavorable opinion on December 10. The document states that while the clinical importance of the immunizer was recognized, the vaccine was not considered cost-effective under the evaluated conditions.

The financial analysis played a central role in the decision. The Ministry provided a comparison to illustrate the scale of the expense: the total cost of all medicines distributed by the Popular Pharmacy Program last year was R$ 4.2 billion, which is lower than the projected cost for just this single vaccine incorporation.

The Ministry noted that the laboratory responsible has not yet presented a new proposal. However, the government affirmed its interest in incorporating the vaccine and intends to continue negotiations to find a price compatible with the SUS budget availability.

Despite the financial rejection, medical experts emphasize the vaccine's significant health benefits. Renato Kfouri, an infectologist and vice-president of the Brazilian Society of Immunizations, explains that this vaccine represents a major advancement over previous versions.

According to Kfouri, older vaccines had lower efficacy, around 50% to 60%, with shorter protection duration and worse performance in the elderly. "The recombinant vaccine changed this scenario: it has an efficacy of around 90%, regardless of age, including in the elderly," he stated.

Shingles is more frequent with advancing age and in people with compromised immune systems. Beyond skin lesions, the disease can evolve into postherpetic neuralgia, a chronic pain condition that can last for months or years. Because of these risks, the Brazilian Society of Immunizations recommends routine vaccination starting at age 60, and consideration from age 50. For immunocompromised individuals, indications can begin at age 18 depending on the clinical condition.

Recent studies have investigated potential indirect benefits of the vaccine beyond preventing the rash itself. Observational studies suggest that preventing the repeated reactivation of the varicella-zoster virus may have wider health impacts.

A major international meta-analysis presented at the 2025 European Congress of Cardiology gathered data from 19 studies over nearly two decades. The analysis observed that people vaccinated against shingles had a lower incidence of cardiovascular events, such as heart attacks and strokes, compared to non-vaccinated individuals. The reduction was estimated at up to 18%, depending on the age group.

Another significant study published in the journal Nature analyzed more than 280,000 adults in the United Kingdom. It found a lower frequency of new dementia diagnoses among people who received the shingles vaccine over a seven-year follow-up period.

However, experts urge caution in interpreting these findings. Helder Picarelli, a neurosurgeon at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), notes that these findings do not change formal vaccine indications or replace randomized clinical trials. Still, they help contextualize the growing scientific interest in preventing shingles in the elderly.

The primary barrier to incorporation remains financial. Renato Kfouri clarifies that the discussion is not about whether the vaccine works—it does—but about cost-effectiveness and budgetary impact within the National Immunization Program.

Brazil faces simultaneous challenges in vaccination policy. Kfouri highlights that there are currently large priorities such as dengue, respiratory syncytial virus, updates to pneumococcal vaccines, and HPV. Defining the order of these incorporations is difficult with a limited budget. The decision reflects the understanding that the vaccine has an "extremely high cost" and, in the current context, incorporation was not deemed cost-effective.

Currently, the shingles vaccine is not part of the National Immunization Program and is available only in the private network. The cost is significant for patients paying out of pocket.

Current private market rates include:

• Average cost per dose: R$ 900 to R$ 1,200
• Full regimen (two doses): Up to R$ 2,400

The Ministry of Health stated that the theme can be submitted for a new evaluation in the future if new facts are presented that alter the result of the analysis.