A Vaccine Mystery Hits Older Americans.

http://www.bloombergview.com/articles/2014-09-04/a-vaccine-mystery-hits-older-americans

More than three-quarters of Americans believe vaccines for such diseases as measles, mumps, and whooping cough should be mandatory for children, a new Harris poll finds. The margin increases with age, with 88 percent of respondents over 69 years old and 83 percent of those 50 to 68 voicing support. People who remember the scourge of polio and who themselves may have suffered through such “childhood diseases” as mumps are, not surprisingly, more likely to want vaccines required for kids.

But when it comes to their own health, they aren’t as enthusiastic about a shot of prevention.

It’s been eight years since the Food and Drug Administration approved Merck’s Zostavax shingles vaccine for people over 60. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices officially recommended it for the same group. Yet only about 20 percent of Americans over 60 have had the vaccine. (In 2011 the FDA also approved it for people over 50, but without a CDC recommendation insurers rarely cover it.)

Shingles, also called herpes zoster or zoster, occurs when the virus that once gave someone chickenpox reawakens after lying dormant in nerve tissue. Combining what feels like deep muscle aches with the sensation of burning skin, it can be excruciatingly painful. Having come down with shingles three years ago, I can personally attest to the agony. My economist husband, who developed the disease in early July, said early on that he would have paid at least $3,000 to avoid the experience. (Yes, this is the way we talk in the Postrel household.) After living with the (finally waning) pain for nearly two months, he’s upped the estimate to $5,000 -- a lot less than the roughly $200 the vaccine costs someone whose insurance doesn’t cover the shot.

For healthy patients, getting the vaccine seems like an obviously smart move. So why have so few people opted for it? The main reasons seem to be cost, inconvenience, and inertia. The vaccine is expensive, although for people over 60 it’s now covered under Obamacare plans as well as Medicare Part D. It has to be kept frozen, and many doctor’s offices don’t stock it. That means that physicians don’t routinely offer it to patients and people who want it have to seek out a pharmacy. (At Kaiser Permanente, where clinics keep the vaccine in stock and members receive it for free, 35 percent of those over 60 have been vaccinated.) And, of course, there’s inertia. It’s a lot easier to understand why someone should get a shingles vaccine if you’ve had shingles yourself. If you haven’t, the danger seems remote.