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South Africa has introduced Shingrix, a shingles vaccine that offers over 90% efficacy in adults over 50, sparking interest for its primary purpose and emerging data suggesting a possible link to reduced dementia risk.

New vaccine arrives after a decade

The rollout began at the end of June, offering two doses priced at R2 783 each, according to the manufacturer, GlaxoSmithKline (GSK). The schedule calls for injections spaced two to six months apart. Prior to this, the country relied on Zostavax, a live‑attenuated vaccine introduced in 2011, which showed markedly lower effectiveness—about 64% in people aged 60‑69 and dropping to 18% in those over 80.

Because Zostavax could not be given to individuals with compromised immune systems, many patients on chemotherapy, those with autoimmune conditions, or people living with HIV were left unprotected. The newer formulation can be administered to a broader segment of the population, including those on immunosuppressive therapy.

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Evidence of a cognitive benefit

Additional research has linked shingles vaccination to fewer strokes, reduced heart‑attack rates, and lower overall mortality. However, experts caution that these findings are not yet definitive. The gold standard—a double‑blind, randomised trial—has not been conducted for this purpose, leaving room for uncertainty about causation.

In South Africa, adult‑vaccination uptake is limited—about one‑third of adults receive the flu shot and fewer than 4% have taken the previous shingles vaccine. The high price of Shingrix, combined with a health system that often prioritises acute crises over preventive measures, may dampen enthusiasm.

One reason for cautious optimism is the biological plausibility presented by virologists. Shingles can cause vasculitis, a swelling of blood vessels, which may lead to tiny blockages in the brain that do not manifest as overt strokes but could contribute to cognitive decline over time. This mechanism supports the hypothesis that preventing shingles might indirectly protect brain health.

Former Member of Parliament Melanie Verwoerd endured a severe shingles outbreak last year and now advocates for free access. She argues that the cost of dementia care far exceeds the price of vaccination.

General practitioners report limited patient inquiry about the dementia angle. “I do not think many people are aware of it,” said a Cape Town doctor, noting that interest is likely to grow among older adults who have already suffered from shingles.

The potential dual benefit of Shingrix illustrates a recurring theme in preventive medicine: interventions aimed at a specific condition can yield ancillary health advantages. While the evidence is not yet conclusive, the possibility of mitigating two serious age‑related ailments with a single shot is an appealing proposition for health planners.

Decision‑makers will weigh clinical evidence, regulatory standards, and affordability. Discovery Health’s chief clinical officer indicated that any subsidy would depend on these factors, and the national advisory group on immunisation has yet to issue a recommendation. GSK has expressed willingness to discuss terms, but no tender has been announced.

As South Africa grapples with a growing elderly population and rising rates of diabetes and hypertension—both risk factors for dementia—the conversation around Shingrix may gain urgency. Whether the vaccine will achieve widespread adoption remains uncertain, but its arrival marks a notable shift in the country’s approach to adult immunisation.