NZ falling behind: We need to fund adult vaccines

Summary

A recent Public Health Expert Briefing discussed how Aotearoa New Zealand (NZ) is falling behind comparable high-income countries by not protecting our infants from Respiratory Syncytial Virus (RSV) infection. However, we also have important omissions in our adult immunisation programme, notably highly restricted access to funded shingles and pneumococcal vaccines and no funded access to an adult RSV vaccine. Furthermore, unlike Australia, we do not address the important equity issue of greater disease burden by ethnicity for Māori and Pacific peoples.

Immunisation decision-making and funding processes differ from comparable countries such as Australia and the United Kingdom. For NZ, Pharmac considers and funds vaccines alongside all medications. Pharmac is constrained by its limited budget. As a result, newer highly effective vaccines are not getting onto the national schedule in the way they are in other comparable countries.

Vaccines are one of the most cost-effective health interventions. Evidence on their return on investment shows that they deliver substantial benefits for every dollar invested.1 They prevent disease and downstream health and societal costs, and therefore, should be assessed differently from medicines that treat established illness (see Appendix for more details).

Current Pharmac health economic models do not adequately account for broader population-level societal and long-term benefits. Consequently, we are falling behind other comparable countries.

Omissions in NZ funded adult immunisation schedule

A recent Briefing discussed how NZ is falling behind comparable high-income countries by not protecting our infants from Respiratory Syncytial Virus (RSV) infection and its complications.2 Here we focus on vaccines that are state funded for adults without specific medical risk factors, and benchmark NZ with two comparable countries (Table 1).

Table 1: Comparison of the funded routine adult immunisation schedule in NZ with Australia and England

‍

Herpes zoster (HZ) / Shingles

A notable difference is for Shingrix, the Herpes Zoster (HZ) vaccine. This is funded in NZ for adults only while they are in their 66th year for their first dose, and for a limited number of adults with significant immunocompromising conditions. The risk of HZ and the rate of complications including post herpetic neuralgia, increase markedly with increasing age, so it is illogical that older adults are not eligible to receive the highly effective vaccine.

Narrowing funding to only the 66th year can also disadvantage those who, for a range of reasons, miss out accessing services in that one-year window. Furthermore, there are other groups with significant immunocompromise leading to elevated herpes zoster rates and complications that are not included in the programme.

HZ vaccination has important indirect benefits beyond the direct reduction in zoster, with evidence that it reduces myocardial infarcts, heart failure and ischemic stroke,3 and a likely significant reduction in dementia.4

‍

Pneumococcal and RSV

In NZ, pneumococcal vaccines are only funded for a small number of adults with high-risk conditions and adult vaccines for RSV are not funded. In Australia and England, all adults from 65 years and 75 years, respectively, receive new broad valency pneumococcal vaccines and the adult RSV vaccine.

RSV immunisation is funded during every pregnancy in Australia and England. This addition has resulted in a reduced risk of severe RSV disease in infants during the first six months of life.

Lack of different eligibility age for ethnic groups with elevated risk

Another significant difference is with ethnic groups and equity issues. In Australia, Aboriginal and Torres Strait Islander adults receive funded immunisations from younger ages than other ethnic groups (see Table 1 for details). This difference acknowledges their higher risk of multiple vaccine preventable diseases, including influenza and invasive pneumococcal disease.

These ethnic differences are also very clear in NZ. For example, in 2025 invasive pneumococcal disease incidence in Māori and Pacific adults aged 50 years and older was 3 to 5 times higher than in non-Māori/non-Pacific populations.5 In the same year, Pacific peoples had the highest influenza hospitalisation rate (218.9 per 100,000), followed by Māori (121.4 per 100,000), compared with European or Other (58.7 per 100,000).6 These differences are due to multiple factors such as higher rates of comorbidity, living in large multigenerational houses and socioeconomic deprivation.

These differences support age cutoffs for influenza and pneumococcal immunisations (if we funded them for adults) to be lower for Māori and Pacific peoples to try and reduce the excessive burden of these infections.

‍

Difficulties with Pharmac process for determining vaccine funding in NZ

Since Pharmac assumed responsibility for vaccine funding decisions in 2012 (2004 for influenza vaccines), vaccines must compete with medicines and other health technologies within its fixed budget (see Appendix for more details). This process differs from countries such as Australia and the United Kingdom (see Table 2).

Table 2: Differences in the immunisation programme decision-making processes (since 2012) comparing NZ with Australia and the United Kingdom.

‍

Since the 2024 funding injection of $604 million, Pharmac has funded or increased access to multiple new cancer and non-cancer pharmaceuticals, but almost no new vaccines until an announcement in late August 2026. This advance included a decision to fund influenza vaccine for all children from 6-59 months inclusive, and cell-based influenza vaccines and adjuvanted influenza vaccines for adults aged 65 years and over.7

While it is pleasing to see these gains, NZ has been slower than similar countries to change to an enhanced influenza vaccine for older people. The adjuvanted influenza vaccine first became funded in both Australia and the United Kingdom for people aged 65 years and over in 2018. An application to Pharmac was made in May 2020 for this vaccine.

‍

Conclusion

In NZ, funding of vaccines is from a constrained and competitive Pharmac budget. This situation is limiting access to some newer, expensive but highly effective vaccines.

Vaccines are public health interventions with broad health gains, both direct and indirect, giving a very different profile of benefits than medications. NZ’s uptake of these vaccines is behind comparable countries. While limiting vaccine expenditure for adults in NZ saves money in Pharmac’s budget, the cost of managing important vaccine preventable diseases such as shingles, influenza, RSV and pneumococcal disease in older adults is considerable, both for direct protection and indirect effects. Furthermore, we are not funding vaccines at different ages for Māori and Pacific people despite their significantly higher risk of several vaccine preventable infections.

‍

What this briefing adds

NZ is falling behind comparable countries in access to important adult vaccines, particularly for shingles, pneumococcal disease and RSV, with substantially narrower funded eligibility than Australia and England.

Current vaccine eligibility does not adequately reflect major ethnic inequities in disease risk. Unlike Australia, NZ does not routinely offer earlier age-based access for Māori and Pacific peoples despite their substantially higher burden of several vaccine-preventable diseases.

NZ’s vaccine funding model may systematically disadvantage prevention, because vaccines compete with medicines within Pharmac’s constrained budget and their wider population, societal and long-term benefits may not be fully captured in conventional health-economic assessment.

‍

Implications for policy and practice

NZ should review funded adult immunisation, with priority given to broader access to shingles, pneumococcal and RSV vaccines and closing important gaps with comparable countries.

Eligibility criteria should explicitly address equity, including considering younger eligibility ages for Māori and Pacific peoples where disease burden and vaccine-preventable risk are substantially higher.

Vaccine assessment and funding processes should be reformed to better recognise the distinctive value of prevention, including indirect health effects, health-system savings, equity benefits and wider societal returns, rather than treating vaccines in essentially the same way as therapeutic medicines.

‍