Why All Vaccines Should Be Free

Want to ease the burden of health-care costs, and especially hospitalization? Easy. Just spend whatever it costs to provide all Canadians with free vaccinations — for life.

The other day I went to the local pharmacy for my flu and COVID-19 shots, which are free to all B.C. residents. I asked the pharmacist about the vaccination for respiratory syncytial virus, or RSV.

I learned that it would cost me about $300. And a vaccination for shingles, recommended for adults age 50 and older and sometimes administered together with the RSV vaccine, costs about $160 per dose.

Like most people, I pondered whether it was worth spending that amount to stay out of hospital and maybe stay alive; older adults are at highest risk for RSV complications, and shingles disproportionately affects adults aged 60 and older.

But I decided I had better uses for the money.

Then I asked myself: Why should any of us old folks pay for any vaccine?

Seniors spend more time in hospital than younger patients

I did some digging and found a report from the Canadian Institute for Health Information, or CIHI, that told me B.C. had spent an average of $9,673 per capita on health care in 2024.

But it wasn’t evenly distributed. In 2022, B.C. had spent $16,583 per capita for infants under a year old; $2,195 on young people aged one to 14; $3,818 per capita on people aged 15 to 64; and $14,042 on people 65 or older.

Granted, that was in the midst of the pandemic, when everyone needed help and seniors needed it most. But the proportion of health spending going to seniors is pretty high — about 45 to 50 per cent.

According to the B.C. Office of the Seniors Advocate, in 2023 about a quarter of all emergency visits and 47 per cent of hospitalizations were for seniors; they spent an average of 8.6 days in hospital, almost four days longer than younger patients.

And hospital stays cost the system money. According to CIHI, a typical hospital stay in B.C. in the 2022-23 reporting period cost $8,321. For a six-day stay, that amounts to $1,200 to $1,300 per day. (I spent six days in Lions Gate Hospital last summer, and learning this number gave me a new appreciation of medicare.)

Now consider that most people who contract shingles or RSV don’t go to hospital. They suffer at home and consult their doctors (if they have them).

But according to the “Shingles Matters: Driving Provincial Policy in Canada” B.C. policy brief: “The lifetime risk of herpes zoster (shingles) in the general population is approximately one in three, increasing sharply after the age of 50 to an approximate lifetime risk of one in two by age 85. Additionally, many common chronic conditions can increase an individual's susceptibility to herpes zoster, and an episode of herpes zoster can further complicate underlying health issues.”

Remember chickenpox parties?

Herpes zoster, the virus that causes shingles, is the same virus that causes chickenpox, the itchy, unpleasant illness that some contract as children.

I am old enough to remember the decades before chickenpox vaccines were introduced to North America in the mid-1990s. In the pre-vaccine era, parents took their kids to “chickenpox parties” where at least one kid infected all the others — “to get it over with,” as my mother said. No one knew that many infected kids would later come down with shingles.

“Shingles Matters” estimates about 130,000 Canadians contract shingles every year, so B.C.’s share would be 13,000 to 15,000 cases. Using that policy paper’s data, we can estimate that about 150 to 200 people in B.C. are hospitalized with shingles each year.

But if we include secondary infections and complicated cases like postherpetic neuralgia, the number rises to about 1,000 patients a year, staying an average of six to 10 days or even more.

Similarly, RSV causes somewhere between 900 and 1,200 hospitalizations in B.C. each year among people aged 65 and older. According to the Canadian Public Health Association, most such cases will cost about $5,000 for a hospital stay of five to six days. But between 10 and 16 per cent of RSV cases require treatment in intensive care, which runs the cost up to $20,000 per patient, and case fatality rates among such cases average five to 10 per cent.

The case and fatality numbers for RSV and shingles would likely be even higher without vaccines.

In the case of RSV, a vaccine called Arexvy was found to be 82.6 per cent efficacious against RSV-associated lower respiratory tract disease, and 94.6 per cent against severe disease. Protection lasted for at least one year.

But a government report last summer found that only about 12 to 15 per cent of B.C. seniors have been vaccinated against RSV, and most of those were in long-term care — where uptake was 30 to 35 per cent.

The chief reason is cost. The RSV vaccines are not publicly funded in B.C.

Similarly, the two-dose Shingrix vaccine costs about $300 in B.C. It has 90 per cent efficacy and long-lasting protection, but the “Shingles Matters” policy brief says only about one B.C. senior in three has had the shots.

Yet Shingrix is publicly funded in Ontario, Prince Edward Island and the Northwest Territories, where uptake ranges between 47 and 57 per cent.

Staying healthier longer

Higher uptake rates for RSV and shingles vaccines would keep B.C. seniors healthier longer, while reducing demand for primary care, emergency care and hospitalization. Demand for long-term care would likely fall as well.

I thought this was a pretty radical idea until I stumbled across an editorial in the November issue of The Lancet Infectious Diseases, a respected medical journal. It was really radical, pointing out that vaccination has historically been focused on children; COVID-19 inspired much more adult vaccination, but vaccination for other diseases of middle and old age has been neglected.

The editorial argued that “adult vaccination is emerging as a crucial tool for ensuring healthy aging and resilient health systems — both through disease prevention and cost savings from averted care.”

What’s more, the editorial said: “Adult vaccination can also promote antimicrobial stewardship by directly reducing the incidence of antimicrobial-resistant infections and indirectly reducing antibiotic use. A recent World Health Organization technical report estimated that licensed vaccines could reduce antibiotic use by 142 million defined daily doses annually if coverage was expanded, in turn reducing annual hospital costs associated with antimicrobial-resistant infections.”

I hadn’t even thought about reducing antimicrobial resistance, though the reason for my own recent hospital stay was mostly to pump a lot of antibiotics into me. (Fortunately, whatever had infected me was not resistant.)

So it now appears that many health ministries, including B.C.’s, are being penny-wise but pound-foolish: they may save a little by making people pay for some vaccines, but then they spend more on the old folks crowding the emergency rooms and hospital corridors — and often infecting one another in the process.

If we made all vaccines free and freely available, we would have healthier, happier kids, adults and seniors.

Older people would have more years of good health and independence. Some might want to refuse such protection, but the vast majority would take it up because they could see the lifelong benefits.

Universal free vaccination ought to be like universal safe drinking water: just another benefit of living in a civilized society.