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18+? Expanded Guidelines and Growing Vaccination Pressure for Shingles

Laura Chrobok  11.11.2025

Germany’s Standing Committee on Vaccination (STIKO) has expanded its recommendation for vaccination against Herpes zoster (shingles)—officially to better protect particularly vulnerable people. Yet, as seen with previous vaccination campaigns, medical prevention, political steering, and economic interests are increasingly intertwined.

Find out why the new zoster guidelines are more than just health care, which corporations profit from the expansion—and why growing vaccination pressure through state structures is to be feared!

 

First: What Exactly Is Shingles (Herpes zoster)?

Herpes zoster, commonly known as shingles, is the reactivation of the chickenpox virus (varicella-zoster virus, VZV), which lies dormant in the nervous system after an initial infection. Decades later—often triggered by stress, age, or immune weakness—it can become active again. (So it may not be cynical to suspect that one motivation for extending the vaccination recommendation to 18-year-olds is financial in nature.)

The virus then travels along the nerve pathways to the skin’s surface. Typically, it causes a belt-shaped, burning rash with blisters, usually on the back, chest, or face. In addition to severe pain, zoster can also lead to long-term nerve damage (postherpetic neuralgia).

Worldwide, the incidence of zoster is increasing—primarily due to longer life expectancy and a rise in immunosuppression caused by medication or disease. Authorities use this development as an argument for broader vaccination recommendations (Epidemiological Bulletin No. 45/2025, RKI).


How Does the Vaccine Work?

The modern shingles vaccine does not contain a live virus but a single viral protein (glycoprotein E, gE)—the main target of the immune system in a zoster infection. To enhance the immune response, the vaccine includes an adjuvant system (AS01B), which strongly activates immune cells via cytokines such as IL-6 and TNF-α.

These “immune boosters” explain the high efficacy—but also the frequent systemic reactions after vaccination (fever, chills, muscle pain).

Approval was based on two major studies:

·       ZOE-50 (Lal et al., 2015)

·       ZOE-70 (Cunningham et al., 2016)

Both studies were peer-reviewed but conducted under manufacturer sponsorship.

 

Risks and Side Effects

·       On Long-Term Observation: The protection appears to last about seven years, but long-term safety data beyond 10 years are still lacking.

·       Autoimmunity and Cytokine Activity: The AS01B adjuvant intentionally triggers pro-inflammatory cytokines—immunologically desirable, but potentially problematic in people with autoimmune conditions (Didierlaurent et al., 2020).

·       Common Reactions: Pain, redness, and swelling at the injection site, fatigue, headache, fever—well-documented and usually temporary (CDC, 2024).

·       Rare Complications: Guillain-Barré Syndrome (GBS) is a possible, very rare risik (FDA, 2021).

 

The Expanded Guidelines and Their Impact on the System

Since November 2025, STIKO has recommended the recombinant, non-live vaccine Shingrix® not only for people aged 60 and older but also for adults aged 18 and older with weakened immune systems or specific underlying diseases (RKI/STIKO, 2025).

The decision is justified by an “increasing disease burden” and “high efficacy.” Indeed, Shingrix® shows up to 90% effectiveness in older adults in clinical studies. However, how long protection lasts remains unclear.

A recent analysis in Clinical Infectious Diseases emphasizes that long-term data beyond five years are missing (Tseng et al., 2025).

Another analysis in BMJ RMD Open points out limited real-world data and possible bias due to industry-sponsored studies (Mayer et al., 2025).

 

Shingles Vaccination: A Growing Billion-Dollar Market!

Manufacturer GlaxoSmithKline (GSK) reported £3,364 million in 2024 revenue in the “Shingles” segment (including general shingles-related products, not limited to vaccines), according to its annual report (GSK, Annual Report 2024).

In Germany, the retail price for two doses is around €460 (Medikamente-per-Klick, 2025). Not all of this stays with the producers of course. But with STIKO’s expanded recommendation, producers can now reach younger target groups and benefit from additional government-funded programs. Once the Federal Joint Committee (G-BA) adopts the recommendation, statutory health insurers cover the costs.

A private product becomes supported by public funds—similar to previous vaccination campaigns. According to market analyses, the global market for zoster vaccines continues to grow rapidly (Precedence Research, 2024).

 

Health Data as a Steering Instrument

At the same time, the legal framework for centralized collection of medical data is being greatly expanded. The Health Data Use Act (GDNG) and the Digital Care Act (DVG) of the Federal Ministry of Health now allow for broader evaluation of care data—including vaccination statistics (BMG, 2019; BMG, 2024).

The Institute for Quality Assurance and Transparency in Health Care (IQTIG) is also developing so-called quality indicators, which, according to its 2024 report, will soon include preventive metrics (IQTIG, 2024).

Critics warn: if practice ratings or reimbursements become tied to such data, indirect vaccination pressure will emerge.

The National Association of Statutory Health Insurance Physicians (KBV) notes in internal reform proposals that “preventive performance indicators could in future become part of remuneration agreements” (KBV, 2024).

This would economically incentivize physicians to vaccinate more frequently—or penalize them for vaccinating too little.

That the expanded shingles guidelines coincide with the introduction of the mentioned digital laws may not be accidental but rather signal the start of a new steering logic: public health as a data set.

 

Conclusion: From Voluntary Prevention to De Facto Obligation

At first glance, the new recommendation may seem like progress. Upon closer look, it represents a transformation of the health system—from care to control and profit.

As long as independent long-term studies are lacking and economic interests outweigh transparency, the question remains: Who truly benefits—the public or the pharmaceutical industry?

 

FAQ – Frequently Asked Questions About Shingles and Vaccination

1. Why is there so little discussion of alternative prevention?

Because stress reduction, sleep, and nutrition are hard to patent. Yet studies show correlations between stress, vitamin D deficiency, and zoster reactivation (Glaser et al., 2020). Nevertheless, nearly all research funding flows into vaccines.

2. Why do so many people react so strongly to the vaccine?

Because the AS01B adjuvant provokes a strong immune activation, releasing IL-6 and interferon-γ—xactly what happens during viral infections. The effect is intended, but some experience it as a “mini flu.”

3. Is it possible to get shingles despite vaccination?

Yes. The vaccine reduces the risk but does not eliminate it entirely. There are documented cases of zoster reactivation after vaccination, likely due to stress or other infections (Rodriguez et al., 2021).

4. Can the vaccine itself cause a shingles-like reaction?

It contains no virus, so no infection occurs. However, the strong local inflammatory response can produce similar skin reactions.

5. Are there independent long-term studies on the vaccine?

Hardly any. Most data come from manufacturer or authority collaborations. Independent academic cohorts are rare, even though the vaccine has been widely used since 2018.

6. Are there indications of interactions with other vaccines or medications?

Yes. Studies show that coadministration with pneumococcal or influenza vaccines can enhance reactions. Patients more frequently report fatigue and fever, as multiple vaccines simultaneously activate different immune pathways—which may sharpen defense but also promote overreactions (Lal et al., 2021).

 

Further information on vaccinations and many other topics can be found in the individual posts on our blog. Please feel free to also visit our online shop, where you’ll find volumes of our “Codex Humanus” and the “Medizinskandale” series.

 

Sources:

  •  Robert Koch-Institut/Ständige Impfkommission (2025): Epidemiological Bulletin 45/2025 (06.11.2025): “Beschluss und wissenschaftliche Begründung für die Erweiterung der Indikationsimpfempfehlung zur Herpes-zoster-Impfung mit dem adjuvantierten Subunit-Totimpfstoff für Personen ≥ 18 Jahre mit einem erhöhten Risiko, an Herpes zoster zu erkranken”.

(Published separately): “Anhang zur wissenschaftliche Begründung der STIKO für die Erweiterung der Indikationsimpfempfehlung zur Herpes-zoster-Impfung mit dem adjuvantierten Subunit-Totimpfstoff …”. (Epidemiolog. Bulletin 45/2025).

  • Lal, H. et al. (2015): “Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults,” The New England Journal of Medicine.

  • Cunningham, A.L. et al. (2016): “Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older,” The New England Journal of Medicine.

  • Tseng, H.F. et al. (2022): “Long-term effectiveness and safety of recombinant zoster vaccine in real-world practice: a cohort study,” Vaccine.

  • Didierlaurent, A.M. et al. (2020): “Adjuvant system AS01: helping to overcome the challenges of modern vaccines,” Frontiers in Immunology.

  • Centers for Disease Control and Prevention (2024): “Shingles (Herpes Zoster) Vaccine Safety”

Online: https://www.cdc.gov/shingles/vaccines

  • Tseng, H.F. et al. (2025): “Effectiveness of recombinant zoster vaccine against herpes zoster in adults aged 50 years and older during long-term follow-up: a real-world cohort study,” The Journal of Infectious Diseases.

  • Mayer, S. et al. (2025): “Economic evaluation and budget impact of herpes zoster vaccination strategies in aging populations,” Health Economics Review.

  • Medikamente-per-Klick (2025): „Shingrix Pulver und Suspension zur Herstellung einer Injektionssuspension“, Lauer-Taxe-Price/dose: ~ €230.

  • Precedence Research (2024): “Shingles Vaccine Market (by Type, Age Group, Region) 2024–2033”

Online: https://www.precedenceresearch.com/shingles-vaccine-market

  • Bundesministerium für Gesundheit (2019): “Gesetz für eine bessere Versorgung durch Digitalisierung und Innovation (Digitales-Versorgung-Gesetz, DVG)”

Online: https://www.bundesgesundheitsministerium.de/gesetz/digitales-versorgungsgesetz

  • Bundesministerium für Gesundheit (2024): “Gesetz zur Nutzung von Gesundheitsdaten im Gesundheits- und Pflegebereich (Gesundheitsdatennutzungsgesetz, GDNG)”

Online: https://www.bundesgesundheitsministerium.de/gesetz/gesundheitsdatennutzungsgesetz

  • Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (2024): Bundesqualitätsbericht 2024 – Verfahrensübergreifender Teil.

  • Kassenärztliche Bundesvereinigung (2024): Qualitätsbericht 2024 – Vertragsärztliche Versorgung.

  • Glaser, R. et al. (2020): “Stress, immunity, and latent herpesvirus reactivation: implications for aging populations,” Epidemiology and Infection.

  • Rodriguez, C. et al. (2021): “Herpes zoster reactivation following recombinant zoster vaccination: case series“, Journal of Clinical Virology.

  • Lal, H. et al. (2021): “Immunogenicity and safety of coadministration of the adjuvanted recombinant zoster vaccine with seasonal influenza vaccine in adults aged 50 years or older: a randomized, open-label, phase 3 trial“, Clinical Infectious Diseases.

 

 

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