When it comes to preventing the painful rash and blisters of shingles, a new vaccine has arrived that promises to be more effective at protecting people from these agonizing symptoms.

But experts are still worried they’ll have difficulty persuading people to get the new shot.

The Food and Drug Administration (FDA) approved the new vaccine called Shingrix in September of 2017. Now, the Centers for Disease Control and Prevention (CDC) have updated their guidelines to recommend Shingrix over an older vaccine, Zostavax.

“The reason why Shingrix was developed is because Zostavax just wasn’t as effective as it could potentially be,” Dr. Navjot Jain, an internal medicine specialist from The Ohio State University Wexner Medical Center, told Healthline. “Zostavax basically loses its efficacy by about 15 to 25 percent after one year, and after nine years it’s thought to no longer be effective. Shingrix is a new vaccination, but the studies have shown that its efficacy remains at about 85 percent four years after vaccination.”

It’s a promising development when it comes to preventing shingles, an ailment that will afflict about one in every three Americans during their lifetime.

But despite the fact that the risk of getting shingles increases as you get older, and older adults are more susceptible to complications from disease, only about 33.4 percent of adults 60 years and older reported receiving the shingles vaccine in 2016.

This rate is far lower than the childhood vaccine compliance rate for the measles, chicken pox, and whooping cough vaccines. Those vaccination rates hover between 84 percent to 91 percent nationally depending on the vaccine.

While Shingrix would seem to be a positive step when it comes to preventing shingles, there are a few factors that may stop people from getting the recommended vaccine including medical record availability, the fear of vaccines, and the vaccines’ price tag.

Obstacles to vaccination

Despite the fact that the small but vocal anti-vaxxer contingent remains strong, Jain says she hasn’t encountered much opposition to getting vaccinated among her patients.

“A lot of patients will actually come to me asking how they can get the shingles vaccination, so I actually have experienced the opposite,” she said. “There’s a very small percentage of patients, I’d say under 10 percent, that are very averse to getting vaccinations, though.”

Jain said that with these patients, their concerns often center around possible adverse effects from the vaccination, fears that they’ll contract shingles by getting the vaccination, or the belief that since they’ve never had the illness, they don’t need the vaccine.

“Another big concern that patients have is cost,” Jain said. “Zostavax cost $213, and Shingrix costs about $280 out of pocket.”

She explained that even insurance or Medicare coverage doesn’t solve the problem.

“The issue is that Medicare Part B is not covering it, Medicare Part D is covering part of it, and Medicaid may or may not cover it — it really depends on the insurer and the insurance plan,” she said. “So, I think cost is also a big barrier for patients as well.”

While CDC-recommended vaccines are typically covered by private insurers, there’s a trickle-down effect that sees insurers gradually incorporating new vaccines into their plans. This means that it can take some time between the time a vaccine is recommended and when it’s covered by insurers.

How medical records can be a problem

Another obstacle is the fact that it can be difficult for family physicians to know exactly what vaccinations a patient has received. Unlike pediatric patients, who typically have accessible records of their vaccination schedule, it can be trickier for adults.

“For adults, it becomes quite challenging, especially when they switch providers, because often times you have to track down records to find out if they’ve been vaccinated,” said Jain.

She said it can be complicated to try and decipher which vaccines patients have received and which they should get without clear records.

“For adults over the age of 65, you want to find out if they’ve gotten the two pneumonia vaccinations that are recommended, so it becomes a challenge to find out if they’ve gotten both, or just one,” she said. “Same thing goes now for the shingles vaccination. You’re kind of tracking down records, and when you don’t have them, you have to make a clinical judgment.”

Despite these challenges, Jain says the fact that Shingrix is a newly-minted vaccination may make things a bit more straightforward.

“The nice thing about Shingrix is that it’s so new, most patients have not gotten it,” she said. “Even if they’ve had Zostavax, it’s recommended that they get Shingrix in addition to it, so that’s a little bit less of a challenge with a new vaccination.”

For people who are hesitant about getting vaccinated — whether it’s the shingles vaccine, the flu shot, or another recommended vaccine — Jain says she emphasizes the importance of getting vaccines.

“I try to, from a symptomatic standpoint, convey to them that even though their symptoms may not be severe, it doesn’t mean they haven’t contracted something,” she said. “It’s also important to get vaccinated because it protects your family members — particularly older family members who are more susceptible to getting sick.”