Shingles, a painful reactivation of the varicella zoster virus that causes chickenpox, remains a common and preventable condition with major consequences for older adults. Public health authorities are renewing efforts to expand vaccination after years of uneven uptake, saying broader coverage could reduce suffering, cut health care utilization and narrow disparities that leave low-income and minority populations at greater risk.

One in three people in the United States will develop shingles in their lifetime, and the chance rises with age. The current preferred vaccine, a two-dose recombinant vaccine, has shown high efficacy in clinical trials at preventing both shingles and its most debilitating complication, postherpetic neuralgia, which can cause severe, chronic nerve pain. The vaccine is recommended for adults 50 and older and for some immunocompromised people, and it is widely available in doctors’ offices, pharmacies and health clinics.

Despite strong clinical evidence, vaccination rates lag. Barriers include cost, limited awareness among patients and clinicians, logistical hurdles such as transportation and scheduling, and confusion about insurance coverage. Many Medicare beneficiaries must obtain the vaccine through Medicare Part D plans, a structure that can result in copays and confusing pharmacy billing that deter some older adults from getting immunized. Rural areas and communities of color also report lower uptake, driven by fewer local providers, language barriers and long-standing mistrust of the health system.

Public health experts emphasize that improved access is a matter of equity as well as prevention. Higher vaccination coverage could prevent thousands of cases of severe pain and lower the need for emergency care, specialty visits and long-term pain management. That, in turn, could reduce reliance on opioid prescriptions for pain control and lessen financial strain on families and the health system.

State and local health departments, community clinics and pharmacy chains have begun pilot efforts to close the gap, deploying standing orders, mobile vaccination clinics, outreach through trusted community institutions and targeted education campaigns for clinicians and patients. Advocates are urging policymakers to consider changes in how vaccines are covered for older adults—such as shifting the shingles vaccine to broader preventive coverage under Medicare Part B—to remove financial barriers and simplify access.

Clinicians are being encouraged to make strong, routine recommendations during visits with older patients and to use electronic health records to identify and recall those due for the two-dose series. Community health workers and multilingual materials can help reach people who face cultural or linguistic obstacles. For homebound seniors, in-home vaccination programs and pharmacy delivery models have shown promise.

The vaccine’s side effects are generally short-lived and include injection-site soreness and brief systemic symptoms such as fatigue or fever. Serious allergic reactions are rare, and vaccination is avoided in certain acute severe illness or in people with specific contraindications.

As public health leaders push to raise coverage, they frame the issue in human terms: preventing the acute, sometimes incapacitating pain of shingles and guarding older adults’ independence and quality of life. Addressing the structural barriers that limit access will determine whether the benefits of the vaccine reach all communities, not only those with the greatest means.