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

VaccineNew ZealandAustraliaEngland  Influenza (annual)

 

Funded for adults ≥65 years (currently standard inactivated vaccine), pregnancy, and eligible medical risk groups.

Funded for adults ≥65 years (adjuvanted), pregnancy, all Aboriginal and Torres Strait Islander adults and eligible risk groups.Funded for adults ≥65 years (adjuvanted or high dose), pregnancy and eligible clinical risk groups.COVID-19Booster recommendations based on age and risk factors.Funded for ≥75 years, 65-74 years, Aboriginal and Torres Strait Islander people 50-74 years, and severely immunocompromised adults ≥18 years. Funded for adults ≥75 years, residents of care homes for older adults and those ≥6 months who are immunosuppressed.Tetanus, diphtheria, pertussis (Tdap)Funded booster at 45 years and 65 years; funded during every pregnancy.Routine adult boosters are not universally funded at specific ages; funded during every pregnancy. Catch-up and booster doses are recommended in certain circumstances.Routine adult boosters are not universally funded at specific ages; funded during every pregnancy. Catch-up and booster doses are recommended in certain circumstances.Shingles (Herpes zoster)

Funded for adults during the 12 months after their 65th birthday. 

Funded for a limited number of immunocompromised adults.

Funded for adults ≥65 years and for Aboriginal and Torres Strait Islander adults aged ≥50 years and a comprehensive list of immunocompromised adults.

Funded for adults turning 65 (eligible until 80th birthday) and catch-up programme for all adults aged 70 to 79 years.

All severely immunosuppressed adults aged ≥18 years.

Pneumococcal

Not routinely funded solely by age for adults.  

PCV13 and 23PPV funded for specific risk groups of adults.

PCV21 funded routinely for adults ≥65 years and for various risk groups; funded for all Aboriginal and Torres Strait Islander adults aged ≥25 years.PCV20 funded routinely for adults ≥65 years and for those with clinical risk conditions.MMR (measles, mumps, rubella)Free for adults who do not have evidence of two doses. Catch-up vaccination funded for adults lacking immunity or documented vaccination.Funded for anyone who is not adequately protected.HPVFunded up to 26 years.Funded through adolescent programme with catch-up eligibility to age 26 years.  Funded up to 25th birthday, MSM funded (through sexual health clinics and HIV clinics) up to and including age 45 years.RSVNo adult age or risk-based programme funded.Funded RSV vaccination for older adults ≥75 years, Aboriginal and Torres Strait Islander adults aged ≥60 years and some other eligible groups; funded during every pregnancy.Funded RSV vaccination for adults 75 years and catch up to age 79; funded during every pregnancyHerpes 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.

StepNew ZealandUnited KingdomAustraliaRegulatory approvalMedsafeMedicines and Healthcare products Regulatory Agency (MHRA)Therapeutic Goods Administration (TGA)Technical vaccine advicePHARMAC Immunisation Advisory Committee provides advice to PHARMACJoint Committee on Vaccination and Immunisation (JCVI) provides national adviceAustralian Technical Advisory Group on Immunisation (ATAGI) provides national adviceFunding decisionPHARMAC decides whether a vaccine will be publicly funded from its fixed medicines budgetGovernment generally funds vaccines recommended by JCVI when cost-effectivePharmaceutical Benefits Advisory Committee (PBAC) evaluates cost-effectiveness and advises government; funding occurs through the National Immunisation ProgramProgramme policyMinistry of Health sets overall policyUK Health Department /National Health Service (NHS)Department of Health and Aged CareProgramme deliveryHealth NZ (Te Whatu Ora)NHSStates and territories under the National Immunisation Program

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 addsNZ 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 practiceNZ 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.Authors’ details

Dr Joan Ingram, infectious diseases physician, medical advisor to the Immunisation Advisory Centre (IMAC)

Professor Nikki Turner, Department of General Practice and Primary Care, Waipapa Taumata Rau | University of Auckland and medical director of IMAC

AppendixVaccines are a cost-effective public health intervention

Beneficial effects of vaccines include reduced hospitalisation, improved school attendance and workforce productivity, and prevention of non-communicable disease that has not traditionally been fully assessed and measured. Such broader vaccine benefits include reduction in cardiovascular events with influenza vaccination, potential reduction in dementia with shingles vaccination, prevention of cancers with human papillomavirus vaccines (HPV), and reduction in long-term respiratory problems with prevention of RSV in infancy. There is also herd immunity leading to protection beyond those immunised (for example the reduction in influenza among all ages with the use of nasal influenza vaccine in school children in the United Kingdom and reduction in pneumococcal disease in adults following infant pneumococcal immunisations). By reducing the need for antibiotic treatment, vaccines also contribute to slowing development of antibiotic resistance. 

Increasing Pharmac consumer engagement may disadvantage vaccines 

Pharmac incorporates consumer input through funding applications from members of the public, public consultation processes, submissions from patients and advocacy groups, and targeted consumer engagement activities ⁸. Patient perspectives and lived experience are increasingly used to inform Pharmac’s assessment and funding decisions. While this process is generally positive for medication decisions, it does tend to disadvantage vaccines as there are few advocacy groups focused on vaccine-preventable diseases.  Vaccines that result in a reduction or absence of disease tend to be less visible. Many vaccine-preventable diseases disproportionately affect disadvantaged members of society: Māori and Pacific people, those living in areas of high deprivation, people at the extremes of age, those living with disability, and those with addictions. These groups almost certainly have fewer opportunities to advocate for vaccines than many patient groups.