The Case for Universal Varicella Zoster Virus Vaccination

By Danélia Botes

January 11, 2024


The COVID-19 pandemic has monopolised the scientific community’s focus, often at the expense of other crucial health matters. One such overlooked area is the universal vaccination against the varicella zoster virus (VZV). This article explores the reasons behind the delay in its approval and the potential benefits it could bring to public health.

The Delay in Universal VZV Vaccination:

The Joint Committee on Vaccination and Immunisation (JCVI) in the UK, while proactive with COVID-19 immunisations, has been slow to approve the VZV vaccine. This delay has been largely due to the Hope-Simpson hypothesis, which posits that reducing VZV exposure could lead to an increase in herpes zoster (HZ) infections. However, real-world data from countries with a universal VZV immunisation program, such as the USA, contradict these fears.

Private Vaccinations and Epidemiological Concerns:

Despite the JCVI’s hesitance, many UK parents are opting for private VZV vaccinations for their children. The financial burden of children missing school due to chickenpox often outweighs the cost of the vaccine. However, these private vaccinations are not being counted by the UK Health Security Agency (UKHSA) or Department for Health and Social Care (DHSC), leading to an incomplete picture of the disease’s current burden.

The Potential Impact of Universal VZV Vaccination:

The JCVI has recently suggested that the multivalent Hib vaccine could be given at 18 months, freeing up space for the VZV vaccination. This change would require acceptance that the Hope-Simpson hypothesis does not carry significant weight. As a result, they have finally advised that the measles, mumps, and rubella (MMR) vaccines be given with the varicella vaccine at 12 and 18 months.

Remaining Concerns and the Way Forward:

While the risk of febrile seizures when combined with the MMR vaccine is low, some concerns remain. Governmental funding concerns around the cost of vaccination are valid. The indirect economic impact of lost days of work is far more significant. Universal VZV vaccination could also reduce vertical transmission and potentially protect immunosuppressed individuals.


Our healthcare systems often fall prey to the inverse care law. However, by reducing time off from work for parents, universal VZV vaccination could have the greatest impact on those who earn the least, and potentially improve economic growth in the process.

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