Vaccination remains one of the most effective tools for preventing infectious diseases and reducing their complications, but advances in vaccine technology and changing disease patterns continue to influence clinical decision-making. In Medical Academic’s Vaccine Perspectives #2, accredited for 2 general CEUs and 1 ethics point, Associate Professor Benjamin Kagina, Director of the National Immunization Technical Advisory Group Support Hub and Co-Director of The Vaccines for Africa Initiative at the University of Cape Town, and Prof Jeremy Nel, Head of Infectious Diseases at Helen Joseph Hospital and the University of the Witwatersrand, speak to Medical Academic about the evolving epidemiology of herpes zoster (HZ), advances in recombinant vaccine technology, and the implications of having a non-live, adjuvanted vaccine for HZ prevention in South Africa. Dr Marietjie Botes examines the ethical considerations surrounding the newly available recombinant herpes zoster vaccine (RZV) in South Africa, exploring how clinicians can balance evidence-based recommendations, shared decision-making and patient autonomy with the practical challenges of affordability and equitable access to preventive healthcare.