Every year, thousands of adults get sick from diseases that could have been prevented by vaccination, according to the Centers for Disease Control and Prevention. Some are hospitalized, and even die. One recent study of four vaccine preventable diseases in people 50 and older — flu, pertussis, shingles and pneumonia — estimated that current vaccination coverage prevents 65 million cases of illness in 30 years, and additional vaccinations could avert another 33 million.
“Think about how well we’ve done getting covid vaccine awareness into everyone’s lives,” says Jeffrey Goad, vice president of the National Foundation for Infectious Diseases and professor and chair of the Department of Pharmacy Practice at Chapman University School of Pharmacy. “If we could bring that same energy in common messaging to other vaccines, we could prevent a tremendous amount of illness, hospitalization and death.”
With the pandemic, routine adult vaccinations continued to fall behind. “Coverage of adults by routine vaccination has always been low, but it was driven even lower by the shut-ins produced by covid,” says William Schaffner, professor of preventive medicine at the Vanderbilt University School of Medicine. “People stayed away from their providers and took advantage of telemedicine. But you can’t vaccinate through the computer.”
One recent analysis found a sustained drop in adolescent and adult vaccines in non-influenza vaccinations during the pandemic compared to the previous year. While flu vaccinations initially exceeded the earlier season — perhaps because of more awareness of respiratory diseases — these surges leveled off as the flu season went on, ending up actually lower than the previous year, according to the report.
The CDC also reported that vaccination rates among Medicare recipients declined by 25 percent to 62 percent during the first week after a national coronavirus emergency was declared in March 2020, compared to the same period in 2019. By mid-April, vaccination rates in this group reached lows of between 70 percent and 89 percent below 2019 rates, although they partially recovered between May and July, according to the CDC.
“Adult vaccination levels were stagnating before the pandemic, one reason being lack of general vaccine awareness and understanding of how they can prevent disease,” says Jason Hall, managing director for policy at the consulting firm Avalere Health. “With covid vaccines, the information is in your face, but this has not been so for other vaccines.”
All 50 states require routine childhood vaccinations to attend school, but Hall points out most jobs don’t require any. “Although, current conversations around covid are changing that,” he adds.
Children see their pediatricians for “well child” visits, but adults often don’t visit their doctors unless they are ill, removing the opportunity for a vaccine conversation. “When you’re sick, you take medication,” Hall says. “But when you’re healthy, you don’t necessarily think about getting a vaccine.”
Flu shots are more common than other routine vaccinations, even though fewer than half of the nation’s adults typically get them, despite extensive campaigns promoting them every fall.
“It’s harder to target other vaccines because there is no urgency about them,” Goad says. “Other vaccines are year-round, so people by nature will procrastinate.”
Still, experts worry it will be more of a challenge getting people vaccinated against influenza this fall. There was little flu this past year, largely because of mask-wearing, social distancing and other public health measures.
Also, many children, often “vectors” in transmitting flu and other illnesses, spent much of the school year learning from home lessening their ability to pass on infections.
Furthermore, people are pandemic weary, Schaffner says. “We will have to work extra hard to get people vaccinated against flu this fall,” he says.
Cost may be a barrier to vaccination for some. Traditional Medicare Part B pays for only a few vaccines, including influenza, pneumonia and, for certain high risk groups, such as those with diabetes, hepatitis B. It doesn’t cover the shingles vaccine. The coronavirus vaccine is free, but Medicare will pay administrative fees for delivering it. For other vaccines, Medicare recipients must look to their Part D prescription drug plans, where there often are co-pays, or to Medicare Advantage plans. In states without Medicaid expansion, the cost is on the patient. In expansion states, however, the Affordable Care Act requires coverage of all vaccines.
How health care is delivered may effect on vaccination rates, as well. Adults may see multiple specialists who don’t regard vaccines as part of their expertise.
“There is no ‘medical home’ for adults as there is for kids,” Hall says. “There are fewer well visits and less consistency, so the need for vaccination sometimes gets lost in the variety of other health-care providers.”
This has been changing in certain settings, especially within systems that share a network of doctors. Since 2010, for example, Kaiser Permanente has recorded a patient’s screenings or vaccinations electronically, with charts available to all providers within the system.
“This systemwide electronic health record . . . helps keep members up-to-date on important vaccinations and health screenings,” says Elizabeth Schainbaum, a spokesperson for Kaiser.
Also, many pharmacies routinely remind patients when it’s time to refill a prescription and have begun to do that with vaccines, Goad says. Pharmacies stock many vaccines and train their technicians to administer them.
During the pandemic, “community pharmacies never shut down,” Goad says. “People had access. We still need to do a better job [of reminding people] but it’s happening. It’s on its way.”