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Despite this country’s high rates of childhood immunization, millions of adults go without routine and recommended vaccinations each year. The consequences are staggering: an estimated 40,000 to 50,000 preventable deaths, thousands of preventable illnesses, and $10 billion in preventable health costs each year. A new report from IDSA and Trust for America’s Health (TFAH) highlights the troubling statistics and underscores the need for all of us to be supportive of adult vaccination, including with our colleagues in other medical specialties.
The report, “Adult Immunization: Shots to Save Lives,” found that more than 30 percent of seniors nationwide are not immunized against pneumonia. Even in the state with the highest pneumonia vaccination rate, Oregon, more than a quarter of adults were not immunized, despite recommendations from the Centers for Disease Control and Prevention (CDC) that all individuals ages 65 and older be vaccinated.
The troubling statistics don’t end with pneumonia: Only 2.1 percent of eligible adults have had the tetanus, diphtheria, and pertussis vaccine in the previous two years, the report notes, while only 10 percent of eligible adult women have had the human papillomavirus (HPV) vaccine. Just 36 percent of all adults were vaccinated against influenza in 2008.
Several obstacles hinder adult vaccination: limited access to vaccines outside of institutionalized settings, limited primary and preventive care and insurance coverage, limited financing for immunizations, misunderstanding and misinformation about vaccine safety and effectiveness, and limited vaccine research and development. There is also a need to educate health care providers who provide care for adults about the importance of immunization.
To boost adult vaccination rates, IDSA and TFAH recommend several key steps, such as closing gaps in insurance coverage for recommended vaccines and creating a new federal program to cover vaccinations for uninsured adults. Additional information for health providers and patients, including the development of standard practices to review patient immunization histories and offer vaccinations at appropriate medical encounters, would also help address the problem, as would more resources to educate the public and combat misperceptions about vaccination.
A new online video about adult immunization available from the Pennsylvania Immunization Coalition (PAIC) is an example of one educational tool. Featuring Paul Offit, MD, a strong advocate for vaccination, the video follows several families to highlight the importance of adult vaccinations at certain life moments. (The videos are available on PAIC’s website).
The National Network for Immunization Information (NNii), of which IDSA is a founding affiliate, is another valuable resource. Developed for health professionals, parents, the media, and policymakers, the network’s website offers up-to-date, science-based information about vaccines, links to vaccination guidelines and downloadable PowerPoint presentations to help providers communicate about vaccine safety with the public.
ID physicians can play a key role in the effort to improve adult vaccination rates, and IDSA has long taken a leading role in supporting immunization for all age groups. The Society and the American College of Physicians (ACP) issued a joint statement in 2008 urging physicians across different specialties to become more active with adult immunizations. Seventeen other medical societies also endorsed the statement. In 2007, IDSA issued policy principles for strengthening adult and adolescent immunization coverage.
More recently, a 2009 survey of IDSA members by the Society’s Immunization Work Group suggested ways to improve adult vaccination rates. The survey found that those who had most recently completed a fellowship were least likely to be immunizing patients, an obstacle that internal medicine and ID training programs could help address. The results also identified financial challenges and other issues such as access to immunizations that, if addressed, could boost adult vaccination rates. (The survey results and commentary are available on IDSA’s website.)
Despite the obstacles that keep adult vaccination rates unacceptably low, there is room for hope. The nation has an effective, lifesaving system for immunizing children, and there is no reason we cannot do the same for adults. To move the needle on adult immunization, we need a commitment from policymakers, the public, and physicians and medical providers across the health care system. As ID physicians, we should be the leaders in securing that commitment. Lives depend on it.
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