Vaccines are among the simplest, most effective, and least expensive ways to prevent serious, and often deadly, diseases. Yet vaccination seems to be an afterthought for many adults.

It’s time to shift that thinking and elevate vaccines to the scientific and technological zenith they deserve as one of the greatest advances of the 20th century, one that now has the potential to prevent some types of cancer. Such a shift would align scientific fact and medical expertise with public health policies and practices.

For many adults — especially those who are older, those with other significant medical conditions, or those who are pregnant — vaccination should be a cornerstone of preventive health care. Yet adult immunization rates in the U.S. are low: Under half of adults receive most vaccines recommended for them, and rates have been relatively steady since 2010.

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There are several reasons for this. Many adults aren’t aware they need vaccines. Health care providers often don’t routinely assess their patients’ vaccination status or clearly communicate national recommendations for vaccination. Common adult vaccines often aren’t stocked in clinical offices. And as is true with so many other facets of health care in the United States, non-Hispanic black, Asian, and Hispanic adults have lower immunization rates than whites.

When it comes to adult immunizations, recommendations from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) or from the myriad of respected professional medical societies, including the American Cancer Society, the American Medical Association, and the American Academy of Pediatrics, are not sufficient to improve adult vaccination rates. We need to see a broad shift in culture and policy at local, state, and federal levels.

This shift must start with policies around childhood vaccines, because these lay the groundwork for adult vaccinations. We have seen gains in this area with the establishment of the CDC’s Vaccines for Children program to address socioeconomic barriers to vaccination for those under 18 years of age. Vaccine proponents have advocated for commonsense legislation around school-based requirements for vaccines that include tightening vaccine exemption rules in many states. In addition, some states permit adolescent minors to make independent decisions to consent to vaccination.

Similar advances are needed for adult immunizations. For example, catch-up vaccination against the human papillomavirus (HPV), which can cause cancers of the cervix, vulva, vagina, penis, anus, and throat, could be included in the federally funded National Breast and Cervical Cancer Early Detection Program. This program, developed in the 1990s to reduce deaths from breast and cervical cancer, has provided access to cervical cancer screening for thousands of women since its inception. It is remiss for it not to incorporate HPV immunization.

In many states, this program provides access to Pap screens and HPV testing for uninsured women, some of whom are undocumented. They can benefit tremendously from HPV immunization, especially if they are within the catch-up immunization ages of 13 to 26 years, and even if they are between 27 and 45 years of age. Inclusion of the HPV vaccine for uninsured adults, who are not eligible for the Vaccines for Children program, would ultimately save money by reducing the number of abnormal cervical cancer screening results later on that require follow-up and procedures.

Paying for adult immunization is fraught with challenges.

Many medical practices cannot afford to stock and manage vaccine supplies. State purchasing of ACIP-recommended vaccines could help alleviate that burden.

Pharmacies can also play a role. Many pharmacies currently administer the flu vaccine. Embracing a broader spectrum of ACIP-recommended vaccines, including the HPV vaccine, could improve adult vaccination rates. For that to happen, though, resources must be provided to shore up state immunization information systems, also known as vaccine registries. These confidential, population-based computerized databases record vaccine administrations and consolidate immunization information from different locations.

In many states, the structure of Medicaid impedes adult vaccination. Although the Affordable Care Act requires Medicaid to cover all ACIP-recommended vaccines, the system for administering them is fragmented. In some situations, vaccines are considered a pharmacy prescription benefit, so administering them using supplies stocked by a clinician’s office will be reimbursed at a lower rate than if the vaccine was given by or obtained from a retail pharmacy.

Many vulnerable or sick patients end up in the emergency department or are admitted to the hospital. This should be seen as an opportunity to help them get back on track with preventive care, everything from blood pressure or diabetes management to needed vaccinations. Yet it often isn’t possible to access recommended vaccines from inpatient hospital formularies because they tend not to reimbursed as part of inpatient care.

That leads to a broken cycle in which hospitals identify vaccines as “ambulatory care,” ambulatory care offices provide adult vaccines with great variability or identify them as “pharmacy care,” and pharmacy administration of a broad spectrum of vaccines remains tenuous. Where can an adult reliably go to access essential preventive health?

It is long past time that the U.S. invests in a modern-day immunization infrastructure. This would leverage advanced information technology for identifying children and adults needing vaccination and consolidate vaccination history across locations and delivery systems; create innovative ways to finance and supply vaccines; and use proven preventive health delivery programs to minimize missed opportunities to immunize individuals of all ages against vaccine-preventable diseases.

Sangini S. Sheth, M.D., is an assistant professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine.

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  • My wife – a PhD-level Clinical Psychologist – was called to a local hospital one day by an Attending Physician. When she got there, the physician asked to refer her to one of his patients on the hospital floor. The relevant details are: a 27 year old male business owner, stopped in at a local physician’s office to get a flu shot. He was given the flu shot and he went on his way. Within a few hours he began feeling odd, but continued through his day and went home. He began feeling weak and having trouble breathing. His wife called 911. They came and took him to the aforementioned hospital. By the time my wife saw him, he was a quadriplegic. His prognosis was that, while there was a small chance that he could recover from this over a period of months, the likelihood was that he would be a quadriplegic for the rest of his life. 27 years old.

    My wife came home that night and said to me: “you are never getting a flu shot. Promise me that.” I promised her.

    • The one vaccination I don’t get as contents are only “educated guess work” with absurdly low results is the flu shot. The one shot I had 8 years ago rendered me sicker than a dog (with the flu). I never had the flu shot since, and only had a (much milder) flu event about 4 years ago. I can concur with never getting a flu shot. But all others have proven solid merits.

  • I keep up with all vaccinations as I firmly believe in the merits. Anti-vaxxers are misguided, or obstinate. They should then also not get a tetanus shot when injured by a rusty nail. One-way tickets to the Congo or South American jungles will remove a lot of un-vaccinated, thus life is safer for the vaccinated. And they should not balk at this idea, because their own choice is at fault.

    • True; a vaccine informed person would NOT get a tetanus vaccine after stepping on a rusty nail because 1/ Tetanus is not nor has ever been caused by rust and 2/ IF c. tetanii spores were present on the nail, which requires particular conditions, AND the spores managed to reactivate, which also requires particular conditions, tetanus symptoms would set in before the vaccine started to work.

  • Vaccines are poison. No gold standard double blind placebo test? Using another vaccine or the adjuvant aluminum which is a neuro-immune toxic. Not tested for carcinogenesis, mutagenesis, impairment of fertility? Using live virus vaccines which people DO shed? Aborted fetal cells? Animal cells? Heavy metals? Polysorbate 80? Bovine calf serum? Formaldehyde? I mean seriously this is bogus. Where there is risk, there needs to be INFORMED CONSENT.

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