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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.

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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.

  • I was told that if you have HPV infection, then the vaccine is useless. Is that still the case? Also when Flu shot first came out we were told, it stopped you from getting the flu, now we are being told it just lessens the side effects of flu. Which is it? What’s this Primary and Secondary vaccine failure about? Why do we need more boosters? Why are people who were fully vaccinated getting Mumps? Isn’t it more dangerous to adults to get these diseases than children? I have lot’s of questions first.

  • I’d like to see the research reports that show adult vaccinations save lives.

    Research, all research, is notoriously biased by the ever-changing conditions of the subjects, but “evidence-based” die-hards choose to ignore this bias in research. We really cannot say that vaccinations are 100 percent effective in preventing disease, yet the poor reactions (I am not taling about MMV leads to autism) are legion, and these results are not given to the public, the persons being pushed to get vaccinated.

    I also resent the notion that we need “herd” immunity. People are not cattle, although this metaphor certainly reflects on the mental construct of those pushing for it.

  • If vaccines are so safe, why are the vaccine makers free from liability? All you have to do is read the vaccine label or insert to find out all the possible side effects to the toxic ingredients. The MMR II product insert acknowledges that death is a potential side effect from the vaccine, along with a long list of other potential permanent injuries. Are vaccine injuries or death rare? Are vaccine injuries or death one in a million? Just go to the U.S. CDC’s VAERS Database where you will find for 2018 in the U.S.:
    60,544 Reports of Injuries including:
    443 Deaths
    267 Permanent Disabilities
    4,414 Hospitalizations
    According to a Harvard study payed for by the CDC, less than 1 % of injuries and deaths are reported to VAERS because most Doctor’s do not know or care to report the injuries. So the projected actual numbers are:
    44,300 Deaths
    26,700 Permanent Disabilities
    441,400 Hospitalizations.
    Those numbers are not 1 in a million. How many lives must be sacrificed for the mythical herd immunity? The only emergency is that people need to wake up sooner to Big Pharma’s fraud.

  • There is plenty TV advertising about the merit of vaccines (Shingles, pneumococcal vaccines etc), but the onus is also on health units and Doctor’s offices to provide info (printed, take-home) on vaccinations for all ages. Doctors, pharmacists, health units, and vaccination clinics should readily administer the vaccines. If adults lack these simple health defense mechanisms, then education and awareness efforts simply need to be stepped up. Otherwise, with weakened herd-immunity, everyone will suffer more. In the US, apparently state governments need to step up to the plate, it really is that simple.

  • Wow! Way to miss the point!
    1. Your “commonsense legislation” is seen as an assault on personal freedom for some people.
    2. The most common/“popular” vaccine – against “the” flu – is widely seen (even by vaccine proponents such as Dr David Sinclair) as a “Hail Mary”. It is based on guesswork (strain) and hope (mutation) and some stats show it is only 30% effective.
    Why do some illnesses affect people even when they HAVE been vaccinated?
    So…
    The problem isn’t access and delivery, the problem is that the vaccine “industry” just isn’t convincing the general public that vaccines are a) effective and b) safe.
    It is futile to blame anti-vaxers and social media. Get your house in order and provide a proper education program – and do not stoop to compulsion (your commonsense).
    And finally…how about paying some attention to the power of a functioning immune system. Even in the most dire epidemics/outbreaks – even something as lethal as Ebola – a percentage of people do not get ill. Why? What can people do to improve their resilience with and without vaccination.

    • Great comment! Unfortunately improving resilience and making sure the immune system is working well are not as easy as taking a pill or shot. Plus, it doesn’t provide massive profits for large corporations.

      Here is another theory why adults don’t get vaccines: We aren’t excited about getting injected with a product from the pharmaceutical industry, the most hated industry in America.

      Lastly, please research the HPV vaccine before agreeing to it. Its approval process was very sketchy and injury reports are heart-wrenching. Especially for a “theoretical” vaccine whose efficacy is based on surrogate endpoints and has not proven to prevent a single case of cancer

  • The anti-vaccination movement deserves its share of the blame for the spread of vaccine-preventable diseases. Social media has helped these people to organize and recruit others by spreading unjustified fears about vaccines. The mainstream news media are failing in their duty to effectively inform the public about the existence of these snakes and the harm that they do.

    • Pure nonsense. There is no evidence or science to back up what you just said. When 10% of vaccinated individuals can get the infection that they have been vaccinated against and spread it around you blame the 2% unvaccinated. What kind of scientist are you?

    • MSM has done its utmost to discredit anti vax. MSM are all about hype. The narrative is changing too. Once we were told we had lifetime immunity for Measles with the MMR. Now we’re being told, we need boosters and that it doesn’t prevent measles, just makes it less serious.

  • Great article Dr Sheth. Adult vaccination rates are definitely a concern today. I work for a company called VaxCare. We partner with practices to maximize their immunizations programs (or lack there of). We provide offices with vaccines at no cost. We work with all major manufacturers (doctors can choose which vaccines work best for their practice), we do not hold doctors responsible for expired vaccine, and use technology to monitor their supply (automatic shipments are initiated when their stock is low). Our services remove the financial risk, automate processes and increase vaccination rates.

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