By Judy Stewart
As if we needed another thing to worry about during this time of a pandemic, a new analysis reveals a significant and alarming drop in recommended vaccinations for teens and adults.
The Covid-19 Pandemic: Impact on US Adolescent and Adult Vaccine Utilization Across Markets, from Avalere Health with support from GSK, is the first to highlight the public health threat of missed and delayed vaccination of teens and adults.
There has been coverage in the media about the impact of the pandemic on childhood vaccination coverage. The public health community is focused on getting kids caught up on missed vaccines — in fact, the CDC recently released a call to action on this issue — but immunization rates are also coming back too slowly in adults and adolescents, and that’s a major problem.
When teen and adult immunizations decline, the risk for preventable diseases — such as meningitis, shingles, or pneumococcal pneumonia — increases, potentially leading to serious illness and further strains on an overworked health care system. A drop in recommended vaccinations could lead to avoidable outbreaks of hepatitis, measles, pertussis, and other transmissible diseases.
Key to recovery from the pandemic is a return to basic, routine health care, including recommended immunizations, that creates a strong health foundation as kids return to school, college students take up residence in dorms, and adults go back to the workplace.
The Avalere study, based on analyses of insurance claims for vaccine services, reports a 41-53% drop in teen and adult immunizations from March-August 2019, before the emergence of the Covid-19 coronavirus, to the same period in 2020, when widespread closures and shelter-in-place orders took hold. The drop is across all vaccine types and all age and risk groups.
Vaccines included in the analysis are those that prevent or reduce the risk of influenza, Hepatitis A and B, Human Papillomavirus (HPV), meningococcal and pneumococcal diseases, chicken pox, shingles, tetanus, diphtheria, and pertussis (Tdap), measles, mumps, and rubella (MMR), and Haemophilus influenzae (Hib).
Every month that vaccines are delayed compounds the problem. Adults and teens who missed vaccination during months of sheltering in place are coming back slowly, so large numbers of individuals remain under-immunized.
Experts in adult immunizations are concerned. “We’re talking about serious illness, the risk of death, and the economic damage to patients from missed work and the cost of medical care. As a patient, I don’t want that,’’ says L.J Tan, chief strategy officer at the Immunization Action Coalition, “and I certainly don’t want that on top of Covid-19.’’
Even before the pandemic, vaccine rates for teens and adults did not approach national targets, with only about half receiving recommended immunizations. As shelter-in-place recommendations took effect in April 2020, things got worse, the report says. Routine doctor visits dropped off by up to 69%, and demand for adult vaccines plummeted by more than 60%.In their study, Avalere analysts looked at claim reports from commercial insurers, Medicaid managed care, Medicare Advantage, and Medicare fee-for-service payers and found, despite some variations, that “changes in claims trended similarly across vaccines, markets and ages.’’ The biggest drop was in April 2020, the first full month of widespread shutdown, compared to the previous April. After a 66-86% plunge that month, rates began to rebound in May as stay-at-home orders in some states lifted, the report says, yet claims for nearly all vaccines remained lower in the March-August 2020 period compared to the previous year, in all markets.
One bright spot was an increase in flu vaccine billing from 2019 to 2020. Analysts suggest that may have resulted from a concerted public health messaging and policy effort in late summer and fall that could point to a way to increase vaccination overall.
Health care professionals are encouraging patients to get caught up by spacing out visits, limiting the number of patients in waiting rooms, requiring masks, even immunizing people as they sit in their cars.
As Covid-19 vaccines become more widely available, people should plan, with their doctors, the timing of their catch-up vaccines, because health officials advise a two-week window free of all other vaccines before and after getting a Covid-19 shot.
Everyone has a role to play in addressing the gaps in vaccine coverage. Companies like GSK can raise awareness of the problem, providers and public health leaders can integrate catch-up messaging into the conversation about re-entry, and consumers can ask their health care professional about vaccines that may have been missed during the pandemic.
Routine immunizations are foundational to protecting individual and community health. They cannot become another casualty of the pandemic. It is critical that people of all ages get caught up on missed immunizations. It would be devastating to add unnecessary outbreaks of preventable diseases to this already tragic public health crisis.
Click here to learn more about the drop in adult and teen immunization rates.
About the Author
Judy Stewart is senior vice president, head of US Vaccines at GSK