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Efforts to offer proactive protection through the childhood vaccination program have been a great success. The current challenge is to extend that success to the adult population.

THE DIFFERENCE WE CAN MAKE

Adults suffer 99% of all vaccine-preventable deaths.

• Each year, between 50 and 70 thousand adults die from vaccine-preventable diseases; more than from breast cancer, prostate cancer, colorectal cancer, suicide, HIV or car wrecks.
• Influenza alone is responsible for an average of 36,000 deaths and 200,000 hospitalizations each year.^1,2

Most adults are not vaccinated even though there are vaccines available to prevent serious disease.

• CDC recommends 261 million people or 86% of the total U.S. population for influenza vaccination, yet only 42% of those 50 – 64 years are vaccinated and only 68% of those 65 and older, the group at highest risk, are vaccinated.¹⁴
• Only 2% of adults are fully vaccinated against tetanus, diphtheria and whooping cough.
• Only 12% are vaccinated against HepA, and only 23% against HepB. 30% of health insurance plans do not cover vaccines.^9,11

Failure to vaccinate is expensive.
Flu alone results in more than $87 billion of U.S. economic burden annually (hospitalization costs, missed days of work, lost lives, etc.). Influenza vaccination for adults is cost saving relative to treating them. On average, people with Influenza-like Illness (ILI) were sick for ~8 days, missed about 1.5 days of work, and worked at least 4 days with reduced effectiveness. Also, 31% of people with ILI visited a health care provider, and 24% received antibiotics.³

• Over a ten year period, direct costs of whooping cough were estimated to be more than $1.4 billion and with additional $15.1 billion in indirect costs.
• Adults with pertussis or whooping may undergo extensive medical evaluation, miss work and possibly pass the disease on to young children who are at most risk of complications from whooping cough.^4,5,6
• A study in the VA Health System showed that when vaccination rates for influenza went from 27% to 70% and for pneumococcal from 28 % to 85%, pneumonia hospitalization rates decreased by 50%, and the health care system saved $117 for each vaccine administered.⁷

WHAT WE NEED TO ACHIEVE

Adult vaccination should be a key element in health care reform.
Adult vaccination is cost effect and is good public health policy. Including adult vaccination as a part of a basic patient-centered prevention health benefits package makes good public health and economic sense.

WHAT WE NEED TO CHANGE

Consumers do not know where to get vaccinated, or what to be vaccinated for.

• Fewer than 25% of consumers are aware of the Tdap (Tetanus-diphtheria-acellular pertussis) vaccine; even less (only 2.1% of adults aged 18 to 64) are immunized against Tdap.⁸
• In the 2007 National Immunization Survey (NIS), the reasons cited by individuals as to why they were not vaccinated was that it was not needed, they did not know about it, or that a doctor did not recommend it. Less than 5 % cited cost as a barrier.¹⁴

Vaccine reimbursement for many with health insurance is unclear or inadequate. Public programs and funding are insufficient for the target population.

• Although 67 % of adults (126.1 million people) have insurance coverage,⁹ it is estimated that 30% of insurance plans do not cover vaccinations.¹⁰
• 13% of adults (25 million people) are underinsured in that their out of pocket medical expenses are 10% or more of their income. This population is predominantly in the 50-64 age group and many have chronic diseases.¹¹
• 36.8 million adults are uninsured, and 9.4 million of them (5% of adults) are living below the poverty line. Yet, Section 317 and state funds to vaccinate these adults are insufficient and totaled less than $35 million in 2008.¹²

There is a lack of infrastructure for adult immunization.
Frequently adults do not make regular, preventive health visits, and there is limited use of alternative sites for vaccinations, such as pharmacies.
Both insured and uninsured adults seek healthcare in a variety of settings.¹³
Unlike well-established pediatric vaccination quality improvement measures, there are not measures for adult vaccination.

References:

1. CDC. National Vital Statistics Reports: Deaths: Final Costs for 2000. Hyattsville, MD: National Center for Health Statistics; 2002.
2. NCHS “Number of Deaths from 113 selected causes by age: US 2005”.
3. KL Nichol, et al “Burden of Influenza-Like Illness and Effectiveness of Influenza Vaccination among Working Adults Aged 50-64 Years” Clinical Infectious Diseases 2009: 48 (1 February). P.292-298.
4. Postels-Multani S, et al “Symptoms and Complications of Pertussis in Adults.” Infection. 1995;23:139-142.
5. Cortese MM, et al. “A "New Age" in Pertussis Prevention New Opportunities through Adult Vaccination. Am J Prev Med. 2007;32:177-185.
6. Lee GM, et al “Societal Costs and Morbidity of Pertussis in Adolescents and Adults.” Clin Infect Dis. 2004;39:1572-1580.
7. AK Jha, et al “Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care” American Journal of Public Health. 2007: 97, 12: 2167-2172.
8. L Landro “Get Your Shots: Adults Need Vaccines, Too”. Wall Street Journal. 9 July 2008. Pages D1 and D3.
9. Kaiser Family Foundation and Commonwealth Fund.
10. MM. Davis and K Fant.“Coverage of Vaccines in Public Health Plans: What does the Public Prefer”. Health Affairs. 2005.
11. “How Many Are Underinsured? Trends Among US Adults 2003 and 2007”. Health Affairs. 10 June 2008.
12. US Census Bureau: “Income, Poverty, and Health Insurance Coverage in the United States: 2007.
13. Kaiser Family Foundation. Kaiser Primer on the Uninsured.
14. Vaccination coverage among U.S. adults. National Immunization Survey – Adult, 2007.