In June 2009, the Assistant Secretary for Health (ASH), Dr. Howard Koh, asked the National Vaccine Advisory Committee (NVAC) “to develop recommendations for establishing a comprehensive, sustainable, national adult immunization program that will lead to vaccine-preventable disease reduction by improving adult immunization coverage levels.” The NVAC serves in an advisory capacity to the ASH, in his role as Director of the National Vaccine Program. During a nearly two-year period, the NVAC reviewed prior recommendations and reports on adult immunization from the last two decades and examined the current landscape of research devoted to barriers to vaccinating adults. Based on this analysis, the NVAC developed a white paper and recommendations that aimed to address unresolved issues in a novel way to protect adults in the United States from vaccine-preventable diseases through increased vaccination. The report and recommendations were presented to the NVAC by the Adult Immunization Working Group (AIWG) and approved on June 14, 2011. The report and recommendations have been transmitted to the ASH as an official report of the NVAC.
The NVAC identified a need for national leadership and coordination of adult immunization activities. Strong leadership and coordination for adult vaccination are critical, as health-care utilization by adults, when sought, is often spread across a variety of specialist and generalist physicians and nonphysician providers. This model contrasts with the childhood vaccination model, where vaccinations are often provided within a medical home by a limited range of physician providers. Additionally, developing a cohesive system for delivering routine vaccinations to adults can have a longer-term impact by providing a framework to rapidly and efficiently deliver vaccines during public health emergencies such as pandemics, utilizing all available vaccination venues in concert.
Through the review and development of recommendations, nine categories of barriers to adult immunization were identified and examined in detail:
- Lack of coordination of adult immunization activities
- Lack of public knowledge
- Lack of provider recommendations for immunization
- Financial impediments to vaccinations
- Lack of access to, and utilization of, health-care services by adults
- Lack of utilization of reminder or assessment systems
- Racial/ethnic disparities
- Health literacy
- Concern about adverse events
To address these barriers, the NVAC developed three recommendations, which are summarized in this article. These recommendations address the need for national leadership for an adult immunization program, the identification of resources for this program, and the development of a strategic plan for the adult immunization program. Additionally, more specific gaps in adult immunization were addressed through the development of recommended focused activities. These activities are categorized as addressing (1) general infrastructure considerations, (2) the expansion of access to vaccination, (3) provider- or system-based interventions, (4) the increasing community demand for vaccinations, and (5) research needs.