Vaccination is a complex topic in 2022. The COVID-19 pandemic has driven conversation and action on immunization, as innovative technologies such as mRNA offer new ways to protect from disease.
Over 200 million Americans have received COVID-19 vaccines since December 2020 – but American adults still missed over 37 million other routine vaccinations from January 2020 to July 2021. Vaccine claims are significantly below 2019 levels.
At NEHI’s webinar, Taking Stock of Adult Vaccination in the U.S., on October 11, speakers and participants discussed current trends in adult vaccination and potential strategies for increasing rates.
1. People won’t get vaccines if they can’t afford or access them.
If a patient can’t afford a vaccine, they likely won’t get that vaccine. The approximately 135 million Americans on public insurance may face co-pays for the 26 vaccines recommended by the CDC Advisory Committee on Immunization Practices (ACIP).
That will change starting January 1, 2023: patient cost-sharing will no longer be in effect for those 26 vaccines under Medicare and Medicaid as a result of the Inflation Reduction Act (IRA). This is a meaningful step toward affordability.
For vaccine administrators/providers, insurance literacy can help to inform patients about which vaccines their insurance covers. Confusion about immunization coverage will likely persist despite the IRA’s vaccine provisions.
Panelist Dr. Jewel Mullen, associate dean of health equity at Dell Medical School at the University of Texas at Austin, recently encountered a pharmacy employee who said her insurance wouldn’t cover her routine immunizations.
“I knew enough to understand that this person needed to look a little more deeply,” Dr. Mullen said, “but that’s enough to turn some people away – particularly people who are already worried about the decisions that they have to make [regarding vaccines].”
Dr. Jewel Mullen
Supply of vaccines is also key to equitable access: if a vaccine isn’t in stock, or if it’s only available in an inconvenient location, the patient likely won’t get that vaccine.
Innovative new vaccines will likely become available in the coming years. These vaccines must reach locations that are convenient for adults to visit. Otherwise, they may sit on the shelf and expire.
“How do we make sure that there’s no disparities in who can get those vaccines?” panelist Abby Bownas, co-manager of the Adult Vaccine Access Coalition, said.
Abby Bownas
2. Education and encouragement is key for patients to understand the science and utility of vaccines.
Vaccinators can utilize talking points to increase patient confidence, such as:
- “Have you missed any routine vaccines? If you did, let’s get you caught up.”
- “Vaccination protects you and your community.”
- “Getting a vaccine now helps you avoid getting very sick in the future.”
“A lot of the messages for catching up on preventive care we’ve heard in the last year and a half have been around things like cancer screenings and diabetes, and less about ‘get your shots,’” Mullen said.
3. Data can help us keep track of vaccination uptake rates across the country, and inform strategies to raise these rates.
During the webinar, panelists Kate Hashey, director of vaccine policy at GSK, and Sean Gallagher, senior principal at IQVIA, presented Vaccine Track, a new tool to display current data trends on adult vaccination in the U.S.
Vaccine Track, and tools like it, can show differences in vaccination rates across states. This data can serve as a knowledge base to build interventions and campaigns to raise vaccination rates targeted to specific areas. This data can also help us examine the effect of policy changes - like the IRA’s vaccine provisions - on vaccine uptake rates.
Kate Hashey introduces Vaccine Track.
“We wanted to get [a tool] out there that’s more regularly updated, that the partner community [can use],” said Hashey. “It’s not going to be a silver bullet, but it can inform actions.”
4. The more uniform vaccine policy and implementation is, the better.
Different states’ public insurance plans cover different mixes of vaccines, creating a complex patchwork across the country. A Medicaid plan in Idaho might cover all 26 ACIP-recommended vaccines, while a Medicaid plan in another state might cover only 10-15.
Starting in 2023, the IRA's vaccine provisions will broadly ensure nationwide Medicare and Medicaid coverage for those 26 vaccines.
This still leaves obstacles in billing and reimbursement. Doctor’s offices are comfortable billing for vaccines covered under Part B of Medicare, such as the COVID-19 vaccine, but the process becomes more complicated for vaccines under Part D, such as the shingles vaccine.
Many doctor’s offices broadly refer patients to pharmacies for vaccinations due to these billing issues, and because pharmacies might have more vaccines in stock. However, pharmacies have inverse difficulties billing under Part B vs. Part D.
“Wouldn’t it be amazing if we could just make it easier for our providers to bill in whatever system they are most comfortable using?” Bownas said.
5. Collaboration and teamwork across all vaccine stakeholder groups is key to increasing adult vaccination.
The COVID-19 mass vaccination campaign brought together government, community, and health care delivery organizations to vaccinate patients rapidly. Continuing partnerships, and new partnerships targeting historically under-served communities, will be critical to restore adult vaccination rates and safeguard public health.
Companies such as IQVIA can potentially partner with the CDC or other organizations to gather additional data, like mask-wearing rates and social determinants of health (SDOH) such as ethnicity and income level, to overlay with their existing data. Insights from this data could help refine outreach and education strategies to promote vaccination and other behaviors.
Care practitioners, community representatives, and other “vaccination network” members can also exchange knowledge at immunization summits and other gatherings.
“It’s the knowledge of what actually happens on the ground for people when they show up [for vaccinations] that we need to know more about,” said Dr. Mullen, “as we drift down from the policy level to when the vaccinations actually occur.”
View the recording of this event here.
