Just the Vax, Please: Too Many Adults Aren't Getting Immunized- and Why We Need Them To

Feb 3, 2014 | Jane Huston | Featured Series

There’s big news today in the world of public health professionals focused on immunization (or as I like to think of us, vaccinerds.)

The updated adult immunization schedule has been published and will be available here. Adult immunization recommendations can be a bit more complicated than those for children. Childhood immunizations are more or less based on age. When it comes to adults, your job, travel plans, or chronic health conditions may put you at risk of contracting certain infectious diseases and therefore make you a candidate for certain immunizations. (You can see personalized recommendations at vaccine.healthmap.org/recommendations by completing a short questionnaire.)

This year’s updates are mostly clarifications and small changes in wording-- there are no exotic new vaccines to unveil or special populations to start targeting. The publication presents another opportunity for what we do every day: encourage adults to get their recommended immunizations.

And it seems like many adults in the United States aren’t hearing that message. Adult vaccination coverage remains low for routinely recommended vaccines, with coverage rates for most vaccines falling between 20 and 60 percent.  By comparison, in 2012, 92.8 percent of children aged 19-35 months were fully vaccinated against poliovirus; coverage rates for other vaccines ranged from 82 to 92 percent.

The reasons that many adults aren’t fully immunized are again some of the same reasons why not all children are immunized: access to healthcare, limited knowledge of immunization, or fears about safety still hold people back from getting their shots. These are substantial barriers, which we’ve discussed before and will likely discuss again. There are, however, a few challenges unique to adults.

First, paying for immunizations may be more challenging for low-income adults than for children (or parents). Vaccines for Children is a federally-funded program that provides vaccines to children who might not otherwise be able to afford them. There is no analogous program for low-income adults. However, the Affordable Care Act will expand access to vaccines for many adults. All insurance plans must now cover preventive services (such as vaccines recommended by the Advisory Committee on Immunization Practice) with no cost-sharing (co-pays).

Of course, cost will still be a barrier to anyone without insurance. And many adult immunizations aren’t cheap. But the price of the vaccine is much lower than the thousands of dollars a hospital stay due to pneumonia might cost you, for example. Or the days at work you might miss due to having the flu.

Second, adult immunization is also affected by social barriers. If you want to send your child to public school in any of the 50 states, you must provide proof of immunization (yes, there are exemptions and it’s a growing problem, but the majority of most school-aged children are still immunized). There’s no social contract around getting immunized as an adult.

Children are also more likely to see a pediatrician regularly than most adults are to make an annual visit to a doctor’s office, especially young, relatively healthy adults. With fewer points of contact, providers have fewer opportunities to encourage their patients to receive any needed immunizations and research suggests that recommendation from a provider is one of the strongest predictors of receiving a vaccine.

You might be asking: if getting immunized will cost me money and no one’s going to make me do it… why should I?

Getting vaccinated as an adult is a good idea for the same reason you were immunized as a child: vaccines are the best protection we have against a number of infectious diseases. 

There are vaccines today that didn’t exist when many adults were young, like HPV or chicken pox. Other vaccines, like the shingles vaccine, target diseases that don’t usually occur in children, so the vaccines are recommended for older adults who need the most protection. Still other vaccines, like Tdap, require booster shots because your immunity wanes as you age.

Immunized adults can contribute to a phenomenon known as herd immunity, also commonly called community immunity. Herd immunity occurs when a sufficient proportion of a population is immune to a disease and the disease cannot spread within that population. Put more simply, people who aren’t immune are protected from getting sick because no one else is sick. Check out this short demo on herd immunity from Harvard Medical School for a visual explanation.

Herd immunity motivates many adults to get vaccinated, whether or not they call it by that name. Take the example of whooping cough, a respiratory infection that causes a persistent cough in adults but can be fatal for infants. The Tdap vaccine offers protection against whooping cough and booster shots are recommended for pregnant women and any adults who spend a lot of time around children under 12 months. As one grandmother recounts after learning she transmitted whooping cough to her infant granddaughter,  “I hope no one has to feel the frustration, sadness, or guilt of bringing such a horrible thing to their child or grandchild.”

There’s a reason why vaccination is a cornerstone of public health-- by getting vaccinated you’re protecting the health of those around you, not just yourself.

Adult immunization isn’t always an easy sell, but the reasons to do it outweigh the reasons to avoid it. Thanks to the Affordable Care Act, vaccination is covered for more people. Couple that with the growing trend of expanded immunization by pharmacists, and now vaccines are more available than ever.

With so many reasons to get that vaccine and so many places to do it, what’s holding you back?

Let’s make 2014 the year you get fully immunized.

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