Strategies to Boost Adult Vaccination Rates in the US

Why vaccines matter

Vaccines play a critical role in preventing severe illness, hospitalization, and death from infectious diseases such as influenza, pneumonia, and shingles. For individuals, the benefits are substantial: For example, rates of reported acute hepatitis B in younger adults decreased by 50 percent from 2000 to 2014, and pneumococcal vaccination has led to a 22 percent reduction in all-cause mortality among adults with cardiovascular disease or high cardiovascular risk. More broadly, adult vaccination contributes to community protection by reducing disease transmission and safeguarding vulnerable populations who may be immunocompromised and unable to receive certain vaccines.

Consequences of lagging adult vaccination rates

And yet, despite compelling evidence of their efficacy, adult vaccination rates remain considerably lower than pediatric rates in the United States (Exhibit 2). Adult populations exhibit roughly half the immunization rates of children, for whom there is an established immunization schedule. This disparity creates a persistent coverage gap that increases the disease burden among older and at-risk adults.

Factors contributing to low adult vaccination rates

Efforts to improve adult immunization should start with a clear understanding of the root causes behind persistently low uptake. Three structural barriers to adult vaccination stand out.

Increasing market complexity

The adult vaccine market is expanding, with several vaccine options available for the same disease area—many tailored to specific age groups, risk factors, or health conditions—and even more advancing through the development pipeline (Exhibit 3). Although multiple consumer options can spur innovation among manufacturers, a plethora of choices also makes decision-making more difficult for both consumers and healthcare providers (HCPs). A 2022 survey of HCPs revealed that 38 percent of them reported challenges understanding which type of PCV vaccine to offer to which patient.

Low consumer awareness of eligibility

Millions of eligible adults remain unvaccinated simply due to a lack of awareness, not a lack of access; as a result, some adults are not sure which vaccines are recommended for them (Exhibit 4). For example, the CDC’s Advisory Committee on Immunization Practices (ACIP) recently shifted from recommending the respiratory syncytial virus (RSV) vaccine for all adults aged 60 and older with shared decision-making to recommending it for all adults 75 and older, as well as high-risk adults between 60 and 74. This change required HCPs and consumers to reassess eligibility.

Evolving and diverse sites of care

The expansion of vaccination sites beyond traditional medical settings such as physician offices has increased accessibility. Today, adult vaccines are increasingly administered across a wide array of settings, including workplaces, mobile clinics, and faith-based organizations, though the largest increase has been at pharmacies (Exhibit 5). For example, roughly 85 percent of RSV vaccines and 75 percent of shingles vaccines are now delivered through retail pharmacy channels. Although enhanced access options enable the healthcare industry to meet consumers where they are, they may also lead to a dispersal of responsibility in recommending and monitoring vaccinations.

Reimagining the vaccine go-to-market strategy

To address the ongoing challenges in adult vaccination and fully realize the potential of vaccines, a comprehensive, coordinated approach is required across the entire healthcare ecosystem. These four go-to-market strategies can help to counter the structural challenges and support vaccine uptake by US adults:

1. Articulate clear value propositions to reduce the complexity. Given the increased complexity around vaccine choice and eligibility, manufacturers should deliver clear, concise value propositions that emphasize efficacy, safety, and the unique benefits of their products, especially for HCPs, who need simplified, easy-to-navigate guidelines. Clear messaging from manufacturers can reduce vaccine hesitancy and improve awareness, especially when guidelines change, as was the case for ACIP’s RSV vaccine recommendation.
2. Reinvest in consumer activation to boost awareness. Boosting consumer awareness and interest is essential to increasing vaccination rates. Organizations that run awareness campaigns should ensure that they are scalable across vaccine types. Such campaigns are also more effective when the efforts are sustained and supported by streamlined communications. For example, stakeholders could send digital reminders to ensure appointment adherence, such as text-based reminders, which boosted appointment rates by 84 percent and vaccination rates by 26 percent during the COVID-19 vaccine rollout. Tools, such as the Walgreens Flu Index to predict outbreaks, can also be used to target high-risk populations with tailored messages, ensuring that vaccine awareness and reminders reach those who need them most.
3. Expand partnerships to meet consumers more effectively where they are. The increased diversity of vaccination sites has broadened access and increased convenience for consumers. Cross-industry stakeholders can make vaccinations more convenient by exploring partnerships with a wide array of health systems, employers, and consumer-facing services such as rideshares. This could increase access through pop-up clinics, off-hour appointments, marketing collaborations to link to scheduling tools, and convenient transportation options—efforts that are particularly beneficial for low-income or mobility-challenged populations. In this evolving landscape, stakeholders can work together to streamline consumer activation—for example, by eliminating obstacles between HCP vaccine recommendations and consumers self-scheduling at retail pharmacies.
4. Engage with key opinion leaders and policymakers on vaccine benefits. Vaccine stakeholders should maintain active engagement with key opinion leaders and policymakers to bolster public health initiatives aimed at disseminating vaccine recommendations and enhancing accessibility. Manufacturers, healthcare institutions, and research organizations should provide robust, evidence-based data on vaccine efficacy and safety to facilitate the FDA approval process and strengthen recommendations by the ACIP. Policymakers and the healthcare ecosystem can build trust and overcome vaccine hesitancy by delivering consistent messaging and reliable data—essential steps to reinforcing the critical role of vaccines in public health.

Conclusion

To close the gap between innovation and impact, the US vaccine ecosystem should take swift action, collaborating with health authorities and vaccine retailers, to boost adult vaccination rates in the United States. The strategies proposed above will be critical in those efforts. Sustained implementation of these strategies could establish a new benchmark where adult vaccination rates are sufficiently high and the public is better protected against major preventable diseases.

FAQ

Q: How can I find out which vaccines I am eligible for as an adult?

A: It is recommended to consult with your healthcare provider or pharmacist to determine which vaccines are recommended for your age group, health conditions, and risk factors. They can provide guidance based on the latest recommendations from health authorities.

Q: Are there any common misconceptions about adult vaccination?

A: One common misconception is that vaccines are only for children. In reality, adults also benefit greatly from vaccination to prevent serious illnesses and protect vulnerable populations.

Q: How can I stay informed about the latest developments in adult vaccination?

A: You can follow updates from reputable sources such as the CDC, WHO, and FDA, as well as consult with your healthcare provider for personalized recommendations.