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Further funding needed for adolescent, adult vaccination
Public awareness of immunization is important to help target at-risk populations, such as adolescents and minorities.
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WASHINGTON – Financial support from federal and state government is necessary to improve immunization coverage in adolescents and adults, according to Neal A. Halsey, MD, who chairs the Immunization Working Group for the Infectious Diseases Society of America.
“New financial support and commitment from federal, state and other sources are essential to make these changes,” Halsey said at the National Vaccine Advisory Committee meeting held here last month.
He discussed the IDSA’s working principles on vaccination coverage at the NVAC meeting.
The IDSA issued its principles, “Actions Needed to Strengthen Adult and Adolescent Immunization Coverage in the U.S.,” as a guide and instrument to affect public policy and improve protection against infectious diseases, Halsey said. The IDSA based the adolescent and adult immunization principles in part on the lessons learned from the success of the pediatric immunization program.
IDSA’s six general principles include: increasing demand for vaccines, strengthening vaccine delivery capacity, expanding provisions for insurance, promoting health care quality measurement of immunization, improving vaccine delivery and safety monitoring systems’s performance and assuring support for research. Halsey emphasized that gains in adolescent and adult coverage should not be achieved at the expense of pediatric immunization nor the additional needs in that area.
New vaccines have created new opportunities to prevent diseases such as meningococcal disease, cervical cancer and shingles in adolescents and adults, Halsey said, but substantial challenges remain.
Improving demand
Vaccine demand must be improved, according to IDSA’s principles. Medical and nursing schools should increase education on vaccine-preventable diseases, and medical providers should offer immunization during all encounters with patients. Physicians should emphasize visits for adolescents aged 11 to 12, 14 to 15 and 17 to 18 to administer vaccines. In addition, subspecialties and medical societies, such as the IDSA, should increase education.
The CDC estimates that the annual burden of adult vaccine-preventable diseases is more than $10 billion annually, according to IDSA.
“The idea of focusing on adult immunization as the number one priority … the reasoning is because of the very large burden of disease that is still out there,” according to CDC data cited by Halsey.
All health care workers should be immunized as a way to not only protect themselves and their patients against disease, but to set an example for the public as to what the appropriate standard of vaccine use should be, Halsey said.
Public awareness is key and can help target specific vaccines and populations at high risk, such as adolescents and minorities.
Tetanus vaccination rates are highest among white adults, according to Halsey. Among white adults aged 18 to 49 in 1999, about 70% received tetanus vaccine, compared with 60% of blacks and about 50% of Hispanics and Asians. About 60% of whites aged 50 to 64 received tetanus vaccine, compared with nearly 50% of black and Hispanic adults and slightly more than 40% of Asian adults. Tetanus vaccination rates were lowest among adults older than 65; more than 40% of white and Asian adults received vaccination, compared with about 30% of black and Hispanic adults.
The CDC and Department of Health and Human Services need to develop a plan to finance and deliver vaccines to strengthen the health care system’s ability to deliver vaccines, according to IDSA. The CDC and HHS should enhance the 317 program, which emphasizes a strong immunization program by covering all Advisory Committee on Immunization Practices-recommended vaccines and distributing vaccine based on state need. Additional funding should be given to the adolescent and adult immunization programs and not taken away from childhood immunization resources. In addition, Section 317 should receive increased appropriations whenever the ACIP approves a new vaccine.
“We think the program should cover all vaccines recommended by the ACIP,” Halsey said.
Strengthening coverage
To strengthen adolescent coverage, IDSA stated that Vaccines for Children providers who work with adolescents should receive increased funding, including internists and gynecologists because many adolescents have already transitioned from their pediatricians. Nontraditional immunization settings should also be financed, such as school-based clinics. Halsey emphasized that national and state authorities and professional societies consider broadening minors’ consent for health care to include immunizations against sexually transmitted diseases.
Financing for immunization should not solely be a federal effort, according to IDSA. State and local public health agencies should strengthen financial investments toward immunizations for adolescents and adults. IDSA recommended standing order policies that allow nonphysicians to administer vaccines, such as pharmacies, schools and walk-in clinics.
Hospitals should step up immunization efforts, as well, Halsey said. Hospitals should have mandates for vaccination of eligible inpatients and outpatients and receive adequate financial incentives for vaccination, including payment for vaccine acquisition, storage and administration.
In order to expand vaccine coverage in public and private health insurance, states should require payers to cover all ACIP-recommended vaccines, including administration and carrying costs, according to IDSA.
To promote immunization rates as a measure of health care quality, health care organizations should establish criteria to assess hepatitis B, influenza and pertussis vaccination rates among health care workers, according to IDSA. In addition, the National Committee for Quality Assurance should revise the Health Plan Employer Data and Information Set measures to eventually include all vaccines recommended for adolescents and adults.
Agencies including the CDC, FDA and NIH should receive adequate funding for vaccine research regarding cost-benefits, effectiveness, efficacy and safety, according to IDSA. Further research should also be aimed at public and provider acceptance of vaccines, eliminating ethnic and racial disparities, factors associated with delays or refusals of vaccines and vaccine delivery systems. – by Lauren Riley
For more information:
- Halsey NA. IDSA working principles: Actions needed to strengthen adult and adolescent immunization coverage in the U.S. Presented at: National Vaccine Advisory Committee; Feb. 5-6, 2007; Washington.