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86 Executive Briefing Making Prevention the Priority — How to Boost Adult Immunization Rates D espite providers' and health agencies' efforts to advocate for the importance of vaccinating adults — especially those most vulnerable to infection — rates of adult immunization remain low, creating a substantial burden on the American health system. Adult immunization is an uphill battle due to a number of reasons, including cultural misperception and socioeconomic barri- ers. However, healthcare organizations that make adult vaccination a strategic care priority can realize significant im- provements in population health. In 2015, the overwhelming cause of the economic burden of disease was attrib- utable to poor vaccine adherence by U.S. adults, according to a 2016 study pub- lished in the journal Health Affairs. For the study, researchers analyzed health data compiled in various national data- bases on 14 different pathogens that can be inoculated by 1 of 10 available vac- cines. In 2015, these pathogens generat- ed an economic disease burden of $8.95 billion. Eighty percent, or $7.1 billion, of that burden was attributable adults who'd forgone immunization. "Low rates of vaccine uptake lead to costs to individuals and society in terms of deaths and disabilities, which are avoid- able, and they create economic losses from doctor visits, hospitalizations and lost income," wrote the study's authors. "These results not only indicate the po- tential economic benefit of increasing adult immunization uptake but also highlight the value of vaccines. Policies should focus on minimizing the negative externalities or spillover effects from the choice not to be vaccinated, while pre- serving patient autonomy." Culturally ingrained While pediatric immunization rates sit above 90 percent, largely because vacci- nations are required by school systems, immunization rates among adults have stubbornly remained below goals set by national health agencies. Despite a myriad of health initiatives launched by organiza- tions like the CDC to improve immunization rates among this population, progress has been largely slow-moving and incremental. "We kind of get pediatric immunizations, it's almost ingrained in the culture, but that's not necessarily the case with the adults," says John Bulger, DO, CMO for population health at Danville, Pa.-based Geisinger Health System and CMO of the system's 500,000-member health plan. "I think one of the challenges is that even though there is a large burden of diseases we have vaccines for, most patients will still not get that disease [whether they're vac- cinated or not], so they'll forgo a vaccine." The substantial benefits and protections offered by adult immunization are often undercut by vaccines' varying rates of ef- fectiveness. Pediatric immunizations like the polio vaccine and the mumps, measles and rubella vaccine offer protection from illness at rates approaching 100 percent. Adult vaccinations, like the flu vaccine, have much lower efficacy rates. The 2014 flu vaccine only reduced an individual's chances of infection by 19 percent. Such low rates can make it difficult to persuade adults and the elderly to partake. For this reason, it is important for health professionals to openly laud the protec- tions offered by adult immunization. Pneumococcal disease — which can cause pneumonia, sepsis and meningitis — kills nearly 5,000 people in the U.S. every year, most of whom are adults older than 65 years of age, according to the Na- tional Foundation for Infectious Diseas- es. Studies have shown just one dose of the pneumococcal vaccine can protect 75 percent of older adults from invasive pneumococcal disease and 45 percent against pneumococcal pneumonia. While these protection rates don't match the efficacy of certain pediatric vaccines, the pneumococcal vaccine offers significant protection from life-threatening illness. Still, pneumococcal immunization rates among adults 65 years and older remain below HHS Healthy People 2020 goals. Another factor inhibiting adult immuni- zation is that many adult patients do not perceive immunization as essential to their wellness care regimen. "There has been a long history of pediatri- cians incorporating vaccines into routine well care," says Jerry Penso, MD, CMO and quality officer for American Medical Group Association and the president of AMGA Foundation. "In the adult world that hasn't been as much a routine for most adult pa- tients as far as well care. Most adults only enter the health system when something is wrong. And we [providers] simply react to whatever the problem is." Though engaging the older U.S. pop- ulation in preventive care can be chal- lenging, the current trajectory of Amer- ica's healthcare system as driven by value-based models of care offer provid- ers a unique moment in history to boost adult immunization rates to all-time highs. Value-based care and adult immunizations Under outcome-based care models, pre- ventive care and timely medical interven- tions have an outsized effect on patient health outcomes. Adult immunization ini- tiatives have the potential to make a sub- stantial impact on care outcomes while remaining cost-effective for hospitals. With more and more health systems focusing on population health initiatives, adult immuni- zation can play a valuable role in caring for vulnerable populations, such as adults old- er than 65 years of age or patients facing socioeconomic barriers to care. "More and more health groups and health systems are looking into how to take care of a population of patients, recognizing that it's not only important to treat patients that are sick, but to keep them well," says Dr. Penso. Immunizations offer health sys- tems a cost-effective treatment option that can reduce the instance of high-cost illness throughout a large patient population. Low-income populations represent a key opportunity for adult immunization. Accord- ing to the CDC, racial and ethnic disparities persist for the six most common adult vac- cinations, with affluent, white adults having a higher likelihood of immunization than their low-income, non-white peers. With lower vaccination rates, it's unsur- prising that poorer neighborhoods are Sponsored by: