Adult Vaccinations and Decentralization of Health Care: How to Navigate the Landscape

We’re all familiar with the numerous vaccinations recommended by the CDC for children aged from birth to 6 years of age, most of which are required prior to entering school for the first time.¹ Yet now, the landscape of adult vaccinations has become just as full and complex. With multiple vaccines recommended for older adults, patients and physicians are now faced with the complicated decisions of which ones to receive when, and whether certain vaccines should be prioritized.

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On top of navigating these questions, keeping accurate record of when and where patients receive vaccines can be a challenge for both patients and providers. Despite this complex picture, there are certain steps that can be taken to ensure that all adults remain healthy.

The landscape of adult vaccinations

There are 5 vaccines that are currently recommended for adults ages 65 and older: influenza, pneumonia, shingles, COVID-19, and tetanus, diphtheria, and pertussis (Tdap).² Additionally, GSK’s respiratory syncytial virus (RSV) vaccine was recently approved and Pfizer’s will likely receive approval once evaluated by the FDA.

Of course, patients can’t receive all 6 of these vaccines at once. When deciding which ones to receive first, patients and their physicians must consider the patient’s conditions and health history. For example, a patient with a respiratory illness such as COPD should prioritize getting vaccinated for pneumonia and COVID-19 because they would likely have greater complications from these diseases as opposed to shingles or tetanus.

On a more general level, getting vaccinated is especially important for older adults with any chronic health conditions because vaccines can prevent serious illness and resulting complications down the road. Despite this, vaccine hesitancy remains a major barrier to widespread vaccination. As we know, this issue came into the spotlight during the rollout of COVID-19 vaccines, which received much negative press during the height of the pandemic.

Vaccine hesitancy persists today. During the pandemic, many people developed negative feelings toward vaccines in general, as they felt they were forced to be vaccinated against COVID-19 rather than actively choosing to be vaccinated. Many patients are also experiencing vaccine fatigue after multiple doses of the vaccine and its corresponding boosters.

Because of these lingering trends, we’re likely to see some adults avoid any additional vaccines and thus not become fully vaccinated against all diseases. Unfortunately, this will lead to some patients developing serious illness, and potentially dying, due to a vaccine-preventable disease, which happens to thousands of patients every year.³

The importance of centralized vaccine records

For those who choose to become fully vaccinated, most of the applicable vaccines are easily accessible at a variety of different venues from physicians’ offices and walk-in clinics to drugstores and even supermarkets. However, this creates the issue of keeping track of when and where patients receive different vaccines. There may not be communication between these different venues, and there is no centralized record system in the United States for adult immunizations.

When children are vaccinated, they receive physical vaccine records that are required for entry into many schools and other forms of childcare. Although no such system currently exists for adult vaccinations, keeping record is no less important for older adults. In fact, many adults are not immunized to the extent recommended by physicians, in part because they do not have a way to keep track of them.

We need a centralized, digital record system for immunizations—no matter the patient’s age. These virtual records are something the patient, not their health system or the payer, should own. And, ideally, the patient should carry the record around like a passport, so all providers can see a patient’s vaccine history in any setting.

The trend toward decentralization of health care

The availability of vaccines at a variety of venues and the lack of a unified record system is indicative of a larger trend in the health care industry: decentralization. Forty or 50 years ago, the US health care system was highly decentralized, with many patients receiving care at physician-owned practices and independent pharmacies.

Over the past several decades, however, health care delivery has evolved to a largely centralized, hospital system-based model. The intention was to improve operational efficiency, increase revenue, and create a better patient experience.

In reality, for many patients, centralization has actually decreased ease of access and convenience when seeking care. Although local, community-based options still exist, patients are now encouraged to seek care at larger hospitals that may be farther away. As a result, care has become less personalized, and patients are often treated simply as numbers.

With the evolving landscape and the increased availability of vaccines, we’re seeing a shift back toward decentralization. Now, fewer patients are turning to health systems and more patients are receiving care in other venues, such as clinics and even at home.

Decentralization, if done correctly, will bring convenience back to health care, and patients stand to benefit immensely from this improved access. We need to bring back more personal medicine at independently owned practices so patients can be treated in their own communities and home-based settings.

We also need to further leverage technology, including creating digital vaccine records as described earlier and putting them into widespread use. Personal digital health tools already exist – just think about the many apps already available for tracking blood sugar, weight, and nutrition. Patients want to be able to manage their own health care, and we already have the technology that enables them to take better control. If we can maximize the potential of these tools and develop new solutions where needed, we can enable patients to take full ownership of their care journey.

The current landscape of adult vaccinations is complex, but patients and physicians can work together to navigate it. By making informed decisions around vaccines and leveraging technology to allow patients to take back control of their care, we can ensure that all individuals remain safe, happy, and healthy.

About the Author

Jayne Hornung is chief clinical officer at MMIT (Managed Markets Insight & Technology).

References

1. 2023 Recommended Immunizations for Children from Birth Through 6 Years Old. CDC. https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf
2. Adults Age 65 and Older. HHS. https://www.hhs.gov/immunization/who-and-when/adults/seniors/index.html
3. Vaccine-Preventable Adult Diseases. CDC. https://www.cdc.gov/vaccines/adults/vpd.html