In 1999, the US Centers for Disease Control and Prevention (CDC) named childhood immunization one of the top ten public health achievements of the 20th century and pointed to a dramatic drop in deaths from a range of vaccine-preventable diseases. This progress has continued into the 21st century, where more than 90 percent of children have been fully vaccinated against diseases such as polio, measles, mumps, rubella, hepatitis B, and chickenpox.
Vaccinating adults, however, is a completely different story. Each year, between 50,000-90,000 adults die in the United States from vaccine-preventable diseases. Adult vaccination rates for a range of diseases are suboptimal, and the consequences in terms of fatalities and healthcare costs are severe.
We can change this development by learning from the pandemic: Recommended vaccines should be available free of charge to everyone, especially those who would otherwise not be able to pay. CDC’s Vaccines for Children (VFC) program is based on this premise, and the results were remarkable. CDC has requested funding from Congress to establish an adult vaccine program along the lines of VFC. Congress should approve this request because such a program would be a huge public health achievement.
VFC was created in 1994 after another public health crisis: a measles epidemic that resulted in more than 55,000 cases, 11,000 hospital admissions, and at least 120 deaths between 1989 and 1991. This epidemic was primarily due to the lack of vaccinations among children of color in low-income communities — many of whom did not have health insurance. That is why VFC was deliberately developed to remove the cost barriers for vaccinations.
As part of the program, CDC purchases recommended vaccines for children and distributes them to state and local health agencies. The vaccines are then sent to participating healthcare providers and made available free of charge to children who are either uninsured, underinsured (insured but vaccination costs are not covered), eligible for Medicaid, or are Indian/Alaska Native.
As a pediatrician and former commissioner of the Chicago Department of Health, I’ve seen first-hand how VFC has become one of our nation’s most effective public health programs. Each year, around 75 million vaccines are distributed to healthcare providers that participate in VFC. This has revolutionized children’s health: CDC estimates that — from children born in 1994 when the program was launched to 2021 — vaccinations among children prevent 472 million illnesses and more than 1 million deaths while saving $2.2 trillion in overall social costs. Research shows that VFC has not only played a leading role in increasing overall vaccination rates among children, but has also helped to reduce or, in some cases, even eradicate persistent racial and ethnic disparities.
In recent years, several states have taken the initiative and created their own adult vaccination programs along the lines of VFC — including Florida, California, New York, Washington, and Virginia — but a national program is urgently needed. At least three quarters of adults do not receive at least one recommended vaccine. Research shows that vaccination rates tend to be lower for vaccines that adults have to pay for out of pocket.
According to the CDC, only 30 percent of adults ages 19 to 64 with a significant risk of serious pneumococcal disease (such as bloodstream infections and meningitis) have received a pneumococcal vaccine, while only 40 percent of adults over 60 years of age have received a zoster (shingles) vaccine. In a typical year, around half of adults do not get vaccinated against the flu. Racial and ethnic disparities persist within different adult vaccination categories. And the resulting healthcare costs are staggering: Four vaccine-preventable diseases alone result in healthcare costs of at least 26.5 billion US dollars annually.
We’ve recently made some progress in removing costs as a barrier to vaccination. Major federal investments guaranteed free COVID-19 vaccines for all eligible people in the United States. Almost 80 percent of adults have completed their first series of vaccinations, and studies estimate that millions of lives have been saved as a result. Starting in 2023, thanks to the Inflation Reduction Act, the recommended vaccines will be free for adults covered by both Medicare Part D and Medicaid.
However, this progress is in jeopardy. Congress’s continued refusal to provide additional funding for COVID-19 vaccines means that when these vaccines hit the commercial market — which is expected to happen in early 2023 — they will no longer be free for everyone.
In fact, Pfizer has already said it is expected to charge up to $130 for COVID-19 vaccine doses over the next year. The latest recommendation from the CDC’s Vaccine Advisory Committee to add COVID-19 vaccines to VFC will help mitigate the costs for America’s 3.9 million uninsured children, but without an appropriate adult program, the nearly 24 million U.S. adults without health insurance could be forced out of this market. That will make it even more difficult to increase acceptance of the updated, bivalent COVID-19 booster, which lagged behind previous COVID-19 vaccine campaigns.
Costs aren’t the only barrier to vaccinations. We need to take a number of additional measures to improve access to vaccination and build trust. These measures include ensuring paid family and medical leave and affordability of childcare so that people can take time off work to make vaccination appointments without risking a paycheck or even a job; maintaining COVID-19 public health emergency regulations, which significantly expand pharmacists’ ability to deliver vaccines; continuing to provide vaccines directly to communities where there is an There is a lack of healthcare providers, and vigilance to combat the recent explosion of misinformation and disinformation surrounding vaccines.
Removing the cost barrier for adults, as we have done successfully for children, would fundamentally change public health. In a country as wealthy as ours, a person’s income or health insurance status should never determine whether to give or withhold a vaccine. An adult vaccination program would put us on track to making adult vaccination one of the most important public health achievements of the 21st century.
Julie Morita, MD, is executive vice president of the Robert Wood Johnson Foundation and a member of the CDC Advisory Committee to the Director. Twitter: @DrJulieMorita