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Blog: A Q+A with Dr. William Schaffner on Adult Vaccination Rates

August 20, 2019   |   Alliance for Aging Research Team   |   Vaccination (Health Education), Vaccination (Policy)

Vaccines are important for people of all ages, including older adults! Yet a new survey distributed to primary care physicians and nurse practitioners, commissioned by the Alliance for Aging Research, found that vaccine discussions as part of prevention planning are a low priority at the Annual Medicare Wellness Visit. Join us for a webinar on Tuesday, August 27 as experts discuss the survey results and strategies to overcome vaccine hesitancy. In the meantime, learn more about the importance of vaccines from Dr. William Schaffner, who will be speaking at the webinar.

August is National Immunization Awareness Month. Why is an awareness month like this so important?
As the name states, National Immunization Awareness Month brings attention to the importance of immunizations across the lifespan, ranging from newborns through senior citizens. August was chosen as a good time to remind everyone of how effective vaccines are in preventing disease because many families are catching their children up on their vaccinations so that they may attend school. It also is well to remember that “vaccines are not just for kids.” There are vaccines that are routinely recommended for adults and this is a great time to ask your healthcare provider about them as well.

A recent survey conducted by the Alliance for Aging Research found that vaccine discussions as part of prevention planning are a low priority at the Medicare Annual Wellness Visit; and, that more education is needed to overcome patient awareness barriers. You will be participating in a webinar on Tuesday, August 27 discussing this topic. Why do you think discussions about prevention through vaccination are a low priority?
There are several reasons that conversations among patients and providers about vaccines often are a low priority. Many patients and even providers may not be aware of the vaccines that now are recommended for adults. At the beginning of each year the CDC’s Advisory Committee on Immunization Practices (ACIP) publishes an updated Adult Immunization Schedule that elegantly displays which adults are eligible to receive which vaccines. It is very easy for providers to use. Another important reason, frankly, is that the mechanisms for paying for adult immunization through both private and public insurance are complex and have gaps. Some insurance programs require co-pays or have deductibles, and even Medicare only includes some vaccines under Part B with first-dollar coverage (influenza and pneumococcal vaccines, for example). However, other vaccines (e.g. shingles vaccine and Tdap) fall under Part D, and many individuals do not elect Part D coverage.

We need to bring vaccines into the routine discussion during the routine Medicare Annual Wellness Visit in order to extend the maximum prevention benefits to this vulnerable population.

Why are vaccination rates for older adults low, and what can be done to fix this?
As noted above, there are a number of barriers to optimal adult immunization. Our response needs to be steadfast: increasing education of both the general public and providers about the benefits of vaccines. In addition, providers can be helped with practical information about practical issues such as standing orders, how to order and stock vaccines, how to bill for them and, importantly, how to be a vigorous advocate for immunizations. As I like to say, “Don’t be a vaccine recommender, be a vaccine insister.”

August is an ideal time to start planning for the flu season. Why and when should older adults get a flu shot?
Everyone should receive the influenza vaccine every year. This is particularly important for older adults because that segment of the population suffers the complications of influenza most severely. Let us be clear: the influenza vaccine is not a perfect vaccine—it will prevent many influenza infections, but it cannot prevent them all. Here is what is important: even if one gets the flu despite being vaccinated, the vaccine likely will make the illness less severe—you are less likely to suffer the complications of pneumonia, be hospitalized, and die. The flu vaccine is not perfect, but it moves the odds in our favor. Thus, everyone should get vaccinated.

One would like the protection from the vaccine to extend throughout the flu season, which can last through March. Thus, focus on getting vaccinated starting in late September, through October, and into early November. That interval should offer plenty of opportunities for everyone to visit their doctor, pharmacist, senior citizens center, or wherever you get your vaccine. Do not put it off, as a vaccine delayed is often a vaccine not received. And bring the entire family with you—you can all roll up your sleeves at the same time.

A word to seniors: there are two flu vaccines that have been licensed expressly for persons 65 years of age and older: one is the high-dose vaccine, and the other is an adjuvanted vaccine. Both have been shown to provide enhanced protection in older adults.

You serve as Medical Director at the National Foundation for Infectious Diseases. What are some of NFID’s priorities when it comes to vaccine education?
The NFID is dedicated to providing science-based information about vaccines both to the general public, as well as to the entire array of medical professionals. The NFID disseminates and explains the recommendations of the CDC’s Advisory Committee on Immunization Practices (ACIP).

What does healthy aging mean to you, and how do you practice healthy aging?
Aging is inevitable, beginning at birth. I try to maintain health by watching my diet and being physically active, as well as by having interest in the global environment. Finding joy in family and remaining optimistic are fundamental. And, of course, by advocating energetically on behalf of vaccines that promote healthy aging for everyone!

Dr. William Schaffner is Medical Director at the National Foundation for Infectious Diseases and the Professor of Preventive Medicine in the Department of Health Policy and Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine. Next Tuesday, August 27 from 11 a.m. to 12 p.m. ET, he will be speaking in a webinar on vaccine discussions at the Medicare Annual Wellness Visit. Register for the webinar now.

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