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Addressing Barriers to Adult Immunization with Abby Bownas

Published January 25, 2023

Show Notes

It’s no secret that vaccination is our best defense against preventable illnesses like the flu and COVID-19. However, for our most vulnerable communities, access to preventative care can feel just out of reach. 

Luckily for us, the Adult Vaccination Coalition is combatting the financial obstacles to critical treatment that many older Americans face. Joining us today is a patient advocate and co-manager at AVAC, Abby Bownas. Tune in as we discuss the importance of vaccination along with the amazing work that AVAC is doing to support older adults everywhere this flu season. 

Episode Transcript

Michael Ward: 

Hi, everybody. Welcome to This Is Growing Old, a podcast from the Alliance for Aging Research. I’m Michael Ward, and I serve as the Vice President of Public Policy and government Relations. This year’s flu and respiratory disease season has been particularly severe and older adults are at significantly elevated risk of severe infection. 

In addition to flu, we’ve seen alarming spikes in both RSV as well as COVID-19. Vaccination remains our best shot at protecting ourselves and our loved ones from harmful outcomes as a result of preventable illnesses. However, many Americans have difficulty accessing critical vaccines and treatments, though as a result of the coalition based work of today’s guest, Medicare beneficiaries now face fewer financial obstacles to vaccination. I’m joined today by Abby Bownas, patient advocate and co-manager of the Adult Vaccine Access Coalition known as AVAC. 

AVAC represents an incredible group of organizations and advocates that are working on legislative and regulatory policies that improve access to and utilization of vaccines among older adults and aging adults. In today’s podcast, we’ll discuss the importance of vaccination and what AVAC is doing to support our most vulnerable communities this flu season. Abby, thank you for joining us. 

Abby Bownas: 

Thank you. Glad to be here. 

Michael Ward: 

All right. Well, let’s just jump into it. Can you tell us a little bit more about where we are with adult vaccination this season and how AVAC is addressing barriers to adult immunization? 

Abby Bownas: 

Absolutely. So as you mentioned, the Adult Vaccine Access Coalition, we’re over 70 members strong, made out of patient groups, provider groups. We have vaccine makers at our table as well as a lot of the specialty companies that work on supporting the immunization infrastructure. And we came together back in 2015 because we knew adult vaccine rates were not where they could and should be. 

So even before the pandemic, we really were thinking about how we could make improvements to adult vaccination. We work on a number of different areas that really focus on improving access, quality measures and immunization infrastructure such as immunization data. And there really have been a number of different barriers that have been longstanding to some of the reason why our adult rates aren’t where they could and should be. 

We especially see discrepancies in who’s getting vaccinated when it comes to low income communities. And so we really want to be thinking about how to reach people where they are and make sure that we’re providing access for immunization. Some of that’s been done over COVID, and we can talk about that more. But when we look at the barriers to vaccinations, there’s a number of different things. 

So coordination among healthcare providers. A lot of times older adults see a lot of different providers. And how are they talking to each other to make sure who should be getting which vaccines? The data systems, they’re different in every state and locality. 

So there’s things we can be doing to be improving immunization data along the way. There’s general knowledge about which vaccines are right for you or even some skepticism or questions that people often have on getting vaccinated and what that actually means. So trying to really think about how to improve those conversations. 

And then there’s financial barriers. Up until very recently, which we’ll talk about, there’s been cost affiliated with just some vaccines. And that’s really been a barrier to people getting access and receiving those vaccines. And so that’s something we’ll talk more about today and I’m excited to talk about that. But then there’s some other just state and federal barriers on how vaccines are tracked between state to state. 

I mean, I live in Virginia, but work in DC and so how do people know cross lines, especially when we’re in communities that really do cross borders about getting vaccinated. And so then I think the last thing I would just mention on the barriers front is really about just missed opportunities. 

How can we all work together to make sure that every time you’re visiting a provider, they’re making strong recommendations for vaccines? We’d love to see that happen. And so we have a lot of work to do on opportunity-wise on the policy front to try to improve adult immunizations. And I think AVAC is just thrilled to have the Alliance as a partner in this work in moving it forward. 

Michael Ward: 

Yeah. I mean, I think that’s exactly right. I think fortunately in recent years there’s been an expansion of the types and places where you can receive a vaccination. But to the point you brought up, there’s so many ways that these things are connected, and does the provider that you’re seeing today know that you may have received a vaccine three months ago for something that they would, may recommend for you due to your age or other comorbidities that you may have? And so I think that’s really important. 

And I think I’ll say anecdotally, I will say among the Medicare population, so for the over 60, the 65 and older, as well as individuals that have a disability that are on Medicare, anecdotally I heard that, I’ve heard from a lot of folks that in the past that it’s actually been they’ve faced a pretty significant financial barrier in the Medicare program to vaccination that it was more expensive when they’re in Medicare to receive some vaccinations than it was when before they were on Medicare and in a private insurance program. 

So kind of counterintuitive, but some folks received had actual challenges just in wanting to receive vaccination due to the cost involved. So there has been a recent change in that, the Inflation Reduction Act passed last year in August and included a number of great provisions that help address some of those financial issues. So could you share a little bit more about those reforms and what they mean for the aging population? 

Abby Bownas: 

Yeah, absolutely. So the bill that passed and was signed into law back in August, the Inflation Reduction Act was a very big legislative vehicle. But inside that, there were two things that were near and dear to the Adult Vaccine Access Coalition and the work that we do. And those were things that will close those gaps around financial barriers in both Medicare Part D and Medicaid. 

And as you mentioned, Michael, I think the history there is there’s just been a discrepancy in how vaccines get covered across the board. So if you have private insurance and you’re under 65, all vaccines are covered for no cost for if they’re recommended by the CDC. And when it comes to Medicare, there were actually a couple vaccines that had previously been written into a statute one at a time. So for the flu vaccine or the Pneumococcal vaccine, there was no cost involved. 

And so as you’re listening to this, you may be thinking, “Well, I didn’t have to pay for my vaccine.” Those vaccines are covered under Medicare Part B as in boy. But then there were vaccines that are the, what we call newer. They’re not necessarily new anymore, but since 2005 vaccines that have automatically gone into the prescription drug benefit, Medicare Part D, had some cost sharing involved. And it depended on what plan you had. 

So there were some plans that had no cost. There were other plans where sometimes there were very high cost associated with a vaccine. And if you were going to get a vaccine. Shingles, for example, it’s a two dose vaccine, that could be really cost prohibitive when you go to get that vaccine and you find out how much the cost is. So maybe you were willing to get your flu and your Pneumococcal vaccine, but you’d hold off on your Shingles vaccine for a little while. 

So now, what we’ve actually done through this legislation that was passed is the Center for Medicare will be offering vaccines whether they’re in B or D, at no cost to the beneficiary. So you, individuals can go and get any recommended vaccine if your doctor or if you’re at the pharmacy and they tell you, they suggest that you go get vaccinated, there should be no cost involved. 

And that should really help us to boost immunization rates in Medicare. So we’re really excited about that. Similarly, there’s a second provision that does something very similar in the Medicaid program. And this is interesting because it’s state by state, Medicaid’s a state program. And so across the country there were different things happening for vaccination coverage. 

And so what this bill really does is it says for when it comes to vaccines, no matter what state you’re in, those recommended vaccines that the CDC says that you should be getting will be covered and that there’ll be no cost involved. So that’s really exciting too. 

And what our hope is, by implementing those provisions and you add in kind of the programs that we have both in childhood and private marketplace and you add in Medicare and Medicaid, we should be boosting coverage and access to about 90% of adults. And so we’re really excited, not, sorry, I didn’t mean to say adults, but adults and children,. But we should be able to get that coverage rates way up, which is an exciting place to be shooting for right now. 

Michael Ward: 

Yeah. I think it kind of goes back to the whole policy of announcer prevention is worth a pound of cure. And certainly vaccines are really a critical part of our core medical infrastructure, making sure that people are healthy at all ages. And so I that the AVAC and AVAC’s members have been working for years on the provisions that you talked about and getting them passed into law. 

So we take the victory lap. And then often that’s where the real work begins and implementation. So I wanted to ask, how is AVAC working now with the Medicare and Medicaid programs to implement the provisions that they talked about, including ensuring that beneficiaries know about the elimination of co-payments starting this year and the relevant timelines for each program? 

Abby Bownas: 

Absolutely. So the first, the Medicare piece, it’s already happened. We’re so excited about this. So that went into effect in January. So any older adult that goes to get their vaccines that are Part D vaccines, whether it’s Shingles or Tdap, they can go to the pharmacy or to their doctor’s office and get those vaccines now. That went into effect January 1st. 

So Center for Medicare did a lot of the pre-work leading up to that between August and January, making sure they were talking about it to the beneficiaries, to individuals and patients. They were talking about it with the providers, and so that everybody should be ready to go on that. It’s already been implemented. The Medicaid program is on a different timeline, that will start to happen in October of 2023. 

So now is a really important time, I think, to be talking both with the Center for Medicaid on kind of what they’re going to be releasing in terms of guidance and information, but also starting to work with our friends and partners and states on kind of what this means for them and how they can start to get everything ready to have that come into effect next year. 

And so it’s actually not that far away we’re in. So we’re really excited about that. And so what AVAC’s doing as a coalition is just making sure that the information that comes out, that we’re sharing that and making sure that both patients and providers, that everybody’s aware of things as we know it so that they can help plan as well. 

Michael Ward: 

Okay. Yeah. And just for the folks that may be on Medicaid, I know you mentioned that, so state by state program, but it’s true that in a number of states that for some beneficiaries that they may already have no cost for all vaccines. Right? It just varies state by state. So it’s probably best for them to check in with their provider on any relevant cost. Is that fair to say? 

Abby Bownas: 

That’s right. It’s a great idea to check in. And you probably can have that conversation with your providers who probably know state by state. I think there were about 14 states that have vaccines with no co-payment whatsoever. I think there’s an additional, I want to say 24, so sorry if I don’t have my numbers exactly right, that also have kind of arrangements for coverage. 

And so there are different levels of what’s being offered right now, but I think what we’re most excited about is that no matter where you are, very soon you will have that same ability to access vaccines with $0 cost sharing. So free. 

Michael Ward: 


Abby Bownas: 

Free vaccines, which is what’s important. 

Michael Ward: 

Yes, absolutely. And I think that’s very important kind of this year especially, I mentioned at the beginning that we’ve been hearing a lot about the tripledemic of flu, RSV and COVID-19 over the last few months. So could you just share a little bit about what vaccines older adults in particular should be thinking about and considering in order to protect themselves during this cold and flu season? 

Abby Bownas: 

Yeah. We certainly have been hearing a lot. The rates have just been so high for all three of those things. Luckily we have vaccines for flu and COVID-19. Those are readily available and certainly are being recommended to older adults. RSV, just to note, they’re working on a vaccine, I think there’s multiple candidates, and so they’re really close. 

So that could be something that we will have a vaccine for in the near future. And I think that’s really what’s so amazing about adult vaccinations is I think we’re really at the cusp of seeing some new innovations coming in terms of what will be available in the future for us. But I think overall, to your point, there really are over a dozen adult vaccines that are out there. 

And this gets to one of those other barriers of people not necessarily knowing what vaccines are recommended. And so that’s something you can talk to your provider about, whether you’re in the doctor’s office or visiting a pharmacy setting or a public health setting, you can have those conversations about which vaccines are right for you. 

A lot of these vaccines will help prevent or spread, help prevent spreading of serious disease. And I think this is important, especially when we have this conversation about reaching older adults. Because as we do age, our immune systems can get weaker. And so it’s all the more important to be receiving recommended vaccines. 

So there are, I think we talked about flu and we certainly talked about COVID, there’s Pneumococcal, there’s a Shingles vaccine out there, there’s Tdap, which helps with whooping cough. For any of you that have grand babies, that’s really important not only to protect yourself, but the little ones around you. And Hepatitis B. Recently, I think it was last year, the CDC’S Advisory Committee for Immunization Practice actually made some updates to different recommendations. 

So Pneumococcal was one of the ones that they were looking at. Hepatitis B was another where they really were thinking about kind of broadening out which vaccines people should get. So again, I would recommend you talk to your provider about which vaccines are right for you, and make sure that of that list of all those vaccines that you’re up to date as recommended. 

Michael Ward: 

Yeah. And included in the updates that the CDC made last year was a preferential recommendation. So they say you should do this if it’s available, but if you’re an older adult that they recommend a high dose or an adjuvanted flu vaccine. So those types of vaccines are a little bit stronger. They help create a more robust immune system response, which is particularly important for older adults. 

So I will say that it’s not, those higher dose or adjuvanted vaccines aren’t always available. And so any shot is, any flu shot is better than going without. But certainly if those are available, that’s something that older adults may want to consider in conjunction with their physicians. So vaccines have been in the news a lot over the last three years. It’s kind of been omnipresent, certainly with the development and rollout of the COVID-19 vaccines. 

At the same time, we’ve unfortunately started to see growing vaccine hesitancy and an amount, growing amount of misinformation that’s out there. So I just wanted to kind of ask Abby, how can community leaders start to combat this trend, and what are some of the resources that you point the public to as far as receiving kind of accurate science-based information about vaccines? 

Abby Bownas: 

Yeah. It’s a great question. It’s an unfortunate reality. I think it’s really important that we’re talking about vaccines right now and talking about all vaccines, right? I think the COVID-19 having something that came out so quickly. And of course, that science had been evolving over the last decade, but it did spark some conversations and mis and disinformation, I would say. 

And so it’s really important that we rely on our trusted resources to be getting accurate information. And as we talked about, people sometimes do have skepticism, but they deserve to have their questions answered with by talking to experts and providers and getting that information. Because lots of times we can answer people’s questions and then they’ll go ahead and they will get vaccinated. 

I think overall what we saw during COVID was kind of a lot of different things happening at once. A lot of people didn’t go out and therefore they missed other recommended vaccines. So we also saw a drop in routinely recommended vaccine access. I think some of the studies that we’ve seen. 

Avalara Health is one that put some numbers out recently, said 37 million doses were missed in terms of routinely recommended vaccines over the course of the pandemic. So we have some work to do, not only on making sure that there’s confidence around which vaccines people should be getting, but also just helping people get caught up on things that they may have missed. And so kind of two different paths forward there to be doing this work. 

I would note that over the course of the pandemic, some really amazing outreach happened by organizations such as your own and others that really helped kind of guide people through the process of getting their COVID-19 vaccines. And in some ways, they broke down a lot of barriers and created really, a really nice platform for equitable access. 

So those are things AVAC’s looking at moving forward is how do we move beyond COVID-19 vaccine to try to replicate some of the positives of how we were able to talk to people and reach people for all the recommended vaccines moving forward. And really just have a conversation about prevention and vaccination overall with this being part of, one part of the full complement of recommended vaccines. 

Michael Ward: 

Yeah. Yeah. And certainly as listeners are maybe checking things out after the podcast, the Alliance’s resources on vaccines are available, So there’s a lot of great resources there. And we’ve also served as co-conveners of the COVID-19 Equity and Education Project. So you can just search for that. 

But it has a lot of great resources around that particular vaccine, especially for communities that may be underserved and thinking about, well, the implications that it may have for different communities. And so as we continue to think about the future, Abby, I know that the advocate’s work is never done. 

Abby Bownas: 


Michael Ward: 

So what do you see as the next gray area? What’s the emerging areas that you’re working on to improve access to vaccines? 

Abby Bownas: 

Yeah. Happy to share some of those out. I would add to your resource list, because I think I didn’t finish talking through all of the different resources. There’s some great government resources. CMS has a, Medicare has a great list of kind of their vaccine information for beneficiaries. The CDC, the Centers for Disease Control is, I mean, that is the go-to. 

Michael Ward: 


Abby Bownas: 

There’s also a lot of other patient and advocacy groups in addition that have really strong resources available, the National Foundation for Infectious Disease,, Vaccinate Your Family. If you want to get into the policy and advocacy side, come to our website, the But I think we’re very much on what we can be doing to boost immunization. 

So come be an advocate with us. But I think there’s just so many great information sources and I think it’s really important that we help push those out. In terms of the work, yes, you are correct, we have more to do. I feel like success is just one opportunity to look at everything else that we still want to be doing and get to work there. So AVAC has a big agenda for the year ahead. 

I think infrastructure’s right at the top. We talk about immunization infrastructure as basically it’s how are we supporting all the work that we want to be doing? And so supporting the Centers for Disease Control and those dollars that go directly to state and local to be able to offer vaccines, that’s really important to the AVAC table. 

And we want to make sure that we’re supporting that moving forward, especially as the additional funding from COVID maybe won’t be available as it has been. And so it’s really supporting base immunization programs. On the data side, we talked a little bit about that earlier, but how are we supporting immunization data to make sure that no matter where you go, if you go into your pharmacy, if you go visit one of your health specialists, are they talking to one another in terms of which vaccines? 

We want to get those systems as strong as possible so that it’s really easy for providers and public health to all be talking to one another and help you figure out which vaccines are right. I think we’re going to be working a lot on the rest of the population too. What if you don’t have insurance? How are we protecting you with vaccines and making sure you have access? So those are a couple of the areas that we’re focused on. 

I think providers, in supporting our providers is another core area. I mean, we’ve done a ton with this closing the gap for coverage on financial barriers on the beneficiary side, how do we make sure our providers also what, they have what need to stock and carry vaccines and be ready to give them to folks who are arriving ready to get them? 

And so that’s another area where I think our focus is for the year ahead. So we’ll be busy. And there’s lots of great things to be doing to improve the landscape. I think one of the benefits is at this point, we know what we want to do. And so now it’s just an opportunity to really get to work and try to figure out how to get things done working with Congress and this administration and partners all across the country to do this work. 

Michael Ward: 

Yeah. And I think I’ll just, I know AVAC’s done such great work and in this area, but there’s also been a number of flexibilities that have enabled more providers, as you mentioned, to provide vaccines during the pandemic. And some of those are tied to the public health, the announcement of the public health emergency. 

And so I know that the AVAC is working in that area to make sure that providers, no matter where they are, can continue to provide those types of vaccines moving forward. And so that’s an important issue, especially we’re thinking about older adults, thinking about nursing homes and in areas where folks may be living in closer contact with one another, that certainly vaccines important for everyone, but certainly in those settings, it’s of even greater importance, so. 

Abby Bownas: 

I can’t agree more. It feels like the long-term care network, the things that were accomplished during COVID is something that I think it’s one of those areas that we have eyes on. That’s one of the ones we want to replicate, how do we do that for other vaccines as well? Because the community and being able to reach people in long-term care facilities, that was really important part of the COVID-19 campaign for vaccines. 

And it feels like it’s a longstanding opportunity. I think when we look at kind of the PhD, the public health emergency and it coming to an end, there’s a number of different things that we want to look at and say like, “Okay. Well, maybe it won’t be continuing under the public health emergency, but how do we work to see that those things can continue?” 

Because they really did broaden access for immunization. And so that’s one of them. I think in addition there’s, again, who’s vaccinating, how to make sure that all of those partners stay involved in the immunization neighborhood is another. And then just making sure what was, I think just a very readily available vaccine with COVID-19. How do we make sure that continues as we transition from public health emergency into just this is where we are day to day. 

Michael Ward: 

Absolutely. And as we come to a close today, Abby, I’ll start the question that we ask every podcast guest, which is what has surprised you most about growing older, which is, I think is, it’s interesting. I think we get different answers based on where each person is in the spectrum of the aging journey that they’re on. And so I guess I’d just ask, how has aging to this point in life differed kind of from what you may have expected? 

Abby Bownas: 

I don’t age. 

Michael Ward: 


Abby Bownas: 

Timeless, of course. The gray hair maybe gives me away a little bit, but it’s such a great question. And it’s one I’ve been trying to think a little bit, because it’s so interesting. It’s like I do. I see those around me aging, but I don’t always see myself aging. 

So I think it’s all in the eye of the beholder. But certainly one thing is I’ve learned working with AVAC is that vaccination is key to healthy aging and the things that we do do in our forties, and they can actually contribute to being healthier as we go into our fifties and sixties and seventies and beyond. 

And so it’s really a great opportunity for all of us to be thinking about what those recommendations are for keeping ourselves healthy with, I guess, preventative health overall now so that we can really be living our best lives as we do continue down that aging spectrum. 

Michael Ward: 

I think… 

Abby Bownas: 

I want to hear what other people have responded though. What a great question. I need to start listening to the podcast more regularly. 

Michael Ward: 

Yeah, absolutely. I think we may even have a link to a video of a compilation of what people have said over the last year in the podcast that we might be able to link to on the podcast description. But no, it is interesting. It ends up being very insightful, so. Well, Abby, thank you so much for joining us for today’s podcast. 

And for our listeners who haven’t done so yet this season, please, please do consider getting your flu shot, which I’ll say this year is important, not only because rates have been high, but just from our perspective of this year’s vaccine has been a really good match for the dominant strain of flu that’s been circulating. 

And so it’s a really important investment in your health. So you can find out convenient locations to get your flu shot, certainly by talking to your provider. You can also find locations for flu shots and COVID-19 vaccines or boosters by visiting And also, many of your primary care physicians and retail pharmacies offer appointments. 

Abby Bownas: 

And no cost for that vaccine, right Michael? 

Michael Ward: 

Yes, exactly. Which we’re so excited that, like I said, it’s coming. It’s here for Medicare for all recommended vaccines now. So it’s so important to check into that and make sure that you’re up-to-date with all the vaccines that are appropriate for where you’re at for each individual. So Abby, thank you again for joining us. 

To learn more about the Adult Vaccine Access Coalition and their impactful work, you can visit their website at And if you’re enjoying the show, please subscribe wherever you get your podcast. And you can also follow the Alliance for Aging Research on all major social media platforms. So thank you and we look forward to seeing you next time on This is Growing Old. 

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