A Blueprint for Improving the Promotion and Delivery of Adult Vaccination in the United States

by Katherine M. Harris, Lori Uscher-Pines, Soeren Mattke, Arthur L. Kellermann

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Research Questions

  1. Where do most U.S. adults receive vaccination?
  2. What are the main barriers to adult vaccination?
  3. How can adult vaccination rates be increased?

Vaccine-preventable disease continues to take a heavy toll on adults despite the widespread availability of effective vaccines. This report identifies where efforts to improve the delivery of adult vaccination have stalled and recommends targeted strategies that are supported by available evidence and build on existing infrastructure. The authors conducted a comprehensive review of the published literature on adult immunization, a stakeholder workshop, and follow-up interviews with meeting participants and additional experts. They also partnered with an organization represented at the workshop to conduct a telephone survey of adults to learn about the relationship between influenza vaccination and beliefs about the safety of influenza vaccine.

Findings include that office-based providers remain the primary source of vaccination, though a substantial proportion of physicians who treat adults appear not to vaccinate at all and adult vaccination is infrequently discussed at health care encounters. Adult practices also lack a strong business case to offer vaccination, as it entails substantial fixed costs. In addition, achieving substantial increases in adult vaccination will require persuading large numbers of individuals disinclined to be vaccinated.

Vaccination stakeholders need to engage in a collaborative fashion to promote adult vaccination and the integration of advice about vaccination into routine office-based practice. Recommendations include strengthening evidence surrounding practice gaps and the economic value of promoting vaccination in office-based settings, improving guidance to providers about vaccinating adults, and formalizing procedures for referring patients to complementary vaccinators.

Key Findings

  • Office-based providers remain the primary source of vaccination
  • However, many physicians who treat adults do not vaccinate and seldom discuss adult vaccination
  • Adult medical practices also lack a strong business case to offer vaccination
  • Increasing adult vaccination rates will require persuading large numbers of adults who are disinclined to be vaccinated

Table of Contents

  • Chapter One


  • Chapter Two


  • Chapter Three


  • Chapter Four

    Conclusions and Policy Implications

This work was sponsored by GlaxoSmithKline. The research was conducted in RAND Health, a unit of the RAND Corporation.

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