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Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Adult vaccination should be promoted as a way to improve health, rather than just avoid disease, according to a new report
A new study suggests that offering vaccines as an element of a healthy lifestyle like diet and exercise may be more successful in improving adult vaccination rates than promoting them as medical interventions.
The study, published in Annals of Medicine, focuses on the idea that increasing lifespans also requires increasing “healthspans,” or the number of years in life spent in good health. Vaccination plays an important role in achieving longer healthspans, especially as immune responses decrease with age thereby increasing disease risks, the study notes.
Mark Doherty, PhD, senior medical manager for Vaccine Science and Adjuvants at GSK Biologicals and co-author of the study, said there is a two-fold message that clinicians should take from this report.
“First, vaccination for older patients is standard of care, and offers substantial benefits in terms of improved quality of life and reduced burden of disease. But in too many cases we, as a field, are failing to deliver on that,” Doherty said. “Secondly, part of the problem seems to be communication. It’s not enough to say to a patient, ‘You should get the vaccine against influenza’ without explaining what that actually means in terms that are relevant to the patient.”
More than 50,000 deaths are attributed to vaccine-preventable diseases in adults each year, at a cost of $9 billion in direct medical costs and lost productivity, according to the report. About 79 percent of these costs were incurred by unvaccinated individuals, the study noted, and even these figures are believed to be underestimated.
In addition to the acute disease processes caused by vaccine-preventable diseases, the study highlighted the toll these diseases take on overall healthspans. According to the study, diseases like influenza and varicella-related diseases are associated with higher risks of cardiac and cerebrovascular diseases.
Vaccination, however, can lessen these impacts, with one study referenced in the report citing a 20 percent decline in strokes and heart attacks in older adults who were vaccinated against flu compared to those who were not. Other research indicates that influenza pneumococcal vaccination reduced intensive care and cardiac unit hospital admissions by 41 percent and 55 percent, respectively, and reduced overall mortality by 35 percent.
“Instead of considering vaccination only in the context of preventing hospitalization and death, we should be looking at the benefit of vaccination to improve overall health and quality of life,” the report states. “However, achieving better vaccination coverage is almost certainly going to require changing the public perception of vaccination from a medical intervention-which we tend to think of as a response to illness-to a health-promoting activity-a preventive role. Ideally, vaccination needs to be seen by the public as something that lies within the scope of individuals to take charge of, for the benefit of their own health.”
Vaccination rates among adults are traditionally low across all of the recommended adult immunizations, such as 45 percent for the annual influenza vaccine-well below the 70 percent goal set by Healthy People 2020. Adult vaccination has not been a public health priority the way pediatric vaccination has, according to the report, and as a result there is not adequate infrastructure and education developed to promote vaccination in adults.
Cost and access to care is often cited as a barrier to adult vaccination, according to the study, yet even in areas where access to healthcare and vaccination are free, coverage remains poor.
“This implies that not all barriers to vaccination are economic or medical, but instead may be psychological and/or educational,” the report noted.
Clinicians may need to work a little harder in terms of the way they are delivering the message on adult vaccination, Doherty said.
“In the past, the emphasis with vaccination has been on preventing acute disease, and that has meant the focus has been on medical intervention. The problem with that approach is that we tend to think as medical intervention as something you do when you are sick. So the one of the common reasons for adults to not get vaccinated is that they say, ‘but I am healthy now, I don’t need an intervention,’” Doherty said. “But vaccination is a long-term preventive measure, like preventing cancer by not smoking.”
For years, healthcare advocates tried to use scare tactics to prevent smoking, like showing pictures of cancer in older adults, he said. This didn’t work well, Doherty explained, because it required an action today to prevent something that might happen in the future.
“It wasn’t until people understood that smoking was making them unhealthy right now that we started to get traction in reducing smoking,” Doherty said. “It’s the same with vaccination. The consequences and benefits need to be made concrete to people before they will change their behavior.”