THE NATIONAL VACCINE PROGRAM OFFICE Adult Immunization Challenges

THE NATIONAL VACCINE PROGRAM OFFICE Adult Immunization: Challenges & Opportunities Women in Government Learning Exchange on Adult Vaccine Policies & Planning August 1, 2017 Angela Shen, Sc. D, MPH CAPT, U. S. Public Health Service National Vaccine Program Office of the Assistant Secretary for Health THE NATIONAL VACCINE PROGRAM OFFICE

SUMMARY KEY POINTS • Adult immunization is important for disease prevention • Women are the chief medical officer of the home and therefore have a big impact on their family’s immunization decisions • WIG can extend that role into the legislative and advocacy arena for adult immunization in their state THE NATIONAL VACCINE PROGRAM OFFICE

The Importance of Adult Vaccination – There are 13 recommended vaccines for adults based on age, medical conditions, or other indications – Yet, adult immunization coverage rates remain low for most routinely recommended vaccines and are well below Healthy People 2020 targets THE NATIONAL VACCINE PROGRAM OFFICE

Adult Vaccination Coverage for Selected Vaccines and Age Groups, BRFSS 2010– 2016 Influenza Seasons and NHIS 2010– 2015 100 90 80 70 Tetanus 19+ 60 Pneumococcal HR 19 -64 Pneumococcal 65+ 50 Tdap 19 -64 40 Hepatitis B Zoster 60+ 30 Influenza 65+ 20 10 0 2011 2012 2013 2014 2015 THE NATIONAL VACCINE PROGRAM OFFICE

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Adult Influenza Vaccination Coverage, By Age, United States, NHIS 2012 -2014 2013 -14 Influenza, ≥ 19 yrs 2012 -13 2011 -12 2013 -14 Influenza, ≥ 19 yrs, HCP 2012 -13 2011 -12 0 10 20 30 40 50 60 70 80 90 100 % Vaccinated HP 2020 Targets: 70% ≥ 19 years, 90% HCP ≥ 19 years THE NATIONAL VACCINE PROGRAM OFFICE Source: 2011, 2012, 2013 and 2014 NHIS, CDC

The National Adult Immunization Plan • • Recognizing the importance of adult immunization and the lack of sufficient progress in increasing rates, NVPO worked with partners to develop the first ever National Adult Immunization Plan (NAIP) The NAIP outlines four goals for advancing U. S. adult immunization efforts: Goal 1: Strengthen the adult immunization infrastructure Goal 2: Improve access to adult vaccines Goal 3: Increase community demand for adult immunizations Goal 4: Foster innovation in adult vaccine development and vaccination-related technologies THE NATIONAL VACCINE PROGRAM OFFICE Read the Report: www. hhs. gov/nvpo/national-adult-immunization-plan

Opportunities for State Policy Makers THE NATIONAL VACCINE PROGRAM OFFICE

Opportunities for State Policy Makers • In 2017, NVPO released the NAIP Path to Implementation • The report identifies implementation priorities and potential activities for advancing NAIP goals • States can use this menu of activities to help identify areas for action THE NATIONAL VACCINE PROGRAM OFFICE Read the Report: www. hhs. gov/nvpo/national-adult-immunization-plan

Opportunities for State Policy Makers Strengthen the Adult Immunization Infrastructure Barriers: • Lack of coordination of adult immunization activities Percentage of Adults Aged 19+ Participating in an Immunization System – United States, Five Cities, and D. C. , 2015 • Lack of utilization of reminder or assessment systems THE NATIONAL VACCINE PROGRAM OFFICE

Opportunities for State Policy Makers Strengthen the Adult Immunization Infrastructure Opportunities: • Address technical, legal, administrative, and practical barriers to greater use of electronic health records (EHRs) and immunization information systems (IIS) to collect and track adult immunization data • Explore technical and policy options to implement interjurisdictional exchange of immunization data THE NATIONAL VACCINE PROGRAM OFFICE

Opportunities for State Policy Makers Improve Access to Adult Vaccines Barriers: • Financial impediments to vaccinations • Lack of access to, and utilization of, health care services by adults Opportunities: • Identify legal, practical, and policy barriers that may impede expansion of the adult immunization provider network, and communicate those challenges e. g. pharmacists authority to vaccinate Source: Williams WW et al. MMWR 2016; 65(1): 1– 36 THE NATIONAL VACCINE PROGRAM OFFICE Vaccination coverage for influenza, Tdap, zoster, and HPV is 2– 5 x higher with health insurance

Opportunities for State Policy Makers Increase Community Demand for Adult Immunizations Barriers: • Lack of public knowledge • Lack of provider recommendations for immunization • • ASSESS RECOMMEND ADMINISTER/REFER DOCUMENT THE NATIONAL VACCINE PROGRAM OFFICE

Adult Knowledge and Interest in Vaccination Which of the following best describes you… Tdap (19+) Pneumo (65+) Zoster (60+) I am not aware that I need this vaccine 52% 22% 18% I am aware that I need this vaccine, but haven’t thought about getting it 6% 3% 6% I am considering getting this vaccine, but have not yet decided 5% 3% 9% I have decided to get this vaccine, but have not yet gotten vaccinated 3% 4% 8% I have decided not to get this vaccine 13% 19% I have gotten this vaccine 22% 56% 39% THE NATIONAL VACCINE PROGRAM OFFICE Source: Porter Novelli 2015. Consumerstyles (Fall) Unpublished

Vaccination Uptake by Provider Recommendation and Offer 100% Percent Vaccinated 90% 80% 70% Influenza vaccination coverage before and during pregnancy among women pregnant any time during October 1, 2016 – January 31, 2017 and who visited a health care provider at least once since July 2016, by provider recommendation or offer 71% 60% 44% 50% 40% 30% 15% 20% 10% 0% 1 Source: CDC Internet Panel Survey 2017, preliminary 2 THE NATIONAL VACCINE PROGRAM OFFICE 3

Opportunities for State Policy Makers Increase Community Demand for Adult Immunizations Opportunities: • Encourage all providers, including providers in complementary settings, to implement the NVAC Standards for Adult Immunization Practice • • ASSESS RECOMMEND ADMINISTER/REFER DOCUMENT • Engage community leaders in reaching the public with information about the importance of adult vaccination THE NATIONAL VACCINE PROGRAM OFFICE

Additional Resources See Handout THE NATIONAL VACCINE PROGRAM OFFICE

NATIONAL IMMUNIZATION AWARENESS MONTH (NIAM) • Annual observance held in August to highlight the importance of vaccination for people of all ages • Weeks for NIAM 2017: • • • July 31 -August 6: Babies and Young Children • A healthy start begins with on-time vaccinations. August 7 -13: Pregnant Women • Protect yourself and pass protection to your baby. August 14 -20: Adults • Vaccines are not just for kids. August 21 -27: Preteens/Teens • Ensure a healthy future with vaccines. Resources available: www. nphic. org/NIAM THE NATIONAL VACCINE PROGRAM OFFICE

Acknowledgements • • • Carolyn B. Bridges, CDC David Kim, CDC Megan Lindley, CDC Amy Parker-Fiebelkorn, CDC La Dora Woods, CDC Jeff Kelman, CMS Mary. Beth Hance, CMS LJ Tan, Immunization Action Coalition National Adult and Influenza Immunization Summit THE NATIONAL VACCINE PROGRAM OFFICE

EXTRA SLIDES THE NATIONAL VACCINE PROGRAM OFFICE

National Adult And Influenza Immunization Summit • Our charge: Determine what we can do as the NAIIS and as individual organizations to improve adult and influenza vaccination rates: – Identifying data gaps and filling them – Identifying barriers and addressing them • Working Groups www. izsummitpartners. org – Provider and Access – Influenza – Quality Measures • Maternal, Adult composite, ESRD THE NATIONAL VACCINE PROGRAM OFFICE

Opportunities for State Policy Makers Improve Access to Adult Vaccines Vaccine Financing in the United States – Medicare • Federal health insurance for those age 65 years and older, disability, permanent kidney failure • Part B Coverage (named by statute) – influenza, pneumococcal, hepatitis B (for high risk), tetanus for wound care • Part D Coverage (pharmacy platform) – All other vaccines (e. g. Zoster) – Tranx. Rx (interface between pharmacy and medical benefit claims) – Potential cost-share for Part D products (widely varies based on benefit plan) – Medicaid • Adults with coverage through Medicaid expansion have coverage of all ACIP-recommended vaccines, without cost-sharing • States can choose whether to provide coverage of vaccines to adults covered through traditional Medicaid (pre-expansion). All states cover at least one vaccine. NATIONAL VACCINE OFFICE • States reimburse. THEproviders for. PROGRAM administration fee and vaccines, at rates set by the state.

Standards for Adult Immunization Practice • Developed in 1990 to improve vaccine delivery to adults, most recently updated in 2014 by National Vaccine Advisory Committee • All HCPs, including those who do not provide vaccine services, have role in ensuring patients up-to-date on vaccines • Based on key impact of provider recommendation for patient vaccination • Call to action for HCPs for adults to: • ASSESS vaccination status of all patients at every clinical encounter • Strongly RECOMMEND vaccines that patients need • ADMINISTER needed vaccines or REFER to a vaccine service provider • DOCUMENT vaccines received by patients in state vaccine registries Source: Public Health Reports 2014; 129: 115– 123 THE NATIONAL VACCINE PROGRAM OFFICE

Overview • Why adults? Why now? – The Importance of Adult Vaccination in Preventing Diseases – Where we are today • Adult Immunization: A National Health Priority – Addressing barriers – Working on Solutions • Opportunities for State Policy Makers – What you can do to help THE NATIONAL VACCINE PROGRAM OFFICE

The Importance of Adult Vaccination As the U. S. population ages, the impact of vaccine-preventable diseases and their complications among adults is likely to grow • Adult vaccination reduces morbidity and mortality. – – – • 40, 000 cases and 4, 000 deaths attributable to invasive Pneumococcal Disease 3, 000 -49, 000 deaths due to Seasonal Influenza 9, 000 cases of Pertussis (Whooping cough) 3, 000 reported cases of acute Hepatitis B 1, 000 cases of Herpes Zoster (Shingles) Adult vaccination reduces health care costs – Up to $87 billion estimated in annual health and productivity costs of flu alone • Adult vaccination protects families and entire communities – Unvaccinated adults may unknowingly spread vaccine-preventable diseases to people who cannot be vaccinated like small children or people with weakened immune systems like cancer patients, organ transplant recipients, etc. THE NATIONAL VACCINE PROGRAM OFFICE

NVPO and the National Vaccine Plan • • On behalf of the Assistant Secretary for Health, the National Vaccine Program Office (NVPO) coordinates national immunization activities NVPO oversees the National Vaccine Plan (NVP)—the nation’s leading roadmap for a 21 st century vaccine and immunization enterprise—which has five overarching goals: Goal 1: Develop new and improved vaccines Goal 2: Enhance the vaccine safety system Goal 3: Support communications to enhance informed vaccine decision-making Goal 4: Ensure a stable supply of, access to, and better use of recommended vaccines in the United States Goal 5: Increase global prevention of death and disease through safe and effective vaccination THE NATIONAL VACCINE PROGRAM OFFICE Read the Report: www. hhs. gov/nvpo/national-vaccine-plan

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Adult Immunization Coverage, Selected Vaccines By Age And High-risk Status, United States 2014 2013 2012 Pneumococcal, HR 19 -64 yrs 2014 2013 Pneumococcal, ≥ 65 yrs 2012 2014 2013 2012 Zoster, ≥ 60 yrs 0 10 20 30 40 50 60 70 % Vaccinated HP 2020 Targets: 90% PPV ≥ 65 years, 60% PPV HR 19 -64 years, OFFICE 30% zoster ≥ 60 years THE NATIONAL VACCINE PROGRAM Source: 2012, 2013 and 2014 NHIS, CDC 80 90 100

More Information • Join the National Adult Immunization and Influenza Summit http: //www. izsummitpartners. org/ • Attend our upcoming NVAC meeting In-person or via live webcast http: //www. hhs. gov/nvpo/nvac/meetings/upcomingmeetings/inde x. html • Visit our NVPO webpage and download the National Vaccine Plan or the National Adult Immunization Plan: http: //www. hhs. gov/nvpo/index. html THE NATIONAL VACCINE PROGRAM OFFICE