This article for developing awareness surrounding racial and ethnic disparities in care was funded by GSK.
Drs Folasade May and Jose Camargo are contracted by GSK and are compensated for the development of this article.

Many adult patients, especially those who may face barriers to accessing adequate and consistent healthcare, do not receive all recommended vaccinations. In this roundtable discussion, two experts share strategies to encourage our communities and hospital systems to focus on these critical preventive health measures and support patients’ efforts to protect and improve their health.

To generate urgency in vaccine uptake, I believe it is useful to begin with a discussion of what consequences individuals, communities, and society at large can face without adequate vaccination. At the individual level, people not only face the prospect of painful and serious illnesses—or potentially death—from viral and bacterial infections, but also the increased risk for significant consequences later in life. For example, human papillomavirus (HPV) can cause cancer, while pneumococcal pneumonia leads to 1 million hospitalizations a year and is the eighth leading cause of death in the United States. An ounce of prevention is worth a pound of cure; patients can end up needing much more healthcare to treat these downstream complications than they would have needed to prevent them, and eventually this can put an enormous strain on the individual as well as the healthcare system.

We are unfortunately beginning to see outbreaks of vaccine-preventable diseases that were once considered eliminated in the United States, such as measles and polio. I believe it is likely such outbreaks will affect those communities most that already lack consistent and stable access to high-quality healthcare, which tend to be poorer communities and communities of color. This leads us to the community effects of under-vaccination. When people are sick, families may have to take time off work and even reorganize their lives, depending on the level of illness or disability. While wealthier people may be able to accommodate such a change more easily, the consequences of illness can be severe for those who are already struggling to make ends meet. Conversely, when people are vaccinated, the positive effects radiate out to the community. Herd immunity is achieved when enough people in a group or place have immunity—acquired either through exposure or vaccination—that the disease cannot easily spread among them.

I believe one barrier to increased vaccine uptake is the tendency of healthcare to be siloed off from other parts of a patient’s life. This can have a particularly strong impact on patients who do not have the time or resources to devote to more appointments. To help patients prioritize vaccination, we can continue to weave preventive medicine into major life events or transitions, such as going off to college, joining the military, or even starting a new job. For example, many colleges and universities require—or at least highly recommend—incoming students to be current on their meningococcal vaccination, which has led to higher rates of vaccination in college students compared with their peers who are not in college. Hypothetically, expanding this strategy to more colleges, as well as including other vaccine regimens such as HPV, could not only improve health outcomes for students but also save these institutions significant financial strain and healthcare utilization. With the advent of the SARS-CoV-2 vaccine, many employers began requiring their employees to be vaccinated, recognizing the salutary group-level health effects of individual vaccination choices. Businesses could give employees dedicated time off for vaccination, ensure their health plans provide free preventive health, offer vaccination through institutional occupational health services, and require certain vaccinations for onsite workers. We must be careful with vaccine mandates though, as they may also be counter-productive and highly contentious. As an infectious disease specialist, I try to focus my conversations on addressing my patients’ concerns and explaining how vaccines can help them meet their health goals and continue doing the things that matter to them. I find the greatest success with patients when there is a collaborative decision-making process in their preventive health goals. That is, it is more about educating and giving people the opportunity to actually make a conscious decision regarding their own health. I believe pursuing this same outreach strategy at the population level can also instill a sense of urgency in patients and institutions alike.

The science supporting the importance of adult vaccinations is well established, yet many people struggle to—or choose not to—stay current with all recommended vaccinations. Healthcare providers, tasked with caring for high patient caseloads, also may not prioritize vaccination during short patient visits. Furthermore, healthcare systems often do not have systematic vaccination policies or procedures in place to ensure patients are notified of and receive all recommended vaccinations. Clearly, we have not created sufficient urgency for vaccination among patients, providers, and healthcare systems. What can we be doing differently?

At the patient level, it is interesting to consider the example of herpes zoster, an infection that most elderly people are unvaccinated for despite its universal recommendation for patients over 50 and the potentially severe consequences of infection. A 2017 study found that people are seven times more likely to receive the herpes zoster vaccine in the month following a spouse’s infection with herpes zoster than they were in the six months preceding infection. People were even more likely to get the vaccine when their spouse’s infection was severe. To me, these data suggest that a patient’s personal experience is critical to their health choices and whether they view a vaccine as an urgent matter.

While we as providers certainly do not want people to only get vaccines when a loved one is ill, there are strategies we and our associated institutions can employ to engage with patients in a personal, respectful way to encourage vaccination. First, we can appreciate the role a physician’s recommendation does play in patient decision-making. In my clinical experience, patients take provider advice seriously, especially when it is grounded in a relationship built on collaboration and trust. We therefore need to ensure we are not missing opportunities to recommend the appropriate vaccine at the right time. The case of the HPV vaccine provides a useful illustration of this. HPV vaccination, which can prevent some forms of cancer, is mostly prescribed to young and relatively healthy people who tend to not make frequent doctor’s office visits. This means there are fewer opportunities to recommend and administer a vaccine, and studies show we still miss many such chances. The good news is that patients who receive high-quality education and recommendation from their provider are nine times more likely to receive at least one dose of the HPV vaccine than patients who receive no recommendation.

Clearly, we can improve patient urgency in vaccination, but such recommendations and vaccine administrations must be built into the existing patient routines. When patients view preventive care as optional, they may not prioritize it above their other demands. COVID-19 drive-through testing and vaccination clinics were one example of how to bring preventive health to where patients are already going. Other examples are getting a vaccine while you pick up a prescription or even having pop-up vaccination sites at local bars, as happened during the recent Mpox outbreak. Finally, one place we know patients are with some frequency is their phones. Researchers are conducting studies to understand the best ways to use text-based and other digital communications to reach patients and remind them of vaccine appointments or even alert them to vaccines for which they are eligible. By both integrating vaccines into patients’ daily lives and educating them around the importance and urgency of receiving vaccines, we can increase uptake and improve our patients’ overall health.