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A Pathway to Leadership for Adult Immunization

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A Pathway to Leadership for Adult Immunization NVAC: Recommendations for Adult Immunization A Pathway to Leadership for Adult Immunization: Recommendations of the National Vaccine Advisory Committee Approved by the National Vaccine Advisory Committee on June 14, 2011 EXECUTIVE SUMMARY and efficiently deliver vaccines during public health emergencies such as pandemics, utilizing all available In June 2009, the Assistant Secretary for Health (ASH), vaccination venues in concert. Dr. Howard Koh, asked the National Vaccine Advisory Through the review and development of recommen- Committee (NVAC) “to develop recommendations for dations, nine categories of barriers to adult immuniza- establishing a comprehensive, sustainable, national tion were identified and examined in detail: adult immunization program that will lead to vaccine- preventable disease reduction by improving adult • Lack of coordination of adult immunization immunization coverage levels.” The NVAC serves in activities an advisory capacity to the ASH, in his role as Direc- • Lack of public knowledge tor of the National Vaccine Program. During a nearly two-year period, the NVAC reviewed prior recommen- • Lack of provider recommendations for dations and reports on adult immunization from the immunization last two decades and examined the current landscape • Financial impediments to vaccinations of research devoted to barriers to vaccinating adults. • Lack of access to, and utilization of, health-care Based on this analysis, the NVAC developed a white services by adults paper and recommendations that aimed to address • Lack of utilization of reminder or assessment unresolved issues in a novel way to protect adults in systems the United States from vaccine-preventable diseases through increased vaccination. The report and recom- • Racial/ethnic disparities mendations were presented to the NVAC by the Adult • Health literacy Immunization Working Group (AIWG) and approved • Concern about adverse events on June 14, 2011. The report and recommendations have been transmitted to the ASH as an official report To address these barriers, the NVAC developed of the NVAC. three recommendations, which are summarized in this The NVAC identified a need for national leadership article. These recommendations address the need for and coordination of adult immunization activities. national leadership for an adult immunization pro- Strong leadership and coordination for adult vaccina- gram, the identification of resources for this program, tion are critical, as health-care utilization by adults, and the development of a strategic plan for the adult when sought, is often spread across a variety of specialist immunization program. Additionally, more specific and generalist physicians and nonphysician providers. gaps in adult immunization were addressed through This model contrasts with the childhood vaccination the development of recommended focused activities. model, where vaccinations are often provided within These activities are categorized as addressing (1) gen- a medical home by a limited range of physician pro- eral infrastructure considerations, (2) the expansion viders. Additionally, developing a cohesive system for of access to vaccination, (3) provider- or system-based delivering routine vaccinations to adults can have a interventions, (4) the increasing community demand longer-term impact by providing a framework to rapidly for vaccinations, and (5) research needs. Public Health Reports / 2012 Supplement 1 / Volume 127 1 2 NVAC: Recommendations for Adult Immunization SUMMARY OF RECOMMENDATIONS Recommendation #3: strategic plan for adult immunization The full text of the recommendations, with identified The Interagency Working Group created in Recom- essential governmental and nongovernmental entities mendation #1 should lead the development of a and proposed timelines for implementation, can be comprehensive National Strategic Plan for Adult found starting on page 25. Immunization (hereafter, National Strategic Plan) that incorporates input from a broad range of stakeholders Recommendation #1: national leadership (e.g., the public; health-care providers and organiza- for an adult immunization program tions; federal, state, and local government; insurers, The Department of Health and Human Services (HHS) payers, and employers; and vaccine manufacturers), should develop and adequately support a coordinated obtained through a collaborative effort of the NVPO and comprehensive National Adult Immunization and NVAC. To facilitate continuous refinement and Program, administratively led by the Secretary of HHS, action on the National Strategic Plan, ongoing input operationally led by the Centers for Disease Control from nonfederal stakeholders (including traditional and Prevention (CDC), and closely linked to other and nontraditional immunizing health-care providers governmental and nongovernmental organizations and their representative professional organizations, involved in adult immunization. health-care payers, employers, public advocacy groups, The Secretary of HHS should designate and and vaccine manufacturers) should be regularly pro- empower the ASH as the central point person to coor- vided to the Interagency Working Group through dinate adult immunization activities through HHS. This routine public and stakeholder engagement sessions coordination should occur through either the appoint- facilitated by the NVAC. ment of an Interagency Adult Immunization Working At a minimum, the National Strategic Plan should Group or through creation of an Adult Immunization be designed to meet adult immunization goals speci- Working Group of the existing Interagency Vaccine fied in Healthy People 2020 and the National Vaccine Group (hereafter, the Interagency Working Group). Plan, and efforts of the National Adult Immunization The Interagency Working Group would provide Program to meet these goals should be included in an annual report to the NVAC on progress toward routine NVAC progress reports related to Healthy meeting these recommendations and improving adult People 2020 and the National Vaccine Plan. immunization uptake. The Interagency Working Group created in Recom- mendation #1 will be charged with routine evaluation Recommendation #2: resources for an of the contents of and progress toward the goals of the adult immunization program and National Strategic Plan, with these evaluations serving action plan implementation as the basis of the Interagency Working Group annual Appropriate resources (financial and infrastructure) report to the NVAC. should be allocated by the leadership of the National Adult Immunization Program in consultation with the Summary of recommended activities Interagency Working Group to carry out the strategic for a comprehensive National Adult action plan outlined in Recommendation #3. At a Immunization Program minimum, these resources will include staffing for a The full text of the recommended activities, along with National Adult Immunization Program office at CDC, at identified essential governmental and nongovernmen- levels sufficient to implement the components outlined tal entities and proposed timelines for implementation, after Recommendation #3. can be found starting on page 27. Funding levels could be partially measured through CDC assessments of immunization grantees regarding 1. General infrastructure considerations their projected plans for implementing a widespread a. Alignment of adult immunization goals across adult immunization program within their jurisdiction, agencies with overall coordination through the Interagency b. Adult immunization activities in federal grant Working Group described in Recommendation #1. guidance CDC and the National Vaccine Program Office c. Infrastructure development and coordination (NVPO) should work to utilize this information, in d. Quality measures for adult vaccination conjunction with internal expert analyses, to estimate 2. Expanding access to vaccination the costs of implementing the focused activities recom- a. Ensuring a consistent and adequate supply of mended in this report. adult vaccines for the U.S. Public Health Reports / 2012 Supplement 1 / Volume 127 Summary 3 b. Increasing application of Section 317 funds l. Researching state-level policies and practices used for adult immunization m. Researching the development of new and c. Developing and fostering innovative adult improved vaccines and vaccine delivery systems immunization partner organization networks d. Standardizing Medicaid vaccine administration NATIONAL VACCINE ADVISORY COMMITTEE reimbursement rates and mechanisms 3. Provider- or systems-based interventions Chair a. Education of providers on quality improve- Guthrie S. Birkhead, MD, MPH, New York State Depart- ment/quality assurance activities ment of Health, Albany, NY b. Education of providers on standards of care and immunization practice Executive Secretary c. Expansion of the adult immunization provider Bruce G. Gellin, MD, MPH, National Vaccine Program network Office, U.S. Department of Health and Human Ser- d. Improving and expanding immunization vices, Washington, DC information systems for adult vaccinations e. Education of vaccine providers and partners on Public Members health-care reform and immunization business practices Tawny Buck, Wasilla, AK 4. Increasing community demand for vaccinations Richard D. Clover, MD, University of Louisville, School a. Development and implementation of an ongo- of Public Health and Information Sciences, Louisville, ing, comprehensive education and outreach KY campaign on adult vaccines,
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