Vaccine Barriers for Older Adults
News reports have been full of stories about the uptick in cases of respiratory disease this season with its triple threat of influenza, COVID and RSV (respiratory syncytial virus). With last year’s FDA approval of the first ever RSV vaccine for adults, we were hopeful that older Americans would take advantage of this ability to finally protect against all three threats. Unfortunately, vaccination rates for RSV are abysmal, reaching only about 22 percent of older adults. That number is surprisingly low given the disease results in as many at 160,000 hospitalizations of older Americans annually and the fact that this population is typically known for embracing the protections of vaccines.
So why the disconnect? For starters, guidance from the Centers for Disease Control and Prevention (CDC) on who should receive the vaccine and when to get it, has not been clear. This has led to a lot of confusion among both patients and providers. Our organization, along with several others who have joined with us to advocate for the health and wellbeing of older adults, have one primary goal in mind: for older adults to have full access to the most up to date and effective vaccines approved for their use. Specifically, we have raised concern with CDC’s decision made in June 2023 to recommend a practice called shared clinical decision making for the RSV vaccine for older adults. While we certainly support a dialogue between a patient and their provider on what vaccines are appropriate, what we are seeing instead is that unless a vaccine is recommended as a routine vaccination (as they often are for children), patients don’t ask about it and many providers do not bring it up. As a result, many older adults who could be protected by the RSV vaccine are not being informed about it.
To address this, CDC must issue clear, concise recommendations as new vaccines are approved and with the upcoming February meeting of the Advisory Committee on Immunization Practices (ACIP), we hope they will use this opportunity to evaluate whether the shared clinical decision-making designation is serving as a barrier for some vaccines and should be reversed.
The second concern is that we recently learned of yet another hurdle in the road to raising immunization rates when, in December, the Centers for Medicare and Medicaid Services (CMS) had to issue a letter to health insurance providers—both public and private, as well as pharmacy benefit managers (PBMs) addressing the agency’s concerns around potential roadblocks to patient access to approved vaccines. The letter stated that there are concerns that insurance industry practices like prior authorization ‘threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.”
The letter highlighted potential access concerns regarding vaccines and treatments that can prevent and treat respiratory illnesses like COVID, flu and RSV. It went on to call out the insurance industry for bad practices that can negatively impact both pharmacies and thus patients’ ability to get the vaccine they want and need at the pharmacy of their choice. This is beyond worrisome on two levels. As we saw during COVID, and in the day-to-day lives of the individuals we serve, pharmacists play an increasingly critical role in the healthcare of patients of all ages, especially older adults. Pharmacies are often more accessible than the primary care office and many pharmacists see their customers far more often than other clinicians, allowing older adults more opportunity and more “face time” to develop a comfort level and ask questions. Access barriers at pharmacies interrupt this very important relationship, hampering choice and thus reducing the number of patients of all ages receiving needed services.
Already, pharmacies are raising the flag about unnecessary hurdles being placed upon them and some can no longer offer vaccines to their customers as they are actually losing money on administering them. This will inevitably result in even lower uptake of vaccines by the vulnerable Americans we should be most concerned about protecting during the next respiratory disease season. While we are grateful to be living in a time when there are more and better protective tools than ever before to preserve the health and well-being of all generations, we simply cannot continue to put hurdles in front of those protections.
CMS is right in taking the position that they have set forth and we support them for its action on behalf of all patients. We urge our healthcare leaders to continue to work to make access to vaccinations easier, not more of a challenge and we urge CMS to continue to monitor these issues and be vigilant in taking action with the insurance industry if warranted. Likewise, CDC must establish clear and implementable guidance for all vaccines that do not place unnecessary barriers to access.
Too many lives will be at risk if we don’t get this right.
Bob Blancato is the executive director of the National Association of Nutrition and Aging Services Programs (NANASP).
