We Can Address Vaccination Disparities Through Policy Changes, Education

Health disparities persist in the U.S. based on gender, race, ethnicity, age, sexual orientation and even physical location.

There is a general concern by policymakers, who worry how these disparities will eventually affect not only those who face such inequalities, but also how health disparities will make it difficult to provide quality care for the overall population as it continues to diversify. Failure to address health disparities will eventually impact access to health care and increase health care costs.

A reliable barometer of disparities in health care is the vaccination rate among minority populations. Despite the fact that vaccines have dramatically reduced the threat of diseases that were once widespread and oftentimes fatal, the rate of vaccination among ethnically diverse patients is abysmal.

For example, in a study of the elderly population, the rate of pneumococcal vaccination was lower by 27 percent for African-Americans and 34 percent lower for Hispanic Americans when compared to white Americans, according to the Morbidity and Mortality Weekly Report from June 2017. A heartbreaking example of vaccination disparities came in 2011, when a whooping cough outbreak killed 10 Hispanic-American children in Long Beach, Calif., because they had not received the pertussis vaccination.

But race and ethnicity are not the only two factors that affect vaccination rates. The vaccination rates get even lower when you add poverty and geography to the calculus. Children who live in poverty-stricken households and/or live in rural areas have lower vaccination rates than those from affluent families who live in urban areas, according to a study published in MMWR in 2016.

In 2012, the American Association of Retired Persons identified the following factors as the reasons for the low rate of flu and pneumococcal immunization among African-Americans and Hispanics:

— Cultural and linguistic barriers that limit access to care;

— Living in linguistically isolated areas and newer immigrant destinations;

— Consumer lack of awareness about the need for the vaccinations;

— Consumer fear that the vaccines will cause severe illness;

— Distrust of immunizations due to memories of the Tuskegee syphilis experiments;

— Few consumer-initiated visits to providers to receive the vaccines;

— Provider underestimation of the safety and efficacy of the vaccines;

— Provider lack of familiarity with age-based immunization recommendations;

— Provider failure to recommend age-appropriate immunizations to older adults;

— Provider failure to institute the Advisory Committee on Immunization Practices’ recommendations for standing-order programs that authorize nurses or pharmacists to administer vaccinations according to an institution- or clinician-approved protocol.

Considering all of these factors, what can be done to reduce the disparities in vaccination rates and improve patient outcomes immediately?

There is an imminent need to develop more campaigns to educate ethnically diverse patients about the importance of vaccination as a disease-prevention method. These campaigns are most effective when conducted in partnership with organizations that serve minority communities, such as Healthy Churches 2020. In addition, there needs to be a focused effort on promoting educational materials that are geared toward ethnically diverse communities, such as the audio visual novelas developed by the University Of Southern California School Of Pharmacy.

Levels of vaccination as a quality measure must be used in geographies with large populations at risk of health disparities. This quality measure can then be utilized to determine reimbursement of health care professionals by government-funded programs such as Medicare and Medicaid. In addition, the improvement of vaccination rates due to quality measures will protect these vulnerable populations, which are at a greater risk of vaccine-preventable diseases due to a higher presence of underlying health conditions such as chronic lung disease or diabetes.

We need to ensure providers are adequately reimbursed so that they stock and offer vaccines for low-income patients. There should be no barriers for adult vaccinations due to cost-sharing. All CDC-recommended vaccines should be offered at zero out-of-pocket cost to patients by private and public insurance plans.

Pharmacists should be allowed to administer all CDC-scheduled vaccines. After all, nine out of 10 Americans live within 5 miles of a pharmacy. Community pharmacists are the nation’s most readily accessible health care professionals, especially when one considers that not all patients have a primary care physician. And finally, every state and U.S. territory should build an accessible vaccine registry to help ensure all eligible patients are vaccinated.

The World Health Organization estimates that immunizations save 2.5 million lives from infections such as tuberculosis, whooping cough and measles annually. For every dollar spent in the U.S. on childhood vaccination, we save $10 in treatment costs. Vaccines also play an important role in reducing the incidence of antimicrobial resistance by helping prevent infections that require an antibiotic treatment.

It is time for the United States to put strong policies and procedures in place that will help reduce the health disparities that prevent many individuals from benefiting from life-saving therapies such as vaccines.


Robert Popovian is the vice president of Pfizer Inc. U.S. Government Relations.

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