In the JournalsPerspective

‘We have a problem’: Experts highlight racial disparities in flu vaccination coverage

Gregory A. Poland, MD
Gregory A. Poland

Experts called on the health care industry to work to improve influenza vaccination rates among older and vulnerable adults and to address racial disparities in vaccination coverage.

In April 2018, experts in epidemiology, clinical research, behavioral economics and psychology were convened for a roundtable to address low influenza vaccination rates and racial disparities in immunization coverage among older adults. Writing in Vaccine, Gregory A. Poland, MD, professor of medicine and infectious diseases at the Mayo Clinic, and colleagues summarized what was discussed, and the resulting recommendations for “significantly increasing influenza immunization rates in the near term.”

“We have a problem. There is a morbid and sometimes lethal disease which affects tens of thousands of Americans each year,” Poland told Infectious Disease News. “We have a vaccine that is inadequately utilized — especially among minorities — and there is currently an inadequate response to these problems.”

According to the report, the impact that influenza has on the independence, morbidity and mortality of older adults and those with chronic illnesses is potentially underestimated.

“Regardless of the growing documentation of the toll of influenza on older adults and increasing vaccine options, influenza vaccination rates remain insufficient, with disparities between different racial and ethnic subpopulations,” Poland and colleagues wrote.

During the 2015-2016 influenza season, among adults older than age 65 years, 76% of Asians, 72% of whites, 65% of African-Americans and 60% of Hispanics were vaccinated, according to Poland and colleagues.

Poland said clinicians should “be informed about the challenges affecting each patient population, including the elderly, minorities and those with chronic health conditions.”

“For instance, our roundtable identified lack of trust as a major barrier for flu vaccinations among African-American and Hispanic populations, so it is critical as health care providers that we work to build a rapport with the patients we serve,” Poland said.

The experts noted “common barriers to immunization,” including low baseline immunization rates; limited patient health literacy; transportation and financial access challenges; data access challenges; copays and state-based limitation on pharmacy practice. They suggested six strategies that could rapidly improve uptake of influenza vaccination among older and vulnerable adults, including developing multidisciplinary evidence-based approaches, using geo-mapping to target communities and populations with the highest need and risk, and establishing a national agenda to promote immunization and remove barriers to vaccination.

Poland and colleagues noted “a stubborn and persistent gap between recommended and actual immunization rates” in diverse and high-risk populations.

“However, if we can push health and community stakeholders to implement innovative, evidence-based strategies, we have an opportunity to address these inequities in flu vaccination and make this a public health priority,” Poland said. – by Marley Ghizzone

Disclosure: Poland reports numerous ties to industry. He is the editor-in-chief of Vaccine.

Gregory A. Poland, MD
Gregory A. Poland

Experts called on the health care industry to work to improve influenza vaccination rates among older and vulnerable adults and to address racial disparities in vaccination coverage.

In April 2018, experts in epidemiology, clinical research, behavioral economics and psychology were convened for a roundtable to address low influenza vaccination rates and racial disparities in immunization coverage among older adults. Writing in Vaccine, Gregory A. Poland, MD, professor of medicine and infectious diseases at the Mayo Clinic, and colleagues summarized what was discussed, and the resulting recommendations for “significantly increasing influenza immunization rates in the near term.”

“We have a problem. There is a morbid and sometimes lethal disease which affects tens of thousands of Americans each year,” Poland told Infectious Disease News. “We have a vaccine that is inadequately utilized — especially among minorities — and there is currently an inadequate response to these problems.”

According to the report, the impact that influenza has on the independence, morbidity and mortality of older adults and those with chronic illnesses is potentially underestimated.

“Regardless of the growing documentation of the toll of influenza on older adults and increasing vaccine options, influenza vaccination rates remain insufficient, with disparities between different racial and ethnic subpopulations,” Poland and colleagues wrote.

During the 2015-2016 influenza season, among adults older than age 65 years, 76% of Asians, 72% of whites, 65% of African-Americans and 60% of Hispanics were vaccinated, according to Poland and colleagues.

Poland said clinicians should “be informed about the challenges affecting each patient population, including the elderly, minorities and those with chronic health conditions.”

“For instance, our roundtable identified lack of trust as a major barrier for flu vaccinations among African-American and Hispanic populations, so it is critical as health care providers that we work to build a rapport with the patients we serve,” Poland said.

The experts noted “common barriers to immunization,” including low baseline immunization rates; limited patient health literacy; transportation and financial access challenges; data access challenges; copays and state-based limitation on pharmacy practice. They suggested six strategies that could rapidly improve uptake of influenza vaccination among older and vulnerable adults, including developing multidisciplinary evidence-based approaches, using geo-mapping to target communities and populations with the highest need and risk, and establishing a national agenda to promote immunization and remove barriers to vaccination.

Poland and colleagues noted “a stubborn and persistent gap between recommended and actual immunization rates” in diverse and high-risk populations.

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“However, if we can push health and community stakeholders to implement innovative, evidence-based strategies, we have an opportunity to address these inequities in flu vaccination and make this a public health priority,” Poland said. – by Marley Ghizzone

Disclosure: Poland reports numerous ties to industry. He is the editor-in-chief of Vaccine.

    Perspective
    William Schaffner

    William Schaffner

    A group of experts convened recently to tackle the continuing problem of the underuse of influenza vaccine in older adults. They re-emphasized some things we already knew and offered us some opportunities to improve.

    We all know that, although not ideal, annual influenza vaccination benefits older adults and those with underlying medical conditions. The vaccine prevents many infections completely, as well as ameliorating the severity of influenza when it occurs despite vaccination. Nevertheless, the meeting emphasized that approximately one-third of older adults, many of whom have chronic medical conditions, do not receive annual influenza vaccination. Furthermore, there are persistent racial/ethnic disparities among adults in the receipt of vaccines, including influenza vaccine. African-American and Hispanic adults are substantially less apt to be vaccinated than are persons of white or Asian backgrounds.

    That said, the experts provided a menu of strategies that can help improve the delivery of vaccines. They include establishing a vaccine-aware milieu among the entire patient care staff, using standard orders, taking advantage of each patient visit to promote vaccination and using performance feedback reports. In addition, they also emphasized cultural awareness and responding to the expressed concerns of patients. This year’s influenza season thankfully is behind us; it was substantial and lasted longer than many. The annual opportunity for influenza prevention will be upon us soon enough again this fall. Let us try together to get more of our patients vaccinated than we ever have before.

    • William Schaffner, MD
    • Infectious Disease News Editorial Board member,
      Professor of preventive medicine,
      Vanderbilt University Medical Center
      Medical Director, National Foundation for Infectious Diseases

    Disclosures: Schaffner serves as an advisor or consultant for Dynavax, Merck, Novavax, Pfizer, Roche, Seqirus, Shionogi and SutroVax.