GSK Launches New Platform for Tracking Adult Vaccination Rates

Adult Vaccine Coverage

The Centers for Disease Control and Prevention (CDC) provides a list of recommended adult vaccinations depending on age, medical history, immunization history, and additional morbidity data. Despite these recommendations, immunization rates still need improvement.

The CDC’s National Health Interview Survey (NHIS) provides insight into vaccination coverage among adults, noting that, in 2019, age-appropriate composite adult vaccination coverage was under 45%. Across all races and ethnicities, vaccine coverage for adults 19 and older was under 50%. Racial and ethnic data maintained that vaccine coverage among non-White adults was statistically lower than among White adults.

Len Friedland, MD, Vice President, Director of Scientific Affairs and Public Health, GSK Vaccines, explained vaccine uptake in terms of pre-pandemic and post-pandemic trends, explicitly focusing on changes in adult vaccination rates.  

“Leading up to 2019, we were making some gains, but we were certainly far behind the public health goals for immunizations, particularly for adults,” he said.

This claim is backed by CDC data which showed an upward linear trend in vaccine coverage for influenza, herpes zoster, and Tdap (tetanus, diphtheria, and pertussis) vaccines.

He explained that shingles, whooping cough, hepatitis, human papillomavirus (HPV), pneumococcal, and influenza vaccine rates were all lower than the ideal levels for population health but pre-pandemic, the vaccine rates were trending upward with some disparities due to health equity issues.

However, once the COVID pandemic hit, there was a reset in these trends.

“Initially, what happened was that people weren't seeking out regular healthcare as they were social distancing, so immunization rates declined,” noted Friedland.

These declining rates were seen across all different types of preventative healthcare, including colonoscopy screenings, melanoma skin testing, and breast cancer screenings. However, while rates of other preventive care have begun to recover, immunization rates are far from being restored to pre-pandemic rates.

Vaccine Track

“In the setting of COVID, there was real-time information around COVID vaccination rates,” noted Friedland. “The CDC had a pretty excellent trackable website, and there was power behind that data; we knew what was happening.”

While some improvements could have made the data more robust, the information provided by real-time tracking was unparalleled and unprecedented in the vaccine space.

In 2022, GSK launched a program called Vaccine Track. The theory behind Vaccine Track was to create a similar dataset for all adult immunizations.

“We focused on adult immunizations because that's where the greatest declines were. Pediatric vaccination rates were starting to come back up,” he clarified.

GSK collaborated with IQVIA to collect vaccine claims data for adults 19 and older, dividing data on recommended adult vaccine coverage by class.

“We report out every three months. It's essentially real-time; it only lags by three months. Vaccine Track can see what's happening across the nation by state, by gender, by payer type, by class of vaccines across vaccines, and other social determinants as best as we can get at them right now,” said Friedland.

Vaccine Track may sound familiar to healthcare professionals and some patients. In his discussion with PharmaNewsIntelligence, Friedland explained that some systems are intended to collect vaccination data, called immunization information systems (IISs).

Unfortunately, most existing IISs are state-specific, only focusing on that location’s specific immunization registry with varying data. Without a standardized form of data collection, there are interoperability issues.

“There's no national database for immunization registries, just like there's no national database for licenses and so forth. This is something that we want to tackle because people travel, people work in one state, and live in another state.”

Many routine adult vaccinations are given at pharmacies. Still, without interoperable, robust IIS systems, pharmacists cannot know if a patient has received a particular vaccine, relying on them to remember or find their medical records.

Insights

Based on the data, GSK researchers noted that vaccination claims in 2022 were roughly 14% lower than in 2019 for recommended vaccines excluding influenza.

“The data from Vaccine Track also suggests that most adult vaccinations occurred during the flu season, so it's become seasonal. But if we look at the recommended adult vaccines, the only one recommended right now in the winter/fall is influenza. Every other vaccine, pneumococcal, shingles, and now coming RSV, are recommended; there's no season behind them in their recommendations,” added Friedland.

That insight indicated excessive pressure on the healthcare system during the fall months.

“We can spread this out and make vaccination a year-round activity — except influenza — because we're still behind from where we were.”

Beyond trends in vaccination timing, Vaccine Track data also highlighted trends associated with vaccination inequities based on social demographics and other determinants of health. Vaccinations are meant to help and protect everyone in the recommended patients, including those with comorbidities who cannot access regular healthcare or are underinsured. This class of patients is more likely to contract these illnesses and have severe complications, making vaccination an even higher priority.

Managing Vaccine Pressures

“The good news is that in the last few years, innovations in vaccines technology have made major advances which have brought new vaccines for adults to patients that are CDC recommended,” explained Friedland.

Many people saw this first-hand throughout the coronavirus pandemic, as FDA advisory committees reviewed and recommended multiple vaccines against the SARS-CoV-2 variants, notably the Pfizer and Moderna vaccines.

With extensive vaccine innovation, the number of recommended routine immunizations continues to grow; however, if nearly all vaccine administration is done in one season, it can get crowded. Healthcare providers weigh the burden of administering multiple vaccines with the opportunity to make vaccine recommendations.

“We don't want to miss opportunities. But, if we focus on that, it all has to happen in the fall, which places a tremendous burden on the healthcare system and the patients.”

Friedland recommends a dialogue between providers and their patients, emphasizing that — aside from flu vaccinations — there is no “season” for adult vaccination.

Even without enough data to reasonably conclude the timing of RSV vaccines recommended for older adults, the research shows that the vaccines provide coverage for two full RSV seasons, meaning that a patient could get vaccinated in the spring and maintain protection for the next RSV season.  

“Healthcare systems could build their electronic medical record systems to have flags that come up outside of the fall for vaccination,” recommended Friedland.

Beyond that, he recommends interdisciplinary partnerships to promote vaccination year-round.

“Across academia, industry, public health, and the retail chain — the whole healthcare enterprise — we all work together; we can spread it out and not miss those opportunities because not everybody is going to show up at their healthcare provider setting in the fall.”

In addition to emphasizing that most adult vaccines can be administered anytime during the year, researchers, healthcare professionals, and public health organizations must continue to combat vaccine hesitancy to facilitate improved adult vaccination rates.

“We need to continue generating data about the safety and the effectiveness of giving vaccines.”

Access and Equity

“The healthcare industry needs to work on the issues around access and equity. We need to make sure that everybody benefits from vaccines and work on issues around access, implementation, and feasibility,” stressed Friedland

In the pediatric vaccination space, the Vaccines for Children program (VFC) is intended to provide routine vaccines for uninsured or underinsured children and adolescents. There is no adult equivalent to VFC.

Friedland estimates that roughly 10% of adults in the United States don’t have access to healthcare.

“In the last year, some excellent things happened through policy work to make vaccine access less of a burden for adults. Under the Inflation Reduction Act, all ACIP-recommended vaccines for adults over 65 enrolled in Medicare Part D no longer have a copay for the patients.”

Not all Medicare-eligible patients are enrolled in Medicare Part D; it is supplemental. However, having some coverage and barrier reductions in that space can be very beneficial.

“Under the Affordable Care Act, all ACPI-recommended vaccines for people who've got private insurance are covered at $0 coverage, which is for recommended vaccines. For example, the shingles vaccine is recommended starting at age 50. Hepatitis B vaccines are recommended up through age 59,” continued Friedland.

Breaking down some cost barriers can help improve vaccine uptake; however, these improvements do not always reach uninsured, underinsured, and all at-risk patients.

“Unfortunately, the disparities are greatest in people who don't recognize their risk — those who might have asthma, COPD, or early onset renal failure. They may not know they're at risk for pneumococcal pneumonia or RSV, so we need to educate them.”

COiMMUNITY Initiative

GSK’s COiMMUNITY project is focused on improved accessibility. One of the most significant ways the company hopes to improve accessibility is through data transparency by using Vaccine Track to get real-time vaccination data.

Additionally, the program hopes to expand the message that vaccinations are available year-round. Patients do not have to wait and rely on vaccines during the fall or winter. For that, GSK plans to disseminate research and immunization schedules to healthcare providers.

“We also have upward of $1 million of grant money that we want to provide to local groups working on issues of adult immunization and equity because we know that the local groups do amazing work and can make important impacts in their communities. We want to make sure that we're paying attention to not just the big players, but to everybody who wants to improve health because prevention is better than treatment is really what it boils down to,” revealed Friedland.

“The COVID-19 pandemic highlighted what we always knew was there; the pandemic just was right in front of us. We have tremendous disparities in care in the United States and worldwide, and immunizations are no exception.”