September 29, 2017

To Whom It May Concern:

AVAC appreciates the opportunity to offer comments in response to the Healthy People 2030 Framework. As a stakeholder coalition interested in improving the health and wellbeing of adults through better access to immunization services, we value the work of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention on an approach to the development and implementation of objectives for Healthy People 2030.

AVAC includes more than fifty organizational leaders in health and public health who are committed to addressing barriers to adult immunization. AVAC works toward regulatory and legislative solutions that will strengthen and enhance access to adult immunization across the healthcare system. Our mission is informed by scientific and empirical evidence in support of the benefits immunizations provide by improving health, protecting lives against a variety of debilitating and potentially deadly conditions, and saving costs to the healthcare system and to society. A top priority for AVAC is to achieve increased adult immunization rates by encouraging compliance with federal benchmarks and performance measures that encourage utilization of recommended vaccines.

Immunizations are a highly cost-effective form of preventive medicine that help save lives by protecting the health and wellbeing of individuals and families in communities nationwide. Since the Healthy People initiative began in 1979, there has been tremendous progress with respect to improved childhood immunization rates – one of the greatest public health achievements of the 20th century. Vaccine programs have contributed to the elimination of polio in the US and have dramatically reduced the spread of many more crippling and potentially life-threatening diseases such as diphtheria, tetanus, measles, mumps, and rubella. Vaccines also prevent the spread of common infectious and potentially fatal diseases such as chickenpox, influenza, hepatitis A, hepatitis B, meningococcal disease, pneumococcal disease, and whooping cough (pertussis). Vaccines not only help protect the immunized person but also those around them who may not be able to be immunized because they are too young to be vaccinated themselves or suffer from a health condition that prevents them from being immunized. These persons are protected indirectly because they are not exposed to the infectious agent. When immunity levels in the population are high, the infectious agents do not circulate, which is known as herd immunity. Maintaining herd immunity is essential to protecting and preserving the health and wellbeing of individuals and entire communities from vaccine preventable conditions.

Despite the demonstrated benefits of vaccination and the tremendous success in achieving and maintaining high immunization coverage rates for children, every year, more than 50,000 adults die from vaccine preventable diseases and thousands more suffer serious health problems. Despite Advisory Committee for Immunization Practices (ACIP) recommendations, vaccines are underutilized in the adult population for the most commonly recommended vaccines (influenza, pneumococcal, Tdap, hepatitis B, herpes zoster, human papillomavirus (HPV,)and meningococcal vaccines). Disparities are even greater among at-risk populations, including seniors and people with chronic illness, as well as racial and ethnic underserved populations.

Background

Healthy People goals and objectives are an essential tool in guiding the actions of the wide range of stakeholders who are committed to improving the health and wellbeing of our nation. AVAC is grateful that Healthy People 2020 included several objectives aimed at reducing or eliminating instances of vaccine-preventable diseases in adult populations. While the Healthy People 2020 Midcourse review indicates progress in several areas, including a decline in the incidence of pneumococcal infections and an increase in the percentage of adults vaccinated against influenza and herpes zoster, other indicators reveal that there is more work to be done as we look ahead to the next decade.

Vision

With the aging of the U.S. population, the impact of vaccine preventable conditions and their complications in adults is only expected to grow, with significant implications for the economy and society. With Americans age 85 and older representing the fastest growing segment of the elderly population, it is imperative that as a nation we remain focused on improving adult vaccination rates. Adult immunization is a core preventive health intervention that supports healthy aging and helps to avoid the costly effects of vaccine preventable illness. As such, AVAC urges the Committee to ensure that adult immunization goals and objectives remain an integral part of the Immunization and Infectious Diseases Topic Area for Healthy People 2030.

The 2016 Department of Health and Human Services’ National Vaccine Program Office National Adult Immunization Plan, cites a number of barriers to adult immunization, including lack of information about recommended vaccines, financial hurdles, as well as technological and logistical obstacles. The Healthy People 2020 goals and objectives for adult immunization provided an important benchmark and framework for measuring the progress of federal coordinated efforts to improve adult vaccines.

Foundational Principles

Another area where Healthy People 2030 plays an extremely important role in improving the health and well-being of all Americans is the focus on “eliminating health disparities, achieving health equity and attaining health literacy”. AVAC supports this effort and strongly believes that reducing disparities in adult immunization rates is central to our work to increase access and to  improve utilization of this proven disease prevention intervention. Annual adult vaccine coverage reports consistently show disparities in immunization rates depending on race or ethnicity. Access to regular sources of health care, linguistic, and cultural barriers are often obstacles for medically underserved populations. National goals and objectives centered on reducing these barriers will go a long way toward improving the health and well-being of our nation.

In closing, AVAC strongly encourages the Advisory Committee to update and maintain objectives centered on advancing adult immunization coverage rates in the Healthy People 2030 framework. For decades, Healthy People has set the standard at the national, state, and local levels as we strive to improve health and well-being across all stages of life and among all segments of our great nation. Immunization has demonstrated “effective prevention” in reducing rates of morbidity and mortality from a growing number of preventable conditions and has been proven to improve overall health in a cost-efficient manner. Improving immunization opportunities across the lifespan should remain a foundational element in the overall effort to improve health and reduce the burden of disease for the United States.

Thank you for this opportunity to offer our perspective on this important framework. Please contact the AVAC Coalition Manager at (202) 540-1070 or info@adultvaccinesnow.org if you wish to further discuss our comments. To learn more about the work of AVAC, visit www.adultvaccinesnow.org.

Sincerely,
American Academy of Family Physicians
Asian & Pacific Islander American Health Forum
Every Child By Two
Families Fighting Flu
GSK
Immunization Coalition of Washington, DC
Medicago
National Association of Chain Drug Stores
National Association of County and City Health Officials
National Foundation for Infectious Diseases
National Viral Hepatitis Roundtable
Sanofi
Takeda Vaccines, Inc.
The Gerontological Society of America
Trust for America’s Health