The Need for Strategies to Increase Influenza Immunization in Underserved Communities

By Kate Jackson

To address racial disparities in influenza immunization, a summary report in Vaccine—the leading peer-reviewed journal about immunization science—encourages health systems, health care providers, and community stakeholders to make a difference by committing to the use of evidence-based strategies.

The report, “Effective and Equitable Influenza Vaccine Coverage in Older and Vulnerable Adults: The Need for Evidence-Based Innovation and Transformation,” announced by Sustainable Healthy Communities and published during National Minority Health Awareness Month, grew from an April 2018 roundtable that explored racial disparities in older adults, discussed undervaccination, and addressed differences in vaccination rates, especially among older adults with chronic health conditions. Experts in clinical research, epidemiology, psychology, and behavioral economics convened at the roundtable and reviewed the ways in which influenza worsens chronic disease, the response of older adults to influenza vaccines, and the data on influenza epidemiology, focusing on African American and Hispanic populations.

“Despite years of work and millions of dollars invested in vaccine development and education, we have failed to significantly raise vaccination rates in adults, particularly in people of color with chronic health conditions,” says Gregory Poland, MD, a professor of medicine and infectious diseases at Mayo Clinic, and lead author of the report. “Urgent action is needed to address the barriers in this susceptible population and avoid a public health crisis resulting from inadequate immunization.”

Findings from the roundtable were developed into a number of strategies for rapidly increasing immunization rates in older and at-risk adults. Sustainable Healthy Communities, a subsidiary of the National Minority Quality Forum, and Sanofi Pasteur, the vaccines division of Sanofi, developed and launched an initiative to address the barriers identified. In pilot programs in select regional health systems, the program, called DRIVE (Demonstrating Rising Influence Vaccine Equity), resulted in double-digit increases in immunization rates. Sustainable Healthy Communities and Sanofi will expand the DRIVE demonstration projects for the 2019–2020 flu season. That expansion includes a pilot program with Walmart associated with the company’s annual Wellness day in July 2019.

According to Laura Lee Hall, PhD, chief operating officer and executive vice president of Sustainable Healthy Communities, “Older adults account for the vast majority of severe flu cases, particularly because they’re more likely to have chronic conditions like heart disease and diabetes. These diseases can be exacerbated by the flu, resulting in severe complications, hospitalization, even death. Therefore, geriatricians must take a holistic approach to understand each patient’s individual risk while encouraging broad flu vaccinations in these patients.” The good news, she adds, “is that older adults with declining immune function can benefit from newer flu vaccines designed to boost protection against the virus.”

— Kate Jackson is editor of Today’s Geriatric Medicine.