Vaccine-preventable disease (VPD) incidence in the United States is at or near record-low levels for most diseases against which children are routinely immunized; infant and child vaccination rates are approaching or meet record levels. However, coverage levels are below Healthy People 2020 targets for many vaccines targeted to adolescents and adults, and substantial disparities exist among racial and ethnic groups in adult and adolescent vaccination levels. Limited knowledge about recommended vaccines and attitudes towards vaccines exist among the public, health care professionals, and health policy- and decision-makers. Lack of health care access and financial barriers also contribute to these disparities and need to be addressed in strategies moving forward. Research on how best to overcome such barriers will dictate strategies and practices. Ongoing partnerships among national, state, local, tribal, private, and public entities are needed to sustain and improve vaccine use and the concomitant individual and public health benefits.
Ensuring a reliable and steady supply of all vaccines is critical in the United States, where shortages of several commonly used vaccines have occurred since 2000 (e.g., Hib, hepatitis A, and influenza). New 21st-century vaccine supply concerns, such as vaccines for pandemic influenza, emerging diseases, and bioterrorism threats, present different challenges for sustainability and may require surge manufacturing capacity compared with traditional vaccine pathways.
Immunization information systems (IIS) and electronic health records (EHR) may become increasingly important components of immunization programs. Jointly they can lead to much better immunization recordkeeping for children and adults, thereby reducing the barrier of unknown immunization status and the receipt of additional unneeded doses of vaccines and enhancing efficiency and cost-effectiveness of national immunization efforts.
Strong public health surveillance to monitor and evaluate VPDs and the effectiveness of licensed vaccines provides the link between vaccination policy and health outcomes. Such public health surveillance is a key component of strategies to overcome barriers and improve use of existing vaccines.
Challenges persist to improve vaccination rates and to incorporate new vaccines into child and adolescent vaccination schedules. Between 2005 and 2010, six new vaccines or vaccine recommendations were added for children and adolescents by the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention (CDC):
- Meningococcal conjugate vaccine
- Tetanus, diphtheria, acellular pertussis vaccine
- HPV vaccine
- Rotavirus vaccine
- Universal influenza vaccination
- 13-valent pneumococcal conjugate vaccine
Barriers to improved vaccine uptake include persistent cost, awareness, and access problems; lack of knowledge of necessary vaccines; and limited use of evidence-based strategies to improve vaccine uptake, such as reminder-recall systems. Community health centers, other community immunization sites (e.g., pharmacies and stores), and school-located clinics offer venues for improving vaccine uptake, in addition to traditional provider sites. Goal 4 identifies nine objectives and related strategies to strengthen our nation’s vaccination program and overcome barriers. Enhancing communication and education activities about vaccination is a key approach to overcome many of the current challenges identified in Goal 4, and is addressed in detail in Goal 3.
- Ensure consistent and adequate supply of vaccines for the United States.
- Ensure consistent and stable delivery of vaccines for the United States.
- Reduce financial barriers to vaccination.
- Maintain and enhance the capacity to monitor immunization coverage for vaccines routinely administered to all age groups.
- Enhance tracking of VPDs and monitoring of the effectiveness of licensed vaccines.
- Educate and support health care providers in vaccination counseling and vaccine delivery for their patients and themselves.
- Maintain a strong, science-based, transparent process for developing and evaluating immunization recommendations.
- Strengthen the National Vaccine Injury Compensation Program (VICP) and Countermeasures Injury Compensation Program (CICP).
- Enhance immunization coverage for travelers.
For more information on this goal and the defined set of strategies for achieving each objective mentioned above, view the National Vaccine Plan.