Box 1.

Gaps and recommendations to advance adult immunization policies and advocacy.

GAPS

-Epidemiologic and economic literature is primarily from HICs -Few LMICs have implemented policies or recommendations for influenza, pneumococcal or herpes zoster vaccination -Little is known about disease burden for adults under 60 years of age -Disease burden and economic data are generally viewed through a narrow lens of deaths and direct costs of disease -Country policies are self-reported and data are unreliable -Surveillance capacity for adult VPD is lacking in LMIC -There is no comprehensive WHO recommendation for adult immunization -Vaccine delivery systems are not optimized for adult immunization

RECOMMENDATIONS

Strengthen the body of evidence through research -Assess country-level adult VPD burden data in LMICs -Assess VPD burden data for adults < 60 years -Standardize age strata and definitions for epidemiologic and economic analyses of adult VPDs -Establish the impact of community protection from pediatric immunization programs in varying settings and identify key population gaps not addressed by these programs -Assess the impact of adult VPD on quality of life, functional capacity, and productivity, and the potential gains from immunization -Establish epidemiological and cost parameters from LMICs to better inform economic analyses, including understanding out-of-pocket expenditures on adult vaccines -Assess key drivers of country decision-making for vaccination policy, to inform further studies Improve data quality and availability -Refine global reporting mechanisms (e.g., Joint Reporting Form) to improve the accuracy and completeness of data on country-level vaccination policies and recommendations -Monitor immunization coverage using quality measures Establish policy and advocacy guidance -Advance global and regional recommendations for adult immunization, including key considerations for countries -Promote immunization standards through professional bodies -Develop communication messages that resonate with older adults and their caregivers about the value of older adult immunization with existing and future new vaccines. Assess and address health system and delivery gaps -Assess the feasibility of expanding immunization financing mechanisms to include adult vaccination and mitigate out-of-pocket expenses -Conduct research to understand the benefits and challenges of integrating adult immunization and primary care -Expand access to vaccinations to non-medical places, such as pharmacies, workplaces, and schools/colleges; particularly in the context of public health emergencies (e.g., COVID-19), more innovative delivery should be explored (e.g., self-administration of mobile outreach)