Even as older adults await the coronavirus vaccine, many are skipping the standard ones. That’s not wise, health experts say Photograph:( Chris Lyons © 2020 The New York Times Company )
Experts fear that vaccination rates may have fallen further during the pandemic, as they have among children, if older people wary of going to doctors’ offices or pharmacies skipped shots
Peggy Stein, 68, a retired teacher in Berkeley, California, skipped a flu shot this year. Her reasoning: “How could I get the flu if I’m being so incredibly careful because of COVID?”
Karen Freeman, 74, keeps meaning to be vaccinated against shingles, but hasn’t done so. A retired college administrator in St. Louis, she quipped that “denial has worked well for me these many years.”
Sheila Blais, who lives on a farm in West Hebron, New York, has never received any adult vaccine. She also has never contracted the flu. “I’m such an introvert I barely leave the farm, so where’s my exposure?” said Blais, 66, a fiber artist. “If it’s not broke, don’t fix it.”
While older adults await vaccination against COVID-19, public health officials also worry about their forgoing, forgetting, fearing or simply not knowing about those other vaccines — the ones recommended for adults as we age and our immune systems weaken.
“There’s a lot of room for improvement,” said Dr. Ram Koppaka, associate director for adult immunization at the Centers for Disease Control and Prevention.
Every year, campaigns urge older adults to protect themselves against preventable infectious diseases. After all, influenza alone has killed 12,000 to 61,000 Americans annually over the past decade, most of them 65 or older, and has sent 140,000 to 810,000 people a year to hospitals.
The coronavirus pandemic has introduced another imperative. Those hospitals are filling fast with COVID-19 patients; in many places they are already swamped, their staffs overworked and exhausted.
“Knowing how stressed the health care system is, prevention is key,” said Dr. Nadine Rouphael, a vaccine researcher and infectious disease specialist at Emory University. “When we have record numbers of deaths, why would you go to a hospital for a vaccine-preventable illness?”
Yet the nation has long done a better job of vaccinating its children than its elders. The most recent statistics, from 2017, show that about one-third of adults over 65 had not received a flu shot within the past year. About 30% had not received the pneumococcus vaccine.
The proportion receiving the shingles vaccine, a fairly recent addition to the list, has inched up, but by 2018 only 34.5% of people over 60 had been vaccinated.
Moreover, Koppaka pointed out: “When you look deeper, there are long-standing, deep, significant differences in the proportion of Black and Hispanic adults getting vaccines compared to their white counterparts. It’s really unacceptable.”
Close to 40% of non-Hispanic whites had been vaccinated against shingles, for instance, compared with fewer than 20% of Blacks and Hispanics.
One might expect a group who can recall polio fears and outbreaks of whooping cough to be less hesitant to get vaccinated than younger cohorts. “You’ll probably have a different concept of vaccination from someone who never experienced what a serious viral illness can do,” Koppaka said.
When it comes to the COVID-19 vaccine, for instance, only 15% of those over 65 say they would definitely or probably not get it, compared with 36% of those 30-49, a Kaiser Family Foundation tracking poll showed earlier this month. (Stein, Blais and Freeman all said they would happily accept the COVID vaccine.)
But for other diseases, vaccination rates lag. Given that older people are more vulnerable to severe illness from them, why the gaps in coverage?
Internists and other doctors for adults don’t promote vaccines nearly as effectively as pediatricians do, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. Older patients, who often see a variety of doctors, may also have trouble keeping track of when they got which shot.
Experts fear that vaccination rates may have fallen further during the pandemic, as they have among children, if older people wary of going to doctors’ offices or pharmacies skipped shots.
Financial and bureaucratic obstacles also thwart vaccination efforts. Medicare Part B covers three vaccines completely: influenza, pneumococcus and, when indicated, hepatitis B.
The Tdap and shingles vaccines, however, are covered under Part D, which can complicate reimbursement for doctors; the vaccines are easier to obtain in pharmacies. Not all Medicare recipients buy Part D, and for those who do, coverage varies by plan and can include deductibles and copays.
Still, older adults can gain access to most recommended vaccines for no or low cost, through doctors’ offices, pharmacies, supermarkets and local health departments. For everyone’s benefit, they should.