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A summary of presentations from the weekly Summit partner webinars

November 30, 2023 – The latest Summit Summary

Improving the Vaccination Experience – Kelly L. Moore (Immunize.org)

Kelly L. Moore, MD, MPH, President and CEO, Immunize.org, and Sharon Humiston, MD, MPH, Associate Director for Research, Immunize.org gave a presentation on Immunize.org’s suite of materials to improve the vaccination experience.

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For all resources on improving the vaccination experience for vaccine recipients, see: www.immunize.org/clinical/vaccine-confidence/topic/improving-vaccine-experience

The problem: vaccination anxiety leads to vaccination hesitancy

  • Fear of needles and injections is common
    • About 2 out of 3 children and 1 out of 4 adults are nervous or anxious about vaccination
    • One in 10 people refuse vaccinations because of fear
    • Negative consequences
      • Not getting vaccinated or avoiding vaccination
      • Anxiety can fuel pain, which is subjective
        • Pain can be reduced by addressing anxiety
      • Anxiety and pain can lead to vaccination stress response
        • Dizziness, headache, nausea, fainting (and subsequent injury due to falling)
      • Negative vaccination experiences reinforce negative attitudes about vaccination and further hesitancy

Materials for Healthcare Providers

See: www.immunize.org/clinical/topic/addressing-anxiety

Materials for Vaccine Recipients and Parents

Immunize.org’s Next Steps

  • All the videos are available on org’s YouTube channel
  • Everything is available on the Improving the Vaccination Experience web page
  • In the process of redesigning org, a site with information for the public, which will launch in the first quarter of 2024
  • Videos are being featured in IZ Express, and on social media. Find Immunize.org on social media at @ImmunizeOrg.

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Flu Vaccination Coverage Update – Carla Black (CDC)

Carla Black, PhD, Epidemiologist, Immunization Services Division, CDC, gave a flu vaccination coverage update for week ending November 18.

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Weekly Cumulative Influenza Vaccination Coverage, Children 6 months–17 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey-Flu

  • For week ending November 18, 37% coverage for children, compared to about 42% during the same week last season
  • About 4–5 percentage points lower than last season at this time
  • Trending several percentage points below same point before the pandemic

National Immunization Survey-Flu (NIS-Flu): Weekly Data, November 12–18

  • Coverage and parental intent for vaccination
    • Children already vaccinated – 37%
    • Parents who say they definitely plan to get vaccinated – 18%
    • Parents who say they will probably or are unsure – 15%
    • Parents who say they will definitely not get their children vaccinated – 30%
  • Coverage and parental Intent for vaccination by demographic
    • Vaccination coverage among White, Hispanic children, and multiple/other races is similar, but lower among Black children

Coverage lowest among children in rural areas; rural parents also with lowest vaccination intent

Weekly Cumulative Influenza Vaccination Coverage, Adults ≥18 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey Adult COVID Module

  • In mid-October, adults had 36% coverage. At the same point last season coverage was at 38%.
  • The most recent week coverage was at 37.5% (which is below last season)

Influenza Vaccination Status and Intent among Adults ≥18 Years of Age, NIS-ACM

  • Coverage and intent for vaccination
    • Children already vaccinated – 37.5%
    • Parents who say they definitely plan to get vaccinated – 13%
    • Parents who say they will probably or are unsure – 19%
    • Parents who say they will definitely not get their children vaccinated – 30%
  • Coverage and intent by demographic
    • Adults in rural areas are less likely to get vaccinated and have lower coverage
    • Asian and White adults have the highest coverage and Black and Hispanic adults have lower coverage
    • Hispanic adults have lower hesitancy, but lower coverage
    • Black and White adults have similar intent to be vaccinated, although Black adults have lower coverage

Weekly Cumulative Estimated Number of Flu Vaccinations Administered in Pharmacies and Physician Medical Offices by Flu Season, Adults 18 years and older, United States, through week ending November 11

  • Data is based on claims for vaccinations given in pharmacies and physician offices for the past five seasons
  • About seven million doses below the same point as last season
  • Season 2020–2021 coverage was higher than the 2019–2020 season, and has been decreasing
  • Concerns or issues about flu vaccination
    • For those already received the vaccine or will definitely get it, most don’t have any concerns
    • For those who will not get the vaccines, concerns include:
      • Not worried about the flu
      • Side effects or vaccine not effective
      • Don’t trust the government
    • For those unsure if they will get the vaccine, concerns include:
      • 33% said they don’t have concerns
      • Haven’t had time
      • Not worried about flu
      • Worried about side effects

Monthly Cumulative Flu Vaccination Coverage by Flu Season, Pregnant Persons 18–49 Years, United States

From the Vaccine Safety Datalink, a collaboration between CDC and about 8 managed healthcare organizations

  • Data currently goes through the end of October
  • So far this season, at 29% versus 29.8% last season
  • Currently at 15 percentage points lower than pre-pandemic

FluVaxView

Data presented today and weekly updates can be found at www.cdc.gov/flu/fluvaxview/index.htm

  • Now includes estimates from previous seasons and more detailed reports on estimates from previous seasons

Summary

  • For children, four percentage points lower flu vaccine coverage compared to the same time last season. Overall, about 8 percentage points lower at this point compared to the 2019–2020 season.
  • Lowest intent for vaccination is among parents of Black and White children, as well as those living in rural areas
    • About two percentage points lower compared to coverage at the same time last season
    • Translates to almost 7 million fewer doses administered in pharmacies and physician offices
    • Data is similar for adults.
  • About 30% of adults say they probably or definitely don’t plan to be vaccinated, which is similar to parents of children
  • For those who say they will probably get vaccinated or are unsure, most had no concerns about the vaccine or said that they haven’t had time. Other concerns included not being worried about flu and concern about side effects.
  • Pregnant person coverage is similar to the same time last season, but remains at about 16 percentage points below coverage in the 2019–2020 season.

If you have questions, contact Carla Black at zwc0@cdc.gov.

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Manufacturer Update on Current Seasonal Flu Vaccination Rates: Presented by “The manufacturers” – Julian Ritchey (Sanofi Pasteur) and Amy Walker (CSL Seqirus)

Julian Ritchey, VP, Head of Public Affairs and Patient Advocacy, US Vaccines, Sanofi Pasteur, and Amy Walker, Director, US Policy & Advocacy, CSL Seqirus, gave a manufacturer update on the current seasonal flu vaccination rates.

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Julian Ritchey

Historical Medical/Retail Claims by Week, Retail Week Ending November 10 and Medical Week Ending November 11

  • This season is trending well below previous seasons with a high point during the pandemic, 2021 season
  • Each season seems to be going down in coverage rates
  • So far this season, coverage reached peak vaccination weekly rates earlier than other recent years and has since been going down
  • Need to extend the flu vaccination season

With medical down 15% year-on-year (YOY)and retail down 10%, overall flu immunized population shrinks each year 

  • Declines in both retail and medical claims
    • Both are 20% down from prior years
    • Medical claims down from previous years at a concerning level
  • Loss in the net number of people who are being immunized

18–64 age segments witnessing YOY lag greater than the overall population

  • This season is substantially down from prior years
  • Covering the missed volume is going to be very difficult or not possible

Influenza immunization trends are heading the wrong way

  • Across every age group, influenza immunization rates are lagging substantially over the past seasons, especially vaccination in medical offices
  • Retail is remaining fairly consistent, though decreasing in total volumes
  • Overall rates are significantly down, medical in particular
  • Concern is that people are not getting immunized in medical offices are not necessarily going to retail, which means people are not getting vaccinated
  • Rates for people age 65 years and older are down even further considering baby boomers aging. These trends need stakeholder action to avoid further decline. In the meantime, there is still time to immunize patients.

Amy Walker

All immunization stakeholders—especially providers—need to continue education and administration to extend the immunization season

  • There’s still time for people immunization this season
  • Immunization stakeholders play a role in education and outreach
  • Providers in particular are critical to efforts to extend the immunization season
  • Reminders and best practices for flu immunization as a call to action
    • Continue reaching out to patients who have not yet received flu vaccine
    • Remind people of the importance of getting a flu vaccine and that access points are still available
    • Strong recommendation has been shown to be impactful and increases patient acceptance
    • Need to continue educational outreach and offering the vaccine as long as flu is circulating
    • CDC guidance allows for coadministration of flu with COVID-19 and RSV shots, so providers should use patients seeking other vaccinations to also recommend and coadminister the flu shot
    • If a patient declines coadministration, schedule a visit in the near term to ensure they are immunized
    • There are many tools and resources from CDC, Immunize.org, and many other stakeholders such as all the medical societies and advocacy organizations that are part of the Summit

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Questions

Q: Is the reduction in the medical office due to patient behavior or to medical office changes?

Julian Ritchey (Sanofi Pasteur): I’m sure the answer is all the above. We don’t know exactly what the cause is. It seems to be components of each feedback we do here. There’s a lot of confusion and activity with commercialization of COVID-19 this fall with the addition of the RSV to the schedule with flu. You start to hear a little bit more about patient apathy towards immunization and that they haven’t necessarily seen severe flu seasons. So that’s not dissimilar to what we’ve seen in the past without even having these other factors around. So something that could be very helpful in the longer term is for us to work with some of the partners to try and figure out how we can tease apart some of those different factors. At this point we’re relying on that a lot of this is probably the distraction in the office. To focus on provider behavior is probably the best way to address disease prevention—to address getting immunized before disease sets in.

Amy Walker (CSL Seqirus): I think we’ve heard universally from across different provider types concerns about workforce in terms of burnout, shortages, and the burden that providers are working through in terms of their workload. I think in addition to the patient, the consideration around providers is that workforce is really critical to trying to find efficiencies in our vaccination effort so that it’s not this burdensome process that we’re asking providers to undertake for so many different vaccines.

Carla Black (CDC): An update from a survey last year when we asked people about place of vaccination and their preferred place of vaccination for both flu and COVID-19, most respondents said they prefer to get vaccinations in their medical office. Among those who were vaccinated, the overwhelming majority got it in a pharmacy. There’s a mismatch there and I don’t know if it’s because of lack of availability in provider offices.

 

Q: Are there staffing issues that contribute to the fewer numbers getting vaccinated in medical offices? Do they not have as many opportunities to offer vaccination clinics due to staffing issues?

Julian Ritchey (Sanofi Pasteur): We have heard anecdotally health systems will stop offering immunizations and defer them to pharmacies or other partners. The reality is that when you take it out of the medical office, there’s a loss of provider contact and the importance of providers and convincing people and reminding people of active follow up creates potential for a big gap. The decisions people are making about what care they can provide in their particular setting is something that we have to really try and dig into and get under.

L.J Tan (Immunize.org): I think that also ties into the whole idea of even if you have staffing, there might be fatigue as well. How much is fatigue in medical staff going to keep pushing where they might have offered it five times in the past, now might be only offering it twice. It’s hard to quantify that.

 

Q; Are we tracking declinations or is there a way to track that? Or are we at a potential theoretical threshold of where we are going to be pushing really hard against a wall?

Carla Black (CDC): I can tell you those numbers are consistent year after year among people who say they’re going to not get vaccinated. I don’t know of any systems that specifically track declinations. We have asked and probably will be asking in surveys about whether somebody got a recommendation or offer from their provider and then we can see among those how many didn’t get it. I can tell you that among those who do get a recommendation, they’re more likely to be vaccinated. Getting the offer at the visit is the highest percentage of people get vaccinated.

Julian Ritchey (Sanofi Pasteur): First off, it’s tracked in the HR systems. The problem is that with the HR systems not being broadly linked, it’s harder to assess and so it’s more of a sampling exercise. Looking at that more retroactively study-wise there are ways that we can assess that. I think it’s going to be important and one of those things that we need to dig under to understand what’s happening in terms of the broader trends. Despite all the things we know are working against us, when there is provider alignment, there is a strong recommendation. We need to figure out long-term some of these other things and try and get broader improvements in place.

 

Q: Is there data that’s tracking vaccination rates at places of employment? And is there any way to capture vaccination in settings such as educational settings and  workplaces? How can we target those places to increase immunizations?

Carla Black (CDC): In our surveys we ask about place of vaccination. So we can look at how many people who are vaccinated report that they were vaccinated at their employer versus the mass vaccination site, pharmacy, etc. This is obviously a sample and subject to all the survey variability. I don’t know of any systems that count claims, number of doses, other sites, or anything like that.

Julian Ritchey (Sanofi Pasteur): To my knowledge there’s not a difference in coding that occurs for those because those are usually handled as regular claims, or they’re covered by the employer from their purchase. From a supply side and from a distribution side, there’s a way to be able to look at that, but it’s not aggregated data. Survey and sampling would be the way to try and get at that but there’s probably something we could do through trade. There’s been talk in the past about encouraging more employer immunization.

L.J Tan (Immunize.org): This summit has been working with the business group trying to figure out ways to get employees to become more interested in giving employer-based flu vaccinations and all adult vaccines. About 10 years ago they used to be fairly regular reporting of flu vaccination at places of employment, and at some point, it was as high as 17–20%.  It’s unknown where that is now.

Comment from audience: Some providers are now seeing a huge uptick in flu vaccination, and they’re burning through their supply especially pediatric offices and will probably be ordering more vaccines. Shipments were delayed until mid-September but now they’re ordering in December. So maybe there might be an opportunity to continue to push with providers to capitalize.

 

Q: Part of the reason for lower coverage may be the transition in mentality where people got really used to doing drive through clinics and off-site clinics for COVID-19 vaccination and flu. Now the intensity to go back into a medical office is just not there anymore. Any thoughts on that?

Julian Ritchey (Sanofi Pasteur): From a behavioral standpoint, flu has always been about convenience and access. Anything that gets in the way of that when you used to have more office-based immunization was always about making sure there was a good flu clinic so that people could get in and out instead of having to have separate appointments. We always saw more success that way. Retail has demonstrated that people like the access opportunity and it makes a lot of sense how people are biased towards even more convenient immunizations. They are concerned if they don’t find that same convenience. That would also go in the opposite direction of the provider challenges when there are staffing issues. Now suddenly you don’t feel that you can run that separate clinic. Those are creating unfortunate circumstances and lower vaccine access.

L.J Tan (Immunize.org): One of the downsides of improving that access is that if they’re coming to congregate settings we may not be able to push the provider message as much as we would like because the provider recommendation is a strong leverage point for people getting vaccinated. Less people interacting with the providers about vaccination may might mean we lose of the population likely to get vaccinated in the past.

 

Q: Pharmacies get their vaccines weeks before a large employer on-site clinic, and employees often have pharmacies closer to home which is why they go to pharmacies. Is there a dramatic difference between when different people get their supplies?

Julian Ritchey (Sanofi Pasteur): This is always a perennial issue, and it has everything to do with what you see around in the local community. There are a lot of different factors behind it because there’s different distribution channels that affect whether it’s a private office, be it a VFC-supplied office retail employer or something else. I don’t know that there’s a good singular answer other than to say that we work very hard to not reinforce any type of difference in the distribution that is out there. What happens after we ship as a manufacturer to the next stop in the distribution chain can be very highly variable and sometimes there are organizations that stood on doses and waited until a certain volume to distribute further. We’ve often seen the pharmacies are very forward-leaning and start advertising earlier. Some people think that there are doses in the fridge, and they may not even be there yet, but they’re advertising and starting to make people aware of the fact that they will be immunizing. Whereas offices sometimes handle it a little bit differently knowing they’re going to be preparing for a flu clinic on whatever date. I can tell you that it’s not intentional on the part of us as manufacturers. I don’t deny that that is very real perception, and it certainly plays out that way based on some of the different variables and on where you are and who you’re working with.

 

L.J Tan (Immunize.org): Final words?

Amy Walker (CSL Seqirus): I think we’ve covered a lot of ground already. I really appreciate the partnership of the Summit and look forward to working together to continue to address these trends.

Carla Black (CDC): I imagine the less availability in provider offices is kind of a self-fulfilling prophecy because we definitely have seen a shift in people going to pharmacies, so provider offices don’t want to lose money. They see less people coming and they order less. Then they’re ordering fewer vaccines. I don’t know if it’s true that they’re ordering fewer and fewer doses each year.

Julian Ritchey (Sanofi Pasteur): I think if there’s one thing we can take away from this, it’s the power of the provider. There is this reinforcing loop and potentially there’s a lot of challenges out there, like staffing or other things. I think the most concerning idea is that if we have people that are going, as long as they’re getting an immunization, where they get it that’s up to them. But when you have people that aren’t getting it in the medical office, but also aren’t getting at the pharmacy, that’s the real problem. Any engagement we can get out of anyone listening and anybody that you can talk to would be the way to reverse some of those trends and help people see the positive message to get immunized. We are seeing people who want to get immunized now when traditionally this is a time of year we slow down a lot. I think that through the effort it can be reversed.

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Announcements
  • There will be an upcoming webinar on adult immunizations and rural health; watch for more information
  • org has a new streamlined look! Please feel free to give feedback: www.immunize.org/about/org/contact.
  • The Summit held a workshop on August 2nd to develop tools to address challenges in providing multiple adult vaccines along with COVID-19, flu, and RSV vaccines. Tools that address billing and insurance issues that go along with vaccinating patients were also developed. See the Summit’s Operationalizing Adult Immunizations in the 2023 Fall Season and Beyond Workshop web page for the deliverables. Note: some deliverables are in process of being finalized and uploaded to the website so check back for more.
  • If you are registered for the Summit not getting the emails from Mailchimp, please add “NAIIS” at info@izsummitpartners.org to your contact list
  • If you have any agenda items that you are interested in sharing with the Summit, please let us know and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org

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