The word “immunization” has long evoked images of nervous children wincing as they get injections to protect them from measles, mumps and other diseases.
Now California’s doctors are turning their attention to adults, who haven’t been as diligent about getting their own shots. The California Medical Association Foundation, the charitable arm of the Sacramento-based physicians’ organization, published a vaccine schedule last year to inform doctors and patients about recommended vaccines for adults.
Vaccines received as children, including for tetanus and diphtheria, wear off over time. The specific vaccines that are recommended by state and federal officials depend on age, health and travel plans.
Millions of people newly covered under the Affordable Care Act can get certain vaccinations — for the flu, tetanus, measles, hepatitis A and B, meningococcal disease and other illnesses — with no copay or other out-of-pocket cost.
The California Department of Public Health uses limited federal and state funds to provide vaccinations for both children and adults at community health centers and local health departments. Federal funding for the vaccination program, aimed primarily at the uninsured, dropped from $32 million in 2010 to $8 million in 2014, according to the department.
State public health officials said many adults don’t get vaccinated, even though immunizations can protect them against some dangerous diseases. They urge Californians to check with their doctors to figure out what vaccines they need.
The public health department also monitors vaccine-preventable diseases. In June, the department urged certain gay and bisexual men, and people with HIV, to get vaccinated against meningococcal disease following an outbreak in Southern California.
We recently spoke to Dr. Ruth Haskins, president-elect of the California Medical Association, about why vaccines are important for adults and what is being done to increase their vaccination rates. A condensed version of the conversation is below.
Q: Why has the California Medical Association taken on the issue of adult vaccines?
We think vaccines are important at all ages. There has been so much focus on the controversy about unvaccinated children and measles that people have sort of lost sight of the fact that there are vaccines that are important at every age and every stage.
Q: How big of a problem is the lack of vaccinations among adults?
It literally is a life-and-death issue. There are people dying from flu. It is completely preventable if everybody was to get the influenza vaccine during the flu season.
I see it in my practice on a regular basis as a gynecologist. When it comes to influenza, pregnant women’s resistance is down. Their immune systems are dimmed so they are more susceptible to getting the flu.
Q: What other vaccines are recommended for adults?
Shingles vaccine. Ninety-three percent of adults have had varicella in their childhood. If they had chicken pox as a child, it can come back as shingles as an adult. It can cause blindness, it can cause pain that is not consolable and it can also cause death. It is preventable with a vaccine. The simple varicella vaccine is very effective at preventing shingles.
By the time they reach 80 to 90 years old, 50 percent of people not vaccinated will have an episode with shingles. That is huge. Because our life expectancy, especially as women, is 85 now, it is very important for older women to get the shingles vaccine.
The other vaccine that affects me as a gynecologist every single day is [for] pertussis. If adults who are around newborns were vaccinated and if pregnant women were to get the pertussis vaccine, that would help to protect children. The youngest are the most vulnerable. Babies between 0 and 6 months old don’t have the capacity to form antibodies to respond to the vaccine, but they are absolutely at risk of getting pertussis.
Every resource recommends that all pregnant women have the influenza vaccine during flu season and have the pertussis vaccine during their pregnancy to protect their unborn child. Despite all of our efforts, only about 30 percent of women are getting it.
Q: It’s not just pregnant women who need these vaccines, right?
For shingles, all adults over age 50 should consider it. All people, as long as they don’t have a contraindication, should have the influenza vaccine.
Q: Why don’t more adults get vaccinated?
I think it is misinformation. I think they are looking at the sensationalized information about the folks who are … against vaccines. They are paying more attention to the stuff that makes headlines than they are to their own physician, who only cares about public health.
At the California Medical Association Foundation, our role is to educate people that you don’t get the flu from the flu vaccine. And absolutely the flu vaccine does not cause autism or cause diseases. It helps prevent you from getting influenza. But more than that, it helps everybody else in the population from getting influenza.
Q: Is there also a sense of invincibility — people thinking they aren’t going to get the flu or they aren’t going to get shingles?
The thing I hear most often among my patients is, “I’ve never had the flu before so I’m not getting the vaccine.”
That just really ignores herd immunization — the fact [is] that the more who are vaccinated, the less you see the disease.
Q: How could the public service announcement help increase vaccination rates among adults?
I hope it starts to get people talking. I hope that just seeing the happy faces on the [public service announcement] of people getting vaccinated, especially people of a variety of ages and stages of life, they recognize it’s not just for kids.
The take-home message I wish everybody would have from the [public service announcement] is “Maybe I should be getting vaccinated, maybe it’s for me too.” These are adults who are happy and healthy. It’s not just for sick people, and it’s not just for kids.
Q: What else is being done to increase vaccination rates among adults?
A good electronic medical record system will prompt a physician to give the vaccines when they are due. Even better systems send out widespread notices to patient populations automatically to tell them it’s time for their flu vaccine.
More than that, there is more peer pressure that if you don’t vaccinate your patient population, you will be judged. Eventually that will be one of the markers for how much you get paid.
We also supported bills through the [California] legislature that allowed pharmacists to give vaccines. So now pharmacists are able, willing and compensated for giving vaccines as well.