Operationalizing CDC-Recommended Vaccinations for Adults Is at a Critical Point in Time

Carolyn Bridges, MD and Litjen (L.J) Tan, MS, PhD, Immunize.org

Even prior to the onset of the COVID-19 pandemic, adult vaccination coverage rates were poor, reflecting large gaps in adult immunization infrastructure for implementation of routine vaccinations.   These gaps left the U.S. unprepared to quickly and efficiently respond to a national vaccination emergency during the pandemic,1 requiring just-in-time investments to develop the infrastructure and systems for a COVID-19 immunization program which required real time or near real time tracking of vaccine inventory, provider enrollment, and vaccine doses administered across the U.S.2Despite the limited adult vaccination infrastructure, heroic efforts by public health, medical and pharmacist providers, and community organizations helped deliver and administer hundreds of millions of COVID-19 vaccine doses.

Unfortunately, the COVID-19 pandemic took a toll on already low routine adult immunization rates, resulting in dramatically fewer routine adult vaccines administered between 2020 and 2022. Low adult vaccination coverage further impacted by COVID-19 led to the urgent issuance of a Call to Action to improve adult immunizations developed by the partners of the National Adult and Influenza Immunization Summit and endorsed by the Centers for Disease Control and Prevention.3

As the country emerges from the depths of the pandemic, we now have an opportunity to sustain adult immunization efforts developed during the pandemic and utilize them for all ACIP/CDC recommended adult vaccines, including COVID-19 vaccines. This point in time is particularly important because there are new adult vaccination recommendations and less than 1 in 4 adults are currently up to date on routine vaccinations.  We now have many vaccines recommended by CDC for adults based on their age. These include:




2-dose primary series followed by bi-valent booster

Hepatitis B

For adults less than 60 years of age, one primary series of vaccination


15 through 26 years of age, 3-dose series


1 dose annually

Pneumococcal Vaccination

1 dose PCV15 followed by PPSV23; OR 1 dose PCV20, for those age 65 years and older and those age 19–64 years with chronic medical conditions or other risk factors


1 dose Tdap, then Td or Tdap booster every 10 years


For those age 50 years and older, 2-dose series of recombinant zoster vaccine, 2–6 months apart

Additionally, there are new adult vaccines on the horizon, such as for RSV, that may be added to the ACIP schedule.  The number of vaccines, new age and medical condition indications for vaccines, and new vaccines on the horizon all point to the critical need for establishing system-wide programs that implement routine adult immunization for adult patients.

Operationalizing should begin with the National Vaccine Advisory Committee’s Standards for Adult Immunization Practice.4 These recommendations state that all healthcare providers of adult patients should:

  1. Assess the vaccination status of patients at all clinical encounters;
  2. Identify vaccines patients need, then clearly recommend needed vaccines;
  3. Offer needed vaccines or refer patients to another provider for vaccination;
  4. Document vaccinations given; and
  5. Measure vaccination rates of providers’ patient panels.

Also, the National Adult and Influenza Immunization Summit has developed a tip sheet for providers on new CDC adult vaccine recommendations and tools to help adults get, and catch up on, their recommended vaccinations.5

Critically, the Inflation Reduction Act has removed many of the cost barriers to vaccination for older adults and adults on public insurance. Effective January 1st, 2023, adult vaccines recommended by the ACIP are available to people with Medicare Prescription Drug Coverage (Part D) at no cost to them. Included in this improved coverage are vaccines with shared clinical decision-making recommendations and travel vaccines.6 Effective October 1st, 2023, adults in Medicaid also will be guaranteed coverage of ACIP-recommended vaccines at no cost, although the details about how this will be implemented in the states are not yet available.

Healthcare systems have an important responsibility to develop year-round immunization programs that will assess and provide recommended vaccines to the adult patient. The time is ripe for a concerted national effort to sustain the adult immunization infrastructure established for COVID-19 immunizations and protect our adults from vaccine-preventable morbidity and mortality and our country from billion of dollars of healthcare costs.


  1. Making Prevention the Priority — How to Boost Adult Immunization Rates. Available at: https://www.izsummitpartners.org/content/uploads/2017/06/making-preventative-priority-becker-hospital-review-2017.pdf.
  2. Vaccinating America: The Inside Story behind the Race to Save Lives and End a Pandemic. Available at: https://ajph.aphapublications.org/doi/book/10.2105/9780875533339.
  3. A Call to Action to Protect All Adults from Vaccine-Preventable Disease and Disability. Available at: https://www.izsummitpartners.org/call-to-action-adult-immunizations/
  4. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904889/.
  5. Get Adults’ Vaccinations Back on Track; Tip Sheet for Providers on New CDC Adult Vaccine Recommendations and Tools to Help Adults Catch Up on Needed Vaccinations. Available at: https://www.izsummitpartners.org/content/uploads/Tip-Sheet-on-New-Adult-Vaccine-Recommendations-and-Implementation-Resources.pdf.
  6. Medicare Part D Eliminates Recipients’ Out-of-Pocket Costs for All ACIP-Recommended Vaccines Starting January 1, 2023. Available at: https://www.immunize.org/express/issue1672.asp#IZX1.

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