Decline in Receipt of Vaccines by Medicare Beneficiaries During the COVID-19 Pandemic

United States, 2020

Kai Hong, PhD; Fangjun Zhou, PhD; Yuping Tsai, PhD; Tara C. Jatlaoui, MD; Anna M. Acosta, MD; Kathleen L. Dooling, MD; Miwako Kobayashi, MD; Megan C. Lindley, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(7):245-249. 

In This Article

Discussion

Before the March 13, 2020, COVID-19 national emergency declaration, the weekly rate of receipt of PPSV23, Td/Tdap, and RZV** among Medicare beneficiaries aged ≥65 years in 2020 was consistently higher than that in the corresponding 2019 week. Because the Advisory Committee on Immunization Practices voted in June 2019 to stop recommending PCV13 for adults aged ≥65 years,†† vaccination with PCV13 among this population declined in 2020 compared with that in 2019. Since the declaration, rates of adult vaccination with these three vaccines and PCV13 were substantially lower than were those during the corresponding period in 2019, with steady recovery after mid-April 2020. These findings are consistent with previous reports of declines in routine pediatric vaccine ordering and vaccine administration[6] and childhood vaccination coverage[7] during the pandemic. Declines were similar across all racial/ethnic groups; however, the magnitude of recovery varied by race and ethnicity and vaccine. Vaccination rates among racial and ethnic minority adults were lower than were those among White adults.§§ The COVID-19 pandemic has disproportionally affected certain racial and ethnic minority groups directly;[8] therefore, monitoring and early intervention to mitigate similar disparities in indirect effects of the pandemic, such as use of other preventive services, might be needed to avoid compounding this disparity.

The findings in this report are subject to at least three limitations. First, the analysis included only Medicare beneficiaries in a fee-for-service plan, which represents approximately 66% of total Medicare beneficiaries; therefore, the findings might not be applicable to all older U.S. adults, who might also have a different racial or ethnic distribution. Second, vaccination was identified on claims data submitted for reimbursement. Vaccination claims not accounted for were those that were not submitted yet or were not billed to Medicare. Finally, race/ethnicity groups other than White and Black could be potentially misidentified in the Medicare administrative enrollment records;[9] therefore, actual declines in vaccination among those groups might be different from those reported.

Because all 50 states had begun lifting business restrictions or stay-at-home orders in some way by August 2020,[10] the likelihood of exposure to infectious diseases, including vaccine-preventable diseases, is increasing.¶¶ Levels of SARS-CoV-2 virus circulation and associated illnesses increased during September 2020–January 2021.*** In response, some jurisdictions reissued lockdown policies,††† which might have affected observed recovery in vaccination rates. As the pandemic continues, vaccination providers should continue efforts to resolve disruptions in routine adult vaccination.[3] When resuming in-person visits, vaccination providers should take actions to prevent the spread of SARS-CoV-2 and address patient concerns about exposure to SARS-CoV-2 during visits. Vaccination providers should also provide reassurance that vaccination services (including influenza vaccination to mitigate non-COVID respiratory illness and preserve health care capacity to treat COVID-19 during the influenza season) can be delivered safely and emphasize the importance of routine vaccination to protect patient health. It is important that vaccination providers counsel patients about expected reactogenicity of some vaccines, such as RZV, to help them understand the potential overlap between vaccination reactions and symptoms of COVID-19. Ultimately, continued efforts by vaccination providers and public health officials at all levels, including specific vaccination guidance for providers by state health departments,§§§ will be needed to ensure that routine adult vaccination returns to prepandemic levels to optimize protection of all older persons against vaccine-preventable diseases. Now that safe and effective COVID-19 vaccines are available, those efforts could also help older U.S adults obtain COVID-19 vaccination.

**The prepandemic weekly RZV vaccination rates in 2020 were notably higher than those in the equivalent week of 2019, likely because RZV was recently approved and recommended: In October 2017, RZV was approved by the Food and Drug Administration and recommended preferentially over Zoster Vaccine Live by ACIP for use in immunocompetent adults aged ≥50 years. https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm?s_cid=mm6703a5_w
††On June 26, 2019, ACIP voted to stop recommending routine PCV13 use among adults aged ≥65 years. Instead, ACIP recommended administration of PCV13 based on shared clinical decision-making for adults aged ≥65 years who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant, and who have not previously received PCV13. https://www.cdc.gov/mmwr/volumes/68/wr/mm6846a5.htm?s_cid=mm6846a5_w
§§ https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html
¶¶Persons can contract varicella zoster virus, the virus that causes zoster, from someone who has zoster. If the infected persons never had chickenpox or never received the chickenpox vaccine, they will develop chickenpox, and perhaps then develop zoster later in life. However, zoster cannot be contracted from someone who has zoster. https://www.cdc.gov/shingles/about/transmission.html
***https://www.cdc.gov/coronavirus/2019-ncov/covid-data/pdf/covidview-02-05-2021.pdf
††† https://www.chicago.gov/content/dam/city/sites/covid/health-orders/2021/2021.1.20-Stay-at-Home-Advisory.pdf
§§§Washington: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PleaseContinueVaccinatingPatients.pdf; Massachusetts: https://www.mass.gov/doc/encouraging-vaccination-during-the-covid-19-pandemic/download

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