By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Monday, June 7, 2010
Publication Date: June 5, 2010
From the Contra Costa Times, June 5, 2010. (Also appeared in the Pasadena Star-News and the Whittier Daily News , both on June 14)
HEALTH OFFICIALS in California just announced an unexpected uptick in cases of the mumps. Nine cases of the disease have already been reported in Los Angeles this year. Since 2007, the number of cases in a particular year had never exceeded seven.
Mumps can cause debilitating swelling and fever. As most parents know, a vaccine can easily protect a person from contracting the disease.
Yet, as Los Angeles public-health authorities know all too well, some people clearly aren't getting immunized. And more recently, mumps has swept through the Orthodox Jewish communities in Brooklyn, N.Y.
Many of the victims had failed to receive the recommended number of vaccinations, although some immunity is lost over time.
This isn't a problem confined to Los Angeles or Brooklyn. While it is customary for parents to make sure that their children get all the recommended vaccinations, many adults avoid getting their shots. As a result, tens of thousands of people contract vaccine-preventable diseases every year.
These diseases can be severe, or even life-threatening. And they cost our medical system and economy hundreds of millions of dollars a year.
By improving the vaccination rate among adults, America's leaders can stem the rise of costly, completely preventable diseases, improve public health, and even help revive the economy.
To see how, consider the human papillomavirus (HPV). It's the most common sexually transmitted infection in this country and is one of the leading causes of cervical cancer. Yet just 10 percent of the population that is most at risk of contracting HPV — women between the ages of 18 and 26 — has been vaccinated.
Consequently, more than 6 million young women are infected with HPV every year. Overall, two-thirds of women and about a quarter of men have been infected. The medical cost of caring for these people totals $4 billion annually.
Influenza — the common flu — is another disease that could be controlled by increased vaccination rates. Modern science has developed preventive vaccines for both the regular seasonal flu virus and "mutant" strains like H1N1 — commonly called "swine flu."
Despite the widespread availability of these options, about 40,000 Americans die every year as a result of complications brought on by influenza. The elderly have generally protected themselves against the flu — some 70 percent of the senior population has been vaccinated against the flu. But just 37 percent of young adults have been immunized.
The costs associated with medical care and lost productivity for those infected with influenza reach nearly $100 billion annually.
Hepatitis B's annual costs hit $700 million last year. A leading cause of liver cancer and cirrhosis, the disease claims the lives of roughly 1,500 people in our country every year.
More than 1.25 million Americans are infected with the Hepatitis B virus (HBV), with 5,000 to 8,000 new cases reported annually.
The standard three-dose HBV vaccination series has proved effective at protecting against the disease. Since the government started requiring that all children get HBV vaccinations in 1990, the incidence rate of acute cases of the disease has dropped 75 percent.
Yet only about a third of adults have been immunized. Not surprisingly, the rate of HBV infections is highest in adults aged 25 to 45.
Dozens of other, lesser well-known illnesses continue to compromise public health simply because adults haven't received the proper shots.
For instance, experts estimate that vaccination could prevent half of the deaths associated with pneumococcal disease, which can cause pneumonia and meningitis. And the new vaccine against shingles — a common cause of a chronic painful rash in older folks — is hardly being given at all.
So why aren't grown-ups getting their shots?
For starters, insurance coverage for vaccinations is spotty at best for most patients. Most private plans don't cover routine adult immunizations. When policies do provide coverage, high deductibles and co-payments often discourage people from following the recommended vaccination schedules.
Paying for these treatments on their own is simply not feasible for many people. Without insurance, a one-time vaccine can cost upward of $300.
There's also the issue of availability. Production levels of popular vaccines are sometimes inadequate to provide protection to all those who need them.
Americans witnessed this problem firsthand last year, when the demand for H1N1 vaccines far outstripped available supply. Many people were forced to wait to get immunized. (Of course, by the end of 2009 supply had outstripped demand to such an extent that it is likely that millions of doses will be discarded).
Another key problem is a lack of information about, and awareness of, the vaccines that adults should be getting — even among doctors.
Apathy on the part of adults and indifference on the part of their caregivers has led to the current situation of unacceptably low vaccination rates.
Adults overwhelmingly insist on having their kids up-to-date on their shots, but they are not so keen on getting their own.
Increasing the adult vaccination rate is a common sense way of improving public health in this country. Getting people immunized would help prevent serious illness, conserve scarce health care dollars and fuel economic productivity.
Dr. Elizabeth M. Whelan is the founder and president of the American Council on Science and Health, a public health, consumer-education consortium of more than 380 scientists and physicians.
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