Findings from Recent Consumer and Health-Care Provider Surveys Adelphi Research by Design

1. Barriers to Adult Immunization Findings from Recent Consumer and Health-Care Provider Surveys Adelphi Research by Design supported by sanofi pasteur David R. Johnson, MD, MPH NVAC Meeting Director, Scientific & Medical Affairs October 22, 2007 sanofi pasteur Washington DC

2. Objectives, Focus, Methodologies • Undertaken to provide assessment of reasons US adults do not get recommended vaccines & to inform efforts to increase rates • Focus on influenza, pneumococcal & Td vaccines • Structured telephone interviews during Sept & Oct 2006 • 2002 consumers • Consumers selected using Random Digit Dialing sampling • Data weighted to approximate US population characteristics • 200 health-care providers (HCP) • 100 primary care physicians • 33 physician assistants, 33 nurse practitioners, and 34 registered nurses • Recruited through a national database • Sampling error • Total consumer sample: ±2.2% [95% CI] • Health-care provider sample: ±9.8% [95% CI]

3. Key Finding: Provider Recommendations Are a Critical Factor in Consumer Decisions • 80% of consumers are likely to follow a health-care provider’s recommendation to get a vaccine; unfortunately, most consumers never talk to their HCP about vaccines • Percent who are aware of the vaccine, but have never talked to their HCP about: • Pneumococcal vaccine by target population: • ≥65 years of age (56%) • Chronic illness or condition (45%) • Tetanus vaccine (69%) • Influenza vaccine (61%) • Among the listed reasons consumers do not get vaccinations, “My doctor has not told me I need it” is cited often: • Pneumococcal (53%) • Tetanus (51%) • Influenza (39%)

4. Key Finding: HCPs and Consumers Have Different Perspectives on Why People Forego Vaccination Percent Citing Side Effects Consumers 64 Health-care Providers 38 37 16 13 4 Vaccine Consumers: What are the main reasons you might not get a (vaccine name) as recommended? HCPs: What are the main reasons that might prevent the adult patients in your practice from getting each vaccine as recommended?

5. Reasons Consumers Forego Vaccination: Tetanus, Aided Responses* Yes, that is a reason (%) *Would you say [REASON] is a reason you have not received a tetanus vaccine as recommended?

6. Key Finding: Consumers Lack Awareness About Adult Vaccines • At best, fewer than half of consumers believe they will need a particular vaccine in the future: • Influenza (46%) • Pneumococcal (19%) • 30% do not know or do not believe they will need any vaccinations in the future • Consumers are unaware of vaccine recommendations • Which adults need an influenza vaccine? • Seniors, elderly, and adults ≥65years of age (44%) • All adults (31%) • Adults ≥50 years of age (7%) • 51% do not believe all adults need a tetanus vaccination • Substantial numbers of consumers do not believe they are at risk of getting ill if they are not vaccinated

7. Key Finding: There Are Gaps in HCP Knowledge and Practices • Immunization schedules are issued annually by the CDC*, based on input and guidance from a 15-member expert panel (ACIP†) • 40-44% of HCPs do not make use of these resources • Mild to moderate illnesses, even with fever, do not contraindicate vaccination • 26-30% believe sick patients should not be vaccinated, regardless of severity of illness • All adults ≥50 years of age should get an influenza vaccine annually • 72% MDs, 85% NP, PA, and RN do not correctly identify people in this age group as recommended for annual vaccination • A tetanus booster is recommended every 10 years for adults • 19% MD, 21% NP, PA, and RN are not aware of or do not believe a booster is necessary every 10 years *CDC=Centers for Disease Control and Prevention; †ACIP=Advisory Committee for Immunization Practices

8. Key Finding: Lack of Regular Well-care Visits is a Barrier to Vaccination • 24% of consumers have not had a well-care visit >12 months; likelihood varies by gender, age, health: • Men (33%) vs. women (17%) • Age: 19-34 years (30%) and 35-44 years (32%) versus ≥65 years (11%) • Excellent or very good health (27%) versus good, fair, or poor health (21%) Likelihood of HCPs Discussing & Recommending Vaccines by Visit Type* *HCP self-report

9. Key Finding: Cost Is Not a Major Barrier to Adult Immunization Consumers Citing Cost as a Barrier, by Vaccine *What are the main reasons you might not get a(n) influenza, pneumococcal, or tetanus vaccine? †Would you say (cost) is a reason you have not received a(n) influenza, pneumococcal, or tetanus vaccine?

10. Consumer Sub-population Differences by Insurance Status Consumers citing cost as a barrier to vaccination

11. Summary: Survey Indicates Main Consumer Barriers Relate to Knowledge • Major barriers include • Lack of health-care provider recommendations • Lack of consumer, and even health-care provider, knowledge about vaccines • Absence of well-care visits for many consumers • Cost appears to be a less important barrier, even among those most sensitive to it • Variations in cost sensitivity seen among those with lower incomes and no insurance

12. Strategies to Increase Immunization Rates • Increase awareness • Large percentage of consumers, and even health-care providers, are unaware of immunization schedules and recommendations • Increase knowledge • Vaccines are safe and effective • Vaccine-preventable diseases (VPD) are serious • Encourage health-care providers to routinize adult immunization • Health-care provider recommendations will have a strong, positive effect on patient vaccination decisions • Health-care providers are best situated to dispel consumer fears and misconceptions about vaccines and VPDs • Expand first-dollar insurance coverage • Support increased private sector vaccination coverage as part of routine care