Global Healthy Living Foundation Report Warns That Complex Vaccine Guidelines May Be Slowing Adult Immunization Rates

A new report, “Enhancing Adult Vaccine Uptake: Challenges in Shared Clinical Decision Making and Risk-Based Recommendations,” released by the Global Healthy Living Foundation (GHLF), investigates how certain CDC Advisory Committee on Immunization Practices (ACIP) vaccine policies—particularly Shared Clinical Decision Making (SCDM) and risk-based recommendations—are contributing to lower vaccination rates among adults, especially in underserved communities.

While intended to foster individualized care and thoughtful patient-provider dialogue, these policies often lead to ambiguity for both patients and health care professionals. The report details how misalignment with FDA labeling, insurance coverage confusion, and complex eligibility assessments can create real-world barriers that reduces vaccine uptake.

“Our goal with this report is not to dismiss the intent behind SCDM and risk-based guidance but to examine how these approaches work in real-world clinical settings,” said Robert Popovian, PharmD, MS, Founder of Conquest Advisors and GHLF’s Chief Science Policy Officer, who authored the report. “Unfortunately, the data show that these policies can create unintended barriers to immunization, particularly when providers lack full access to patient histories or are burdened by unclear reimbursement protocols. When policies lack clarity, the burden falls on providers and patients to navigate a confusing system—often with serious consequences. This report highlights how complexity in vaccine recommendations can delay or prevent immunization entirely.”

Key Findings

• Significant Drop in Uptake After SCDM: The PCV13 pneumococcal vaccine saw uptake decline from over 70% to under 60% following SCDM implementation, including among vulnerable and immunocompromised individuals.
• Stark Disparity Between Routine and SCDM Guidance: Only 11.9% of eligible adolescents received the Meningitis B vaccine under SCDM, compared to 60.8% of the same group who received the quadrivalent meningococcal vaccine (ACWY), which has a routine recommendation from ACIP.
• Equity Gaps Prompt Policy Reversal: The CDC’s SCDM policy for Hepatitis B was modified in 2022 after evidence showed suboptimal uptake among older adults and racial minorities—highlighting the failure of risk-based strategies to reach vulnerable groups.
• Provider Burden in Real-World Settings: Many pharmacists and non-primary care physicians lack access to full medical histories, making it difficult to apply complex criteria or verify patient risk—a critical issue given that nearly 90% of adult vaccines are now administered in pharmacies.

“These findings reflect a consistent and concerning pattern: when vaccine policy becomes overly complex or misaligned across agencies, it places undue pressure on frontline health care providers and leads to confusion for patients. As the U.S. continues to rely heavily on pharmacists and clinics for adult immunization delivery, ensuring that recommendations are practical, unified, and easy to implement becomes critical,” Dr. Popovian said.

Policy Considerations

• Simplify Advisory Committee on Immunization Practices Guidelines by shifting more SCDM and risk-based recommendations to routine ones for high-risk groups (e.g., adults over 60, persons with chronic conditions).

• Improve Alignment Between ACIP and FDA to reduce confusion among healthcare providers and ensure consistent messaging across federal agencies.

• Develop Practical Decision-Support Tools to help providers—especially pharmacists—quickly and safely determine vaccine eligibility.

• Educate and Empower Patients through public awareness campaigns focused on identifying personal risk and requesting appropriate vaccines.

• Offer Financial Incentives or Higher Reimbursement Rates for vaccine providers to counsel patients on vaccines with complex risk-based recommendations.

The complexity of current guidance—particularly around shared clinical decision making and risk-based recommendations—can have the unintended effect of excluding those who already face disproportionate barriers to care, including older adults, ethnic and racial minorities, and individuals in low-income or rural areas.

For more information and to access the full report, visit: https://ghlf.org/issues/vaccines/enhancing_adult_vaccine_uptake/

GHLF's Patient-Focused Economic and Policy Research Division:

At the Global Healthy Living Foundation, the Patient-Centered Economic and Policy Research Division conducts original research focused on health policy economics and outcomes research to better understand how current and proposed health policies, regulations, and legislation affect patients' financial, healthcare, quality-of-life, and other outcomes. We aim to increase transparency and understanding of the public health policies, regulations, and legislation impacting chronic disease patient communities by sharing our research via publication, our website, social media platforms, and conventional media. Our researchers also address these important topics through opinion editorials, speaking engagements, and our world-class podcast series – Healthcare Matters. Our experts have published extensively on the impact of biopharmaceutical and health policies on costs and clinical outcomes in the most prominent medical sources and media publications. They are sought-after speakers, providing briefings and expert reviews for the U.S. Congress, dozens of state legislatures, and at conferences and medical symposiums around the world. Learn more at https://ghlf.org/our-work/economic-policy-research/.

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"Our goal with this report is not to dismiss the intent behind shared clinical decision making and risk-based guidance but to examine how these approaches work in real-world clinical settings," Robert Popovian, Chief Science Policy Officer.