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The US Adult Vaccination Gap: New Analysis Quantifies the Divide, Recommends Solutions
Vaccination rates among US adults are roughly half that of pediatric populations, exposing older adults to risk for disease and complications, according to a new analysis.
Adult vaccination rates in the United States continue to underperform despite significant advances in vaccine development and demonstrated efficacy data, according to authors of a new analysis by McKinsey & Company.1 Their research reveals that adult populations achieve approximately half the immunization rates observed in pediatric populations,2 a disparity that creates a persistent gap in preventive medicine that correlates with increased disease burden among older adults and those at increased risk for vaccine-preventable diseases.
©Shawn Hempel/stock.adobe.com
The downstream effects create substantial public health and economic consequences that require systematic intervention, the authors wrote.
The financial burden of this vaccination gap exceeds $27 billion annually in preventable infectious disease treatment costs, while simultaneously reducing workforce productivity across multiple sectors.3 Geographic disparities further illustrate the correlation between vaccination coverage and disease outcomes. Nevada's 23% pneumococcal conjugate vaccine coverage among adults aged 18 to 64 years corresponds with a mortality rate of 6.0 per 100,000 from pneumococcal disease, while Oregon and Massachusetts achieve mortality rates far lower--1.6 per 100,000 with coverage rates of 36% and 33% respectively.4,5
The lag in uptake is even more lamentable in the context of vaccine research and development, the authors point out. The majority of growth expected in the vaccine marketplace "is driven by the 40 percent of pipeline candidates targeting infectious diseases that disproportionately affect adults," they wrote.1 Innovation in adult vaccines also continues at a rapid pace with examples that include new therapeutic modalities, eg, mRNA vaccines. In fact, the McKinsey analysis found more than 70 mRNA candidates for adult vaccines in development as of March 2025.1
Root Causes
Three primary barriers impede adult vaccination uptake in current healthcare delivery systems.
The complexity of the market has increased substantially as multiple vaccine options are approved by the FDA for single disease areas, many tailored to specific age groups, risk factors, or comorbid conditions. Health care professionals (HCP) report difficulty navigating these options. A recent survey found more than one-third (38%) of HCP respondents expressing challenges in determining appropriate pneumococcal conjugate vaccine selection for individual patients.6
Consumer awareness represents a second critical barrier. Many adults lack knowledge of infectious disease risks and available preventive options, particularly as recommendation guidelines evolve, the authors said. As an example they point to the CDC's Advisory Committee on Immunization Practices recent expanded respiratory syncytial virus vaccine recommendations from adults aged 75 years and older to include all adults 60 and older plus high-risk adults between ages 50 and 59 years, requiring providers and patients to reassess eligibility criteria.7
Health care delivery has rapidly diversified beyond the traditional physician office visit. The McKinsey researchers cite March 2025 data from the CDC showing that retail pharmacies now administer approximately 85% of RSV vaccines and 75% of shingles vaccines.8 While this expansion increases accessibility, it may fragment responsibility for vaccination recommendations and monitoring across multiple care settings, authors cautioned.
The researchers propose 4 strategic interventions that "could foster the potential of adult vaccination."
First, manufacturers should create transparency into vaccine data and benefits. As vaccine choice becomes more complex for both clinicians and patients, vaccine manufacturers need to clearly communicate on efficacy, safety profiles, and the unique benefits of each product, particularly for HCPs who need simple, easy to navigate clinical guidelines that account for time-limited office visits. requiring simplified clinical guidelines.
Second, stakeholders, ie clinicians, health systems, public health organizations, need to build awareness of infectious diseases and availability of appropriate vaccines. The researchers highlight a scalable strategy used during the COVID-19 vaccine rollout that deployed digital immunization reminders to residents, resulting in 84% improvement in appointment adherence and 26% increase in vaccination rates.⁷
Third, meet consumers more effectively where they are. The expansion in vaccination sites broadens access and convenience but barriers remain and present opportunities for collaboration among health systems, employers, and consumer-oriented services, authors wrote. Strategies could include deploying mobile or pop-up clinics, offering extended appointment hours, integrating scheduling tools into consumer marketing channels, and tapping services like rideshares. These approaches are especially important for underserved populations, including those with limited income or mobility. The key is to eliminate obstacles between the HCP vaccine recommendation and the desired shot in the arm.
Fourth, the researchers suggest engaging with key opinion leaders and policymakers on vaccine benefits. Similar to the call to action for vaccine manufacturers, leveraging the expertise and position of physicians, scientists, and public health authorities to communicate evidence-based messaging to consumers on vaccine safety and efficacy can help raise awareness among and potentially increase engagement of vaccine-eligible adults.
Authors of the analysis suggest the proposed strategies could help establish improved benchmarks for adult immunization coverage and enhance population protection against major preventable diseases. Healthcare systems that integrate these approaches into existing workflows may achieve vaccination rates that more closely approximate pediatric immunization success while reducing the substantial economic and clinical burden of vaccine-preventable diseases in adult populations.
