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

2. 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. 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. 4 Key Finding: HCPs and Consumers Have Different Perspectives on Why People Forego Vaccination Percent Citing Side Effects 13 16 4 64 38 37 Consumers Health-care Providers 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. 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. 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. 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. 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%) Well-care Visit (%)Acute-care Visit (%) MD7329 PA, NP, and RN7742 Likelihood of HCPs Discussing & Recommending Vaccines by Visit Type* *HCP self-report

9. 9 Key Finding: Cost Is Not a Major Barrier to Adult Immunization VaccineUnaided* (ranking)Aided † (ranking) Influenza7% (5)18% (10) Pneumococcal3% (6)14% (11) Tetanus7% (6)17% (9) 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. 10 Consumer Sub-population Differences by Insurance Status Consumers citing cost as a barrier to vaccination Unaided (%)Aided (%) InsuredUninsuredInsuredUninsured Tetanus4171038 Influenza3181334

11. 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. 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