Vaccine Policies and Programs for Reaching Older Adults in the United States: Considerations for Vaccine Access and Ethics

Older adults constitute a highly heterogeneous yet very important group for vaccination in the U.S. because they are at higher baseline risk for infectious diseases. A number of vaccines are available to prevent serious sequelae from infectious diseases and are specifically recommended for adults 65+. These vaccines include the shingles vaccine (recommended for adults 50+); pneumococcal vaccines; an array of different options for the influenza vaccine (including high-dose and adjuvanted products to stimulate a stronger immune response for older adults); and the Covid-19 vaccines. Different policy and programmatic strategies have been employed to reach older adults in the U.S. with vaccines, and measurements of progress on public health vaccination goals – including ethics goals derived from moral principles that are tenets of promoting public health – are critical for evaluating success of these strategies. This dissertation looks at questions of access to different vaccines for older adults through two different pharmacy-based approaches and critically analyzes how well current vaccine data pipelines and repositories are allowing measurement of ethically important public health goals of vaccination for this population