Why GAO did this study. The U.S. has made significant progress against vaccine-preventable diseases. However, gaps in receipt of recommended vaccinations— especially among adults—has resulted in preventable disease, disability, and death. While children are guaranteed coverage of routine vaccines, certain adults have limited vaccine coverage, or may face out of pockets costs that contribute to lower vaccination rates. The COVID-19 pandemic has also contributed to a decline in the receipt of routine vaccines. GAO was asked to review vaccination rates, as well as how the federal government and states address coverage of routine vaccines. This report describes estimated adult vaccination rates; factors that could affect such rates; state programs that provide free vaccines to adults; and HHS efforts to improve adult vaccination rates. GAO (1) analyzed national survey data for 2019 and 2020—the most current available at the time—on the receipt of four routine vaccines at the ages recommended for all adults: 18 years and older for flu and tetanus, 50 years and older for shingles, and 65 years and older for pneumococcal; (2) interviewed 13 stakeholders representing a range of perspectives on vaccination, including providers and vaccine manufacturers; (3) collected information from all states on programs that offered free routine adult vaccines; and (4) reviewed HHS documents and interviewed HHS officials. HHS provided technical comments on a draft of this report, which GAO incorporated as appropriate.
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