Few medical innovations have affected global health as profoundly as vaccines. Even after the recent global pandemic, the vaccine industry continues to address both long-standing and emerging needs. Excluding the commercial success of COVID-19 vaccines, the global vaccine market has grown roughly 10 percent annually since 2003 and is projected to reach $78 billion by 2030.1 Much of this expected growth is driven by the 40 percent of pipeline candidates targeting infectious diseases that disproportionately affect adults (Exhibit 1), such as the Epstein-Barr virus and Zika virus. Innovation in adult vaccines also remains strong, as demonstrated by the emergence of new therapeutic modalities such as mRNA vaccines—as of March 2025, more than 70 mRNA candidates are in development—and by growing interest in vaccines for noninfectious diseases, including certain types of cancer.2
Even so, adult vaccination rates in the United States have failed to keep pace with innovation. Adult flu vaccination rates, for example, remain consistently low, hovering between 37 and 50 percent over the past decade.3 Undoubtedly, the potential benefits of vaccines for individuals and for public health can only be fully realized when uptake is high and widespread across the population.
In our 2024 article on sustaining and accelerating vaccine innovation, we proposed five targeted actions the global vaccine ecosystem could take to boost adult vaccination rates and stabilize commercial demand. In this article, we outline four potential strategic actions that vaccine manufacturers, retail pharmacies, healthcare organizations, and other stakeholders in the US vaccine ecosystem could deploy to reimagine their go-to-market models and lower the barriers to adult vaccination.
Impact of lagging vaccination rates
Despite current evidence of vaccine efficacy and safety, adult vaccination rates remain considerably lower than pediatric rates in the United States (Exhibit 2). Adult populations exhibit roughly half the immunization rates of children, for whom there is an established immunization schedule.4 This disparity creates a persistent coverage gap that correlates with higher disease burden among older and at-risk adults.
The gap is not just statistical—it is consequential, contributing to more than $27 billion spent annually on preventable infectious disease treatment and placing an additional burden on workforce productivity.5 In addition, higher vaccination coverage has been shown to reduce mortality rates associated with diseases across regions in the United States. Nevada, which had a 23 percent coverage rate for the pneumococcal conjugate vaccine (PCV) among adults aged 18 to 64 in 2022, recorded a mortality rate of 6.0 per 100,000 from pneumococcal disease. By contrast, Oregon and Massachusetts, which had higher vaccination coverage (36 percent and 33 percent, respectively), reported a far lower mortality rate of 1.6 per 100,000.6
Factors contributing to low adult vaccination rates
Efforts to improve adult immunization should start with a clear understanding of the root causes behind persistently low uptake. Three structural barriers to adult vaccination stand out.
Increasing market complexity
The adult vaccine market is expanding, with several vaccine options available for the same disease area—many tailored to specific age groups, risk factors, or health conditions—and even more advancing through the development pipeline (Exhibit 3). Although multiple consumer options can spur innovation among manufacturers, a plethora of choices also makes decision-making more difficult for both consumers and healthcare providers (HCPs). A 2022 survey of HCPs revealed that 38 percent of them reported challenges understanding which type of PCV vaccine to offer to which patient.7
Low consumer awareness of eligibility
Many adults have low awareness of infectious diseases and available vaccines; as a result, some adults are not sure which vaccines are recommended for them (Exhibit 4). For example, the CDC’s Advisory Committee on Immunization Practices (ACIP) recently shifted from recommending the respiratory syncytial virus (RSV) vaccine for all adults aged 75 and older with shared decision-making to recommending it for all adults 60 and older, as well as high-risk adults between 50 and 59.8 These changes require HCPs and consumers to reassess eligibility.
Evolving and diverse sites of care
The expansion of vaccination sites beyond traditional medical settings such as physician offices has increased accessibility. Today, adult vaccines are increasingly administered across a wide array of settings, including workplaces, mobile clinics, and faith-based organizations,9 though the largest increase has been at pharmacies (Exhibit 5). For example, roughly 85 percent of RSV vaccines and 75 percent of shingles vaccines are now delivered through retail pharmacy channels.10 Although enhanced access options enable the healthcare industry to meet consumers where they are, they may also lead to a dispersal of responsibility in recommending and monitoring vaccinations.
Potential future strategies
These four strategies could foster the potential of adult vaccination:
- Create transparency into vaccine data and benefits. Given the increased complexity around vaccine choice and eligibility, manufacturers should consider how to deliver clear, transparent information that provides clarity on the efficacy, safety, and the unique benefits of each vaccine, especially for HCPs, who need simplified, easy-to-navigate guidelines.
- Further awareness of infectious diseases and availability of appropriate vaccines. Supporting consumer awareness can help increase vaccine understanding in this environment, which can be enabled by scalable and streamlined communications. For example, stakeholders could send digital reminders to ensure appointment adherence, such as text-based reminders, which boosted appointment rates by 84 percent and vaccination rates by 26 percent during the COVID-19 vaccine rollout.11 Tools, such as the Walgreens Flu Index to predict outbreaks, can also be used to educate high-risk populations, ensuring that vaccine awareness and reminders reach those who would most benefit from the information.
- Meet consumers more effectively where they are. The increased diversity of vaccination sites has broadened access and increased convenience for consumers. Cross-industry stakeholders can make vaccinations more convenient by exploring partnerships with a wide array of health systems, employers, and consumer-facing services such as rideshares. This could increase access through pop-up clinics, off-hour appointments, marketing collaborations to link to scheduling tools, and convenient transportation options—efforts that are particularly beneficial for low-income or mobility-challenged populations. In this evolving landscape, stakeholders can work together to streamline consumer activation—for example, by eliminating obstacles between HCP vaccine recommendations and consumers self-scheduling at retail pharmacies.
- Engage with key opinion leaders and policymakers on vaccine benefits. Maintaining transparent engagement with key opinion leaders and policymakers to bolster public health initiatives aimed at disseminating vaccine information and enhancing accessibility can help to build vaccine awareness and inform decision-making. Manufacturers, healthcare institutions, and research organizations should consider how to provide robust, evidence-based data on vaccine efficacy and safety throughout the approval and recommendation process—essential steps to reinforcing the role of vaccines in public health.
The strategies proposed above will be important in enabling the potential for adult immunization. Sustained implementation of these strategies could establish a new benchmark where adult vaccination is significantly improved and the public is better protected against major preventable diseases.
