Workshop Explores Creative Methods of


Encouraging Adults to Get Shots


By Alicia Postema


Closing the Gap, Adult Immunizations Save Lives • November 1998


The Visiting Nurses Association in Denver, Colo., found a 

way to get adult American Indians to pony up for their shots. 

Offering pony rides for the children, families were drawn 

from as far as 40 miles. While their kids rode the ponies, the adults 

were provided education on immunizations and, if they so desired, 

were vaccinated. 

In another program to alleviate the need for transportation to an 

immunization clinic or physician’s office, the visiting nurses attended 

a number of pow-wows where they provided education on the importance of immunization, and administered vaccines. 

These are two of an increasing number of creative solutions to 

convincing adults to get their health protected with vaccines. With 

adult immunization rates sub-optimal, and a large portion of minority 

adults not receiving immunizations, it is becoming increasingly common to see large banners in local grocery stores and pharmacies encouraging people to get their influenza and pneumococcal vaccine. In 

many instances, beneath those banners are tables where people can sit 

down, between picking up the bread and milk, to receive immunizations. 

Yet another creative program sponsored by the Visiting Nurses 

Association made use of time spent in line waiting to vote. Election 

day, the first Tuesday of November, falls within the recommended 

time for administering flu vaccine. Members of the Visiting Nurses 

Association provided informative materials, obtained signed consent, 

and administered vaccine, while individuals were waiting in line. The 

need for an extra trip to an immunization clinic was alleviated. 

Recognizing that these immunization programs in “non-traditional” settings are becoming increasingly common, the National Vaccine Advisory Committee (NVAC) and the National Vaccine Program Office (NVPO) sponsored a public workshop on December 1 

and 2, 1997, to explore the use of non-traditional settings for adult 

immunizations. 

Workshop participants included members of NVAC and representatives from more than 50 organizations including federal and 

state agencies, community and professional organizations, and private 

companies. In addition to learning about creative immunization programs in non-traditional settings around the nation, the benefits and 

challenges associated with the programs were discussed. 

Have site? Will travel 

Pharmacies across the country are now becoming more actively 

involved in immunization activities. Pharmacists are acting as vaccine 

promoters, vaccine facilitators, and vaccine administrators by educating their clients about the importance of immunizations, hosting vaccine clinics and giving vaccine themselves. Twenty-five states now 

have statutes that allow pharmacists to administer vaccine. 

The Horizons program, a collaborative effort of 

HCFA’s Professional Review Organizations and 12 Historically Black Colleges and Universities in eight southern states, has shown that wherever people go, immunizations can go 

too. Under the project, immunizations have been offered to adults in 

more than 14 non-traditional settings including shopping malls, senior centers, voting sites, parks, and public housing projects. The goal 

is to identify successful interventions for increasing immunization 

rates among African Americans by focusing on community-based 

activities. 

A few creative spins on the concept of the home as a non-traditional setting for immunization have also been explored. Immunization clinics have been established within public housing complexes. 

Available medical personnel from nearby hospitals were brought in to 

administer the vaccine. 

This new version of the “house call” was particularly important 

to the elders living in these complexes, since transportation is often 

difficult for them. They were able to receive their shots without 

traveling beyond the complex. 

In Allentown, Pa, the Meals on Wheels program helped identify 

homebound elderly who might be in need of vaccine. Flyers about 

the flu vaccine were given to the Meals on Wheels office to be delivered to the elders along with their meals. Individuals expressing an 

interest in receiving vaccine were contacted by phone to verify eligibility and to set up a convenient time for a home visit in which they 

would receive vaccine. 

Anne Duerst of the Allentown Health Bureau explained their 

program to reach the homeless—a seldom-recognized, vastly 

underserved group that is at increased risk for vaccine-preventable 

diseases. She emphasized the importance of going to the population 

you are trying to reach, rather than having them come to you. 

They learned that the homeless often will not go to senior centers 

or other preexisting immunization sites for various reasons: 

• They don’t know where the sites are located. 

• They feel the shots are only for the elderly. 

The Allentown Health Bureau overcame this problem by going 

to soup kitchens, a site routinely visited by many homeless, to provide 

education on immunization and administer vaccine. 

Those are just some examples of creative programs being developed to reach underserved, at-risk adult populations. The point from 

these examples is that it is important to think about the particular 

characteristics of the population you are trying to reach. Where do 

they like to go? What do they like to do? In what type of situation 

would they feel most comfortable receiving vaccine, and from whom 

would they feel comfortable receiving it? Then you must tailor the 

program accordingly. 

continue to page 2>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Workshop Explores Creative Methods of


Encouraging Adults to Get Shots


By Alicia Postema


Closing the Gap, Adult Immunizations Save Lives • November 1998


Benefits 

Several benefits of using non-traditional sites for immunizations 

were identified. They include: 

•	 Accessibility and convenience. Going to those in need of vaccine, instead of making them come to you, saves them the hassle 

of scheduling an appointment and removes transportation limitations as a barrier. 

•	 Reduced cost. Influenza vaccine administered in a non-traditional setting ranges from $10-$15 and pneumococcal vaccine 

ranges from $15-$20. 

•	 Increase in overall awareness of the importance of adult immunizations. 

Challenges 

There are associated challenges as well. Challenges include assuring that: 

1)	 post-vaccination observation, which is crucial to identifying and 

treating anaphylactic (shock) reactions, occurs routinely and is of 

long enough duration; 

2)	 appropriately trained and skilled personnel are on-site to respond 

to any adverse reaction; 

3)	 primary care providers, the health department, and the vaccine 

recipient are provided with a record of vaccine received; 

4)	 lack of liability protection for providers is not a barrier to promoting or administering vaccine; 

5)	 state legal regulations do not restrict the operation of safe and 

effective immunization programs; 

6)	 immunization programs in non-traditional settings are integrated 

with patients’ “medical homes”, to minimize fragmentation of 

care and maximize utilization of other preventive health measures; and 

7)	 mission and motivation of those operating the program does not 

affect the quality of services provided. 

The NVAC and the NVPO recognized that although no formalized, coordinated effort to provide immunizations in non-traditional 

settings currently exists, many adults are already receiving vaccine in 

such settings. To determine the capacity of immunization programs 

in non-traditional settings for improving immunization rates in 

underimmunized adults, and to better ensure the safety of individuals choosing to be immunized in such settings, the NVAC is developing a set of recommendations for further research and a set of quality 

standards for immunization programs in non-traditional settings. 

In many ways, standards for immunization programs in nontraditional settings are congruent with those developed for programs 

in traditional settings; therefore, the standards NVAC is developing 

will consist of existing adult immunization standards with additional 

caveats unique to non-traditional settings. 

The power of immunization to save lives and spare suffering 

does not cease at childhood. As with childhood immunizations, adult 

immunizations are a cost-effective means of preventing disease. Creative programs, like those described above, could help to increase 

levels of immunization among adults, but many, including a large 

proportion of minorities, are still not receiving appropriate vaccinations. 

To realize these benefits, vaccines must be made readily available 

to the public. As the workshop demonstrated, several approaches are 

needed. Health care workers must be educated to the severity of 

vaccine-preventable disease and the safety and effectiveness of vaccination so they consistently offer vaccine to their patients. 

Enhanced educational efforts are needed to effectively empower 

adults to seek out preventive services such as vaccination. Also, the 

number and type of programs safely administering vaccine to adults 

need to be increased so that more individuals will be able to receive 

vaccine and avoid the consequences of contracting a vaccine-preventable disease. 

Alicia Postema is a policy fellow for the National Vaccine Program 

Office, Centers for Disease Control and Prevention.

Office of Minority Health Resource Center	 2 U.S. Department of Health and Human Services