Ask an Expert: How Can Adults Stay on Top of Routine Vaccines?

Immunizations are a major part of childhood doctor’s visits. Between birth and age 18, the Centers for Disease Control and Prevention (CDC) recommends 15 different immunizations, several of which require four spaced-out doses, and one (DTaP) which requires five. But in adulthood, routine vaccinations can start to feel a little less routine. Some vaccines, like Tdap, need a booster every 10 years. (The CDC also recommends a dose of Tdap during each pregnancy.) Others, like the shingles (herpes zoster) vaccine, aren’t necessary until you’re 50.

A lot can happen during this time. Maybe a year goes by, and you forget to make a physical—and then another year goes by. Maybe you lose access to health insurance or live in a pharmacy desert. Or maybe nobody ever emphasized why vaccines were important in the first place.

Regardless of the reason, Jessica Shepherd, MD, Chief Medical Officer of Verywell Health and a board-certified obstetrician-gynecologist, has seen plenty of patients who are behind on their routine vaccinations. She explains how this happens, and how she encourages people to get back on track.

Verywell Health: In your experience, what is the biggest barrier to routine vaccinations overall?

Dr. Shepherd: Education and awareness are the biggest barriers. People still don’t have a firm grasp of what vaccines do or why they help. And vaccines can be confusing—there’s all different types, from inactivated vaccines to live attenuated vaccines and now, mRNA.

Some people don’t focus on the minutiae; they’re happy enough knowing a vaccine will protect them. But another school of people are vaccine hesitant because they’ve heard something. Maybe they’ve heard of a family member who got the flu shot and later got the flu.

I take this opportunity to tell this second group of people that a vaccine is not a cure. We’re not trying to say this is a cure, as that is not what it is. However, it will prevent you from experiencing the worst-case scenario: severe illness, hospitalization, and possible death. This is disease prevention. You don’t build a fire station after something is on fire. Preventative medicine is important—as we learned with COVID-19, we can’t wait until the community is burning down to address the problem.

Verywell Health: What is the biggest barrier to vaccination among minority populations? Is it the same barrier? 

Dr. Shepherd: Lack of education and lack of awareness are still barriers to vaccination rates in minority groups. But in certain communities, there are added barriers, too. In particular, access is an issue. People may want to get vaccinated, but there’s only one health center and the hours are limited. These access issues are the same type of issues that prevent certain minority communities from voting.

Verywell Health: In your own practice, do you see patients who are averse to a certain vaccine, in particular?

Dr. Shepherd: I definitely see hesitancy, especially with the HPV (human papillomavirus) vaccine. The HPV vaccine is just a little different from other routine vaccinations because it has a sexual connotation, since HPV is often (but isn’t always) transmitted through sex. And the hesitancy almost always comes from parents of potential vaccine recipients.

Parents may worry that if their daughter gets an HPV vaccine, will she start having sex too soon? I tell them it’s a good question, but within their own families, there should be a difference between how they’re going to talk about values in relation to intimacy and sex versus how they’re going to actively protect their kids against STIs. It’s really two different conversations, but I respect the fact that they might think getting a shot may influence their child’s sexual behavior. To alleviate these concerns, I compare it to birth control. We have good data that shows offering birth control before a female is sexually active does not influence her decision of what she starts having sex.

Still, at the heart of the matter, the questions surrounding the HPV vaccine are not so different from what I hear in regards to other vaccines: What’s it going to do to me/my child?

Verywell Health: Which vaccine seems “easiest” to encourage someone to get? 

Dr. Shepherd: As an OB, I highly recommend that pregnant people repeat their Tdap vaccine (a combination vaccine against tetanus, diphtheria, and pertussis) because most people do not follow the CDC recommendations of getting it every 10 years.

Pregnancy is the best time to capture people who are overdue for a Tdap vaccine, because I can explain to them that it’s not only protective for them, but also for their baby. This is mainly because of the pertussis—or whooping cough—component. Whooping cough is highly contagious and very dangerous for babies. It can be transmitted from an asymptomatic adult to an infant, and in the past, childhood pertussis cases were rising because adults weren’t getting their Tdap boosters. So most pregnant people are receptive to getting the Tdap vaccine.

Verywell Health: Have we learned anything from the COVID vaccine rollout that could help reduce vaccine hesitancy for other vaccines moving forward? In other words, will any tactics from COVID vaccine distribution change how providers talk about vaccines in general?

Dr. Shepherd: You get more vaccine buy-in from communities when illnesses impact them in some way. With COVID, everyone was impacted; nothing has ravaged society like COVID-19 other than polio. With that in mind, if we’re able to help people understand why booster shots are needed for COVID, we can remind them they’re needed for routine vaccinations, too.

If COVID vaccines needed to be updated to better target variants, it could help people understand how flu shots work, too, since different flu shots are administered every year to keep up with changing strains.

Verywell Health: Maybe someone has fallen off of regular checkups, or has bounced around from doctor to doctor over the years. How could someone begin to find out which routine vaccinations they even need?

Dr. Shepherd: The best way to start is to go to the CDC website and see what the immunization schedule is for your age. If you can’t remember whether you’ve had a vaccine or a vaccine booster within the recommended time frame, chances are you’re overdue. And if not, it won’t hurt you to get a booster dose of a routine vaccination slightly ahead of schedule.

I see this a lot with the HPV vaccine; people often can’t remember if they’ve had the third dose of the three-dose series. (Editor's note: the CDC only recommends two doses if vaccination is started at age 9 through age 14.) In that case, per CDC guidelines, we’re able to pick up where they left off without restarting the series

Verywell Health: What do you think is the most important thing to improve access to routine vaccinations? 

Dr. Shepherd: Access requires some degree of relationship—some type of healthcare provider on your side. It doesn’t mean you have to go to your doctor every month. But you should take the time to find someone who will advocate for you. Because if you’re ever in dire need, you won’t necessarily have time to find a doctor. You’ll want somebody in your corner.

Verywell Health: What about for people who don’t have health insurance or easy access to a doctor?

Dr. Shepherd: Some community health centers are devoted to having really strong vaccination programs, especially in populations that have a very global, diverse community. You may have smorgasbord of people from all over the world who are still exposed, or have been exposed, to diseases we don’t see much in the U.S. anymore, and if they don’t have a healthcare provider, a community health center can get them vaccinated.

Federally qualified health centers, in particular, offer vaccines to underserved communities and allow for payment on a sliding scale. They are more likely to have some of the routine vaccinations in stock than your corner pharmacy.