Despite the availability of effective vaccines, pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year. This is due in part to many eligible patients not receiving a pneumococcal vaccine. For instance, a CDC survey found that only 64% of adults over the age of 65 and 23% of adults 19-64 who were at high risk received a pneumococcal vaccine in 2022. Additionally, Black (54%), Hispanic/Latino (42%) and Asian (50%) adults 65 or older have significantly lower pneumococcal vaccination rates than white (69%) adults. These current rates of pneumococcal vaccination leave a significant number of adults vulnerable to pneumococcal disease.
Common reasons for low vaccination rates include knowledge about who is eligible, potential side effects and misconceptions around vaccine safety. However, healthcare providers are uniquely positioned to help increase these numbers because most patients trust their guidance. In fact, studies have shown that strong provider recommendations are a key driver of vaccine uptake. That is why the Standards for Adult Immunization Practice recommends that the vaccination status of every patient be assessed at each encounter. This way, providers can encourage patients who are not up to date to get vaccinated and answer any questions they may have. We surveyed a number of healthcare providers to see what their patients’ top concerns about the pneumococcal vaccine were and how they suggested addressing them.
Confusion about Eligibility
Many patients are unaware that in 2024, the CDC lowered the age recommendation for routine pneumococcal vaccination from 65 years old to 50 years old, making many more people eligible for this potentially life-saving immunization. “Many people do not know the new CDC recommendation for pneumococcal pneumonia vaccination for healthy adults over 50,” Dr. Felix Aguilar said. “This is for anyone who has never received any pneumococcal conjugate vaccine or whose previous vaccination history is unknown.”
Adult patients 19-49 with certain underlying medical conditions or risk factors, including asthma, chronic obstructive pulmonary disease, chronic heart disease, diabetes and cigarette smoking are also eligible for vaccination. “Vaccination eligibility is a very confusing area right now,” Dr. Meilan Han agreed. “Physicians need to be up to date on the latest recommendations so that they can guide their patients.”
Worry about Side-Effects and Causing Pneumonia
Many patients worry about receiving vaccines because they do not understand the rigorous testing process that every vaccine goes through before they are approved by the FDA. This may require healthcare providers to explain that the testing process specifically looks at the safety and effectiveness of vaccines. After the FDA approves a vaccine for use, the CDC looks at vaccine safety and effectiveness data, how serious the disease the vaccine is indicated for is and if the vaccine will benefit a lot of people. The CDC is tasked with recommending or not recommending a vaccine. Once a vaccine is recommended, both the FDA and CDC continue to monitor vaccines for safety using several different safety monitoring systems.
A common misconception is that vaccinations can cause someone to get the illness they are trying to vaccinate themselves against. It is so important for healthcare providers to clear up this misunderstanding as it relates to inactivated pneumococcal vaccines. “I always reassure my patients that pneumococcal vaccines cannot cause the disease but help teach the immune system how to target and build a defense against it,” Dr. Aguilar explained.
Some patients will have side-effects, however, but talking with them up front about what to expect is a great way to inspire confidence.
Understanding How and Where to Get a Pneumococcal Vaccine
According to 2023-24 National Immunization Survey data, adults who are Black or Hispanic/Latino were more likely to get their flu vaccine in a medical setting versus a pharmacy setting. A separate study found that the doctor’s office/HMO was the most-preferred place to get a vaccine despite most vaccinations being given at stores/pharmacies. But most providers agree that it doesn’t matter where a patient receives the vaccine, as long as they are comfortable. “I recommend they get vaccinated at a location that is most convenient for them, whether it's a doctor's office or a local drugstore, both are safe and efficient,” Dr. Aguilar agreed. A strong recommendation and referral by a trusted healthcare provider is key to patient vaccine acceptance.
Concerns About Cost
Cost can be a barrier to getting preventive care for patients. Currently, most health insurance plans cover all ACIP-recommended immunizations including pneumococcal vaccines. In 2023, two important changes to vaccine coverage allowed more adults to access recommended vaccines without cost. As of January 2023, adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) were covered by Medicare Part D at no cost. By October 1, 2023, all state Medicaid programs were required to cover ACIP recommended vaccines for adults without cost sharing. However, if a patient is uninsured, cost will vary depending on the vaccine received. Providers should encourage patients to talk with their insurance company to determine the best course of action.
What Healthcare Professionals Can Do
Being well-equipped to address misinformation, discuss the benefits versus risks of vaccination and explain preventable disease severity is a great way to create trust and ensure your patients are getting the vaccines they need. Providers can use the SHARE approach, motivational interviewing techniques and the presumptive approach to make a strong recommendation. Learn more strategies to increase vaccine confidence, resources and patient education materials at Lung.org/hcp-pneumococcal.
This content was developed in collaboration between the American Lung Association and Pfizer Inc.
Blog last updated: February 25, 2025
