Exploring the future adult vaccine landscape-crowded schedules and new dynamics

Abstract

Amidst the backdrop of the COVID-19 pandemic, vaccine innovation has garnered significant attention, but this field was already on the cusp of a groundbreaking renaissance. Propelling these advancements are scientific and technological breakthroughs, alongside a growing understanding of the societal and economic boons vaccines offer, particularly for non-pediatric populations like adults and the immunocompromised. In a departure from previous decades where vaccine launches could be seamlessly integrated into existing processes, we anticipate potentially than 100 novel, risk-adjusted product launches over the next 10 years in the adult vaccine market, primarily addressing new indications. However, this segment is infamous for its challenges: low uptake, funding shortfalls, and operational hurdles linked to delivery and administration. To unlock the societal benefits of this burgeoning expansion, we need to adopt a fresh perspective to steer through the dynamics sparked by the rapid growth of the global adult vaccine market. This article aims to provide that fresh perspective, offering a detailed analysis of the anticipated number of adult vaccine approvals by category and exploring how our understanding of barriers to adult vaccine uptake might evolve. We incorporated pertinent insights from external stakeholder interviews, spotlighting shifting preferences, perceptions, priorities, and decision-making criteria. Consequently, this article aspires to serve as a pivotal starting point for industry participants, equipping them with the knowledge to skillfully navigate the anticipated surge in both volume and complexity.

Fig. 1. Demographic trends, projected disease burden, and primary healthcare funding in relation to life expectancy.

A Depicts the growth of the U.S. population segment aged 65 years old and above from 2022 to 2040. Data for 2022 was sourced from the U.S. Census Bureau’s annual estimates (U.S. Census Bureau, Population Division, June 2023), while future projections were obtained from the IHME’s Global Fertility, Mortality, Migration, and Population Forecasts 2017–2100 (IHME, 2020). B Highlights the relationship between primary health care funding schemes in select G20 countries (excluding Saudi Arabia and Turkey due to lack of data) and life expectancy at birth and HALE at birth. Health expenditure data was sourced from WHO’s Global Health Expenditure Database and Life expectancy data was retrieved from the Global Health Observatory Data Repository for 2019. C Illustrates the projected disease burden for age groups 50–69 years and 80+ years, with bubble size denoting death per 100,000. Percentages correspond to an increase in area. Data is derived from the Global Burden of Disease Study 2016 (IHME, 2018). Note: The age group 70–79 is not represented due to unavailability of data.

Fig. 2. The rising tide of adult vaccination in the United States.

A Assessment of the projected future vaccine volume expansion in the U.S., by vaccine category, compared with current and pre-pandemic levels. Notable recent and anticipated vaccine launches are called out. The box around COVID indicates that this launch has already occurred. A more comprehensive representation of anticipated vaccine launches can be found in Supplementary Fig. 1. B Weekly COVID-19 Vaccine Administrations and Productivity in 2022 and Projections for 2032. This figure presents the number of COVID-19 vaccine doses administered weekly throughout 2022. This data was obtained from the CDC’s COVID Data Tracker. Weekly productivity, represented as millions of doses administered per week, during the peak vaccination season (September to December) for actual 2022 COVID-19 vaccine administrations and 2018 influenza administration is shown. Data for influenza vaccines was obtained from the CDC’s FluVaxView. Comparative data is shown for the total vaccine administration volume in 2022 and projections for total vaccine administration volume in 2032, under an assumed forced seasonality and current vaccination behavior.

Fig. 3. Stakeholder preferences across sensitivity scenarios.

Visual comparison of stakeholder preferences is provided across sensitivity scenarios. The sensitivity levels were determined using insights gained through the assessment of qualitative statements gathered from stakeholders (Recommenders & Funders, Stocking & Purchase, General Practitioners [GPs] & Primary Care Physicians [PCPs], Pharmacists, and Consumers). These quantitative statements were gathered in response to future market scenarios.

Fig. 4. The battle for the arm as an expanded vaccine schedule drives complexity.

A quantitative online survey conducted in the U.S. was used to derive consumer (n = 500) and immunizer (n = 103) perceptions regarding a crowded vaccine schedule. A Consumer and immunizer reports for the maximum number of vaccines patients are willing to receive yearly. Consumers were asked “what is the maximum number of different vaccines you would be willing to receive in a year (some possibly requiring several appointments)?” Immunizers were asked “what is the maximum number of vaccines you expect an individual adult patient would be willing to receive in a year?” Results presented are for a “typical” patient with regard to vaccine attitudes, or one who is “busy” (e.g., working full-time). B Immunizer reports for the maximum number of vaccines they would administer in a single appointment, and consumer reports for the maximum number of vaccines patients are willing to receive in a single appointment. Consumers were asked “what is the maximum number of vaccines (individual shots) you would be willing to receive in a single appointment?” Immunizers were asked “What is the maximum number of vaccines (individual shots) you would be willing to give a typical patient in a single appointment? Please assume co-administration is supported by relevant data.” C The reported number of vaccination appointments patients schedule as reported by patients and immunizers compared to actual visits indicated by red lines. Consumers were asked “What is the maximum number of visits for a vaccination you would be willing to attend per year?” Immunizers were asked “How many visits per year for the purposes of getting a vaccine do you think patients would be willing to attend per year (on average)?” Results presented are for a “typical” patient. 2018 data was obtained from the CDC NCHS Data Brief No. 408, May 2021. Consumer data was collected for healthy/low-risk 18–64-year-olds. This data is used for both groups - healthy/low-risk 18–49-year-olds and healthy/low-risk 50–64-year-olds. Consumer data was not collected for pregnant women. D Consumer attitudes within future vaccination schedules. Consumers were asked “Thinking about this future with many different vaccine options available for adults like you, to what extent do you agree with the following statements?”.