An article in npj vaccines in February 2024 considers the future of the adult vaccine landscape, using insights from interviews to “serve as a pivotal starting point” to enable industry participants to navigate an “anticipated surge” in “volume and complexity”.
“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.”
The authors reflect that vaccine innovation drew “significant attention” during the COVID-19 pandemic but was “already on the cusp of a groundbreaking renaissance”. For adult populations, integration of vaccine programmes is notoriously challenging, suggest the authors, who consider “low uptake, funding shortfalls, and operational hurdles”. Adult immunisation is a key theme for the Congress in Washington, so we explore the article here and invite you to join us in April to share your thoughts on the issue.
At a crossroad
“As the adult vaccine landscape rapidly evolves, we find ourselves at a crossroad where addressing the status quo of immunisation efforts is no longer an option but a necessity.”
The authors state that the COVID-19 pandemic “served as a stark wake-up call”, exposing the “fragmented nature” of adult vaccine infrastructure. The system that was revealed is “wholly unprepared for the impending rapid growth” in adult vaccines. While this may be a daunting situation, the authors believe that these challenges can be “catalysts for transformation”.
The article suggests that the “ongoing and accelerating transformation” in adult vaccines will be “propelled by the rise of RNA technology, thrusting us into a new era of digital vaccine”. Comparing RNA-based solutions with “traditional biologic counterparts”, the authors state that the former are “not constrained by the same production processes”, creating potential to “conceptualise innovative vaccine designs using a single manufacturing process”.
Time for a revolution
“The timing of this vaccine revolution is critical.”
Referring to an ageing global population, the authors identify calls for “more potent vaccines to safeguard health and wellness”. This is emphasised by the effects of vaccine-preventable diseases (VPDs) on the economy; VPDs account for an estimated 8 million to 10 million disease cases in the US alone, which result in “up to $34.9 billion in annual societal costs”. There is an “informal economy” consequence as well, as older adults play an “invaluable role” by offering childcare and financial and emotoinal support, which “cannot be quantified through economic analyses alone”.
However, the development of adult vaccines is not simple; future vaccines must be “tailored to different risk groups” to provide “optimal efficacy”.
Market research
The authors conducted a market research study with the US as a pivotal case study to understand the “evolving” adult vaccine market. From their results they identify challenges and weaknesses that, if neglected, may “quickly become overwhelmed in the face of an evolving and expanding industry”. The goal is to shift the “complacent” implications of the phrase “there is always next year” to an “urgent call for innovation”.
Evolution and growth
Recognising the importance of a paediatric “bias” in the mid-twentieth century, the authors state that the US has a “strong” paediatric immunisation programme with “clear guidelines, well-defined immunisation schedules, and school entry requirements”. However, for adult vaccines there are challenges like “limited awareness, accessibility, affordability, and vaccine hesitancy”.
Despite these challenges, the adult vaccine market is “experiencing rapid expansion” with a growth trajectory driven by increasing prevalence of VPDs in adults, technological advancements, and a “heightened focus” on preventative healthcare.
“Over the next decade, we anticipate a tripling in the number of approved vaccine products globally.”
There are 35 products currently available across 13 disease areas, but over the next 10 years this is predicted to grow to 100-120 risk-adjusted products over 40 different disease areas. Vaccine categories are expected to grow from “well-known diseases” and travel or endemic diseases to include nosocomial vaccines. Furthermore, there is a possibility that vaccines for “high unmet” need diseases like HIV will “enter the adult vaccine landscape”.
Alongside expanded offerings, the authors refer to “growing competition”. Four “historical leaders”, GSK, Merck, Pfizer, and Sanofi, may see “increased pressure” from new entrants and global players.
“Additionally, as best-in-class products likely will not be enough to capture the market, manufacturers are expected to distinguish themselves through differentiated portfolio offerings, rather than individual products.”
As more vaccines enter the market, vaccine schedules are “expected to undergo substantial expansion over the next decade”. Indeed, the phenomenon of “forced seasonality”, where non-seasonal vaccines are administered over a compressed period, could “pave the way for a convergence of campaigns for new vaccines with those of seasonal vaccines”.
“Such alignment could pose substantial challenges for immunisers and vaccination delivery sites as they grapple with the task of accommodating new patients and vaccines within a more limited timeframe.”
Breaking down barriers
The authors conducted a market research study of both qualitative and quantitative approaches to understand the “potential challenges and reactions to future states of the adult vaccine landscape”.
“Through interviewing and surveying key adult vaccine market stakeholders, we found that many stakeholders may not be fully cognisant of the impending wave of adult vaccines.”
This ignorance is largely attributed to an “absence of incentives to assess situations beyond the current fiscal year”, which then fosters “short-term thinking” and hingers the identification of “potential long-term effects” within the market. This could lead to “lack of preparation” and result in “missed opportunities”.
“The adult vaccine market has also seen a shift in focus to newer participants, such as the rise of alternative vaccination sites like pharmacies, aiding a decades long trend, which is expected to continue.”
While this change brings opportunities, it also presents challenges, such as “concerns” about pharmacists’ access to medical records and vaccination histories. To address this, the authors state that we need to build a “sense of trust” between pharmacists and physicians, which will be “paramount to the successful dissemination of future vaccines”.
Another consideration is the experience of a pandemic and how it may distort perceptions for the future; the authors emphasise the importance of remembering difficulties in distribution and looking forward to a “dynamic environment” that will demand “continued vigilance, flexibility, and readiness to embrace change”.
The adult population
Another challenge arises in considering the intended recipients of these vaccines. For example, patients were willing to receive “up to four” vaccines a year but preferred to limit administration to two per visit: one in each arm.
“The expansion of the adult vaccine market means that consumers will need to take more ownership of their vaccination schedules and records.”
Even if patients are keen to access vaccination programmes, the authors consider that “far too many in the US still suffer from unequal access to healthcare”. Disparities cause a divide in “actual health outcomes”. However, they recognise that apart from the “moral imperative” of “bridging the equity gap” there is a financial incentive: estimates suggest that eliminating racial disparities alone could save “over $90 billion” annually in “unnecessary medical expenses”.
“Unfortunately, our market research has highlighted that no stakeholder group is individually accountable for addressing vaccine equity. We found a significant gap in understanding and responsibility within the vaccine ecosystem, leading to a disconcerting reality: equity is falling through the cracks.”
What do the authors conclude?
“The adult vaccine market stands on the threshold of significant growth in the forthcoming years. Preparing to incorporate more vaccine into the existing ecosystem could lead to enhanced health and economic outcomes in the future.”
The article recommends “proactive solutions” that consider the “consumer and their choices”. What might this look like in your work? Do you agree with any of the arguments or findings in the article? We look forward to considering adult immunisations in greater detail during the Congress; are you joining us there? Don’t forget to subscribe for weekly insights.
