Vaccination coverage is low among U.S. adults, with deepening disparities.

Adults typically receive preventive care less frequently and can be hard to reach with vaccination messages and services. As of 2019, four of every five adults ages 19 and older were missing at least one recommended routine vaccination. Stark racial and ethnic disparities persist, with lower coverage for most vaccines among non-White adults compared to non-Hispanic White adults. Lower vaccination coverage also poses a threat to the health of rural populations, pregnant women, older adults, adults with chronic underlying conditions, and other disproportionately affected adult populations—and the COVID-19 pandemic further lowered adult vaccination levels.

Through a multisectoral partner network, CDC/NCIRD works at multiple levels of the health system to improve adult vaccination uptake and reduce vaccination disparities. Understanding the successes, areas of unmet need, impact, and sustainability of these efforts is critical to achieving CDC/NCIRD’s adult immunization objectives. 

We conducted an innovative, inclusive evaluation of national immunization efforts. 

NORC applied its expertise in participatory evaluation to lead a comprehensive mixed-methods evaluation of CDC/NCIRD’s adult immunization strategies during the 2020-2022 period, with an emphasis on COVID-19 and influenza vaccine rollouts. 

Using a participatory and culturally responsive approach, the evaluation encompassed formative, process, outcome, and impact evaluation methods. This evaluation engaged partners across sectors and levels of the health system to understand factors that facilitated COVID-19 vaccine rollout; identified best practices and opportunities for improvement in implementing adult vaccination interventions, particularly among disproportionately affected populations; and made recommendations to support CDC to strengthen its collaborations and ultimately, vaccine uptake.