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

This perspective article examines the accelerating evolution of the adult vaccine market and argues that current systems in the United States—across policy, delivery, infrastructure, and consumer engagement—are ill-prepared for a dramatic expansion in adult vaccine offerings over the next decade. Jones et al. project more than 100 new adult vaccine product launches within 10 years, driven by breakthroughs in mRNA platforms, aging demographics, and increasing emphasis on healthy aging. The authors maintain that unless policymakers and health systems address the structural gaps exposed during COVID-19, the adult vaccination ecosystem risks being overwhelmed.

The paper begins by situating the “adult vaccine renaissance” within broader demographic and economic trends: an aging population with suboptimal vaccination uptake, declining healthy life expectancy despite high health expenditures, and significant societal and economic burdens associated with vaccine-preventable diseases. While adult vaccines offer substantial potential for improving morbidity, mortality, and economic productivity, uptake remains well below national targets. The authors argue that innovation in vaccine technology—particularly RNA-based designs using uniform manufacturing processes—will accelerate the availability of novel vaccines but also increase complexity in prioritization, scheduling, and delivery.

A key theme is the projected growth of the adult vaccine market. The current landscape includes 35 vaccines for 13 adult-relevant diseases. Over the next decade, vaccine offerings could expand to 40 disease areas, including nosocomial infections (C. difficile, Staphylococcus aureus), RSV, and even long-sought targets such as HIV. Expansion of both seasonal and non-seasonal vaccines is expected, with COVID-19 and RSV likely mirroring influenza in annual patterns. This may compress vaccine administration into narrow seasonal windows—what the authors call “forced seasonality”—creating operational bottlenecks that far exceed current immunization productivity.

The authors highlight major system-level challenges revealed by their market research. First, across stakeholders—physicians, pharmacists, consumers, payers, and policymakers—there is widespread unawareness or underestimation of the changes ahead. Many respondents expressed complacency or believed that systems could replicate COVID-19 mass-vaccination approaches, ignoring the unique urgency and resources that supported that rollout. Fragmentation persists across professional roles: primary care physicians often deprioritize adult vaccines; pharmacists provide essential access but face limitations in data sharing and coordination; and no single entity assumes responsibility for system-wide planning.

Second, the lack of standardization across adult vaccine schedules is identified as a major vulnerability. Unlike the pediatric vaccine ecosystem—which benefits from national schedules, mandatory requirements, and routine encounters—the adult system is decentralized. ACIP issues recommendations but does not create unified prioritization frameworks for the growing number of adult vaccines. Absence of a national immunization information system leads to inconsistent records, duplicated or missed doses, and increased burdens on both patients and clinicians. This disorganization will be increasingly problematic as the number of recommended vaccines per adult rises substantially.

A third challenge—described as the “battle for the arm”—emerges from survey data showing that adults are generally willing to receive only two shots per appointment and up to four vaccines per year, yet they attend fewer than one preventive visit annually. As vaccine offerings expand, providers will struggle to prioritize which vaccines to administer and when, especially amid rising telemedicine use that further reduces vaccination opportunities. Behaviorally, the increasing number of choices risks overwhelming consumers, contributing to decision paralysis and decreased uptake.

The paper also devotes significant attention to equity concerns. Health disparities already shape adult vaccination patterns, and emerging vaccine technologies often exacerbate this gap. The authors argue that no group—neither ACIP, policymakers, payers, nor providers—currently accepts responsibility for ensuring equitable access. Cognitive biases, misconceptions about the roles of advisory bodies, and a lack of systems thinking further entrench inequities. The authors emphasize that structural barriers, including cost, insurance status, and socioeconomic determinants of health, must be addressed proactively before the adult vaccine landscape expands further.

Critical opinion

Jones et al. provide a comprehensive and timely analysis of the constraints facing the future adult vaccine market. The article excels in diagnosing structural weaknesses, integrating behavioral science perspectives, and identifying operational barriers that may limit the impact of scientific innovation. However, the paper is more successful in defining the problems than in offering concrete, actionable solutions. Recommendations—such as greater coordination, expanding access points, or enhancing digital records—remain broad and lack clear implementation pathways. The perspective would benefit from comparative insights from countries with more standardized adult immunization systems, as well as a deeper discussion of regulatory reforms or financing models that could incentivize system-level change. Nonetheless, the article underscores a critical and underrecognized issue: scientific innovation alone cannot transform public health without parallel investment in infrastructure, policy, and equity.

By Health Literacy Asia