BQ Journal Vol 43 - Q2 2021 - 21

Morbidity and Mortality Weekly Report
Decline in Receipt of Vaccines by Medicare Beneficiaries During the
COVID-19 Pandemic - United States, 2020
Kai Hong, PhD1; Fangjun Zhou, PhD1; Yuping Tsai, PhD1; Tara C. Jatlaoui, MD1; Anna M. Acosta, MD2; Kathleen L. Dooling, MD3;
Miwako Kobayashi, MD2; Megan C. Lindley, MPH1
On March 13, 2020, the United States declared a national
emergency concerning the novel coronavirus disease 2019
(COVID-19) outbreak (1). In response, many state and local
governments issued shelter-in-place or stay-at-home orders,
restricting nonessential activities outside residents' homes (2).
CDC initially issued guidance recommending postponing routine
adult vaccinations, which was later revised to recommend
continuing to administer routine adult vaccines (3). In addition,
factors such as disrupted operations of health care facilities
and safety concerns regarding exposure to SARS-CoV-2, the
virus that causes COVID-19, resulted in delay or avoidance
of routine medical care (4), likely further affecting delivery of
routine adult vaccinations. Medicare enrollment and claims
data of Parts A (hospital insurance), B (medical insurance),
and D (prescription drug insurance) were examined to assess
the change in receipt of routine adult vaccines during the
pandemic. Weekly receipt of four vaccines (13-valent pneumococcal
conjugate vaccine [PCV13], 23-valent pneumococcal
polysaccharide vaccine [PPSV23], tetanus-diphtheria or
tetanus-diphtheria-acellular pertussis vaccine [Td/Tdap], and
recombinant zoster vaccine [RZV]) by Medicare beneficiaries
aged ≥65 years during January 5-July 18, 2020, was compared
with that during January 6-July 20, 2019, for the total study
sample and by race and ethnicity. Overall, weekly administration
rates of the four examined vaccines declined by up to
89% after the national emergency declaration in mid-March
(1) compared with those during the corresponding period in
2019. During the first week following the national emergency
declaration, the weekly vaccination rates were 25%-62% lower
than those during the corresponding week in 2019. After
reaching their nadirs of 70%-89% below 2019 rates in the
second to third week of April 2020, weekly vaccination rates
gradually began to recover through mid-July, but by the last
study week were still lower than were those during the corresponding
period in 2019, with the exception of PPSV23.
Vaccination declined sharply for all vaccines studied, overall
and across all racial and ethnic groups. While the pandemic
continues, vaccination providers should emphasize to patients
the importance of continuing to receive routine vaccinations
and provide reassurance by explaining the procedures in place
to ensure patient safety (3).
Medicare enrollment and insurance claims data for beneficiaries
enrolled in a fee-for-service plan during weeks 2-29 of
2019 (January 6-July 20) and 2020 (January 5-July 18) were
obtained from the Centers for Medicare & Medicaid Services
Chronic Conditions Warehouse (5). PCV13 and PPSV23
were covered by Part B, which pays for services from health
care providers, outpatient care, and some preventive services.
Td/Tdap was covered by Part B if it was administered as part
of medically necessary service because of an injury and was
covered by Part D, which covers a range of prescription drugs,
if it was administered as part of preventive care. RZV was
covered by Part D. Weekly claims for vaccination were identified
by procedure code or national drug code on claims with
a service date within the week examined (measured Sunday
through Saturday).* Because some of the weeks spanned 2 different
months, the denominator populations for PCV13 and
PPSV23 vaccination in each week were defined as Medicare
beneficiaries who were continuously enrolled in Parts A
and B in the claim month and the previous month, and were
aged ≥65 years on the first day of that previous month. The
denominator population for Td/Tdap and RZV were defined
similarly, except that beneficiaries were continuously enrolled
in Parts A, B, and D. Weekly rates of receipt of the examined
vaccines were calculated as the percentage of the denominator
population that received ≥1 dose of the corresponding vaccine
during that week.† The percentage change in vaccination rate
in a week was calculated as the ratio of the rate in that week
in 2020 to the rate in the corresponding week in 2019, minus
1. Descriptive statistical analyses were conducted for the total
study sample and stratified by race and ethnicity (non-Hispanic
White [White], non-Hispanic Black [Black], Hispanic or
Latino (Hispanic), non-Hispanic Asian/Asian American/Pacific
Islander [Asian], non-Hispanic other [Other]).§ All statistical
analyses were conducted during September 12-15, 2020, using
SAS (version 9.4; SAS Institute). This activity was reviewed
* Procedure codes alone for PCV13 and PPSV23 and procedure codes plus
national drug codes for Td/Tdap and RZV.
† RZV was recommended by the Advisory Committee on Immunization Practices
(ACIP) to be administered as a two-dose series. In the analysis a Medicare
beneficiary was counted as receiving RZV if either the first or the second dose
was administered and was counted twice if both doses were administered (in
different weeks) during the study period. https://www.cdc.gov/mmwr/
volumes/67/wr/mm6703a5.htm?s_cid=mm6703a5_w
§ Race/ethnicity of beneficiary was reported in the Medicare enrollment database,
which was obtained from the Social Security Administration's beneficiary record.
American Indian or Alaska Native persons and persons whose race/ethnicity
was unknown were grouped into Other. https://www2.ccwdata.org/
documents/10280/19022436/codebook-mbsf-abcd.pdf
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / February 19, 2021 / Vol. 70 / No. 7
Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
21
A Henry Schein Publication
245

https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm?s_cid=mm6703a5_w https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm?s_cid=mm6703a5_w https://www2.ccwdata.org/documents/10280/19022436/codebook-mbsf-abcd.pdf https://www2.ccwdata.org/documents/10280/19022436/codebook-mbsf-abcd.pdf

BQ Journal Vol 43 - Q2 2021

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