Adults have no system reminding them which vaccines they need

Only 22.8% of US adults have received all age-appropriate recommended vaccines. Tdap coverage is 30.1% among adults 19-64. Shingles vaccination is only 32.6% among eligible adults 50+. Six in ten adults eligible for pneumococcal vaccine have not received it. So what? Adults who skip Tdap boosters lose pertussis immunity and can transmit whooping cough to infants too young to be vaccinated -- the population most likely to die from the disease. So what? Unvaccinated adults account for preventable hospitalizations and deaths: pneumococcal disease kills roughly 18,000 US adults annually, and shingles causes debilitating post-herpetic neuralgia in about 10-18% of cases. So what? These are almost entirely preventable hospitalizations that cost the healthcare system billions while causing immense personal suffering. Why does this persist? Unlike pediatric vaccination, which has a built-in enforcement mechanism (school enrollment requirements) and a clear schedule tied to well-child visits, adult vaccination has no structural trigger. Adults do not have regular well-visits. Primary care physicians are not consistently prompted by their EHR to recommend vaccines. There is no adult equivalent of the school-entry mandate. Insurance coverage for adult vaccines improved under the ACA and IRA, but awareness remains the bottleneck: adults simply do not know which vaccines they need or when they are due.