up with a telephone call (Pearson and Thompson, 1994). In the Monroe County demonstration, all Medicare beneficiaries received a letter from the Health Care Financing Administration, the federal agency that manages the Medicare program, encouraging all Part B recipients to get a free influenza immunization from their physicians. Other promotional and public health educational efforts have included television, radio, brochures, newspapers, public appearances, and press conferences.

National Health Interview Survey data indicate that African Americans and Hispanics are less likely than whites to have received pneumococcal or influenza vaccine (Centers for Disease Control and Prevention, 1995a). During the Monroe County demonstration, investigators noted low rates of immunization with the influenza vaccine among urban, nonwhite elderly people (Bennett et al., 1994). In response to this problem, MCHD convened a task force composed of representatives from urban churches, health centers, and community-based organizations to develop an action plan to increase the rates of immunization among individuals in this group of underserved Medicare beneficiaries. Partnerships were formed with organizations that could influence members of minority populations who were not receiving vaccination services. Media efforts were targeted toward this underserved population, and special outreach clinics were staffed by members of the African-American senior citizen community. Partnerships were formed with church leaders, who publicly encouraged immunization with the influenza vaccine, distributed educational materials in church bulletins, and assisted in transporting their church members to special clinics located throughout the inner city. The processes used to improve the rates of immunization among individuals in underserved groups are the same as those used among well-served groups in the population. The key difference is the selection of appropriate partners in the immunization outreach effort and ensuring that information is channeled through sources that are used by individuals in the underserved groups.

The examples described above and many others not included here provide convincing evidence that adult immunization programs can be successful if they are well organized and efficiently administered. Nonetheless, such “model” programs are in the minority. Improved immunization strategies, not simply better vaccines, will be required if substantial improvements in adult immunization rates are to be made.

Immunization of pregnant women against conditions such as neonatal and pregnancy-related group B streptococcal infections has been proposed. Such efforts would eliminate the need for active immunization of infants against some diseases for which susceptibility is limited to young infants, pregnant women, and adults with either defined underlying medical conditions or advanced age.