National Growth in Adult Vaccination Masks a More Fragmented Market

National adult vaccine claims rose meaningfully over the past decade (Figure 1), but that growth trend tells only part of the story. Across adult vaccines, demand is increasingly shaped by recommendation changes, launch dynamics, and uneven state-level execution. While overall volume rose between 2015 and 2025, performance varied sharply across states—from strong gains in markets like Washington and Montana, to flat or declining growth across parts of the South and Midwest—showing that the market is expanding but not equitably (Table 1).

Table 1. Median Annual YoY Change in All Vaccine Claim Volume* By State, 2015-2025 (Top 10 and Bottom 10)

Adult Vaccine Demand is Not Moving Along a Single Growth Curve

In pneumococcal vaccination, historically one of the strongest-performing adult vaccine categories in CDC NHIS data, policy changed the market quickly: after CDC lowered the routine age recommendation to 50 in October 2024, 2025 volume among adults ages 50–64 surged past older groups (Figure 2). That stands in contrast to flu, which has behaved more like a habit market—remaining broadly stable over the decade aside from the 2020 spike (Figure 3).

Zoster followed a different arc. Volume rose sharply from 2017 to 2019, then entered a prolonged decline (Figure 4). That trend is concerning because one in three people in the US will have shingles in their lifetime, and many may experience a complication. The cost of treating shingles is estimated to be $11,595 for uncomplicated shingles and $13,839 for shingles with any complication.

RSV highlights a third dynamic: strong launch-year momentum did not hold in 2025, with notable pullbacks overall (Figure 5) and especially in retail settings, where volume dropped 43% between 2024 and 2025 (5,258,929 to 2,976,534), and in Medicare Part D, where volume dropped 48% in the same period (3,827,781 to 1,989,683). The trend in volume decrease was consistent across age groups as well, with adults 65 years and older seeing the biggest decline between 2024 and 2025 (Figure 6). That decline matters because lower adult vaccination can leave more people susceptible during RSV season, increasing transmission risk and case volume. The economic burden is substantial: among US adults 60+, RSV is associated with an estimated 4 million annual cases and $6.6 billion in yearly costs, with just 4% of cases requiring hospitalization but driving 94% of direct medical costs.

State Performance Suggests Execution Matters More Than Ever

State-level differences suggest that vaccine availability and recommendations alone are not enough to generate uptake. In pneumococcal vaccination, some states posted sustained annual growth, while others declined sharply over the same period, even as the recommended population expanded (Figure 7; Table 2). Flu shows a similar – if less extreme – pattern, despite being a more established category. (Figure 8; Table 2). Together, these differences point to the rise in vaccine hesitancy and local implementation capacity (provider activation, pharmacy participation, payer alignment, patient outreach, and operational follow-through) as increasingly important determinants of whether recommendation changes and product availability translate into actual vaccination volume.

Table 2. Median Annual YoY Percent Change in Pneumococcal and Influenza Vaccine Claims by State, from 2015-2025 (Top 10 and Bottom 10)

About Vaccine Track

Vaccine Track measures adult vaccinations through claims data.

Vaccine Track measures adult vaccinations through claims data for all adults ages ≥19, including hepatitis A, hepatitis B, tetanus-diphtheria (Td), tetanus-diphtheria-pertussis (Tdap), shingles, pneumococcal, influenza (flu) and respiratory syncytial virus (RSV).

While flu vaccination claims are included in the interactive data tools, they are typically not included in Vaccine Track insights due to their strong seasonality and the availability of robust analyses of flu vaccination trends provided by the CDC. RSV vaccination claims are similarly excluded from overall adult claims analyses due to their association with the respiratory virus season.

Not all vaccines are indicated or recommended for all adults, and the inclusion of the full adult data set should not be interpreted as promoting or endorsing the use of any vaccine beyond its FDA-approved indication(s) or CDC recommendations.

Vaccine Track provides race/ethnicity data stratification. Race/ethnicity data are self-reported and may not be available for all people who received a vaccination. These data may not be representative of the entire US population.