State Immunization Policies for Pharmacists Hinder US Vaccine Uptake
IQVIA released a report detailing pharmacists’ authority to administer vaccines in the US as well as adults’ overall vaccination rates by state.
Many states within the US have protocols enacted that impede pharmacists’ authority to administer vaccinations and has led to decreased vaccination rates nationwide, according to data published by IQVIA.1 Authors of the report believe removing these protocols and giving more authority to pharmacists would significantly improve immunization rates among US adults.
“Vaccination is one of the most cost-effective public health interventions and has been noted to have had a significant effect on reducing not only mortality but also disease, hospitalization, disability, and disparity,” wrote authors of the study. “Despite these benefits, adult immunization rates in the US consistently fall short of public health goals, resulting in significant preventable health care costs and contributing to avoidable deaths and hospitalizations due to vaccine-preventable diseases.”
Adult vaccination data from the CDC reported that influenza and herpes zoster vaccines increased from 2017 to 2022. However, influenza rates plateaued in the last 2 years of the study and herpes zoster rates remained stable and saw decreases among adults over 65—a population group at high risk of developing the disease. Despite some changes, most of the other vaccines saw declines. This led researchers to suggest that adult vaccination coverage among US adults is significantly low and equitable access to immunization is crucial to public health.
To administer vaccines in the US, pharmacists must either have written authorization, a physician's prescription, or they are allowed to administer them independently. | image credit: Roop Dey / stock.adobe.com
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Policymakers have looked to pharmacists to facilitate an uptake in immunization. Because of their accessibility within the community, pharmacists have the potential to be authorities on providing vaccines. However, with a history of minimal authority to provide overall health care services and barriers to practicing at the top of their license, the tasks of many US pharmacists have been obstructed by state regulations.
Authors of the IQVIA report had a 3-pronged objective prior to conducting their review. All focusing on the authority and protocols pharmacists deal with regarding vaccine administration, researchers’ objective included evaluating the expansion of pharmacists’ authority to administer vaccines, examining the elimination of prescriber-level protocols or implementation of statewide standing orders, and assessing the removal of prescription requirements for adult vaccines.1
Prior to each state’s evaluation, the authors noted various levels of authority that states give to pharmacists when it comes to vaccine administration. Those with the most authority for pharmacists to facilitate vaccine coverage are considered independent/SSO states. In these states, pharmacists are allowed to independently prescribe or administer vaccines, or they are able to do the same through a specific statewide standing order (SSO).
Protocol states are where pharmacists are capable of administering vaccines only if “written authorization” is provided by a physician. These state protocols are specific to permitted patients and can have procedural and administrative limitations. Finally, prescription states strictly allow pharmacists to provide vaccines only when a physician provides a prescription for each patient.1
IQVIA researchers explored 3 separate adult vaccination rates in their study, including respiratory syncytial virus (RSV) vaccine rates, PCV20 (pneumococcal) vaccines, and herpes zoster (shingles) vaccines. Pharmacists’ authority to administer these vaccines was spread out across all 50 states plus Washington, DC.
A total of 20 states allowed pharmacists to prescribe and administer RSV vaccines independently or through an SSO. There were 27 protocol states and 4 states requiring prescriptions for RSV vaccines. For both the PCV20 and shingles vaccines, 23 states allowed pharmacists’ vaccine administration independently or through SSOs, while the remaining 28 were protocol states.
Furthermore, approximately 828,000 additional patients may have received the PCV20 vaccine if the 28 protocol states allowed pharmacists to prescribe or administer independently or through SSOs. For the RSV vaccine in adults 60 or over, around 411,000 additional patients would have been vaccinated if protocol states were given more authority.1
“While various tangible and intangible factors can impact vaccination rates within each state, the results show that states with stricter pharmacist vaccination policies have lower vaccination rates among adults compared to states that allow pharmacist vaccination independently or through an SSO,” they continued.
The researchers offered a slew of solutions to address decreased vaccine access, including the expansion of pharmacists’ vaccine authority, education on the importance of immunization, the implementation of more SSOs, and more.
However, recent news of a measles outbreak in Texas—198 cases and 1 death confirmed as of March 7—3and a US Director of Health and Human Services who is shrouded in anti-vaccine controversy4 have created a nationwide issue of Americans’ declining concerns to stay protected against infectious and respiratory diseases. With just under 90% of all US citizens living within 5 miles of a pharmacy, government officials and public health experts must implore pharmacists to repave a path forward in regard to increasing vaccine uptake.1
“Pharmacists are likely to continue being a primary source of vaccinations for the American population,” concluded authors of the report. “In order to improve adult vaccination rates in an equitable and timely manner, state and federal policies should consider adapting to reflect practices that provide access to vaccines regardless of geographic location within the U.S.”
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