Lessons learned from 2 years of influenza vaccinations in the UK and USA during the COVID-19 pandemic as respiratory viruses return.

During the COVID-19 pandemic, immunization programs for other respiratory infections, notably influenza continued worldwide but attracted less public or political attention than COVID-19 vaccinations. Due to non-pharmaceutical intervention measures the global influenza burden decreased substantially; but with lifting of restrictions a rebound in other respiratory virus pathogens is both plausible and likely. This article discusses lessons identified from the UK and USA, and provides recommendations for future influenza vaccination programs in light of emerging data from the southern hemisphere and the need for harmonization with COVID-19 vaccination, focusing on operational delivery and messaging to practitioners and the public.

Shared clinical decision making on vaccines: Nothing has really changed for pharmacists.

Recently, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices has begun utilizing a new recommendation known as "Shared Clinical Decision-Making." This recommendation from Centers for Disease Control and Prevention calls upon health care providers, including pharmacists, to have more engaged conversations with patients regarding their vaccine needs. This commentary is designed to provide pharmacists with clarifications on the intent behind this terminology, and dispel myths that have frequently been attributed to the category of recommendation. Pharmacists must continue to take action to immunize patients and not be confused by a new approach to recommendation terminology.

Pharmacist insights into adolescent human papillomavirus vaccination provision in the United States.

HPV vaccination coverage in the United States (US) falls short of the Healthy People 2020 goal of 80% coverage among 13-15 year-old adolescents. Pharmacies are a promising alternative vaccine delivery site that may increase access to HPV vaccination. Our objective was to assess pharmacists' insights into HPV vaccination provision to adolescents. We recruited 40 licensed pharmacists in eight states with different pharmacy vaccination laws: Alabama, California, Indiana, Kentucky, Maine, Tennessee, Texas, and Washington. Eligible pharmacists either previously provided or were currently providing HPV, tetanus-diphtheria-pertussis, or meningococcal vaccines to adolescents aged 9-17 years. Pharmacists were administered a semi-structured survey to explore insights into HPV vaccination provision. Forty-five percent of surveyed pharmacies offered HPV vaccination to adolescents. Pharmacists' reported challenges to providing HPV vaccination were parental consent (28%), tracking and patient recall (17%), perceived stigma of vaccination (17%), and education about or promotion of vaccination (17%). Pharmacists offering HPV vaccination sent patient reminders for vaccines with multiple doses (89%) and utilized telephone reminders (72%). Pharmacists informed patients' primary care providers of HPV vaccination doses most commonly through fax (72%) and updating electronic medical records (22%). One-third of pharmacists reported vaccination provision using the state immunization information system (IIS). Seventy-five percent reported vaccination rates could be increased at their respective pharmacy. Pharmacies are underutilized, although highly accessible, for HPV vaccination in the US. National efforts should expand educational programs to improve public awareness of in-pharmacy HPV vaccination, and improve the utilization of state IIS for reporting immunization coverage of adolescents by pharmacists.

National survey of pharmacy-based immunization services.

INTRODUCTION: Pharmacists in the United States (U.S.) are authorized to administer vaccines. This study described: how and to what extent immunization services are offered, promoted, and documented in community pharmacies; reasons for referral to other locations for vaccination; and perceived barriers to immunization services. METHODS: A mixed-mode (mail/electronic) survey of a stratified random sample of 1999 nationally-representative community pharmacies in the U.S. was conducted in April-July 2017. Survey instrument development was informed by validated scales and 10 in-depth interviews with community pharmacists; content and face validity were ensured via pre- (n = 5) and pilot-tests (n = 26) among community pharmacists. Potential non-response bias was investigated and descriptive statistics were used to analyze survey responses. RESULTS: Of the 1999 community pharmacies, 119 pharmacies were deemed ineligible. Of those eligible pharmacies, complete responses were provided by 292 respondents, each representing a unique pharmacy (15.5% response rate). Respondents were evenly split male/female (52.5/47.5%) and about half were pharmacy managers (51.3%). The majority (79.5%) reported offering at least one type of vaccine in 2016, with the most commonly administered vaccine types (average doses in 2016) being: Influenza (484), Pneumococcal 13-valent conjugate (55), Herpes Zoster (41), and Pneumococcal polysaccharide (39). Two-thirds (66.7%) of immunizing pharmacies provided adolescent vaccinations. Most frequently reported referral reasons were patients' insurance not covering vaccine administration at the pharmacy and patients' age not within approved protocol, policy or state law. The majority of respondents did not perceive organizational and environmental factors as barriers; however, they reported patient-related factors, especially cost and insurance coverage, as important barriers. CONCLUSIONS: The majority of U.S. community pharmacies reported offering at least one type of vaccine. The scope of pharmacy engagement in immunization services varied in terms of how and to what extent they were offered and documented. Addressing patient-related barriers is needed to further enhance pharmacy-based immunization services.

Pharmacist authority to provide HPV vaccine: novel partners in cervical cancer prevention.

OBJECTIVES: While the provision of cervical cancer prevention services in the United States has expanded to new settings beyond clinics that give Pap smears, prevention efforts are being hampered by relatively low human papillomavirus (HPV) vaccine coverage. Pharmacies are an underused setting to deliver HPV vaccine. To better understand this opportunity, we sought to classify pharmacists' authority to administer HPV vaccine in each US state. METHODS: For each US state and the District of Columbia (for simplicity, we refer to these 51 regions as states), we interviewed a member of the state's pharmacy association, member of the state board of pharmacy, or a faculty member at a school or college of pharmacy. RESULTS: Most states (80%) allowed pharmacists to provide HPV vaccine to adult women ages 19 and older, and 61% of states allowed provision to girls age 12. The mechanism for pharmacists to immunize was highly variable across states. For example, a 12 year-old girl seeking HPV vaccine could receive it from a pharmacist in 31% of states under a protocol between a specific physician and pharmacist, in 24% with an HPV vaccine prescription, and in 6% without prior physician approval. Pharmacists' authority was broadest on the west coast and limited on the east coast. Pharmacist authority to provide HPV, Tdap, and meningitis vaccines was very similar, but it was highly dependent on patient age. CONCLUSIONS: US states' laws governing pharmacists' ability to offer HPV vaccine varied widely. One consequence is that newly expanded cervical prevention efforts underuse pharmacists.

Recommendations for a national agenda to substantially reduce cervical cancer.

PURPOSE: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. METHODS: In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. RESULTS: Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. CONCLUSIONS: Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

Extending the reach: local health department collaboration with community pharmacies in Palm Beach County, Florida for H1N1 influenza pandemic response.

OBJECTIVE: Palm Beach County Health Department (PBCHD) in Florida collaborated with pharmacists, community pharmacies, and pharmacy-based retail health clinics to increase access to influenza prevention through a widespread H1N1 influenza vaccination campaign and to disseminate timely and accurate public health recommendations and information using Flu Ready Cards. Selected pharmacy and store managers were surveyed, before and after distribution of H1N1 vaccine regarding issues facing pharmacists and the public in deciding whether or not to recommend or accept influenza vaccinations. PARTICIPANTS: Palm Beach County Health Department collaborated with Walgreens and CVS pharmacies, Publix and Winn-Dixie Super Market Pharmacies, and the Palm Beach County Pharmacy Association. OUTCOMES: More than 200000 Flu Ready Cards were distributed in 250 pharmacies between September 2009 and March 2010 as part the county-wide H1N1 influenza pandemic response. Approximately 40000 doses of H1N1 vaccine (12% of the PBCHD allocation) were shipped to local pharmacies and retail health clinics to immunize individuals and families, including those most at risk, vulnerable, or without a medical home. Eighty percent of surveyed store managers and 52% of pharmacists reported the Flu Ready Cards were useful and more than 60% of both groups felt partnership with the local health department was useful during the H1N1 pandemic. CONCLUSIONS: The collaborative relationship proved invaluable for distributing, transferring, and administering the H1N1 influenza vaccine, managing access to antivirals, and serving as a vital link to hospitals and other healthcare providers. Pharmacists can be an integral part of the nation's "first line resource" for health and wellness and can extend the reach for public health initiatives. The public-private collaboration between health departments and community pharmacists could improve individual and family readiness, increase access to trained and trusted professionals and strengthen overall preparedness and community resilience.

How effectively can health care settings beyond the traditional medical home provide vaccines to adolescents?

OBJECTIVES: Our goal was to evaluate the capacity of various health care settings to supplement the activities of the traditional medical home by delivering vaccines to adolescents. METHODS: A group of experts in the fields of adolescent-immunization delivery and the provision of preventive care in various health care settings summarized the available literature, considered setting-specific factors, and assessed the ability of various health care settings beyond the traditional medical home to conform to the immunization quality standards set by the National Vaccine Advisory Committee, report vaccination information for the quantitative assessment of vaccine-coverage rates, be likely to offer vaccines to adolescents, and be viewed by adolescents as acceptable sites for receiving vaccinations. RESULTS: Seven candidate settings were evaluated: pharmacies, obstetrics-gynecology practices, sexually transmitted disease clinics, hospital emergency departments, family planning clinics, teen clinics, and local public health department immunization clinics. The panel concluded that all could safely provide vaccinations to adolescents but that vaccination efforts at some of the settings could potentially have a markedly greater impact on overall adolescent-immunization rates than could those at other settings. In addition, for adolescent-vaccination services to be practical, candidate settings need to have a clear interest in providing them. Conditional on that, several issues need to be addressed: (1) funding; (2) orienting facilities to provide preventive care services; (3) enhancing access to immunization registries; and (4) clarifying issues related to immunization consent. CONCLUSIONS: With supporting health policy, health education, and communication, health care settings beyond the traditional medical home have the potential to effectively augment the vaccination efforts of more traditional settings to deliver vaccines to adolescents. These health care settings may be particularly well suited to reach adolescents who lack access to traditional sources of preventive medical care or receive fragmented medical care.

Pharmacist involvement with immunizations: a decade of professional advancement.

OBJECTIVE: To review achievements in pharmacist-administered immunizations, emphasizing the period 1995 to 2004. DATA SOURCES: Published articles identified through PubMed (1995-2004) using the search terms pharmacist, pharmacy, and vaccine, immunization, or shots. Additional sources were identified from personal bibliographies collected by the authors during this decade, as well as the bibliographies of the retrieved articles. The later two sources resulted in manuscripts of primarily historical significance. STUDY SELECTION: More than 300 manuscripts were identified. The authors selected 15 studies that most clearly document the effect of pharmacist-administered immunizations for review. DATA EXTRACTION: By the authors. DATA SYNTHESIS: While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, only 10 years have passed since pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine administration in 1994. On November 1, 1996, the American Pharmaceutical (now Pharmacists) Association (APhA) began its nationally recognized training program for pharmacists, Pharmacy-Based Immunization DELIVERY: A National Certificate Program for Pharmacists. By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement. CONCLUSION: Pharmacists have made significant strides in immunizations over the past decade. Limited activities in the hospital sector have been particularly well documented, as have the perceptions of patients regarding acceptance of pharmacists as immunizers. The activities of community pharmacists are less well documented. More research is needed into novel approaches to pharmacist involvement in public health-focused immunization initiatives, along with continued research evaluating the current practice of pharmacist-administered immunizations.

Pharmacists' opinions regarding level of involvement in emergency preparedness and response.

OBJECTIVE: To assess opinions of pharmacist-members of the American Pharmacists Association Academy of Pharmacy Practice and Management (APhA-APPM) regarding the appropriate level of pharmacists' involvement in emergency preparedness and response activities and to determine whether opinions differed according to demographic characteristics. DESIGN: Cross-sectional, descriptive, Web-based survey. SETTING: United States. PARTICIPANTS: Five hundred eighteen APhA-APPM member-pharmacists. MAIN OUTCOME MEASURES: Responses to survey questions. RESULTS: Respondents to our survey indicated that pharmacists should have a high level of involvement in emergency preparedness and response activities. Traditional pharmacy practice activities (such as medication preparation and dispensing) and patient education were the most highly supported roles for pharmacists. Newer activities such as surveillance, vaccine administration, and mobilization were also strongly supported. Demographic characteristics, such as age, sex, degree, state of residence, practice setting, and employment setting, did not influence respondents' opinions. The only characteristic that influenced pharmacist opinions was previous participation in local and/or state emergency preparedness and response activities. Compared with other respondents, pharmacists who participated in these activities gave higher ratings to these possible roles for pharmacists: surveillance, triage/evaluation, community planning and preparation, mobilization, and training of others. CONCLUSION: Pharmacist-members of APhA-APPM who responded to this survey believe that participating in public health activities related to emergency preparedness and response is important for members of the pharmacy profession.