Willingness of Canadian community pharmacists to adopt a proactive life-course approach to vaccination services.

BACKGROUND: Most Canadian jurisdictions authorize pharmacists to administer vaccines, with differences in vaccine and patient age eligibility. Vaccination rates could be further optimized if pharmacists took a more proactive role in life-course vaccine screening and administration. Health professional vaccine fatigue following the COVID-19 pandemic may negatively impact service delivery. OBJECTIVES: To assess vaccine fatigue among Canadian pharmacists, understand their willingness to provide proactive life-course vaccination services and identify associated vaccine practice facilitators. METHODS: One-on-one interviews were conducted with pharmacists recruited through a national community pharmacist Facebook group. Purposive sampling was used to select a diverse sample considering gender, province, and years of practice. Online interviews were conducted using a semi-structured guide with questions about vaccination experiences, perceptions of assuming a more proactive vaccinator role for adults and children, and current level of fatigue related to offering vaccination services. Interviews were audio-recorded, transcribed, and coded independently by 2 researchers; content analysis was used to identify themes. RESULTS: In spring 2023, interviews were conducted with 24 pharmacists from 5 Canadian provinces. Participants were receptive to a more proactive vaccinator role, feeling that vaccine fatigue had lessened, but strongly advocated for system and practice modifications to facilitate successful implementation. They emphasized the need for patient vaccination history access, the ability to administer all publicly funded vaccines, and fair compensation. Participants requested the development of electronic tools that connected to pharmacy systems that helped them navigate complex vaccine guidelines and clinical decision making, and the required documentation/billing. They also spoke of logistical concerns related to the incorporation of vaccination into their workflow and adequate staffing. Most participants were willing to vaccinate younger children if legislated age limits were lowered, provided they were trained and compensated appropriately. CONCLUSION: Pharmacists are interested in furthering their vaccination services offerings, including proactive screening and vaccination of young children.

Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context.

(1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

Herpes zoster and human papillomavirus vaccination opportunities identified using electronic prompts at the time of scheduling influenza or COVID-19 vaccines.

Background: Due to workload and competing priorities, vaccination-related interactions in community pharmacies tend to be more reactive than proactive. The aim of this study is to determine the proportion of users of a web-based scheduling system for influenza and COVID-19 vaccines who may be eligible for herpes zoster or human papillomavirus (HPV) vaccination and interested in discussing these vaccines with a pharmacist. Methods: Individuals scheduling an influenza or COVID-19 vaccine at a pharmacy using the MedEssist platform between October 2021 and March 2022 were asked about their vaccination status against HPV (if aged 9-45) or herpes zoster (if aged ≥50). Those who were unvaccinated or unsure were asked to indicate their willingness to discuss this with a pharmacist. Logistic regression was performed to identify patient characteristics associated with responses to these screening questions. Results: Among 36,659 bookings by those aged 9 to 45 and 55,728 by those aged ≥50 that included responses to screening questions, 70.1% and 55.5% were potentially unvaccinated against HPV and herpes zoster, respectively, with approximately 1 in 5 also indicating willingness to have a discussion with the pharmacist. Those scheduling appointments for COVID-19 vaccines were significantly less likely to be vaccinated against HPV or herpes zoster and less willing to discuss this with a pharmacist than those seeking influenza vaccination. Discussion: Automated prompts while booking influenza or COVID-19 vaccinations have the potential to identify vaccine-willing individuals who may benefit from further discussion on their vaccination needs. Conclusion: Community pharmacies can leverage available technology to support the efficient and effective identification of individuals eligible for vaccination.

The impact of influenza on the ability to work, volunteer and provide care: results from an online survey of Canadian adults 50 years and older.

BACKGROUND: Influenza is associated with a decline in functional abilities among Canadian older adults, although specific impacts on daily life have not been fully explored. METHODS: In August 2019 and May 2020, we conducted surveys of Canadian adults 50-64 years and 65 years and older through an online market research platform. The survey included questions about the impact of diagnosed influenza or self-reported influenza-like-illness (ILI) on working, volunteering and caregiving. RESULTS: We surveyed 1006 adults in the 50-64 year age group about the 2018/19 season and 1001 about the 2019/20 season. In the 65 years and older age group, we surveyed 3548 and 3500 individuals about the 2018/19 and 2019/20 influenza seasons, respectively. In each season, nearly two-thirds of individuals 50-64 years with influenza/ILI were employed; 51.7% reported absenteeism in 2018/19 and 53.6% in 2019/20. Of the 20% of individuals 65 years and older who were employed, 47.0% of those with influenza/ILI were absent while ill in 2018/19 (39.8% in 2019/20). In 2018/2019, 29.6% of respondents 50-64 years old with influenza/ILI identified as volunteers (29.3% in 2019/2020). In both seasons, nearly half were unable to do so while ill. Of the 164 (32.7%) individuals 65 years and older who volunteered during the 2018/19 season, 80 (48.8%) did not while ill; 224 (37.3%) respondents volunteered in the 2019/20 season, and half were absent while ill. Of those 50-64 years with influenza/ILI, 97 (42.2%) and 57 (22.2%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19 and 2019/20, 40 (41.2%) and 28 (49.1%) caregivers were unable to provide care when ill, respectively. Of those with influenza/ILI in the 65 years and older age group, 123 (24.6%) and 162 (27.0%) were caregivers in 2018/19 and 2019/20, respectively. In 2018/19, 18 (14.6%) caregivers with influenza/ILI did not provide care while ill (42 [25.9%] in 2019/20). DISCUSSION: In Canadian older adults, influenza and ILI had notable impacts on ability to volunteer and provide care across two recent seasons. Optimization of influenza prevention in this population may yield important societal benefits.

Geographic distribution of Ontario pharmacists: A focus on rural and northern communities.

Introduction: Canadians living in rural and northern communities face particular health needs and challenges in accessing primary care services. Ontario pharmacists are increasingly able to optimize patient care with a broadening scope of practice; this was highlighted during the COVID-19 pandemic. This study explores the geographic distribution of pharmacists to evaluate their potential to deliver health care in rural and northern Ontario communities. Methods: A secondary analysis of the Ontario College of Pharmacists' registry data was undertaken, with all Part A pharmacists who had at least 1 patient care practice site included in the analysis. Full-time equivalent (FTE) hours worked at each practice site were calculated and compared with the population distribution. Ratios of FTEs per 1000 residents by census subdivision (which represents communities) were calculated and compared by geography, north vs south and urban vs rural (further subdivided by metropolitan-influenced zones). Results: The greatest availability of pharmacist FTEs was found in urban communities (with slightly better availability in the north), whereas the lowest availability was found in the most rural communities. A more granular observation revealed that northern communities were more likely to have no local pharmacist access (72%) compared with southern communities (24%). Discussion: Rural and northern communities are underserved. Novel approaches to overcoming the rural pharmacist care gap include rural practice incentives, targeted enrollment of rural students, increased rural exposure in pharmacy schools and the utilization of new technologies such as telepharmacy and drone medication deliveries.

Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario.

Introduction: Pharmacist-administered immunizations have been associated with improved vaccination rates; however, little is known about whether areas with little to no access to this service ("vaccination deserts") exist. The objective of this work is to determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario. Methods: Ontario College of Pharmacists registry data were used to identify patient care-providing pharmacists in community pharmacies and their ability to administer injections. Their number of hours worked was converted into full-time equivalents (FTEs), assuming 40 hours per week represents 1 FTE. Practice site(s) were mapped by postal code and presented by Public Health Unit (PHU) area. Communities within PHUs were further categorized as urban or rural and northern or southern, with ratios of FTEs per 1000 population calculated for both injection-trained and non-injection-trained pharmacists. Results: In total, 74.6% of Ontario's practising community pharmacists are authorized to provide injections. Northern PHUs had slightly better access to pharmacist injectors (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41 FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist immunizers, while PHUs with greater land area were more likely to not have any immunizing pharmacists present (p < 0.001 for all). Discussion: As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-based immunizations and collaboration with public health and primary care providers to address them (e.g., through mobile vaccination clinics) will be required to ensure equitable access. Can Pharm J (Ott) 2022;155:xx-xx.

Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review.

BACKGROUND: Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES: We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS: We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS: We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS: We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.

Experiential education supervisors as assessors of pharmacy student injection technique.

BACKGROUND AND PURPOSE: Due to the COVID-19 pandemic, students at the University of Waterloo in spring 2020 enrolled in the injections training curriculum were unable to complete the practical assessment component under the usual in-person model. Therefore, an alternative assessment strategy needed to be adopted to meet these curricular outcomes. EDUCATIONAL ACTIVITY AND SETTING: To allow students to complete their training and apply this skill during co-operative work placements in fall 2020, pharmacist supervisors (preceptors) who were authorized to administer injections were asked to evaluate the practical assessment on behalf of the university. Students were mailed supplies to use for practice and assessment, and preceptors were provided the grading rubric and a copy of the didactic training materials for their reference. To obtain feedback on the process and identify areas for improvement, students and supervisors were invited to complete a brief survey containing both Likert scale and open-ended questions upon completion of the assessment. FINDINGS: By fall 2020 term end, 69 of 121 students successfully completed the practical assessment component at a workplace. Survey responses indicated that, despite some challenges accommodating the assessment within a busy pharmacy's existing workflow and identifying volunteers to receive the injections, the modified assessment was well received. SUMMARY: Supervisors can be effective adjuncts to in-class instruction and assessment of injection technique. Even when initial assessments can take place at the university, providing supervisors with access to training materials and rubrics can reinforce these skills for students immediately prior to their implementation into practice.

The role of pharmacy technicians in vaccination services: a scoping review.

BACKGROUND: A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs. PURPOSE: This research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date. METHODS: In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer. RESULTS: A total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction. CONCLUSION: This review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.

Distributing Publicly-Funded Influenza Vaccine-Community Pharmacies' Perspectives on Acquiring Vaccines from Public Health and from Private Distributors in Ontario, Canada.

OBJECTIVES: To explore community pharmacies' experience with two models of distribution for publicly-funded influenza vaccines in Ontario, Canada-one being publicly-managed (2015-2016 influenza season) and one involving private pharmaceutical distributors (2016-2017 season). METHODS: Online surveys were distributed to community pharmacies across Ontario during the 2015-2016 and 2016-2017 influenza seasons with sampling proportional to Ontario Public Health Unit catchment populations. Quantitative data were analyzed descriptively and inferentially and qualitative data were summarized for additional context. RESULTS: Order fulfillment appeared more responsive with the addition of private distributors in 2016-2017, as more pharmacies reported shorter order fulfillment times (p < 0.01); however, pharmacies reported significantly more days with zero on-hand inventory in 2016-2017 (p < 0.01), as well as more instances of patients being turned away due to vaccine unavailability (p < 0.05). In both seasons, a similar proportion of pharmacies reported slower order fulfillment and limited order quantities early in the season. Improved availability early in the season when patient demand is highest, more vaccines in a pre-filled syringe format, and better communication from distributors on product availability dates were recommended in qualitative responses. CONCLUSIONS: Introducing private distributors for the management and fulfillment of pharmacies' orders for the publicly funded influenza vaccine appeared to have mixed results. While key concerns surrounding the frequency, responsiveness, and method of delivery were addressed by this change, challenges remain-in particular, acquiring sufficient vaccine early in the season to meet patient demand. As pharmacies become more prominent as vaccination sites, there are several opportunities to ensure that patient demand is met in this setting.

COVID-19's Impact on Willingness to Be Vaccinated against Influenza and COVID-19 during the 2020/2021 Season: Results from an Online Survey of Canadian Adults 50 Years and Older.

There is considerable overlap in age-related risk factors for influenza and COVID-19. We explored the impact of the pandemic on anticipated influenza and COVID-19 vaccination behaviour in the 2020/2021 season. In May 2020, we conducted online surveys of Canadian adults 50 years and older via a market research panel platform, as part of a series of annual surveys to understand experiences with influenza. Given the current pandemic, respondents were also asked about COVID-19's impact on their vaccination decision-making for the 2020/2021 season. Of 1001 respondents aged 50-64 years, 470 (47.0%) originally intended on receiving the influenza vaccine and still planned to do so, while 200 (20%) respondents who had planned to abstain now reported willingness to receive the vaccine due to COVID-19. In the 65+ age group, 2525 (72.1%) reported that they had planned to be vaccinated and that COVID-19 had not changed their mind, while 285 individuals (8.1%) reported that they had initially planned to forgo the vaccine but now intended to receive it. Reasons for this change included COVID-19's demonstration of the devastating potential of viruses; and to protect against influenza, and decrease vulnerability to COVID-19. If the COVID-19 vaccine was available, 69.1% of 50-64 year olds and 79.5% of those 65 years and older reported they would opt to receive it. The COVID-19 pandemic has been a sobering demonstration of the dangers of infectious disease, and the value of vaccines, with implications for influenza and COVID-19 immunization programs.

Pharmacy students' perceived willingness and ability to negotiate for paid co-operative education positions.

Background: Evidence of a gender wage gap has been identified across many professions, with some evidence in pharmacy. Negotiation is one potential strategy to address this gap and it is underutilized, especially among women. No studies to date have examined pharmacy student perceptions of negotiation when applying for co-operative education positions - a potential sign of willingness to negotiate for entry-level positions upon graduation. Objectives: To examine pharmacy students' comfort with and ability to engage employers in negotiation over wage and other work-related considerations for mandatory and paid co-operative education work terms at the University of Waterloo (Waterloo, Ontario, Canada). Methods: Two focus groups, one for female and one for male students, were performed with students who had completed at least one co-operative education placement. Focus groups aimed to elucidate students perceived ability to negotiate with potential employers, to identify strategies that educators can employ to better support students through the hiring and negotiation process, and to elicit student perceptions on the gender wage gap in pharmacy. Focus groups were audio recorded and transcribed verbatim, and data were coded inductively by two independent reviewers, employing thematic analysis. Results: Three major and two minor themes were identified: Preservation of the relationship; Power differential and perceived ability to negotiate; Institutional support and training; Negative experience with negotiation and wage gaps; and the presence of a gendered approach to negotiation. Pharmacy students rarely engage in negotiation during co-operative hiring processes at the University of Waterloo, with some female students expressing hesitation to negotiate due to concerns about being perceived as "bossy". Students of both genders felt poorly equipped to engage in negotiation with a potential employer, and lacked confidence in initiating such a conversation. Conclusions: Students identified a number of factors which influence their ability and desire to negotiate wages during co-op placement, including the requirements and logistics of placements, the perceived power imbalance between students and potential employers, and a concern that any wage negotiation may overshadow the value placed by students on the opportunities to provide patient care. Educators can play a role in equipping students, especially female students, with tools to enter into conversations on wages with potential employers.

Helping Unlock Better Care (HUB|C) using quality improvement science in community pharmacies - An implementation method.

INTRODUCTION: Community pharmacists' optimal scope of practice extends far beyond traditional dispensing or compounding, and health promotion or chronic disease management services based in the pharmacy can generate significant social and economic value. But, with many competing demands and performance expectations from patients, payers, and policymakers, many pharmacies face challenges when introducing, maintaining, optimizing, or integrating their service offerings. Quality Improvement (QI) science may provide a practical change management framework for pharmacy professionals to lead their teams in embracing optimal scope and in making pharmacy-based services more feasible and attractive for all parties. PROJECT AIMS: To build community pharmacies' capacity for continuous QI (CQI) and to understand how the implementation of CQI is best achieved in this setting. METHODS: Community pharmacies will undertake a process of change within one or more existing pharmacy services. Participatory action research principles will empower these sites to identify their own opportunities for improvement, generate change ideas, and trial and study those ideas in practice, using a QI system built on the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. An external Quality Facilitator will consult and train an internal Change Champion and other pharmacy staff to use QI tools and strategy. Mixed methods will be used to explore changes in pharmacy service quality, and to understand the experience of the pharmacy professionals taking part in the QI process. INTENDED OUTCOMES: To assess the capacity and willingness of community pharmacies to undertake self-directed QI initiatives, with the support of an external Quality Facilitator and an established QI approach. Understandings surrounding the transferability of this process, including further scale-up, and the production of additional change management tools are additional potential outcomes of this work.

Exploring influenza vaccine hesitancy in community pharmacies: Knowledge, attitudes and practices of community pharmacists in Ontario, Canada.

BACKGROUND: Vaccine hesitancy (VH) remains a prime contributor to poor influenza vaccine uptake. This study explores the knowledge, attitudes and practices of community pharmacists toward influenza VH, including their personal influenza immunization attitudes and behaviours. METHODS: A web-based cross-sectional survey questionnaire was administered to community pharmacists practising in Ontario, Canada. A 38-question survey tool explored 5 domains, including pharmacists' personal attitudes and behaviour toward influenza immunization, their self-reported knowledge of influenza, its vaccine and vaccine hesitancy, and their attitudes, practices and experiences with influenza VH at the community pharmacy. The data were analyzed descriptively. RESULTS: A total of 5530 survey invitations were e-mailed, and 885 responses were collected (response rate 16%). Two-thirds (n = 568, 65.7%) of the respondents reported receiving the influenza vaccine in the preceding season. The most frequent reasons for personal influenza immunization were prevention of disease transmission to patients, friends and family, and contribution to herd immunity. In addition to their confidence and perceived ability to identify and address influenza VH, respondents' self-reported knowledge across a 15-item Likert questionnaire was high. Respondents reported coming across an average of 16 (SD 28) individuals hesitant to receive the influenza vaccine each week. Regular workload (n = 419, 65.6%) and insufficient time (n = 406, 65.3%) were reported as the most limiting barriers to engagement in influenza vaccine conversations. CONCLUSION: Facilitating optimal practice scope for pharmacists, and capitalizing on the convenience and accessibility of the community pharmacy setting, presents a promising means to address influenza VH. However, barriers to pharmacist-initiated engagement on influenza vaccine must be explored and addressed. Can Pharm J (Ott) 2020;153:xx-xx.

Vaccination during pregnancy: Canadian maternity care providers' opinions and practices.

A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.

Shades of gray in vaccination decisions - Understanding community pharmacists' perspectives of, and experiences with, influenza vaccine hesitancy in Ontario, Canada.

BACKGROUND AND OBJECTIVES: Vaccine hesitancy (VH) has been increasingly recognized as a global threat to public health. Yet, limited research exists exploring healthcare providers' experience of this phenomenon. Our study aims to understand community pharmacists' attitudes towards, and experiences with, influenza VH, and explore factors impacting their engagement with patients on the influenza vaccine. METHODS: A semi-structured interview guide was developed, and interviews were conducted to saturation with community pharmacists practicing in Ontario, Canada. Interview data was transcribed verbatim and analyzed using a thematic content analysis framework. The analysis yielded 110 unique codes, which were merged into five major themes and 15 sub-themes. RESULTS: A total of 22 pharmacists were interviewed to achieve saturation. Most pharmacists were authorized to administer injections (n = 20, 90.9%) and practiced for >20 years (n = 16, 72.7%). Pharmacists' engagement with patients on the influenza vaccine was found to be modulated by a complex and mutually reinforcing constellation of attitudes and behaviours which include: a binary (pro-vaccine or anti-vaccine) perception of patient vaccination decisions; a conflation of those expressing hesitancy with those who are anti-vaccine; and a passive approach to patient engagement, wherein patients were found to be the primary initiators of vaccine conversations. Although pharmacists recognized the importance of educating patients and addressing their vaccine-related concerns, barriers such as limited time, inadequate staffing, and poor remuneration were found to restrict optimal patient engagement on influenza vaccinations. CONCLUSION: While pharmacists hold the potential to effectively address influenza VH within their communities, future interventions must aim to break the loop of passive patient engagement and enable proactive pharmacist-patient interactions on influenza vaccinations in this setting.