Pharmacists' Vital Role in RSV Vaccination: Shared Clinical Decision Making and Education

Pharmacists play an important role in the shared clinical decision making process for respiratory syncytial virus (RSV) vaccination, as well as in educating patients about the potential need for RSV vaccination, particularly among older adults and target individuals, explained Richard Dang, PharmD, APh, BCACP, FCPhA, assistant professor of clinical pharmacy, University of Southern California Alfred E Mann School of Pharmacy and Pharmaceutical Sciences, during a presentation at the American Pharmacists Association (APhA) 2024 Annual Meeting & Exposition in Orlando, Florida.¹

Dang explained that shared decision making is particularly important in RSV vaccination currently as the decision to vaccinate a patient is recommended by the CDC Advisory Committee on Immunization Practices (ACIP) guidelines to be, at least in part, based on a conversation with that patient.^1,2 According to these guidelines, the decision to vaccinate should be informed by the patient’s risk of severe RSV disease, as well as their characteristics, values, and preferences; the health care professional’s clinical discretion; and the characteristics of the vaccine.²

“Also, pediatrician and [obstetrician and gynecologists (OBGYNs)] are really eager to get their patients protected, and many are seeking pharmacies they can partner with to help vaccinate pregnant woman, or even to administer monoclonal antibodies, which is administered intramuscularly. Depending on your state jurisdictions, you may be able to administer that [monoclonal antibody] product as well,” Dang said during the APhA session. “I think there's a lot of really eager providers who are looking for pharmacist partners to provide these services.”¹

However, Dang explained that shared clinical decision making remains a controversial issue among pharmacists that can impact the potential for these partnerships, as some pharmacists strongly oppose this approach.¹

“Pharmacists really don't like shared clinical decision making, at least from my conversations [with pharmacists], but medical providers seem to really like it. But that introduces some challenges and some barriers,” Dang said. “I was on a [sic] workgroup for COVID-19 for APhA, and several times there have been physician members who said, ‘Well, I went to my pharmacy, and they didn't do shared clinical decision making.’”1 Dang explained further that this lack of shared clinical decision making posed a problem for these physicians in referring patients to that pharmacy, since the ACIP recommendation is to take a shared decision making approach.¹

“I think a lot of the kind of open questions surrounding these vaccines are the reason that we have that shared clinical decision making component for now,” said Keri Hurley-Kim, PharmD, MPH, BCACP, APh, health science associate clinical professor, University of California, Irvine, during the APhA session. “Although, this need may actually go away and we may see more of a blanket recommendation for these individuals [in the future].”¹

Additionally, Dang explained that another challenge around RSV vaccination that comes up in discussions with clinicians is around vaccination of pregnant women. According to Dang, there have been numerous comments made by OBGYNs about referring patients to a pharmacy to get an RSV vaccination, but the pharmacy then rejects that patient.¹

“For whatever reason, the patient was turned away. It could have been time constraints, could have been store policy against vaccinating pregnant women, could have been a lack of product availability—we don't know the details,” Dang said during the session. “I just want to encourage collaboration where you can, because when looking at where patients are getting RSV vaccines, for older adults, it's preferentially at pharmacies. Medical providers and medical clinics are not really administering that vaccine or carrying it as often.”¹

Additionally, Dang noted that many OBGYN practices also are not carrying the RSV vaccine and are instead referring these patients to pharmacies.¹

Many OBGYN practices are not carrying the RSV vaccine and are instead referring these patients to pharmacies. Image Credit: © catalin - stock.adobe.com

“I think a really great opportunity, if you have a local practice or clinic, is potentially to create a referral system or relationship with that clinic,” Dang said during the session. “You can capture those patients to help them receive the appropriate vaccinations.”¹

Dang summarized the ACIP guidelines for all patients recommended to receive RSV vaccination, including adults aged 60 years and older, pregnant women, and infants and young children. For adults aged 60 years and older, ACIP guidelines encourage shared clinical decision making and recommend one dose of RSVPreF vaccine (Abrysvo; Pfizer) or one dose of RSVPreF3 vaccine (Arexvy; GSK) prior to the onset of the RSV season in September, when possible.¹

For maternal vaccination, ACIP guidelines recommend one dose of RSVPreF vaccine at 32 to 36 weeks gestation during the September to January RSV season. For infants and young children, passive immunization is recommended. For infants aged younger than 8 months whose mother did not receive an RSV vaccination while pregnant, one dose of nirsevimab (Beyfortus; AstraZeneca and Sanofi) after birth or soon before the beginning of their first RSV season is recommended. For infants aged 8 to 19 months at increased risk, ACIP guidelines recommend one dose of nirsevimab soon before the beginning of their second RSV season.¹

“RSV is a disease that has some pretty significant morbidity and mortality outcomes for [these] vulnerable populations, which primarily include the very young and the very old,” Dang said during the session. “When we saw the number of cases, it was almost equal to or more than influenza cases. If we're worried about flu, we also should worry about RSV.”¹

REFERENCES

1. Dang R, Hurley-Kim K. Old Virus, New Vaccines: Preventing RSV in Vulnerable Patient Populations. American Pharmacists Association 2024 Annual Meeting & Exposition; March 22-25, 2024; Orlando, Florida.

2. CDC. For Healthcare Providers. U.S. Department of Health & Human Services. Last updated March 1, 2024. Accessed March 23, 2024. https://www.cdc.gov/rsv/clinical/index.html#:~:text=In%20most%20regions%20of%20the,vary%20from%20year%20to%20year.