Pharmacists Play Key Roles in Seasonal Respiratory Immunizations

In an interview with Pharmacy Times, Chris Altman, PharmD, Director of Immunizations and Clinical Programs at Rite Aid, discussed the upcoming Winter and impending respiratory illness season. In addition to the annual flu vaccines, COVID-19 boosters and respiratory syncytial virus (RSV) vaccines present new opportunities for pharmacists to advise patients and ensure they are up to date on all immunizations.

Q: Can you discuss the importance of immunizations for respiratory illnesses overall, and particularly over the last couple of years?

Chris Altman, PharmD: Yeah, I think the one thing we need as a pharmacy chain [and] as pharmacists, is we really [need to] understand the value vaccinations play in preventing disease, specifically preventing respiratory illnesses. We've seen really sort of a spectrum of what the communities are really up against for the last couple of years, [such as] something as easy as influenza, which is relatively routine and almost, to some extent, expected every year. The influenza is going to creep up, so getting that flu shot gives that protection. And then over the last couple of years, obviously COVID-19 came. In the pandemic, we saw a lot of areas really reacting in real time to that virus spreading and the evolution of the virus. So, at this point, now we're in a state where COVID-19 is now, sort of, in this seasonal sense, with new viruses or new strains of the virus circulating and new vaccines being provided. And then more recently, we've seen attention around things like respiratory syncytial virus or RSV, another virus starting to spread this season. So, luckily, we got a new vaccine also introduced this last year to help protect against that. So really, across the gamut, the idea is there are lots of things you can do to prevent illness: masking, hand washing, and social distancing. But the most important piece of that is getting the vaccine because that vaccine reduces likeliness of getting it. And then if you end up getting sick, [the vaccine] reduces the severity of illness.

Q: Is there any data to help predict how severe this winter could be for respiratory illnesses?

Chris Altman, PharmD: Across the industry and across public health in general, we look at data from the southern hemisphere to see what their influenza season looked like, or what their respiratory diseases looked like. [They are] not necessarily direct effects. We can't say, ‘All right, the southern hemisphere had X, Y, and Z, so we expect the exact same thing up here.’ But it does give us some indication, at least some leading indicators, about what would happen. I've been in sort of the immunization space for about 10 years and the one thing I've learned is that you can never predict a fall flu season, you can never predict what's going to happen. So, it's one of those things where we use the best data we can from the southern hemisphere. We track data internally as well, so we look at reported infection rates, we look at number of public health departments that are saying they're seeing positive cases for influenza. We're doing a lot of wastewater surveillance, as well, to say, you know, is there virus in the wastewater? What does that mean? But really all we can do is make our best guess. And then I always tell people to assume the worst. Assume it's going to be a bad season; assume you should get your vaccines [and] get protected because that sets you up really well in case that virus does start to spread, whichever one it might be. So, we do our best guess with the data available to us. It's never perfect, but it does give us some indication of what may be happening.

Q: How have the emergence of COVID-19 boosters changed the process or timeline for COVID-19 immunizations?

Chris Altman, PharmD: The whole process around the COVID-19 vaccination campaign has changed a lot. Obviously, we saw the original virus, or the original vaccine introduce single-strain 2-dose series, we saw sort of the populations to get vaccinated evolve from those at highest risk in the general population. Then we moved into that bivalent booster space where it was a specific vaccine with additional strain coverage. More recently, we've seen that move to this current vaccine, this 2023-2024 updated vaccine that's got what we're currently seeing as the most prevalent strains out there, as far as giving that coverage. So, the evolution has really gone down that path to evolve the vaccine and evolve the awareness as the vaccine. So, we're going to continue seeing that evolution, we're going to continue seeing sort of public health and continue seeing the responsibility to match that.

Q: How can pharmacists continue ensuring that patients receive boosters, given that they’re a little less in the news this year?

Chris Altman, PharmD: Yeah, I think the great future of pharmacy, or the great hallmark of pharmacy is our easy accessibility and our trustworthiness. Pharmacists are in the communities. They're right there on the street corner, people come and ask questions very easily, and they look to the pharmacist for knowledge. So, I think the number one thing that pharmacists can do is just stay up to date, stay up to date on information available, continue being that trusted source. Now, the other piece is really being proactive with sharing that information. So, if someone comes in, maybe not waiting for that customer to ask a question about it. Look at the customer's profile, review their vaccine history. See when's the last time they had a COVID-19 dose? If it's been more than 2 months, it's a great time to have the conversation and say, ‘Hey, I see you haven't received the 2023 COVID-19 dose, we can take care of that today while you're here in the store,’ or ‘I can schedule you to come back later,’ and really be that that sort of proactive encouragement to get someone vaccinated. And that's not just in the COVID-19 space, that's really in all the vaccine space. Same thing with flu. A lot of folks come in and sort of volunteer their arms to say, ‘I'm here for my flu shot.’ But a lot of people won't. They wait for their health care provider to make the recommendation. And the one thing we know is that the more the pharmacist recommends, the more they're engaging their customers, the more the customers will follow that recommendation. So really utilizing your knowledge as a pharmacist to get the customer vaccinated, to get the customer protected, is really the number one thing we can do in the pharmacy environment.

Q: Turning to RSV, this has been a major topic of discussion in recent winters. How are pharmacists preparing for the upcoming season?

Chris Altman, PharmD: I think we saw a lot of RSV in the news last year, so some of that sort of priming the pump, so to speak. So, we've got customers thinking about it and got customers thinking about asking questions. And with this new vaccine available, we see it now introduced readily available for those 6 years and older. Pharmacists are having those conversations with customers to say, really, what is this new vaccine? How is it giving you protection? But also still just educating on what the disease is. RSV is still not really well known to the general public, so a lot of that foundation still has to be laid to make someone understand what is RSV? And why are you at risk, and why should you get vaccinated? So that's a big piece of it.

The other side of it, too, is just again, staying up to date on the recommendations for the vaccine. So, we've pushed a lot of information to our pharmacists, we really want to make sure they feel confident, and they can give that recommendation, that they feel like what they're providing their patient gives them that protection. So, it's been a big push for us to make sure that that knowledge is disseminated, and then our pharmacists, again, are actively having those conversations with their customers.

Q: RSV vaccines are relatively new and may come with some concerns, particularly for pregnant patients. How can pharmacists address these concerns?

Chris Altman, PharmD: The CDC has some really good resources when it comes to having those conversations, they've got some really good fact-based data to say how safe is the vaccine, how effective is the vaccine? What does it look like for a pregnant person to get vaccinated? Why should they get vaccinated? And really frame that around that safety and efficacy because that's always going to be the questions we get is, is this a safe vaccine? And will it work? The data is there. So, I always say go back to the CDC data. Use that as sort of your starting block and then, as a pharmacist, have trust and faith in that science, because it's been really thoroughly vetted. So, giving that firm, confident recommendation and then when customers have questions and concerns, be very welcoming to them. Let them understand that it makes sense. You should have questions, you should be concerned, and then help walk them through that. Because the one thing I've learned is that no 2 patients have the same concern. So, it's really about addressing that individual person's concern, figuring out what it is they they're looking for, what knowledge they need, filling that gap in, and working with them to make a decision about getting vaccinated.

Q: Flu vaccines are always crucial this time of year. How can pharmacists ensure they aren’t falling by the wayside amid the COVID-19 boosters, RSV vaccines, and other respiratory concerns?

Chris Altman, PharmD: Yeah, that's definitely a big, big opportunity for us in the community. And I think it goes in all directions, right? So, I think we've got people that are coming in to get their flu vaccines, but they may not have COVID-19 or RSV top of mind, and vice versa, they're going to come in because COVID-19 is in the news and because you're seeing information about these new updated COVID-19 vaccines. So, I think the one thing is really take opportunities when you're giving a vaccine to look for those gaps for other vaccine opportunities. So, if someone's in there for the COVID-19 shot, ask them if they've received their flu vaccine—if they haven't, recommend it at the same time. The CDC has been really good about giving really good direction around being able to co administer all these vaccines together. So, really having that conversation with the customer to say, ‘Hey, I see this other opportunity you have. You're getting your RSV vaccine, but I really think you should also get the influenza,’ and having that conversation. And for those customers that don't want to receive more than one vaccine at a time, because we understand that not everyone wants to walk out with 2 band-aids, at least have the conversation and then tell them ‘Let's schedule a time for you to come back. Do you want to come back in 2 weeks, you want to come back next week?’ You know, whatever it is, have that conversation, get that commitment for them to come back in, and make sure again, within that context, you're communicating really the safety of the vaccine, the efficacy of the vaccine, and how it's important to that individual person and why it's important that they be protected.

Q: How have pharmacists stepped up and how do they continue to be crucial team members regarding respiratory immunizations?

Chris Altman, PharmD: Yeah, I mean, I think just generally, I graduated pharmacy school in 2007. And to think about where the immunization program has come from in the pharmacy setting from then until now… I still remember my first year in a store, I gave a grand total of 20 flu shots in the entire year. And just thinking about how small that is now, like we even have pharmacies who give 20 shots before noon. So really thinking about, we've embraced this as this is a huge opportunity for us to serve our communities. We've embraced this as we understand this as a public health need, and taking it as far as we can to really get the information out there. And then just looking at the role we played during the pandemic, and during that initial vaccine wave. Pharmacy was like the destination for COVID-19 vaccines; was the definite destination for information around COVID-19 vaccines and we really saw how the industry and all community pharmacy joined together to really make sure that we were providing the vaccines in a safe and effective manner in our community pharmacies.

And specifically at Rite Aid, we raised our hands at every opportunity. ‘What do you need from our pharmacists to help in this pandemic, and to help get us to the next stage?’ Now that we're in this next stage, we continue—our hands are still up, we're still saying, ‘Give us the vaccines, give us the ability to give them, continue to give us that ability.’ And even think about what else we can do. You know, the adult population pharmacy has had a really good and sort of entrenched position, but there's still a bunch of opportunities in the pediatric population. So, we're still looking for work in those opportunities for us to help fill those gaps and make health care and vaccines as accessible as possible. I think that's continuing the path of what community pharmacy is going to do.

Q: Is there anything you’d like to add?

Chris Altman, PharmD: I don't think so. I mean, I think the message I have is if you've got questions, I get it, it's confusing. There's a lot of information out there in the world around vaccines and around what's new, what's going on. And I think as pharmacists, we need to embrace this opportunity and be ready to answer and to be that source of truth. I think that's really, really important to our communities is that they continue to see pharmacy as that trusted profession that can answer those questions.