Pharmacists Play Vital Role in Improving Vaccine Equity

It is well-known by this point that community pharmacists played a crucial role in the COVID-19 pandemic, particularly for vaccine administration. According to the CDC, as of August 18, 2023, more than 307.4 million doses of COVID-19 vaccines were administered and reported by participants in the Federal Retail Pharmacy Program, which includes 21 retail pharmacy partners and more than 41,000 locations nationwide.¹

However, the COVID-19 pandemic also revealed major gaps in the health care system both in the United States and internationally, particularly for vaccine equity. At the end of 2022, researchers found that 69% of people globally had received a COVID-19 vaccine, but this number dropped to less than 25% in low- and middle-income countries.² There are many reasons for these disparities, including struggling health systems, social determinants of health, and lack of public trust and acceptance.²

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“During the pandemic, there were so many people getting sick and so many people dying, and [there was] this really obvious sort of disparity in the risks of exposure and access to medications, access to vaccines,” said Tyler Marie Kiles, PharmD, BC-ADM, clinical assistant professor at the University of Texas at Austin College of Pharmacy, in an interview with Pharmacy Times. “I think what’s really changed is the spotlight on [equity], maybe a little shame around it…and so now I think we have the social momentum to target this or to make some changes in this area.”

Importantly, these issues go far beyond the COVID-19 vaccines. CDC data show that the percentage of the US population reporting receipt of COVID-19, influenza, and respiratory syncytial virus (RSV) vaccines remains low for both children and adults, as of January 19, 2024. As of that date, 11% of the pediatric population was reported to have received the updated 2023-2024 COVID-19 vaccine, and 21.5% of adults had received it, including 40.9% among adults 65 years and older. Additionally, 46.7% of adults have received a flu vaccine for the 2023-2024 season, and 21.1% of adults 60 years and older have received an RSV vaccine.³

“When we consider, you know, what would we deem as being a limitation to receive different health services, those are the [same] things that we see for vaccines,” said Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of clinical pharmacy at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego, in an interview with Pharmacy Times. “It can be hard to drive to an area for you to get vaccinated, or to make it to a pharmacy if that pharmacy is 20 miles away from where you live and you don’t have a car. Or it can be hard to sign up for the slots that are [open] to receive a vaccine…[if] folks don’t have access to internet.”

Some vaccines have seen significant growth in recent years, although disparities are still present. For instance, shingles vaccination among adults 60 years and older increased from just 6.7% in 2008 to 34.5% in 2018, according to CDC data. However, in 2018, non-Hispanic white adults (38.6%) were approximately twice as likely as non-Hispanic Black (18.8%) and Hispanic (19.5%) adults to have ever received a shingles vaccine. Additionally, vaccination coverage was highest for those who were not poor and those who had more than a high school education, highlighting socioeconomic disparities.⁴

In the US, pharmacists are uniquely positioned to vaccinate their communities, and particularly those who may not frequently engage with traditional health care settings. One study, published in Vaccine, aimed to identify strategies utilized by community pharmacists to support equitable vaccination in their communities.⁵

Respondents primarily emphasized the importance of a “safe space” for patients to receive vaccines, and said they felt that this was a key factor in achieving vaccine equity. The study authors defined “safe space” as both a physical location as well as the interpersonal relationships between pharmacy staff and patients, which allow patients to feel safe, welcome, and respected. This is particularly important for the diversity of patients often seen in community pharmaciess, and having a space welcoming to all can help develop deeper community connections, thereby improving vaccine equity.⁵

The 3 pillars of creating that space were prioritizing trust, meeting patients where they are, and building capacity within the pharmacy and the community. Participants said they build trust during individual patient encounters by acknowledging mistrust in health care, applying shared decision making, and addressing health literacy, among other strategies. Respondents also agreed that community-level trust is built by being engaged in the community and creating genuine partnerships.⁵

“I think we’re trusted in the communities we serve,” Kiles said. “We have a way that we can sort of code switch between talking to health care practitioners, but also communicating that in patient-friendly language, and I think that builds us a lot of trust on both ends.”

This effort often goes hand-in-hand with the second strategy: meeting patients where they are. This can mean both physically (through vaccination clinics, mobile clinics, etc.) and emotionally meeting patients where they are in their knowledge, thinking, and readiness.⁵

“That accessibility [of pharmacies] without having to make an appointment, without having to even call ahead, I think is a really important aspect of our profession,” Kiles said. “But it’s not just community pharmacists. We’ve got hospital pharmacists, pharmacists that work in clinics, that are really taking care of patients and keeping patients from falling into some of these health care gaps that exist.”

Additionally, participants emphasized that building the pharmacy team’s capacity to provide equitable vaccination services is crucial. Preparing teams to interact with patients, engaging non-medical individuals at vaccine clinics or other events, and building infrastructure are all crucial parts of these efforts.⁵

Finally, investigators identified 9 discrete vaccination equity strategies:⁵

• Build community partnerships
• Establish trust to build credibility
• Address transportation issues
• Provide patient education and address health literacy barriers
• Address language barriers
• Create a safe and accessible space for patients with individualized needs (i.e., expanded hours, intentional vaccine allocation, etc.)
• Provide patient-centered and culturally sensitive care
• Train staff on health equity and patient engagement
• Advocate for community pharmacy policy and payment reform

The last discrete strategy—policy and payment reform—is particularly crucial. Earlier research in the United Kingdom has shown that if community pharmacies receive adequate remuneration, they are more likely and able to deliver vaccination services.⁵

In the US, efforts to expand pharmacists’ abilities to vaccinate have come a long way, but still have room to grow. Although every state has authorized pharmacists to administer vaccinations, the specific details and limitations vary. Some factors that vary from state to state include which vaccines can be administered by pharmacies, age limitations, and prescription requirements for individual vaccines.⁶

The findings of this study demonstrated that community pharmacists and their larger teams can play a major role in improving vaccine equity, often through seemingly small strategies.⁵

“I think a lot of times, pharmacists sort of feel like we’re begging to be included, so we have a little chip on our shoulder sometimes,” Kiles said, recalling some initiatives during the COVID-19 pandemic offering free coffee to health care workers, but excluding pharmacists. “But I really do think that when it comes to health equity, it’s such a natural fit for us to be involved. And I really feel like this could be our thing; this could be something that we can really take a run with.”

Pharmacies need not work individually to improve equity, however. Coordinated federal and local efforts to improve vaccine equity have seen some success. The CDC’s Partnering for Vaccine Equity (P4VE) program, launched in 2020, provides more than $156 million in funding and support for national, state, local, and community partners in order to better prioritize equitable vaccine access and uptake, with a specific focus on racial and ethnic minorities. The program currently has more than 500 partners, more than 300 local chapters, affiliates, and community-based organizations, and has a presence in more than 225 cities and all 50 states.⁷

Pharmaceutical companies are also involved in improving vaccine access and equity. For instance, GSK has launched the COiMMUNITY Initiative with the goal of achieving higher adult vaccination rates in the US through grant funding, increased data, and other resources and tools.⁸ On a global scale, Pfizer has a program called “An Accord for a Healthier World,” which is intended to provide the company’s full portfolio of patented and off-patent medications and vaccines on a non-profit basis to 1.2 billion people in 45 lower-income countries.⁹ Programs like these highlight the important ways pharmaceutical companies can partner with others to improve equity both in the US and worldwide.

“The sort of official definition of health equity is the idea that all people should have a quote-unquote ‘fair and just opportunity to obtain their optimal health,” Kiles said. “But to me, it means not having to worry about if who I am, what I look like, how much money I have, is going to prevent me from getting the best care possible.”

With their vital role on-the-ground and their direct relationships with patients, pharmacists cannot be forgotten in these efforts. By building community partnerships and creating space for all, pharmacists can be key players in all of these efforts to improve vaccine equity.

“Because [pharmacists] are community-oriented, I think it allows for us to really make headway into [health] literacy, and we can easily go in and disseminate and provide information,” Abdul-Mutakabbir said. “I think I’m representative of how we, as pharmacists, do approach health care. We can hold your hand and we can walk you through what this looks like, and I love that. I think that’s just the beauty of the profession.”

References

1. CDC. A Collaboration Between the Federal Government, States and Territories, and 21 National Pharmacy Partners and Independent Pharmacy Networks Nationwide. Reviewed August 18, 2023. Accessed January 24, 2024. https://archive.cdc.gov/www_cdc_gov/vaccines/covid-19/retail-pharmacy-program/index.html

2. Privor-Dumm L, Excler JL, Gilbert S, et al. Vaccine access, equity, and justice: COVID-19 vaccines and vaccination. BMJ Glob Health. 2023;8(6):e011881. doi:10.1136/bmjgh-2023-011881

3. CDC. Vaccination Trends—Adults. January 19, 2024. Accessed January 24, 2024. https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html

4. Terlizzi EP, Black LI. Shingles vaccination among adults aged 60 and over: United States, 2018. NCHS Data Brief. July 2020. Accessed January 24, 2024. https://www.cdc.gov/nchs/data/databriefs/db370-h.pdf

5. Carroll JC, Herbert SMC, Nguyen TQ, Schork CJ, Kampas LN, Rebitch CB. Vaccination equity and the role of community pharmacy in the United States: a qualitative study.

6. DeMaagd G, Pugh A. Pharmacists’ Expanding Role in Immunization Practices. US Pharmacist. October 18, 2023. Accessed January 24, 2024. https://www.uspharmacist.com/article/pharmacists-expanding-role-in-immunization-practices

7. CDC. Equity in Adult Vaccination. Reviewed December 27, 2022. Accessed January 24, 2024. https://www.cdc.gov/vaccines/health-equity/index.html#:~:text=Through%20the%20Partnering%20for%20Vaccine,that%20drive%20community%2Dlevel%20action.

8. GSK announces the COiMMUNITY Initiative to help achieve higher adult vaccination rates in the US. News release. GSK. June 1, 2023. Accessed January 24, 2024. https://us.gsk.com/en-us/media/press-releases/gsk-announces-the-coimmunity-initiative-to-help-achieve-higher-adult-vaccination-rates-in-the-us/

9. ‘An Accord for a Healthier World’. Pfizer. Accessed January 24, 2024. https://www.pfizer.com/about/responsibility/global-impact/accord