The Popularization of Immunization

Troy Trygstad, PharmD, MBA, PhD, leads a discussion on the popularization of immunization, and the transition of immunization care to pharmacies as primary providers.

Troy Trygstad, PharmD, MBA, PhD: I’m a Xennial, which means that I grew up in a time when the pharmD curriculum was just coming to pass. When immunizations were something that folks in the Department of Defense [DOD] were talking about the pharmacists doing. What a totally foreign concept when I graduated from pharmacy school. Now we’re nearly ubiquitous. What percentage of pharmacies are now immunized? It’s a very high percentage, right? How did we get there? What were the key seminal moments that got us to that point, in your mind?

Michael Popovich: From a data point of view what got us there was the H1N1 [hemagglutinin 1 neuraminidases 1] pandemic in 2009, because there was a lot of momentum. Some pharmacies were starting to give immunizations. When the pandemic hit, they had to come up with the vaccine and figure out a way to deliver it. That is when public health opened the door and said, “You know, we need help. Let’s engage the pharmacists, the ground work has already been laid out.”

Troy Trygstad, PharmD, MBA, PhD: So arguably we are much better prepared for a pandemic now than we were 15 years ago.

Michael Popovich: Yes. Some 60,000 plus pharmacies out there are prepared. You know, an untold number of pharmacists now are more than capable of giving immunizations. Vaccines are flowing into this community. That entire ecosystem is centered around closing key immunization care gaps. Without the pharmacies and pharmacists involved, you can’t get anywhere close to the goals set in place by the United States government. It really was that pandemic that launched this. The pharmacists and pharmacies were quite wise and business-oriented people who realized the opportunity this created for the patients and customers that walk into their store, in regard to revenue. It’s a good public-private partnership that was launched, unfortunately because of this pandemic.

Troy Trygstad, PharmD, MBA, PhD: Sure. So the pandemic was a seminal event. The business with it was lagging but still an important factor. What else?

Dorothy Loy, PharmD, MBA: I think the trust the patients have with the pharmacists is important. That’s gained through situations where there are pandemics or outbreaks, or a really bad flu season. People start to understand that pharmacies are not just convenient, but they realize they are trustworthy health care professionals.

Troy Trygstad, PharmD, MBA, PhD: So consumer and patient expectations changed over that time too.

Dorothy Loy, PharmD, MBA: Yes.

Troy Trygstad, PharmD, MBA, PhD: Great, what else?

Tana Kaefer, PharmD: Practice. Practice the laws. We can immunize in a lot more States now. I practice in Virginia. We have been vaccinating since the late 1990’s. Obviously, I think it started in an independent pharmacy. That was a niche that we could do to differentiate ourselves. That’s just grown exponentially.

Emily Endres: From a managed care perspective too, that’s grown a lot over the last 5 to 7 years, it is clear that this stemmed from a pandemic issue. Managed care organizations have grown to realize that they also need these alternative types of care offer immunization as well.

Troy Trygstad, PharmD, MBA, PhD: So all of those things contributed to what is now relatively ubiquitous with consumers and patients, regarding plans and other care team members in pharmacies that can administer immunizations. Tell me about your first experience when you got a referral from a practice where you said, “Wow, this is a turnabout. I used to be lobbying for access to provide this service, and now they’re sending them to me.” Tana, you first.

Tana Kaefer, PharmD: When I first started working 15 years ago, we were pretty far ahead in the immunization world. I don’t have a good example of someone sending me a referral. I think they just knew we did immunizations. I never saw the beginning of this. I do have a story though. My dad was an independent pharmacist, so I remember when we ordered our first flu vaccine in the late 1990’s. I was telling them the story: 5 vials were provided for the whole season. You know that is starting early. I remember when all that happened, I kind of lived through it. It’s always nice when doctors refer us for administering travel vaccines, and things like that for our pre-travel health clinic. That doesn’t stand out for me because it seems like it’s been happening my whole career.

Troy Trygstad, PharmD, MBA, PhD: Oh you young pups. How many vaccines do you order at Walgreens in a year?

Dorothy Loy, PharmD, MBA: Quite a bit. Last year we did around 9 million flu vaccines, and that’s just the flu. Then there’s obviously routine and travel vaccines on top of that. For us, referrals really started with Zostavax, when it came on the market, because that was something that needed to be in a freezer. Doctors and physicians didn’t have access to those freezers and tools, so it became a regular thing for physicians to refer patients to pharmacists. That’s where we really started the trust. Now it’s grown, and over the past few years I would say we’ve seen an uptake in referrals for whopping cough for relatives and mothers, because the mother gets immunized by their provider, but not the rest of the family. So we’ve seen an uptake in that, which is great news, because those are the prime patients that we need to come in so they can protect the children and themselves.

Michael Popovich: To give you an idea of the information that’s flown from pharmacies in the last couple years, we’ve had the opportunity to send over 100 million immunization events that have been given for pharmacies across the country, into public health immunization registries. In the early days, the records were mostly for flu vaccines, but now we can see influenza data and other immunizations. It’s exponentially grown where data is flowing into repositories.

Troy Trygstad, PharmD, MBA, PhD: You know it’s interesting. When I talk to family medicine and adult care practices, we’ve gone from, in 10 years, considering whether a lot of their services could be done in pharmacies too. That’s a pain in the butt for us. What does that journey look like, Mike? Ten years is a short timeframe for the health care system to change.

Michael Popovich: It is a huge dynamic.

Troy Trygstad, PharmD, MBA, PhD: How do we get there? Other care team members going from: “I’m not so sure,” to “Oh, please, take this off my hands.”

Michael Popovich: I think the family practitioner is so busy with other things that are critical to their practice, that immunizations have happily been delegated to pharmacies because they recognize that individuals are visiting their pharmacists much more regularly, and are more likely to be immunized. That probably means they’re better protected and healthy, so when they come to the physicians, it’s for a real problem or an annual checkup.

So in a way they’re giving up a piece of their business and opportunities. I think it’s making them more efficient however, and productive, and then it’s creating more synergy between the physicians and pharmacies. That’s a good, healthy thing for all of us, who go to both places for our health care.

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