Vaccine-preventable diseases create a tremendous financial, personal, and societal burden, and that burden is disproportionately higher for older adults.1

The cost of vaccine-preventable diseases among American adults is about $9 billion annually, with more than half that amount attributable to adults aged 65 years and older, and another $2 billion to adults aged 50 to 64 years.2 Clearly, vaccination rates among older adults are suboptimal.

The Advisory Committee on Immunization Practices (ACIP) recommends a short list of vaccines for older adults (see TABLE 13). This article focuses on herpes zoster (HZ or shingles), which infects about 30% of Americans at some point during their lifetime.4 Pharmacists can administer the HZ vaccine in all US jurisdictions and states.5 Community pharmacists can decrease vaccination barriers and increase access.



The US Department of Health and Human Services’ Healthy People 2020 (HP2020) set a coverage goal of 30% for HZ vaccination for adults aged 60 years or above.3 The HZ vaccination coverage rate in 2017 was at 34.9% in older adults, indicating that the goal was exceeded.6 Regardless, better coverage could prevent many cases of shingles. Improving all vaccination rates relies on 3 factors identified by the World Health Organization’s Strategic Advisory Group of Experts Working Group: complacency, which refers to understanding the impetus; confidence, which refers to trust; and convenience, which refers to access.7

CONVENIENCE
Pharmacists are accessible. More than 90% of Americans live within 2 miles of a pharmacy,8 and almost all pharmacies have predictable and often long hours.9 The Medical Expenditure Panel Survey found that patients aged 64 to 75 years visited their pharmacies on average 31 times annually but saw their doctors on average 5 times.10,11 This speaks to the convenience factor.

Pharmacists are America’s preferred vaccinators. Most Americans prefer local pharmacies for vaccinations over their physician’s offices.12 In addition, the likelihood of being vaccinated correlates with the frequency of a patient’s physical presence near a vaccination clinic.13

When it comes to the HZ vaccine, pharmacies have another convenience factor.13 Although physicians often recommend the HZ vaccine, only about half of them stock it, whereas more than 91% of pharmacies stock the vaccine.14 Although the HP2020 goal was met, vaccination coverage for HZ falls behind that of other vaccines recommended for older adults.15 Barriers may include cost-sharing that creates a financial burden for patients, and low vaccine availability in physician offices, both of which are convenience factors.

CONFIDENCE
Americans have consistently ranked pharmacists in the top 3 health care professionals in terms of trust.16 Pharmacists can leverage that trust to improve vaccination coverage by increasing patient confidence in vaccines.17

COMPLACENCY
More than 87% of older Americans are aware of the recommendations for influenza, pneumococcal disease, and Td/Tdap vaccinations. Fewer (73%) are aware of the recommendation for HZ, however.18 One study suggests that physicians prioritize certain vaccines but consider the one for HZ a lower priority. Patients may perceive influenza or pneumococcal vaccines to be more important than the HZ.19 Pharmacists can reduce patients’ complacency by using activities promulgated by the American Society of Health-System Pharmacists (ASHP; see TABLE 220-25).



CONCLUSION
All accredited PharmD programs now train students to be immunizers, but not all practicing US pharmacists are immunizers. It appears as though providing immunizations is a skill associated with younger professionals. If all pharmacists pursued training, geographic and socioeconomic disparities in vaccine access would be reduced.9 Pharmacists also need to be advocates for carefully constructed state vaccine policies that promote unfettered pharmacist participation in vaccination activities.
 
Jeannette Y. Wick, MBA, RPh, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.


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