A Conversation With Michael Hogue, Liaison to the CDC Advisory Committee on Immunization Practices

In 2021, Michael Hogue, was appointed liaison representative of the American Pharmacists Association to the CDC Advisory Committee on Immunization Practices. In a conversation with Pharmacy Times®, Hogue, also the dean of Loma Linda University School of Pharmacy, said the appointment is a culmination of his career in pharmacy.

Q: What is the CDC Advisory Committee on Immunization Practices (ACIP) and why is it important to pharmacists?

Michael Hogue, PharmD: ACIP is a panel of experts that reviews the evidence and provides advice and third-party assessment of data regarding immunizations and vaccines of all types. Any vaccine approved by the FDA is reviewed for clinical use recommendations by ACIP. Its members are not CDC employees, but truly independent advisors, and I think that provides great value and assurance that there’s an emphasis on true clinical outcomes and quality.

Q: What does it mean to be the American Pharmacists Association (APhA) liaison representative to ACIP, and what are your responsibilities in this role?

A: For a little bit of context, ACIP is made up of 15 voting members and about 45 nonvoting liaison members. Out of the 60 people involved, there’s only 1 pharmacist. As everybody knows, pharmacists have really taken on quite a vital role in the provision of vaccines in our nation, and particularly in adult and adolescent patients. So, it’s really important that we have a voice as a profession. And for the past 21 years, we’ve had that voice through APhA and its appointee. When Steve Foster, PharmD, FAPhA, recently announced his retirement and stepped down from the committee, I was asked to take his place. So, it’s definitely an important role for the profession to have.

Q: Why is it important to have pharmacists represented on this committee?

A: If we look at just the past 2 years, 70% of COVID-19 vaccines were administered in pharmacies. Currently, over 50% of flu vaccines are administered in pharmacies. And when you consider other adult vaccines (for pneumonia, tetanus, HPV, etc), pharmacists are giving an increasing number of the vaccine doses, particularly to adult and adolescent patients. Pharmacists are giving some vaccines to children, but that’s a pretty small number overall. The reality is that pharmacists certainly have clinical expertise that needs to be taken into account. And then there are many practical considerations. The recommendations that come from ACIP are based on clinical evidence, but they also take into consideration the practical matters of implementation. And that has to be thought through very carefully. Having a pharmacist at the table makes a huge difference, particularly as it relates to the practicality of ACIP recommendations.

Q: You’ve also served on the ACIP COVID-19 Vaccine Workgroup. What is that and how has it informed your work as APhA liaison representative?

A: The workgroups at ACIP are pretty intense. In April of 2020, shortly after the pandemic was declared, we knew that there would be vaccines under development. So, the CDC appointed a workgroup for COVID-19, and I was asked to serve on it.

The workgroup meets every week, sometimes twice a week. That’s at least 2 hours a week, sometimes 4, and when there’s an ACIP meeting, it can be 12 or 15 hours of meetings per week. The workgroup reviews the data that is becoming available globally about COVID-19 vaccines. We review data that are not publicly available, some that have not yet been published, but we look at everything that’s out there, every single piece of data that is available, whether it’s a small trial, a hospital-based trial, clinical trial, anything at all. It’s out there and it helps us inform [decisions] and we review the safety data in real time. We really look at the safety data very closely for the COVID-19 vaccines.

So, the workgroup really keeps [abreast of] what’s happening with this particular vaccine. For all other vaccines in the ACIP schedule, there are workgroups as well. Clearly, the COVID-19 workgroup has met with some level of intensity, and the workload has been much greater than perhaps that of other workgroups. I’m hoping in the future we’ll reach a state of normalcy and not have quite as many meetings. But it’s been a lot of work. It’s been really intense.

Q: What are some recent changes about vaccines that phar- macy students should be aware of?

A: Everything with vaccines has been so hyperfocused on COVID-19 for the past few years that pharmacy students have probably heard almost too much about COVID vaccines, to the exclusion of everything else. There are 2 major changes that I think pharmacy students need to have on their radar.

One is related to pneumococcal vaccines. We have 2 new conjugate pneumococcal vaccines that are completely changing the landscape—not just in adult populations, but even in pediatrics. So, [we have] a new 15-valent conjugate vaccine and a new 20-valent conjugate vaccine. If students have not read up on the newest recommendations related to the use of those vaccines and the clinical concerns, that would be my number 1 reading assignment for pharmacy students.

Number 2 would be hepatitis vaccines, since we now have broad-based recommendations for utilizing hepatitis B vac- cines in all adult patients. And this really stems from the fact that despite our best efforts to target high-risk or at-risk individuals for hepatitis B, for the past 20 years, we’ve really done no good. We’ve made no impact on the death rate for hepatitis B in the United States. By using an age-based approach and immunizing all adults, rather than those who are high risk, perhaps we might be able to get our death rate down. About 5000 people a year die from hepatitis B in the United States, and it’s been that way for 20 or 30 years. So hopefully, this new strategy will make a difference. Those are 2 big changes pharmacy students should be aware of.

Q: With so much changing around vaccines in the past couple of years—even in terms of logistics, with technicians being able to vaccinate—how are pharmacy students learn- ing and thinking about these shifts?

A: Pharmacy students are realizing that, in most states, pharmacy interns are licensed by their board of pharmacy as an intern. And a pharmacy intern can do anything that a pharmacist can do, as long as they’re under the supervision of a pharmacist. One of the things that pharmacy students have to think about is the activities that a pharmacist really needs to be doing in a practice. Especially community pharmacy practice, but any practice. And what tasks are they performing that could be delegated to a technician? So, in the area of vaccines, now that the pandemic is kind of coming to an end and we’re coming into an endemic peri- od for COVID-19, I would hope that we would be able to do more comprehensive assessments of vaccination needs for patients. Pharmacy technicians are not trained to do that, but pharmacists are. Pharmacy technicians get trained now to do injections and to actually administer the vaccines. So, think carefully about your workflow, wherever you’re practicing as a pharmacy student or doing your internship. Think carefully about what you’re doing in that practice that really requires you and your decision-making capacity as a pharmacist. And then think about those things you could designate to the technician. And giving shots is not really that complicated. It’s pretty straightforward, and pharmacy techs can do that for us. And let’s do the things that require clinical decision-making skills so that we have time to do all the things we need to do in a busy pharmacy. So that’s what I would really challenge pharmacy students to do, to be observant.

Q: Where do you see the future role of pharmacists in terms of vaccination efforts?

A: I think what’s underfoot right now is an extension of the authorities provided under the federal [Public Readiness and Emergency Preparedness] Act. And essentially, during a declared emergency pharmacists were given prescriptive authority, regardless of what state law might have said, and were allowed to prescribe vaccines across the entire lifespan. I know several states have now introduced legislation, and some have already passed legislation, that will now allow pharmacists to prescribe vaccines. I just saw, for example, a copy of the of the law that the state of Alabama has introduced that will allow pharmacists to prescribe vaccines all the way down to age 3. So, [there are] lots of great opportunities in that removal of barriers.

I think pharmacists are going to have to get much more familiar with immunization registries than we have been in the past. We’ve been a little more passive with those. We probably need chain pharmacy organizations to give pharmacists the ability to review patients’ immunization records through the registry, and we need those records to prepopulate into dispensing records. So, there are some technology fixes that need to happen in order for pharmacists to have more ability to do immunization assessments in keeping with the National Vaccine Advisory Committee or any standards for vaccinations, but this is an area where pharmacists can make a huge impact on public health
by being a more easily accessible resource for this life-saving intervention.

Q: Finally, as the second pharmacist to serve on ACIP, what does it mean to you?

A: It’s really kind of a culmination of career-long work in immunization. I did my residency training with APhA in Washington, DC, back in the mid-1990s, as APhA was just beginning its work on immunizations. I was assigned to work with Colonel John Rubinstein, then with the US Army, and with Bill Atkinson, MD, who was with the CDC at the time, a physician in charge of the immunization branch. And the 3 of us—together with Mitch Ross Holtz and a whole group of talented individuals at APhA—launched what became the Pharmacy-Based Immunization Initiative, including advocacy with all 50 states, to get the authorities passed as well as the training for pharmacists.

So, I’ve been engaged with vaccines and immunizations since the mid-1990s. That’s a long time, and it’s kind of nice at this point to have been so closely connected with this world of vaccines. And I’ve worked on a number of initiatives with the CDC in the past as well. It’s gratifying to be in this position and be a part of the bigger conversation. So, I’m grateful to APhA for the opportunity to serve, and I’m passionate about our profession and our profession’s involvement in vaccines. It’s rewarding.