APhA: Pharmacists Are the Front Line of Adult Vaccination—and the Gap Is Still Wide Open

In 1900, vaccine-preventable infectious diseases were the leading cause of death in the United States, and life expectancy hovered around 47 years. More than a century of immunization programs later, the leading killers are now chronic diseases, and life expectancy has grown by roughly two-thirds, to approximately 75 years.¹

Yet even with that hard-won progress as a backdrop, the numbers on adult vaccination remain troubling: less than 27% of adults aged 65 and older and less than 15% of adults aged 15 to 64 are up to date on their recommended vaccinations.¹ At the 2026 American Pharmacists Association Annual Meeting, Damika Walker, PharmD, RPh, manager of a Walgreens Specialty Pharmacy at Howard University Hospital and residency program director for the Walgreens/Howard University College of Pharmacy PGY1 Community-Based Pharmacy Residency, brought that gap into sharp focus—and put pharmacists at the center of closing it.¹

The Burden That Persists

Walker opened her presentation by tracing the arc from the polio era through the approval of respiratory syncytial virus (RSV) vaccines in 2023, illustrating how far vaccine science has come. But she was equally direct about the work that remains, zeroing in on 3 vaccine-preventable diseases she framed as priority targets for adult pharmacists: RSV, herpes zoster, and influenza.¹

The numbers she cited are striking. RSV is responsible for an estimated 2.2 million symptomatic infections and approximately 177,000 hospitalizations annually among adults aged 65 and older in the US. One in 3 Americans will develop herpes zoster at some point in their lifetime, generating roughly 1 million cases per year, with a significant proportion of patients developing postherpetic neuralgia—a chronic, often severe pain syndrome that can linger long after the acute infection resolves. And during the 2024-2025 influenza season, approximately 590,000 adult hospitalizations occurred, with 92% to 96% of patients having at least 1 underlying condition.^1,2

Recent CDC surveillance data underscore the extent of the challenge. As of early 2026, RSV vaccination coverage stood at 40.9% among adults aged 75 and older and at only 30.9% among adults aged 50 to 74 years who are at increased risk of severe disease. Influenza coverage for the 2024-2025 season was similarly modest, at roughly 34.7% of adults aged 18 and older by November 2024. Walker explained that simply having vaccines available isn’t enough; pharmacists must facilitate patients’ vaccination and ensure they gain strong protection against serious illness.^2,3

“Vaccines don’t save lives. Vaccinations save lives,” Walker said, recounting a quote from Walter Orenstein, MD, DSc (Hon), a former director of the United States’ National Immunization Program. “It’s one thing to have the vaccine sitting on the shelf. You have to get it into the patient's arm.”¹

Equity Gaps Demand Attention

Walker was candid about a dimension of the vaccination crisis that is sometimes sidestepped in clinical settings: racial and ethnic disparities in uptake. Black and Hispanic adults are vaccinated at consistently lower rates than White adults across nearly every vaccine category—a pattern documented across CDC surveillance data and echoed in the research literature. Walker named the Tuskegee syphilis study directly as a driver of lasting mistrust among African American patients, and she urged pharmacists not to dismiss that history when making a vaccine recommendation. Recognizing and being honest with patients about their valid concerns can help build trust between a pharmacist and their patient.⁴

“We have to be mindful of the patients we’re speaking to and the different elements that may be causing them to be hesitant," Walker told the audience. “We cannot dismiss them, because they are very real. It is not to shame [the patients]. It is to listen to them, understand why they have the hesitancy, and speak to that.”¹

She also flagged structural barriers—inconsistent outreach to unhoused or underinsured patients, confusing or rapidly evolving recommendations, vaccine storage and handling challenges, and inadequate payment structures, particularly for independent pharmacies—as systemic forces that compound the disparity. Walker also pointed out the harms of misinformation in the technological age, noting that “anybody with a phone and the internet can post anything, and it goes viral.”¹

“We all know that misinformation unfortunately spreads a lot faster than the correct information, right?” Walker highlighted. “We always have to be mindful that we’re competing against what is being put out on these social media platforms.”¹

The Presumptive Recommendation: A Proven Tool

The heart of Walker'“s practice-focused message centered on what she called the "presumptive recommendation”: a communication approach in which pharmacists assume a patient will be vaccinated rather than asking whether they want to discuss it. She contrasted the presumptive approach (“Hello, today you’re due for your influenza and RSV vaccines; we’ll take care of that while you’re here”) with the participatory approach (“Would you like to hear about your vaccine options?”), which she argued leaves too easy an opening for patients to decline before the conversation even starts.¹

The evidence supports her. Findings from a 2025 systematic review and meta-analysis, including 22 randomized controlled trials, showed that pharmacist interventions were associated with a significantly higher vaccination rate, with a pooled risk ratio of 1.58 (95% CI, 1.40-1.79; P < .00001), and that pharmacists acting as direct immunizers had an even greater impact than those serving in advocacy roles alone. Walker described the need for pharmacists to optimize and expand their vaccine counseling approach and not to hesitate to adapt their workflow to maximize positive outcomes.⁵

“I’m assuming she’s going to say yes. And if she doesn’t, then that opens the door for a conversation. The patient thinks, ‘Hey, she must think this is important for me; let me at least hear…what she has to say,’” Walker said.¹

From Clinic to Community

Walker described her own practice as a model for thinking beyond the pharmacy counter. Even when her site’s contract does not allow her to administer immunizations directly, she counsels every eligible patient, connects them with a nearby sister pharmacy, sets up the appointment, and follows up. She also shared experiences vaccinating patients at a metro station in Washington, DC, and at local senior centers, examples she offered as proof that pharmacists need to think outside the 4 walls of the pharmacy to reach the most vulnerable patients.¹

That community-facing posture is increasingly supported by data. Data from a CDC analysis of the 2023-2024 respiratory virus season revealed that pharmacies and drugstores were the most common vaccination settings for COVID-19 (71.5% of vaccinees), RSV (81.7%), and influenza (48.0%) recipients in nonmedical settings. The pharmacy, Walker argued, is not just convenient; it is often the only consistent health care touchpoint some patients have.⁶

She closed with a call to documentation, follow-up, coadministration, and cultural humility. Perhaps most importantly, she offered a reminder that correcting misinformation is not an argument to win but an opportunity to provide patients with the information they need to make the best decision for themselves.¹

“Make sure that we are knowledgeable,” Walker said, “so that we can inform our patients and have them make the best decision for themselves. And by merging our expertise and our education, we can help fill in those gaps so that we can continue to [increase] access to our patients, make sure they are vaccinated, and make sure our communities are healthy.”¹

REFERENCES

1. Walker D. Elevating public health: the pharmacist’s role in adult vaccination. Presented at: American Pharmacists Association Annual Meeting & Exposition; March 27-30, 2026; Los Angeles, CA.

2. Kriss JL, Black CL, Razzaghi H, et al. Influenza, COVID-19, and respiratory syncytial virus vaccination coverage among adults—United States, fall 2024. MMWR Morb Mortal Wkly Rep. 2024;73(46):1044-1051. doi:10.15585/mmwr.mm7346a1

3. Vaccination uptake, intent, and confidence. CDC. February 20, 2026. Accessed March 28, 2026. https://www.cdc.gov/respvaxview/dashboards/vaccination-behavioral-social-drivers.html

4. Geng X, Wang W. Respiratory syncytial virus vaccination among US adults aged ≥60 years. Front Immunol. 2024;15:1427550. doi:10.3389/fimmu.2024.1427550

5. Elghanam Y, Kim EY. Impact of pharmacist intervention on enhancing vaccination coverage: a systematic review and meta-analysis. Res Social Adm Pharm. 2025;21(7):495-504. doi:10.1016/j.sapharm.2025.03.004

6. National and state-specific estimates of settings where adults received influenza, updated COVID-19, and RSV vaccinations, 2023–2024 respiratory virus season, United States. CDC. January 23, 2026. Accessed March 28, 2026. https://www.cdc.gov/respvaxview/publications/national-state-vaccination-estimates.html