Expert Q&A: Pharmacists Address Pneumococcal Vaccine Hesitancy and Screening Complexity in Transitions of Care

Most adults admitted to a safety-net hospital and referred to a pharmacist-directed transitions of care (PharmTOC) consult service were not up to date on recommended vaccinations, according to a study published in the Journal of the American Pharmacists Association.

Of 147 patients screened, just 17.0% were current on all eligible influenza, pneumococcal, and COVID-19 vaccinations at the time of pharmacist review. When pharmacists offered vaccination based on identified gaps, 66.9% of patients accepted at least 1 recommended vaccine, and more than half of those who assented received a vaccine before discharge.^1,2

Pneumococcal vaccination posed a particular challenge. Eligibility depends on age, underlying conditions, and prior vaccine history, and recommendations shifted during the study period.^1,2

Expert Insights on Screening and Counseling for Pneumococcal Vaccination

In this follow-up Q&A, study authors Marissa Cavaretta, PharmD, BCPS, BCACP, department of pharmacy practice at Temple University School of Pharmacy; Rhonda Abouelela, PharmD, BCPS, internal medicine clinical specialist at St. Peter’s University Hospital; Nicholas Ferraro, PharmD, BCPS, clinical pharmacy specialist in internal medicine/transitions of care at Temple University Hospital; Jamie Wagner, PharmD, BCIDP, FIDP, antimicrobial stewardship pharmacist at Beth Israel Lahey Health; and and Jason Gallagher, PharmD, FIDP, FCCP, FIDSA, clinical professor and department of pharmacy practice at Temple University School of Pharmacy, discuss what drove pneumococcal vaccine hesitancy among their transitions-of-care population, how they approached brief bedside conversations with hesitant patients, and what pharmacists should consider when building systematic vaccine screening into their own inpatient workflows.

Pharmacy Times: In your work with this transitions-of-care population, what tends to be the biggest driver of pneumococcal vaccine hesitancy—is it more about safety concerns, lack of awareness of eligibility, or something else—and how do you address it in a brief bedside conversation?

Study Authors: Interestingly, nearly half of the patients with a pneumococcal vaccination gap did not report a reason for vaccine hesitancy. Among those who did, lack of confidence in vaccine safety and/or effectiveness was the most commonly reported reason for hesitancy, followed by complacency.

Bedside counseling was tailored to the individual patient. For those without hesitancy, the goal was to educate them about the benefits of vaccination and explain why they were a candidate for the vaccine. We had similar conversations with patients who expressed concerns about vaccine safety and/or effectiveness but spent more time addressing their specific concerns and discussing vaccine safety.

After counseling, we saw a modest increase in the number of patients reporting no hesitancy and a slight decrease in those reporting concerns about vaccine safety and/or effectiveness. Importantly, more than half of the patients with a vaccination gap ultimately assented to vaccination. This highlights the importance of having continued conversations with patients, as one touchpoint may not be enough to overcome hesitancy barriers.

Pharmacy Times: Pneumococcal vaccination has a more complex schedule than flu or COVID-19 (multiple product options, age- and risk-based eligibility). How did that complexity affect your team's ability to identify gaps and counsel patients, and what would you tell a pharmacist trying to build similar screening into their own workflow?

Study Authors: Pneumococcal vaccination was more complicated to screen for because eligibility depended on several factors, including age, underlying conditions, and prior pneumococcal vaccine history. Then during our study period, the pneumococcal vaccination recommendations changed, so the more challenging part was determining whether the patient was eligible based on the most up-to-date guidance. The introduction of PCV20 (which we had on the formulary) simplified vaccine recommendations.

Having an accurate vaccination history was important. We relied on our electronic health record and the state immunization registry, which gave us a good starting point, but we still had to reconcile information from the registry, the medical record, and the patient's own history. The time it took to complete this task varied, and in our population, a meaningful barrier was that some patients were discharged before recommended vaccines could be administered. Therefore, starting the screening process as early as possible is essential.

For pharmacists trying to build this into their own workflow, it would be helpful to have a short-form reference handy to simplify all of the vaccine schedules at a glance. We kept the CDC's updated pneumococcal recommendations readily available during the study period to streamline our screening process. The key is to make screening systematic: determine when screening will occur; review the patient's age, risk factors, and prior vaccine history; flag if eligible for vaccination; and have a specific recommendation in mind before speaking with the patient or provider.

Once we knew what the patient needed, we moved on to bedside counseling, which was generally simpler than determining eligibility. If the patient was unable to receive the vaccine before discharge, we provided a recommendation for vaccination after discharge.

REFERENCES

1. Cavaretta M, Abouelela R, Ferraro N, Wagner J, Gallagher J. Closing adult vaccination gaps through a pharmacist-directed transitions of care service in a safety-net hospital. J Am Pharm Assoc. 2026;103515. doi:10.1016/j.japh.2026.103516

2. Halpern L. Pharmacist TOC service closes adult vaccine gaps in safety-net hospital. Pharmacy Times. September 18, 2026. Accessed September 22, 2026. https://www.pharmacytimes.com/view/pharmacist-toc-service-closes-adult-vaccine-gaps-in-safety-net-hospital