How Pharmacy and Public Health Partner to Combat Infectious Diseases

In an era of growing public health concerns, finding innovative new ways to disseminate resources to individuals in an equitable manner is crucial. This is especially true when considering chronic disease prevention and management and dealing with infectious disease outbreaks. Fortunately, pharmacists have become more integrated into the health care system than ever, providing an opportunity for key public health and pharmacy partnerships.¹

At IDWeek 2025, experts from the pharmacy and public health spaces came together to discuss innovative new models that make pharmacists integral providers and logistical experts in managing infectious disease. In one session, titled How to Set Up Successful Public Health–Pharmacy Partnerships, Mary Foote, MD, MPH, FIDSA, medical director of the office of emergency preparedness and response at the New York City Department of Health and Mental Hygiene; and Ryan Tomlin, PharmD, BCPS, AAHIVP, a clinical pharmacist at Trinity Health Grand Rapids, highlighted ways for pharmacists to expand their clinical impact in public health efforts.¹

How Can Pharmacists Increase Access to Preexposure Prophylaxis?

Tomlin focused his presentation on how pharmacy and public health can collaborate to dismantle barriers to HIV preexposure prophylaxis (PrEP) access. Numerous barriers have traditionally held up access to PrEP. These include having limited access to providers, being fearful of stigma, or being unable to manage the high costs associated with often brand-name drugs. On the provider end, they may be unfamiliar with HIV treatments, such as long-acting injectables (LAIs), and other PrEP options. These leave obstacles leave patients little options for high-quality HIV care.¹

This is where pharmacists come into play. Pharmacists are in diverse health care settings, spanning emergency department and urgent care to community and ambulatory settings. This allows for easy access and linkage to care, according to Tomlin. In some jurisdictions, collaborative practice agreements (CPAs) allow pharmacists to act as providers, providing support to HIV clinics. Perhaps most important from the logistical side of the system is that pharmacists can coordinate billing and patient access programs while working to implement LAI medications in their practice.^1-3

“We have kind of infiltrated everywhere in health care,” Tomlin said. “Quite often, pharmacists can be the first point of contact for patients in the health care system.”¹

In Tomlin’s program at Trinity Health, clinical pharmacists were embedded within primary care and specialty offices throughout Grand Rapids to provide pharmacist-run PrEP care. These pharmacists were able to conduct full visits under a CPA with providers in their respective clinics. Pharmacists could initiate a full history and risk assessment analysis while ensuring that initial labs and screenings are promptly ordered. If appropriate, the pharmacist could prescribe PrEP medications and provide treatment for sexually transmitted infections (STIs).¹

Next, patients could be linked to appropriate settings for further care. Because pharmacists accepted referrals from all providers in their clinic, patients had faster access to care, while gaining access to PrEP even if the provider was unfamiliar with the treatment. Additionally, patients could be linked to primary care settings by pharmacists across the health system. For example, pharmacists in emergency departments could refer patients for STI and postexposure prophylaxis visits, while infectious disease pharmacists could conduct culture follow-up reports.¹

Pharmacists can play an especially critical role regarding LAI PrEP. In Tomlin’s program, infectious disease pharmacists ran the logistics and ordered medications from several pharmacies depending on patient coverage, including specialty, long-term care, and outpatient infusion clinics. Pharmacists were able to track the arrival and storage of the medications and document patient injection schedules. Because of their medication expertise, pharmacists were in a prime position to offer counseling on LAIs and refer patients as needed.¹

Tomlin emphasized that successfully integrating pharmacists into PrEP dissemination requires buy-in from stakeholders across the team, including providers, pharmacy leadership, and operational leaders. Proper education for all members of the care team is essential, especially regarding clinical knowledge and available services. Perhaps most importantly, pharmacists should ensure there are clear point individuals for effective communication across settings.¹

“You don’t have to reinvent the wheel,” Tomlin conveyed to providers. “We can be here to support you in all of these different ways.”¹

Can Pharmacists Assist in Outbreak Response?

Foote shifted the discussion to how pharmacists can be integral partners in fast-moving public health emergencies. In her role at the New York City Department of Health, Foote had firsthand experiences with such outbreaks, including COVID-19 in 2021 and mpox in 2022. New York City houses over 8 million people with over 3000 pharmacies across 5 boroughs; 75% of these pharmacies are independently owned. In each emergency, Foote and her team leveraged pharmacies’ community presence to overcome the challenges of a large and diverse city and ensure that antiviral treatments were equitably disseminated to those in need.¹

When nirmatrelvir-ritonavir (Paxlovid; Pfizer) was first beginning its rollout, numerous obstacles were evident. The drug’s effectiveness depends on prompt administration, but the initial supply of the drug was extremely limited. To make matters more complicated, many of the neighborhoods most impacted by COVID-19 have less access to chain pharmacies than those less affected by the virus. Initially, there was no reimbursement mechanism for pharmacies, making costs tight.¹

To circumvent these challenges, Foote and her team sought to provide the oral antivirals to patients through a single pharmacy partner that could provide home delivery at no cost to patients. The city government covered the cost of dispensing and other wrap-around services.¹

Requirements for the contract were numerous. The pharmacy partner had to ensure that nirmatrelvir-ritonavir could be delivered on the same or next day to the patient’s home across all 5 boroughs. A scheduling delivery system had to be set up via a smartphone app, desktop, or phone, so older adults would not face barriers to access due to unfamiliarity. Medication counseling had to be provided—with translations, accounting for the extremely diverse nature of the city. And biweekly reports had to be issued to New York City to monitor the rollout and ensure equity.¹

Foote explained how the model was successful, reaching every residential zip code in the city. As expected, older individuals and those in lower-privileged neighborhoods were more likely to schedule a delivery via the phone, validating its inclusion as a communication method. Although more deliveries initially went to higher-privilege neighborhoods, once ordering opened to all pharmacies, there was an increase in the proportion of deliveries to socially vulnerable neighborhoods.¹

A similar strategy was employed when the mpox outbreak began in 2022. New York City was an early epicenter for the disease in the US, necessitating a prompt response. However, access to tecovirimat (Tpoxx; SIGA), an FDA-approved antiviral for smallpox, was limited due to CDC protocol and limited prescribers, who were confined mostly to academic centers and required in-person visits.¹

With a vast-moving outbreak impacting minority communities across the city, Foote leveraged the same resources developed during the COVID-19 pandemic. The team launched a telehealth treatment model that adhered to the CDC-sponsored expanded access investigational new drug protocol for tecovirimat, which enabled a rapid scale-up of tecovirimat prescribing during the outbreak. The New York City Health Department’s sexual health clinic had an established pharmacy partner with delivery services, allowing for equitable access to the treatment—like the rollout of nirmatrelvir-ritonavir. Ultimately, tecovirimat was prescribed to 32% of all patients with mpox in New York City.^1,4,5

Based on these successful cases, Foote said that the pharmacy delivery model could eventually be implemented outside of emergencies for commercially available prescriptions. Additionally, Foote said that the city was developing contingency contracts that could be quickly activated during emergencies, allowing for speedier implementation of pharmacy delivery models.¹

“It really has changed the way we are working with pharmacies,” Foote concluded. “We’re now incorporating these pharmacy partners into our emergency support function aids and health care coalition activities, so they can really be treated as an integral part of the health system in city enterprises.”¹

REFERENCES

1. Lynfield R, Foote M, Tomlin R. How to set up successful public health–pharmacy partnerships. Presented at: Infectious Disease Week 2025; October 21, 2025; Atlanta, GA. Accessed October 21, 2025.

2. Draft 2025 ASHP guidelines on pharmacist involvement in HIV care. American Society of Health-System Pharmacists. Accessed October 21, 2025. https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacist-involvement-hiv-care.ashx

3. Legislative tracker: Pharmacist-initiated PrEP and PEP. NASTAD. Updated December 13, 2024. Accessed October 21, 2025. https://nastad.org/resources/pharmacist-initiated-prep-and-pep-2024

4. Chan J, DiTullio DJ, Pagan Pirallo P, et al. Implementation and early outcomes of a telehealth visit model to deliver tecovirimat for mpox infection in New York City. J Telemed Telecare. 2025;31(4):534-539. doi:10.1177/1357633X231194796

5. Wong M, McPherson TD, Lash M, et al. New York City’s rapid response to the 2022 mpox outbreak. NEJM Catal Innov Care Deliv. 2024;5(8). doi:10.1056/CAT.23.0391