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
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.
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
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).
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.
- Esposito S, Principi N, Rezza G, et al; WAidid-EVASG Panel on vaccination of 50+. Vaccination of 50+ adults to promote healthy ageing in Europe: the way forward. Vaccine. 2018;36(39):5819-5824. doi:10.1016/j.vaccine.2018.08.041
- Ozawa S, Portnoy A, Getaneh H, et al. Modeling the economic burden of adult vaccine-preventable diseases in the United States. Health Aff (Millwood). 2016;35(11):2124-2132. doi:10.1377/hlthaff.2016.0462
- Kim DK, Hunter P; Advisory Committee on Immunization Practices. Recommended adult immunization schedule, United States, 2019. Ann Intern Med. 2019;170(3):182-192. doi:10.7326/M18-3600
- Shingles (herpes zoster). Centers for Disease Control and Prevention (CDC). Updated October 17, 2017. Accessed July 27, 2020. https://www.cdc.gov/shingles/hcp/index.html
- Pharmacist administered vaccines. American Pharmacists Association. Updated January 2019. Accessed July 27, 2020. https://media.pharmacist.com/practice/IZ_Authority_012019_corrected_April_2019.pdf
- Vaccination coverage among adults in the United States, National Health Interview Survey, 2017. CDC. Updated February 8, 2018. Accessed July 27, 2020. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html
- Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007—2012. Vaccine. 2014;32(19):2150-2159. doi:10.1016/j.vaccine.2014.01.081
- Qato DM, Zenk S, Wilder J, Harrington R, Gaskin D, Alexander GC. The availability of pharmacies in the United States: 2007—2015. PLoS One. 2017;12(8):e0183172. doi:10.1371/journal.pone.0183172
- Burson RC, Buttenheim AM, Armstrong A, Feemster KA. Community pharmacies as sites of adult vaccination: a systematic review. Hum Vaccin Immunother. 2016;12(12):3146-3159. doi:10.1080/21645515.2016.1215393
- Stagnitti MN. Average number of total (including refills) and unique prescriptions by select person characteristics, 2006. Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality. May 2009. Accessed July 27, 2020. https://meps.ahrq.gov/data_files/publications/st245/stat245.pdf
- National Ambulatory Medical Care Survey: 2016 National Summary tables. CDC. Accessed July 27, 2020. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2016_namcs_web_tables.pdf
- Survey: Americans prefer pharmacy over physician for vaccines. March 21, 2017. Accessed July 27, 2020. https://www.pharmacist.com/article/survey-americans-prefer-pharmacy-over-physician-vaccines
- Beshears J, Choi JJ, Laibson DI, Madrian BC, Reynolds GI. Vaccination rates are associated with functional proximity but not base proximity of vaccination clinics. Med Care. 2016;54(6):578-583. doi:10.1097/MLR.0000000000000523
- Lutz CS, Kim DK, Black CL, et al. Clinicians’ and pharmacists’ reported implementation of vaccination practices for adults. Am J Prev Med. 2018;55(3):308-318. doi:10.1016/j.amepre.2018.05.011
- Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations — United States, 2015. MMWR Surveill Summ. 2017;66(11):1-28. doi:10.15585/mmwr.ss6611a1
- Brenan M. Nurses again outpace other professions for honesty, ethics. Gallup. December 20, 2018. Accessed July 27, 2020. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx
- Grabenstein JD, Hartzema AG, Guess HA, Johnston WP, Rittenhouse BE. Community pharmacists as immunization advocates. Cost-effectiveness of a cue to influenza vaccination. Med Care. 1992;30(6):503-513. doi:10.1097/00005650-199206000-00004
- Lu PJ, O’Halloran A, Kennedy ED, et al. Awareness among adults of vaccine-preventable diseases and recommended vaccinations, United States, 2015. Vaccine. 2017;35(23):3104-3115. doi:10.1016/j.vaccine.2017.04.028
- Hurley LP, Bridges CB, Harpaz R, et al. Physician attitudes toward adult vaccines and other preventive practices, United States, 2012. Public Health Rep. 2016;131(2):320-330. doi:10.1177/003335491613100216
- Otsuka SH, Tayal NH, Porter K, Embi PJ, Beatty SJ. Improving herpes zoster vaccination rates through use of a clinical pharmacist and a personal health record. Am J Med. 2013;126(9):832.e1-6. doi:10.1016/j.amjmed.2013.02.018
- Hess R. Impact of automated telephone messaging on zoster vaccination rates in community pharmacies. J Am Pharm Assoc (2003). 2013;53(2):182-187. doi:10.1331/JAPhA.2013.12222
- Wang J, Ford LJ, Wingate L, et al. Effect of pharmacist intervention on herpes zoster vaccination in community pharmacies. J Am Pharm Assoc (2003). 2013;53(1):46-53. doi:10.1331/JAPhA.2013.12019
- American Society of Health System Pharmacists Council on Professional Affairs. ASHP guidelines on the pharmacist’s role in immunization. Am J Health Syst Pharm. 2003;60(13):1371-1377. doi:10.1093/ajhp/60.13.1371
- Wehbi NK, Wani RJ, Klepser DG, Murry J, Khan AS. Impact of implementing a technology platform in community pharmacies to increase adult immunizations rates. Vaccine. 2019;37(1):56-60. doi:10.1016/j.vaccine.2018.11.043
- Sparkman A, Brookhart AL, Goode JKR. The impact of an immunization check-up at a pharmacist-provided employee health screening. J Am Pharm Assoc (2003). 2017;57(3S):S274-S278. doi:10.1016/j.japh.2017.02.010