Targeted Screening Tools Can Increase Pneumococcal Vaccine Uptake in Health-System Retail Pharmacies

Rates of pneumococcal vaccination among eligible adults continue to lag desired targets for optimal protection across communities. The CDC, following a 2022 National Health Interview Survey, reported that pneumococcal vaccine coverage among adults at increased risk for invasive pneumococcal disease (IPD) was only 23.0% in 2022, while it was 64.0% for those aged 65 years or older. IPD can be severe and cause widespread infection, with older adults at the highest risk of mortality.^1,2

Streptococcus pneumoniae can cause invasive pneumococcal disease, but a pneumococcal conjugate vaccine can help prevent serious disease. | Image Credit: © ProArt Studios - stock.adobe.com

Not only have eligible adults expressed hesitation and reported obstacles—whether logistical or financial—to vaccination, but pharmacists have expressed concerningly limited knowledge regarding relevant pneumococcal vaccination guidelines and report a lack of resources. Retail pharmacies are a critical component for pneumococcal vaccination campaigns, serving as trusted, local sources where patients can receive their vaccines.^1,3

The Advisory Committee on Immunization Practices recently updated their pneumococcal conjugate vaccine (PCV) recommendations to recommend a single dose of either 15-valent, 20-valent (PCV20), or 21-valent PCV for all adults aged 50 years and older, in addition to a previous recommendation for adults aged 19 to 49 years with risk conditions for IPD. Given the updated guidelines that include a greater portion of high-risk patients and reports of under-vaccination across these key populations, investigators from a large health system conducted an analysis of a targeted screening tool and pop-up alert within retail pharmacies, with the goal of increasing rates of PCV20.^1,4

Technologic Screening Tools Increase PCV20 Uptake Across Pharmacy

A cycle of Plan-Do-Study-Act (PDSA) was initiated, which activated alerts within 24 retail pharmacies among a large health system for patients indicated for eligibility for PCV20 vaccination. Through electronic health records, pharmacists noted adults who were PCV20 vaccine-naïve, met desired eligibility requirements, and were due for medication refill at their pharmacy. During their upcoming visit to the pharmacy, pharmacists screened patients for eligibility and inquired regarding their willingness to receive a PCV20 vaccine at that visit.¹

Investigators compared rates of vaccine uptake and sociodemographic characteristics before and after the PDSA cycle began, with reasons for patient decline noted. A total of 1821 patients were screened for PCV20 vaccines between December 2023 and April 2024, with 1369 (75%) patients deemed eligible.¹

Across the study period, 130 patients (9%) received PCV20 through the new alert process. However, in a major improvement, 285 additional PCV20 vaccines were administered to patients not included in the PDSA cycle; the authors postulated that this was because of the overall success of the program and its tools, bolstering pharmacists to screen more patients for PCV20 overall. Ultimately, the intervention was found to increase PCV20 vaccination rates by 140% compared with the same period of the prior year, according to the study authors.¹

Implications for Community Pharmacists

The PDSA intervention demonstrated a clear increase in PCV20 vaccination rates in retail pharmacies among a large health system, reaffirming the viability of novel technologies to improve screening methods and increase vaccine uptake. Pharmacies are one of the most front-facing and inclusive health care settings for countless individuals, who often develop a strong relationship with their local pharmacist in the process. This analysis reaffirms the critical role that retail pharmacies—and the pharmacists that comprise them—play in vaccinating community members.¹

The most cited reason for declining PCV20 vaccination was a patient having no interest in vaccines (n = 231, 51%). Despite the overall success of the PDSA intervention, this data point highlights the work that remains to reduce vaccine hesitancy and ensure patients trust the medicine they are receiving.¹

REFERENCES

1. CDC—AdultVaxView. Vaccination coverage among adults in the United States, National Health Interview Survey, 2022. Updated October 4, 2024. Accessed June 5, 2025. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html#cdc_report_pub_study_section_7-authors

2. Cleveland Clinic. Pneumococcal disease—Overview. Last Updated September 27, 2022. Accessed June 5, 2025. https://my.clevelandclinic.org/health/diseases/24231-pneumococcal-disease

3. Skogg A, Zagel AL, O’Donnell RM, et al. Implementation of a Targeted Technologic Screening Tool to Increase Pneumococcal Vaccine Uptake in Health-System Retail Pharmacies: A Quality Improvement Initiative. Innov Pharm. 2024;15(4). doi:10.24926/iip.v15i4.6345

4. Kobayashi M, Leidner AJ, Gierke R, et al. Expanded recommendations for use of pneumococcal conjugate vaccines among adults aged ≥50 years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep. 2025;74:1–8. doi:10.15585/mmwr.mm7401a1