The Dilemma of Childhood Vaccines Post Pandemic

The pharmacist’s scope of practice was temporarily expanded with the signing of the 11th amendment under the Public Readiness and Emergency Preparedness (PREP) Act, as COVID-19 posed a significant risk to public safety. The declaration’s period will expire on December 31, 2024.¹ The PREP Act allowed pharmacists to order COVID-19 and influenza vaccines and to administer them, along with pharmacy interns and pharmacy technicians, to patients between the ages of 3 and 18 years, preempting many states’ existing laws on vaccine administration.¹ Beginning January 1, 2025, states will revert to the prepandemic laws that may or may not authorize all pharmacy team members to provide this critical patient care service.

The PREP Act has been instrumental in advancing pharmacy practice and achieving vital public health aims. As of March 9, 2024, community pharmacies accounted for 37.49 million influenza vaccines administered to the public during the last flu season and more than 307 million COVID-19 vaccine doses since the pandemic’s start, according to the CDC Federal Retail Pharmacy Program.² Because nearly 89% of patients live within 5 miles of a pharmacy, the pharmacy team is positioned to continue to provide this crucial public health and patient care service to its community members.3 Another essential consideration is the proportion of the US population that lives in rural areas and how that can affect social determinants of health. Without the same authorization provided by the PREP Act, parts of the US will continue to experience access issues to basic health care needs such as vaccines.

Pharmacies play a significant role in vaccine uptake, ranking in the top 3 most common sites for adults and children to receive vaccination during the 2016-2017 influenza season.⁴ However, state law restricts who can provide vaccines in pharmacies. These issues and others create barriers to evidence-based care for patients. The PREP Act temporarily lifted some key state-specific restrictions and created a universal age range for people to receive specific vaccines, thus expanding access. These restrictions will return upon expiration of the PREP Act at the end of December.

The PREP Act also helped reduce the cost of managing preventable diseases and combating vaccine hesitancy. Before the pandemic, the US spent roughly $730.⁴ billion on treatments for preventable conditions.⁵ Annual influenza vaccines for children considered high risk save $1000 to $10,000 per quality adjusted life year between the ages of 3 and 17 years.⁶ Comparatively, the percentage of children immunized has seen a noticeable decline through the pandemic, with 93% of kindergarteners receiving all their state-required vaccinations for the 2021-2022 school year vs approximately 95% for 2013-2014.⁷ Of the students who did not claim a vaccination exemption, 4.4% were not fully vaccinated during the 2021-2022 academic year.⁸ Having students behind in their vaccination schedule, combined with the potential decrease in access to vaccinations in community pharmacies, may lead to outbreaks of preventable diseases that affect this particular population.⁹

The future of pharmacy is bright, with several states adopting PREP Act provisions as law. It will be essential to assess how the expansion of pharmacists’ scope has impacted health care during the pandemic, and there must be continued innovation in how patients receive health care. States across the country have shown they can be unified under federal law and use legal authorities to deliver patient care effectively. Therefore, states must continue to evaluate the existing construct for vaccine administration in the community pharmacy and advocate for change if decreased access to pharmacy-provided services occurs after PREP Act authorizations expire.

REFERENCES

1. Eleventh amendment to declaration under the public readiness and emergency preparedness act for medical countermeasures against COVID-19. Fed Regist. 2023;88(92):30769-30778. Accessed September 6, 2024. https://www.federalregister.gov/documents/2023/05/12/2023-10216/eleventh-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for

2. The Federal Retail Pharmacy Program for COVID-19 vaccination. CDC. Updated August 18, 2023. Accessed September 6, 2024. https://archive.cdc.gov/www_cdc_gov/vaccines/covid-19/retail-pharmacy-program/index.html

3. Gallagher A. Study: 88.9% of US population lives within 5 miles of a community pharmacy. Pharmacy Times. August 4, 2022. Accessed September 6, 2024. https://www.pharmacytimes.com/view/study-88-9-of-us-population-lives-within-5-miles-of-a-community-pharmacy

4. National early-season flu vaccination coverage, United States, November 2016. CDC. Updated December 9, 2016. Accessed September 6, 2024. https://www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2016.htm

5. Beleche T, Ruhter J, Kolbe A, Marus J, Bush L, Sommers B. COVID-19 vaccine hesitancy: demographic factors, geographic patterns, and changes over time. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. May 2021. Accessed September 6, 2024. https://aspe.hhs.gov/sites/default/files/private/pdf/265341/aspe-ib-vaccine-hesitancy.pdf

6. Galea S, Maani N. The cost of preventable disease in the USA. Lancet Public Health. 2020;5(10):e513-514. doi:10.1016/S2468-2667(20)30204-8

7. Prosser LA, Bridges CB, Uyeki TM, et al. Health benefits, risks, and cost-effectiveness of influenza vaccination of children. Emerg Infect Dis. 2006;12(10):1548-1558. doi:10.3201/eid1210.051015

8. Seither R, Masalovich S, Knighton CL, Mellerson J, Singleton JA, Greby SM; Centers for Disease Control and Prevention (CDC). Vaccination coverage among children in kindergarten – United States, 2013-14 school year. MMWR Morb Mortal Wkly Rep. 2014;63(41):913-920.

9. Seither R, Calhoun K, Yusuf OB, et al. Vaccination coverage with selected vaccines and exemption rates among children in kindergarten – United States, 2021-22 school year. MMWR Morb Mortal Wkly Rep. 2023;72(2):26-32. doi:10.15585/mmwr.mm7202a2

10. Biggerstaff M, Chauchemez S, Reed C, Gambhir M, Finelli L. Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature. BMC Infect Dis. 2014;14:480. doi:10.1186/1471-2334-14-480