The Future of Immunization Coverage & Administration


An overview of the advancements being made in the practice of immunization coverage and administration.

Troy Trygstad, PharmD, MBA, PhD: What about social determinants of health? What role do social determinants of health screening have to do with immunization screening? We talked about uninsured, but we haven't talked about the lack of transportation, health literacy, and at-risk behaviors. We haven't talked about HPV [human papillomavirus infection], which is perhaps one of the more underutilized vaccinations out there, which is a shame. What about those areas? I mean, what's that next generation of practice when it comes to immunization, coverage, and delivery? Tana?

Tana Kaefer, PharmD: Identifying those who are at risk, obviously, and those who have transportation issues. We know that in the pharmacy we can identify those things very easily because obviously if they're not coming in to get their medications you know there are issues, and we offer those other services. So finding ways where we can meet those patients where they are and not have them come to us. Maybe we would go to them.

Dorothy Loy, PharmD, MBA: Having materials available in other languages, sometimes that's all it takes. Maybe that patient doesn't understand the information we're telling them. The pharmacist can't relay that through the patient's native language. And so having materials available in the patient's own natural language—I think it would be helpful. That's something we strive to do, but as you know there [are] so many different languages out there. Whether it's our created materials or having CDC materials, having team members know where to find those in various languages.

Troy Trygstad, PharmD, MBA, PhD: I was speaking to a health care provider the other day who's in public health, mentioning that Greensboro, North Carolina, is a refugee center and that the school district there has to accommodate more than 100 different languages. Think about how that overlays with vaccinations as far as the need and, to your point, the ability to communicate them, to educate them and somebody coming from a wholly different environment about what they might think or might not think of vaccinations or even awareness or knowledge. That's a great one.

What else, Emily, Mike? Gaps? Or what's the next generation of practice and practitioners in this space? Data and reporting, obviously, and building acumen on population health.

Michael Popovich: Right. And I think that data are going to identify where those gaps are, or wehre those social challenges are.

Troy Trygstad, PharmD, MBA, PhD: So it's proactive.

Michael Popovich: Being proactive. And a lot of times I just think the individuals out there don't know. But the pharmacist has the opportunity, if they're proactive, to go out and have those conversations or reach out to them and pull them in and make them part of the fold. And the same with refugees. I mean, they're shopping at the pharmacies all the time. They don't really know, they come from other countries, and so it's really critical to bring them up with their immunization records. I think the future is really going out and empowering and doing outreach efforts tot he hard-to-reach, or they're hesitant or whatever. And so I think that's coming. You're going to use data, and you can use best practices, and you're going to use this public good opportunity that exists.

Emily Endres: I couldn't agree more. A couple of items that come to mind there. There's one we know, that payers also struggle with their member outreach too, right?

Troy Trygstad, PharmD, MBA, PhD: So interacting with payers being the next step.

Emily Endres: Absolutely.

Troy Trygstad, PharmD, MBA, PhD: Becomes sort of a next-generation activity in immunizations.

Emily Endres: Yeah.

Troy Trygstad, PharmD, MBA, PhD: Right now we just bill them. We don't think of them as partners or application of tools or helping one another figure out how to do it better.

Emily Endres: Right, they're experiencing the same challenges. Speaking about social determinants of health, they also can't reach those members either, whether it's through phone, mail, email, etc. But we know 5 to 1 that those people are coming into your pharmacies, so you have a really great opportunity at the pharmacy level to interact with that patient, or their member recommends the service.

Another item that comes to mind as we think about how this continues to grow and evolve, not just with immunization but also with point-of-care testing or prescribing medication. In the recent trends report that we published in the survey as consumers, payers, and pharmacists, we identifying int he survey that when speaking to consumers about how they view the pharmacy today adn then how they view the pharmacy in the future, there were 3 top areas that come to mind for consumers as far as where they think the practice of pharmacy is going.

One is immunization. The second is point-of-care testing, so A1C [glycated hemoglobin], cholesterol, etc. And the third is prescribing medication. Consumers are ready for us to be able to provide that care. It's just coordinating those efforts, aligning incentives among payers and providers, that's going to get us there.

Michael Popovich: If you go onto a website or visit a Walgreens or Amazon and you order you health and wellness products, and they're shipped to you, wouldn't it be great if, when the products came, you opened the box and it said, "Oh, by the way, Mary, John, you know, you're past due for your tetanus shot." And so its' just a little tickler, a little reminder, and you began integrating, you know, what people are purchasing and where they're living and going, "Oh, here's another piece of information that will help you with your health." I can easily see those kinds of opportunities coming up in the near future.

Troy Trygstad, PharmD, MBA, PhD: Excellent. This has been a really vibrant discussion. We usually like to close with a wild card question. We'll start with Tana and go this direction. Sorry, Tana.

Tana Kaefer, PharmD: Thanks.

Troy Trygstad, PharmD, MBA, PhD: The disease condition that you see vaccines emerging in that most excites you?

Tana Kaefer, PharmD: Shingles, because it's a new vaccine that just came out, and the promise that it has is that it's so much more effective. I'm encouraged for my patients because they're very scared about this.

Troy Trygstad, PharmD, MBA, PhD: OK. Emily, either in the market or emerging in the market. Or if you wish there was a vaccine for something.

Emily Endres: I agree actually, just from payer feedback, etc. I think that's a huge opportunity given the population age, etc. That's a great opportunity.

Troy Trygstad, PharmD, MBA, PhD: I saw a statistic the other day. I reviewed the IQVIA latest trend report from the prior year—88% of new-therapy starts come from vaccinations driven mostly by flu and Shingrix, which is amazing when you think about it. Those are our new starts. What used to be our new starts were overused antibiotics and narcotics, right? We've started to manage those, and now it's vaccinations. That's a big public health win, right? What do you think is most exciting in the market now or coming to market, or what do you wish this disease state would be?

Dorothy Loy, PharmD, MBA: I'm most excited around all the research for HIV vaccinations around that space. I think that's a really unmet need right now, and the population is just growing. I feel like that's exciting. I think one space in which I would love to see research is mental health.

Michael Popovich: In my case, all this is good, but what I get really fired up about is genomics—knowing an individual's DNA and then what vaccine is best for them. I look at the influenza. As the influenza vaccine becomes more targeted, it's likely that knowing a person's genomics and their DNA will say a lot about which strain or the effectiveness of that. And when you can target an individual vaccien to an individual person, I think that's really pretty wild. And we're not far away.

Troy Trygstad, PharmD, MBA, PhD: Yep. Mine would be Alzheimer disease. Could you imagine if we had a vaccine for Alzheimer? And there's some fascinating information coming out of this. Maybe we'll meet here again 5 years from now or 10 years from now and they won't be clamoring for a shingles vaccine, which they should, but they'll be clamoring for the back order on a vaccine for Alzheimer.

Well, thank you all for your contributions to this discussion. A great discussion. On behalf of our panel, thank you for joining us. We hope you find this Peer Exchange discussion to be useful and informative. We'll see you next time on Pharmacy Times® Peer Exchange.

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