Pharmacists' involvement in immunizations, although not new, has changed considerably in recent times.2
Over the past decade, there has been a marked increase in the number of states that allow pharmacists to administer vaccines. About 10 years ago, only 11 states allowed pharmacists to administer vaccines. As of June 2008, 49 states have granted authority to pharmacists to immunize people,3
thanks to lobbying by national and state pharmacy associations and changes in state pharmacy practice acts. Nevertheless, the scope and breadth of pharmacists' authorities varies widely, with some states (eg, North Carolina) limiting the type of immunization services that pharmacists can provide and others (eg, Virginia) being less restrictive.
The potential role of pharmacists in addressing the problem of low immunization rates has been recognized not only by state governments, but also by the federal government.4
In 1996, the American Pharmacists Association (APhA) established its Pharmacy-Based Immunization Delivery program (www.pharmacist.com/imz
), which the Centers for Disease Control and Prevention (CDC) endorsed. Later, the CDC granted APhA a liaison position on the Advisory Committee on Immunization Practices (ACIP).4
Prior to January 1, 2006, when Medicare Part D was initiated, vaccination coverage started and ended with Medicare Part B. The advent of Medicare Part D ushered in a new policy that increased vaccine coverage for Medicare beneficiaries and improved the recognition of pharmacists as vaccination providers. While Medicare Part B will continue to cover influenza virus vaccine, pneumococcal vaccine, hepatitis B vaccine for beneficiaries at high or intermediate risk, and other vaccines (eg, tetanus toxoid) when directly related to the treatment of an injury or direct exposure to a disease or condition, as of January 1, 2008, the Centers for Medicare and Medicaid Services (CMS) allowed pharmacists to be reimbursed for both the vaccine cost and the administration fee for a Medicare Part D-covered vaccine.5
The specific vaccines covered and the level of reimbursement are set by individual Part D plans. In general, Part D plan formularies will cover commercially available vaccines that are indicated for the Medicare population but not available for reimbursement under Part B. Pharmacists should contact the Part D plans for more information about coverage and reimbursement for vaccines.
There are about 100 US-based colleges and schools of pharmacy with accredited (full or candidate status) professional degree programs.6
These colleges and schools enrolled approximately 53,000 students in fall 2007, reflecting an increase in enrollment of 4.3% from the previous year. In the United States, there are an estimated 220,000 licensed pharmacists.7
Since its inception, approximately 40,000 pharmacists and student pharmacists have been trained through the APhA Pharmacy-Based Immunization Delivery program.8
Notwithstanding this important achievement, this is only a fraction of the licensed pharmacists and pharmacy students in the United States, indicating that this voluntary program is underutilized considerably.
In spite of the proven effectiveness and widespread availability of vaccines and tremendous efforts by the APhA and federal and state governments, immunization rates remain below the Healthy People 2010 objectives for a substantial portion of the US population. According to data recently released by the CDC, only 2% of adults between the ages of 18 and 64 years have received the new tetanus-diphtheria-pertussis (Tdap) vaccine, only 2% of adults 60 years and older have received the zoster vaccine, and only about 67% of elderly people have benefited from the influenza and pneumococcal vaccines.9
Furthermore, the influenza vaccination rate of high-risk adults between the ages of 18 and 64 years, including health care workers, continues to be well below 50%.9
There are many reasons cited for low immunization rates in the United States. The most common reasons adults tend to cite for not getting vaccinated include concern about vaccine-associated side effects or vaccine-acquired illness, disbelief that the vaccine works, lack of awareness that the vaccine was needed, and lack of healthcare provider recommendation for the vaccine.10-12
The most common reasons noted for vaccine declination among healthcare professionals include concern about side effects or vaccine safety, disbelief that the vaccine works, and inconvenience.13-15
The most consistent reason for vaccine declination among parents on behalf of their children is concern about vaccine risks, most notably concern that vaccines can cause autism.16
Other frequently cited reasons for not receiving vaccinations are specific to the particular vaccine.10
Vaccination misconceptions and barriers to immunization exist at all levels in the public and private sectors and among healthcare professionals.11
The first step to increasing vaccination rates is to recognize these misconceptions and barriers, yet most pharmacists are not educated to do so, nor are they trained to develop strategies to overcome them. This further perpetuates the problem of low immunization rates in the United States.