Pharmacists taking on greater role in fight against influenza: More people getting their shots in stores
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* Kim Krisberg

It is flu season and Steve Simenson is busy. He is administering flu shots, working with local physicians, teaching residents how to stay flu-free and creating easy, accessible ways for his community to get immunized.

Simenson, FAPhA, does not work in a local health department — he is a community pharmacist. The owner of a chain of independent pharmacies in the Minneapolis suburbs, Simenson said when he first began offering flu shots a decade ago, he and his colleagues were administering about 500 vaccines a year. Now, they give up to 7,000 flu shots annually.

“There’s a unique and different perspective that a pharmacist can add to the public health effort,” Simenson told The Nation’s Health. “With diminishing resources, the more we work together, the more people we can help.”

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/1/1.3/F1.medium.gif)

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Pharmacist Crystal Dibella prepares a flu inoculation in High Point, N.C., in January. In the wake of changes to state laws that allow pharmacists to give flu shots, more people are receiving their annual flu vaccinations in pharmacies.

Photo by Sonny Hedgecock, courtesy AP Images/The High Point Enterprise

While the majority of flu vaccinations still take place in traditional medical settings, the number of Americans getting immunized outside the doctor’s office is on the rise, reported the Centers for Disease Control and Prevention. According to data published in June in CDC’s *Morbidity and Mortality Weekly Report*, more than 18 percent of U.S. adults who received flu shots during the 2010–2011 flu season were immunized at a supermarket or drugstore, compared to only 7 percent of adults during the 2006–2007 flu season. Data from CDC’s National Flu Survey for the current flu season found that as of early November 2011, 21 percent of adults getting flu shots were being immunized at a pharmacy, drugstore or local supermarket. CDC recommends that everyone 6 months old and older receive a flu shot.

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[Figure2](http://www.thenationshealth.org/content/42/1/1.3/F2)

A Rite Aid store lets customers know they can get seasonal flu shots at its pharmacy in Mechanicsburg, Pa., in December.

Photo by Paul Taggert, courtesy Getty Images/Bloomberg

CDC attributes part of the rise to changes in state laws. According to the agency, in 1999, only 22 states allowed pharmacists to immunize adults against the flu. As of 2007, the number had risen to 46 states and as of June 2009, all 50 states allowed pharmacists to administer flu shots to adults.

Mitchel Rothholz, MBA, RPh, chief strategy officer at the American Pharmacists Association, noted that while pharmacists have been offering flu shots for more than a decade now, the 2009 H1N1 flu outbreak was a turning point in getting all 50 states on board as well as a “great impetus to collaborate more closely with public health.” During the 2010–2011 flu season, about 20 million flu shots were administered at pharmacies, Rothholz reported.

“We approach this not as a competition or replacement, but as a complementary resource to the public health and health care systems,” said Rothholz, who added that the equivalent of the U.S. population enters a pharmacy every week. “We didn’t just go in for the short term; we’re in it for the long haul.”

Most Americans live within five miles of a pharmacy, making them familiar and accessible places to get immunized, said Kathleen Jaeger, JD, RPh, senior vice president of pharmacy care and patient advocacy at the National Association of Chain Drug Stores. In fact, because pharmacists get to know their patients and their medical histories so well, they are in a unique position to encourage flu vaccination, especially among residents at high risk for flu-related health complications, Jaeger said.

“Community pharmacists are truly the face of neighborhood health care all across the country,” she told *The Nation’s Health*. “Patients feel comfortable going to their pharmacists.”

Plus, pharmacies can often be more accessible than a doctor’s office, as they fit better into people’s busy lives, said Lisa Schwartz Fowler, PharmD, director of management and professional affairs at the National Community Pharmacists Association.

“Many pharmacies are open six, seven days a week, the flu shots are typically cheaper and there’s no co-pay to get in the door,” Fowler said. “The access and convenience is often greater than seeking out immunizations at a medical clinic.”

## Pharmacies look to advance their role

While every state allows pharmacists to give flu shots to adults, regulations differ as to what kind of training is required, whether children can be vaccinated and whether residents need a prescription or referral from their physicians.

When it comes to training, many state laws refer specifically to the American Pharmacists Association’s Pharmacy-Based Immunization Delivery training program, which was created in 1996 and has since trained more than 150,000 pharmacists. According to a 2006 study published in the *Journal of the American Pharmacists Association*, such training programs have helped the “practice of pharmacist-administered immunizations, particularly for adult patients, become routinely accepted as an important role of the pharmacist.”

“Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement,” the study stated.

Carolyn Bridges, MD, associate director for adult immunizations within CDC’s Immunization Services Division, said the movement is “indicative of the pharmacy industry’s commitment to helping to increase access to vaccines.” However, Bridges added that traditional medical settings and one-on-one doctor-patient relationships remain critically important to raising flu immunization rates, particularly among those at higher risk for health problems, such as pregnant women. She noted that as more pharmacies begin offering flu shots as well as other immunizations, a challenge will be making sure physicians have up-to-date vaccination records for their patients.

“We still need to make sure that everyone who cares for the patients knows which vaccines they’ve had and which they’re still in need of,” Bridges told *The Nation’s Health*.

Right now, there is no uniform standard dictating how pharmacy-administered immunizations get into a patient’s permanent medical record. However, Rothholz at the American Pharmacists Association said pharmacists are encouraged to provide documentation to their patients or communicate directly with physicians.

In some states, he said, pharmacists are working with state immunization registries, though many such registries are limited to children and do not track adult immunizations. Rothholz said the ultimate goal is to have a two-way, interchangeable electronic health record — a goal he said the association is working toward.

In the work to raise immunization rates, pharmacists are “great allies…they bring knowledgeable professionals to the effort and are more accessible in many ways,” said APHA member Paul Etkind, DrPH, MPH, senior director of infectious diseases at the National Association of County and City Health Officials.

But Etkind said he does worry that as pharmacy-based immunizations become more popular, policymakers might view it as an opportunity to cut back even more on local health department funding and capacity-building — “the concern is the erosion of our capacity to respond to a public health emergency,” he said.

“It’s not pharmacies versus public health departments — we’re allies in this,” Etkind told *The Nation’s Health*. “But sometimes the folks who make the money decisions only look at the surface data without looking at the layers below.”

For more information, visit [www.pharmacist.com](http://www.pharmacist.com).

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