Pharmacy-based Interventions to Increase Vaccine Uptake: Report of a Multidisciplinary Stakeholders Meeting

"There is a compelling need to promote the role of pharmacists as a key part of healthcare, prevention, and well-being promotion, working in concert with other health professionals towards a common goal, namely the care pathway to keeping patients healthy."

A range of barriers to vaccine uptake have been identified, affecting all groups, in various countries and healthcare settings. In this context, the European Interdisciplinary Council for Ageing (EICA) convened a 3-day meeting in Venice, Italy, to bring together stakeholders from the medical and pharmacy professions, the pharmaceutical industry, patient/ageing organisations, and health authorities to consider the potential for pharmacy-based interventions to increase vaccine uptake. This article reports on the proceedings.

First, the article provides examples from countries that have introduced pharmacy-based vaccination programmes. Some salient findings:

• Ireland - Based on the observation that, for example, a pharmacist is well placed to assess, identify, contact, and encourage at-risk individuals in the population as a whole and initiate a conversation that could result in vaccine uptake, in 2011, Ireland introduced new provisions allowing for pharmacist-led influenza vaccination, expanding in 2015 to include herpes zoster and pneumococcal vaccination. Several challenges needed to be overcome, such as inter-professional communication and vaccine hesitancy among the public. However, the overall success of the Irish experience in introducing pharmacy-based vaccination services underlines the feasibility of this model of healthcare delivery.
• Canada - In a study comparing estimated influenza vaccine coverage before and after pharmacists began administering publicly funded influenza immunisations in Nova Scotia, Isenor et al. reported that in 2013-2014, the vaccination coverage rate increased to 42%, up from 36% in 2012-2013 (p <0.001), and pharmacists administered over 78,000 influenza vaccinations overall, corresponding to nearly 9% of the province's population over the age of 5.
• United Kingdom (UK) - In an online survey of London, UK, pharmacists delivering vaccines, Atkins et al. reported that there was potential for improved convenience, but no statistically significant increase in uptake over the period studied.

Second, the article explores the barriers and solutions proposed by the discussion groups at the meeting, including;

• Engaging the profession: Increase the involvement of pharmacies in vaccine implementation by motivating pharmacists, as a profession, to come together as a single body to voice their support and commitment to changing the social context of pharmacists vaccinating. This unified approach will be necessary to provide the momentum and political will to overcome the barriers - in particular, a need for a change to existing legislation.
• Training: Develop the necessary competence within the profession to ensure that if the lobbying is successful, then the pharmacists will be sufficient in number and adequately trained to implement the service and manage any complications.
• Advocating and lobbying: Assess the regulatory situation of the country, enshrining any new requirements in the law, with guidelines for practical implementation by the profession. "The discussions surrounding the exact modalities for implementing vaccine strategies in pharmacies should ideally take place in open dialogue with other healthcare professionals and other interested stakeholders. The objective is complementarity between healthcare professionals..., thus expanding possibilities to reach a broader audience and ensure wider availability of vaccines for the public."
• Addressing the challenge of internal regulatory diversity.
• Generating evidence of efficacy, which provides a rationale that policymakers can use to justify wider implementation.
• Dealing with access to health records (e.g., who hosts the information, who can view it, who can modify it, and whether and how it can include payment data).
• Grappling with funding issues.
• Collaborating on an international level: Develop a joint action plan on national vaccination policies. "Advocacy should also include the necessity to have different pharmacy and medical societies engage in dialogue, to reach a consensus on how to improve coverage in each country by defining their respective roles and responsibility. Concerted collaborative action at an international level to improve access to adult vaccinations may also send a strong message to the public, and help reduce vaccine hesitancy and strengthen the supply of vaccines....In this regard, the EICA has a key role to play in providing support for the development of synergistic efforts and helping to coordinate educative initiatives across countries."

One of the key messages for the pharmacy profession that came out of this stakeholders' meeting is that it is important to ensure that the public better understands the need for vaccination across the lifespan; trust-building interventions are critical to promote information acceptance.