How pharmacists are improving immunization in Canada

Sixty years ago, immunization was a simpler process. There were fewer vaccines, and the process of immunizing was straightforward. Children had their well-child exams but were immunized almost as an afterthought as they left the office. Today, each Canadian child receives more than 20 doses of vaccine before adulthood. Sixty years ago, the infections that immunization prevents either were still very much present or fresh in people’s memories, so parents were eager to have their children immunized. Today, people have many questions about vaccines, their safety and effectiveness.

Historically, almost all vaccines were given by the general practitioner or the office’s nurse. Over the past decade, pharmacists have become an important addition to the broader group of health professionals involved in immunization, making vaccines far more accessible and convenient to receive. Canadian pharmacists are making a huge impact, not only by increasing the accessibility of vaccines, but also by providing accurate information about them to the public.

According to the Public Health Agency of Canada, pharmacies have become the main location for influenza vaccination of adults over 18 years, where influenza vaccine is administered to 34.2% of adults, more than at doctors’ offices (2017/18).¹ This trend towards immunizations in pharmacies has helped to reduce both indirect and direct costs of immunizing annually against this significant infection.² Instead of taking time off work to line up at a clinic or to visit the family doctor, with associated losses in productivity or pay, individuals can now be immunized efficiently during a pharmacy visit. Moreover, when public health clinics are held at specific, and not necessarily convenient, times, fewer people are immunized, with higher cost per dose administered. In contrast, individuals can now be immunized more cost-efficiently during extended pharmacy business hours, including evenings and weekends. Pharmacy-based immunization helps to relieve pressure on physicians’ offices and to minimize influenza cases in emergency rooms.

How do we move forward from here? First, there is considerable (and unjustifiable) inconsistency across the country with respect to pharmacists’ immunization authority. A more homogeneous approach to scope of practice across Canada will benefit the broader health system but also should extend to all provinces and territories the advantages recently gained in some jurisdictions through wider vaccine access. As scope of practice continues to expand, pharmacists will represent a growing body of knowledgeable and trusted professionals to help patients to understand not only the value but also the safety, of vaccines—potentially reducing vaccine hesitancy.

Second, a strategy is needed to achieve greater standardization across the country regarding the specific vaccines that pharmacists may administer. Building on the benefits and success of providing influenza vaccine, pharmacists should have the authority to provide a more extensive and consistent list of vaccines to facilitate the immunization of adults, adding vaccines such as pneumococcal and zoster, providing travel vaccines and potentially assisting in outbreaks, such as measles or mumps.

Physicians and public health professionals are very fortunate that our colleagues in pharmacy have shown such leadership, initiative and dedication in helping to promote and to provide immunization. Despite the increasing complexity of vaccines and questioning by the public, with the commitment of pharmacists to this worthy program, the future is bright. Working together as a team of health care providers, we can realize the key goals of increasing vaccine access and coverage, as well as maintaining acceptability of immunization, to keep people as safe as possible from infectious disease. ■