Opportunities for pharmacists to recommend and administer routine vaccines

The Canadian National Advisory Committee on Immunization (NACI) makes recommendations for the use of vaccines. Individual provinces and territories determine which vaccines will be funded and the schedules that are appropriate, based on their resources (e.g., funds, immunization providers, etc.). Routine vaccinations recommended for previously vaccinated adults and those who are unimmunized or underimmunized are found in Table 1. This article will focus on influenza, tetanus, diphtheria, acellular pertussis (Tdap) and tetanus and diphtheria (Td) vaccines for routine vaccination, as well as measles, mumps and rubella (MMR), meningococcal and polio vaccines for adults requiring catch-up, with emphasis on pharmacy-based vaccination. Other articles in this special section on pharmacists as immunizers give information on pneumococcal, human papillomavirus (HPV), varicella and zoster vaccines. Canadian pharmacists are highly accessible health care professionals. Approximately 60% of Ontarians reside within walking distance of a pharmacy and 91% within a 5 km drive, and similar results have been observed in Nova Scotia. This degree of accessibility and the resulting frequency of pharmacy visits (up to 14 times per year) provides pharmacists with multiple opportunities to assess for, recommend and administer routine vaccines for adults. However, there is considerable variation across provinces/territories regarding specific vaccines included within pharmacists’ scope of practice. Over 20 years ago, the American Pharmacists Association developed guidelines for pharmacy-based vaccination advocacy that are directly applicable to Canadian pharmacists today. Pharmacists were encouraged to engage their patients as educators (recommending vaccines), facilitators (hosting other immunizers in a pharmacy/clinic) or as immunizers. Evidence supports pharmacists in each of these roles to improve vaccination coverage among adult patients. Nowadays, vaccination is generally considered a standard of practice for pharmacists. In addition, community-based pharmacists are in an excellent position to determine if their adult patients are up to date on recommended vaccines. Medication reviews offer the opportunity to create an “inferred diagnosis” from current drug therapies, which can then be used to identify the need for education and/or specific vaccine recommendations. This might include influenza vaccine for patients receiving insulin, diabetic supplies or respiratory medications used to treat asthma or chronic obstructive pulmonary disease (COPD). Table 1 NACI-recommended routine vaccinations for previously immunized adults and for adults who are unimmunized or underimmunized