Vaccine Awareness
Sonya Collins
Like elective care and routine preventive care, non-influenza immunizations took a nosedive among adolescents and adults from March to June 2020, the first few months of the COVID-19 pandemic in the United States. Data show that non-COVID health care spending has, for the most part, recovered since then. Many patients are now more willing to visit doctors’ offices and pharmacies for non-urgent needs. This return to normalcy provides a prime opportunity for pharmacists to ensure their adult patients are up-to-date on vaccines.
“It’s time to remind patients about the importance of getting vaccinated against some of these other diseases—not just COVID-19,” said Gretchen Garofoli, PharmD, a clinical associate professor at West Virginia University School of Pharmacy. Her research focuses on immunizations.
Time to bring non-COVID vaccines back into the conversation
From January to August 2020, vaccine claims across commercial, Managed Medicaid, Medicare Advantage, and Medicare Fee-for-Service Part B had plummeted by as much as 40% compared to claims rates during the same time period the year before.
The rollout of the COVID-19 vaccines brought patients into pharmacies in droves to get the long-awaited shot. But for many, that was the only thing on their mind.
As the pandemic continues, not everyone’s focus has shifted back to the routine preventive care they may have pushed to the backburner early last year.
Many adults may still be behind on scheduled vaccines.
“It’s time to come out from behind the counter and talk to patients about vaccines,” said Captain Stephan Foster, PharmD, a retired officer of the USPHS.
It’s not enough, Foster said, to post signage about a particular vaccine such as the flu shot or shingles vaccine.
He encourages pharmacists to use messaging that prompts a conversation rather than directing patients to ask for a specific immunization.
“Something that says, ‘We need to talk,’” he said.
Pharmacists who have access to patients’ immunization records (and enough time to check them) can take an even more proactive approach, Garofoli suggests.
At the Community Pharmacy Enhanced Services Network site, where Garofoli practices, the pharmacy lets patients know when their prescriptions are ready and, at the same time, advises them of any immunizations they are due to receive.
The pharmacy owner, whom patients know and trust, recorded messages about certain vaccines that the pharmacy sends to eligible patients.
The effort, Garofoli said, has led to an uptick in shingles vaccines in particular.
“I know we are all very busy and have a lot going on in our pharmacies,” she said, “but we need to do our part to make sure we don’t have a resurgence of these other vaccine-preventable diseases.”
Questions about mixing vaccines
By now, most people who plan to get a COVID-19 vaccine have likely received one. But Garofoli said she is “still picking up a few stragglers.”
She also picks up more than a few patients who want the vaccines when she goes to them at their locations, such as group homes. For some patients, the only reason they have not received the vaccine is a barrier to access such as a lack of transportation.
As pharmacists continue to provide COVID-19 vaccines, there is an opportunity to offer patients other immunizations they may need as well. But pharmacists should prepare for questions about getting additional shots at the same time as the COVID-19 vaccination.
CDC’s initial guidance was to space other immunizations apart from COVID-19 vaccines by 2 weeks, but CDC now says that is no longer necessary.
It is safe and effective to administer multiple immunizations, including for COVID-19, at the same time.
“As with all vaccines,” Foster said, “you try to put them in different arms so you can distinguish your potential adverse reactions.”
As for vaccines that may cause patients to feel ill for a day, such as Shingrix and the mRNA-based COVID vaccines, there have been no trials to explore whether receiving the vaccinations together or apart would lead to more favorable adverse effects.
“The guidance says to discuss with the patient when giving these vaccines and let them know that they may have a reaction to them and what to expect, including the duration of symptoms,” Foster said. “What we don’t know is whether the reaction would be larger when both vaccines are given together or just the same. So the main thing is to warn the patient of the potential for that.”
Post-COVID flu season
Flu season may bring unique challenges to pharmacists this year. The 2020–2021 flu season was a non-event. Only a small fraction of the number of cases of the previous year were seen. That is due in part to COVID-19 preventive measures, such as masking, social distancing, and handwashing.
These practices helped prevent influenza transmission, too. Flu shots get some of the credit as well for the nearly non-existent flu season.
They were the only immunizations whose rates did not drop during the pandemic. In fact, Garofoli’s pharmacy saw an uptick in demand, in part because influenza vaccination was one thing patients could do to protect their health while they awaited a COVID-19 vaccine.
But pharmacists could see some blowback this year from last year’s slow season. Some patients may no longer recognize the flu as a threat.
“Last year we had almost no flu,” Foster said. “So trying to get patients to get the flu vaccine this year may be very difficult.”
Pharmacists should plan to discuss the influenza vaccine, as well as other vaccination needs, with every patient they encounter.
This aligns with the HHS National Vaccine Advisory Committee’s Adult Immunization Standards regarding assessing, recommending, referring, administering, and documenting vaccinations.
In addition, health care providers who administer COVID-19 vaccines have to enroll within state and local immunization information systems.
This tool assesses non-COVID vaccination needs and supports coordination among members of the immunization neighborhood.
As with other adult immunizations, patients may receive an influenza vaccine at the same time as a COVID-19 vaccine.
“If you’re going to use the adjuvant or the high-dose flu in seniors, just be aware that there’s a potential for an increased reaction,” Foster said. “There’s no guidance saying not to do it, but just be aware and discuss it with the patient.”
Timing of influenza vaccination is also important to ensure opportunities to vaccinate are not lost and that we optimize patient protection throughout the peak influenza season.
The CDC Advisory Committee on Immunization Practices recommends for the 2021–2022 influenza season that “For non-pregnant adults, influenza vaccination during July and August should be avoided unless there is concern that later vaccination might not be possible.” The ideal timing is by the end of October 2021.
Distrust of vaccines, science, government agencies
This year may usher in a new wave of skeptical patients. For some, hesitancy to take the COVID-19 vaccine will color their attitudes toward other routine vaccines as well.
Research shows that belief in conspiracy theories and distrust of government recommendations is currently widespread.
These problems are borne in part of a lack of understanding of the scientific process, such that when scientific and government agencies change their recommendations based on new evidence, some members of the public interpret this as dishonesty or a lack of knowledge and experience.
The politicization of the pandemic—including assessments of its severity and appropriate measures to combat it—has also hurt public trust in scientific and regulatory agencies. In November 2020, 84% of Democrats saw COVID-19 as a major public health threat while only 43% of Republicans felt the same way.
For those who are susceptible to conspiracy theories, there is no shortage of them across social media platforms. In June 2020, 1 in 4 Americans believed the pandemic was probably or definitely “planned by powerful people,” according to Pew Research Center.
Pharmacists must be prepared to address all these issues in their pharmacy.
“Keep providing factual information and keep having those conversations with patients, even if you’ve had them before,” Garofoli said. “Don’t give up after just one ask.”