Jill Sederstrom

Pharmacists across the country are seeing a milder flu season this year, thanks in part to the precautions put in place to prevent coronavirus disease 2019 (COVID-19), but many are also seeing increases in the number of flu vaccinations administered at their stores.

The COVID-19 pandemic has ushered in a greater focus on health and prevention efforts, which has led to fewer cases of the flu this season than in past years. “This flu season, we have seen lower incidences of flu compared to an average season, which may be due to our shift in behavior to reduce the spread of COVID-19,” said Tasha Polster, BSPharm, vice president of pharmacy quality, compliance and patient safety for Walgreens. “For example, more people are social distancing, wearing face masks, hand washing, and forgoing travel.”

According to the CDC, laboratory-confirmed cases of the flu remain “low at this time.”1 Additionally, reported deaths due to COVID-19 remain higher than for influenza, according to recent National Center for Health Statistics (NCHS) mortality surveillance data. For the data available on January 7, 2021, the NCHS reported that 14.5% of deaths occurring during the week ending January 2, 2021, were from pneumonia, influenza, and COVID-19 (PIC). However, of the 2150 PIC deaths reported in that week, 1496 had COVID-19 listed as an underlying or contributing cause of death, whereas only 2 listed influenza.

Rite Aid and CVS officials also reported decreased numbers in flu incidence this year among patients. “As a general trend, people are more aware of health and immunity than perhaps ever before, which fits into our purpose to become a neighborhood destination for whole being health, including traditional medicine like vaccinations and alternative remedies and supplements that may help boost immunity or reduce stress,” said Jocelyn Konrad, BSPharm, executive vice president and chief pharmacy officer for Rite Aid.

Moreover, the number of Americans receiving the flu vaccine is on the rise this season. The CDC led a push to encourage more individuals to get their vaccinations in order to avoid illness or hospitalizations that could tax an already overworked health care system.

“During the COVID-19 pandemic, reducing the overall burden of respiratory illnesses is important to protect vulnerable populations at risk for severe illness, the health care system, and other critical infrastructure,” the CDC said in its pandemic guidance released to the public.

The push—and greater concerns about health among Americans—resulted in a significant increase in the number of individuals who have received vaccinations to date. According to the CDC, by December 19, 2020, an estimated 46.9 million adult flu vaccinations had been administered in pharmacies, compared with 32.9 million at the same time in 2019, representing a 43% increase. An additional 28.9 million adult flu vaccinations were administered in physician medical offices.

Although last year 32.1 million turned to physicians’ offices to receive vaccinations—about the same number as those who went to a pharmacy setting in 2019—this year to date there has been a significant increase in those seeking immunizations at pharmacies rather than at their physicians’ offices (46.9 million vs 28.9 million, respectively).

These trends seem to match what pharmacists are seeing in stores. “This flu season we anticipate administering nearly 20 million vaccines, which is more than double last year, so the demand to be vaccinated has certainly increased,” said Ryan Rumbarger, BSPharm, senior vice president of retail 

Polster said Walgreens has seen “double-digit growth” in the number of flu vaccinations administered this year at its stores compared to this time last year

. The company has also seen seniors 65 or older—who are particularly at risk for COVID-19—getting flu vaccinations in higher numbers and earlier in the flu season than in past years.

“Our marketing mix is consistent with previous flu seasons; however, understanding the importance of flu shots amidst the COVID-19 pandemic, we wanted to ensure we reached our customers to raise broad awareness far earlier this flu season, and ramped up our flu messaging beginning in August,” Polster said. The organization continued its Flu Fighter campaign this year, emphasizing that getting a flu vaccination “not only helps protect you, but those you love—your crew,” she said.

Konrad said Rite Aid’s messaging focused on communicating the importance of getting a vaccination “as a way to prevent a possible ‘twindemic’ that some health care experts feared could result from the collision of flu season and the COVID-19 pandemic.”

To date, it appears that concern has failed to come to fruition, but flu season is not over, and experts and the CDC said the community needs to remain vigilant in the months ahead. “We’ve continued to remind people it’s never too late to get your flu shot,” Rumbarger said. “We’ve also increased access to flu shots for communities in need.”

Brian Caswell, RPh, National Community Pharmacists Association president and owner of Wolkar Drug in Baxter Springs, Kansas, said that although he hasn’t necessarily seen an increase in the number of flu vaccinations administered at his pharmacy this season, he has seen more interest from patients who may have declined vaccinations in past years.

“I have not talked to anyone who said that they are going to forgo their flu shot because of what’s going on, but I have talked to a few people who’ve said, ‘You know, I haven’t had a flu shot ever’ or ‘I haven’t had a flu shot in the last 2 years and with everything going on, I thought I better go ahead and get it this year,’ ” he said.

Although the COVID-19 pandemic appears to have motivated many Americans to seek out flu vaccinations, it has also presented challenges to pharmacies in terms of marketing and logistics. Caswell said his pharmacy was forced to close its lobby twice during the pandemic, and had to rely more heavily on communicating with patients through word of mouth and social media outlets like Facebook. It also switched to an appointment-based approach to vaccinations to minimize the number of individuals in the store at any given time.

“Moving over to an appointment model, I thought was going to be a problem. It hasn’t been a problem,” he said. “People were willing to do it, and I think they didn’t want to be hanging around a lobby with sick people, either.”

Caswell said he had expected the pharmacy’s home delivery services to rise during the pandemic, but was surprised to find the biggest growth was in drive-through use. “I think people still wanted to get out,” he said.

Rumbarger said CVS also amplified its digital experience within its mobile app and expanded home delivery options, like DoorDash and Instacart, to reach patients during the pandemic. “Before and during the pandemic we’ve deployed a diverse marketing strategy to meet people where they are—in our pharmacies, in the community, in the home or in the palm of their hand,” he said, adding that officials will continue to revise strategies based on patient feedback.

Konrad said Rite Aid’s marketing messages have focused on how the pharmacy chain is still able to serve patients amid the pandemic and the increased safety precautions in place. “We’ve worked hard to provide essential pharmacy services—including vaccinations—despite the need to socially distance and protect customers and associates from COVID-19 transmission,” she said. “From enhanced cleaning and sanitation protocols to [personal protective equipment] and social distancing, we’ve made sure our customers can safely visit their neighborhood Rite Aid, whether to get a flu shot, get tested for COVID-19, or pick up medications and immunity-boosting supplements.”

Polster said pharmacies are expecting the COVID-19 vaccine to be more broadly available toward the end of the flu season. There will likely be high demand for COVID-19 vaccinations, but even with help on the horizon, pharmacies will need to encourage patients to remain as healthy as possible.

“It’s going to take time for a COVID-19 vaccine to be available to the general population, so we encourage everyone to get vaccinated against the flu to avoid 2 respiratory illnesses circulating at the same time and reduce the burden on our strained health care system,” Polster said.

Flu season. CDC. Updated January 11, 2021. Accessed January 11, 2021. 

https://www.cdc.gov/flu/season/index.html

Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. CDC. Reviewed October 20, 2020. Accessed January 11, 2021. 

https://www.cdc.gov/vaccines/pandemic-guidance/index.html

Weekly national flu vaccination dashboard. CDC. Reviewed January 6, 2021. Accessed January 11, 2021. https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html. 



Articles

Preventive efforts, renewed interest in vaccinations drive milder flu season. 

Pandemic Precautions Lead to Low Incidence of Flu

Results of a recent study showed that the Bacille Calmette-Guérin (BCG) vaccine can protect elderly adults against various respiratory infections—but it’s unclear what effect it could have on the coronavirus disease 2019 (COVID-19).

BCG is a vaccine for tuberculosis (TB). Although not widely used in the United States, the vaccine is often given to infants and small children in other countries where TB is common.

For the double-blind randomized clinical trial, which was a joint collaboration between Radboud University Medical Center and the National and Kapodistrian University of Athens, investigators examined the effect that the BCG vaccine had on elderly adults after they were discharged from the hospital.

The investigators assigned the 198 study participants to either receive a placebo or BCG vaccine as they were being discharged from the hospital and then followed the participants for 12 months to determine whether there were any new infections, according to the results of the ACTIVATE study published in 

Evangelos J. Giamarellos-Bourboulis, MD, PhD, co-coordinator of the study at the 4th Department of Internal Medicine at ATTIKON University Hospital, told 

® that the investigators discovered a “decrease of overall risk of new infection with the BCG vaccination” among those who received the vaccine.

According to the results, 42.3% of the elderly participants developed an infection in the placebo group, whereas only 25% developed an infection in the BCG group, according to 

 announcing the findings. Those in the treatment arm also took longer to develop their first infection—with an average of 16 weeks after vaccination—compared with 11 weeks in the placebo group.

“In addition to the clear effect of BCG vaccination on infections in general, the most important observation was that BCG could mainly protect against respiratory infections: BCG-vaccinated elderly people had 75% fewer respiratory infections than the elderly who received placebo,” Giamarellos-Bourboulis said in the release.

® that the types of respiratory infections included respiratory viruses and pneumonia.

Investigators reported no differences in adverse effects between the groups and determined the BCG vaccine was safe for elderly patients.

It’s also possible the vaccine could help protect the elderly against COVID-19, but that has not been fully studied. The study began before the coronavirus pandemic began and a low prevalence of COVID-19 among those in the study prevented the investigators from being able to draw any conclusions.

Giamarellos-Bourboulis said the next step in the research will be to “run trials with BCG vaccination to protect the elderly from COVID-19.”

Several studies are already underway to examine whether the BCG vaccine could also have a protective effect against COVID-19.

Giamarellos-Bourboulis EJ, Tsilika M, Moorlag S, et al. Activate: Randomized clinical trial of BCG vaccination against infection in the elderly. 

https://doi.org/10.1016/j.cell.2020.08.051

Elderly people protected against respiratory infections by BCG vaccine. News release. Radboud UMC; September 1, 2020. Accessed October 6, 2020. https://www.radboudumc.nl/en/nieuws/2020/elderly-people-protected-against-respiratory-infections-by-bcg-vaccine

The BCG vaccine decreased the overall risk of new respiratory infections in elderly adults, according to the study results. 

Study: BCG Vaccine Protects Elderly Against Respiratory Infections

Health care providers are getting creative and taking their immunization efforts on the road this year in an effort to increase influenza vaccinations.

Giant Food, a regional grocery chain in the greater Washington DC area, announced its pharmacy would be operating mobile clinics, manned by specially trained pharmacists, to make stops throughout the region in October, according to 

Pharmacists will use an Airstream vehicle to stop in key locations to provide influenza vaccines to interested families and individuals. Company officials said the grocery chain opted to take their immunization efforts on the road because of the high demand for the vaccine in light of coronavirus disease 2019 (COVID-19) pandemic.

“As we prepare for the possibility of the unprecedented convergence of COVID-19 and flu, getting your annual flu shot is more important than ever to help you, your family and your community stay healthy," said Paul Zvaleny, director of pharmacy operations at Giant Food.

As part of the effort, Giant also partnered with Gym Jonez, a popular certified fitness trainer in the area, to bring the mobile flu clinic to his outdoor workout classes to offer participants the flu vaccine.

“We are eager to make flu shots as accessible as possible for members of our communities and are hoping to continue to expand this program to more parts of the region to service people and communities who might not have easy access to a pharmacy,” Zvaleny said.

 “As pharmacists being the most accessible health care professionals, we need to ensure we expand that access to people and communities in need.”

Giant Food isn’t the only organization to bring the vaccines to its client base. In Virginia, the Carilion Clinic fixed up a new van to offer mobile health services.

“It was perfect timing for the vaccine season because our strategy this year was to be neighborhood-based,” community health workforce supervisor Cris Sheffield told 

 “We wanted to make it easy for people and go where people already are.”

In September, the van made a stop at a community center and offered free flu vaccinations to anyone over the age of 18. The health care clinic is planning to host free flu vaccination events 4 times a week through the end of October.

“My biggest hope for flu season is that [with] a lot of the precautions and the things we’ve been putting into place that people are listening," Sheffield told the outlet.

 "And that we will be able to keep it down and keep it pretty good so that we don’t complicate it with COVID and the pandemic we’re already dealing with.”

In Canada, Hamilton EMS Chief Mike Sanderson said Hamilton’s paramedic service hopes to vaccinate about 2400 people through mobile flu vaccine clinics this fall, according to 

. Sanderson said the immunization services are being offered at homeless shelters, social housing buildings, and senior centers throughout the city.

“With the risk of simultaneous cold and flu season, it’s even more important now to get people immunized against the flu as early as possible,” he said.

 everyone over 6 months old should get the flu vaccine, with some rare exceptions.

1. Giant Food Pharmacy Takes Flu Vaccinations On-The-Road with New Mobile Flu Clinics. News release. Giant Food; September 22, 2020. Accessed October 6, 2020. 

https://www.prnewswire.com/news-releases/giant-food-pharmacy-takes-flu-vaccinations-on-the-road-with-new-mobile-flu-clinics-301135518.html

2. Roshetko K. Free flu shot clinic launches Carilion mobile health outreach initiative. WDBJ. Published September 25, 2020. Accessed October 6, 2020. 

https://www.wdbj7.com/2020/09/25/free-flu-shot-clinic-launches-carilion-mobile-health-outreach-initiative/

3. Mann K. Paramedics hope to reach 6 times as many at-risk residents through mobile flu shot clinics. Global News. Published September 25, 2020. Accessed October 6, 2020. 

https://globalnews.ca/news/7359321/hamilton-mobile-flu-shot-clinics/

Some health care providers are taking their flu immunization efforts to the road this year. 

Health Care Providers Hope To Expand Patient Reach With Mobile Flu Clinics

The number of adults getting the shingles vaccine is on the rise, but there is still significant room for improvement, according to 

A brief from the National Center for Health Statistics showed that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018, suggesting positive progress in recent years to improve vaccination rates.

But although the figures have continued to rise, the majority of older adults still haven’t been vaccinated.

“I definitely think there is room for improvement,” Mitchel C. Rothholz, RPh, MBA, chief of governance and state affiliates of the American Pharmacists Association (APhA) and executive director for the APhA Foundation told 

Rothholz said one of the biggest obstacles in recent years has been the accessibility of the vaccine for many pharmacies and patients.

Although Merck offered the first shingles vaccine, Zostavax, in the United States beginning in 2006, it stopped selling its product in July after the more effective vaccine Shingrix began to take hold of the market, according to 

Shingrix, which was approved in late 2017, has been found to be 97% effective in adults ages 50 to 69, but it has also been in short supply.

“I think the rate would have probably been higher if there wasn’t a supply issue that manufacturers have just really come out of,” Rothholz said. “I don’t think we’ve seen the maximum potential with the vaccine delivery there.”

Another barrier, he said, has been payment policy. Under Medicare, the vaccine is covered under Medicare Part D but prescription drug plans “have different copays that people are having to pay to get that and some of those are high copays and become a barrier, especially as things in the economy change,” he said.

According to the data from the National Center for Health Statistics brief, there are still significant differences in immunization rates based on race, education level, and socioeconomic status.

The data, which was taken from the National Health Interview Survey, found that non-Hispanic white adults were much more likely to get the vaccine and had a rate of 38.6% compared with non-Hispanic Black adults (18.8%) and Hispanic adults (19.5%).

Adults were also more likely to get the vaccine if they had a high school diploma or GED compared with those adults with less education (39.9% vs 21.1%, respectively).Those adults who were considered poor based on their family income level were also less likely to receive the vaccine (20.4%) compared with those who were above the income category (38.4%). Men and women were equally likely to have gotten the vaccine (33.5% and 35.4%, respectively).

According to Rothholz, pharmacies have been the “primary provider” administering the vaccine and their role is only expected to grow now that the vaccine has become more accessible.

“They’ve been managing the best they can with the limited resources that we have,” he said of pharmacies.

Now that more vaccines are expected to be available, Rothholz said it is important that pharmacists talk with patients about any potential reactions associated with the vaccine, particularly now that people are more in-tune with their health because of the coronavirus pandemic.

It’s important they know which symptoms could be attributed to the vaccine and which symptoms might suggest a more serious health concern, he said.

“This is one of the tools in our immunization tool kit to protect the public and even in this time of COVID people need to be protected,” he said.

1. CDC. National Center for Health Statistics. Shingles Vaccination Among Adults Aged 60 and Over: United States, 2018. July 2020. 

https://www.cdc.gov/nchs/products/databriefs/db370.htm

2. Galewitz P. Shingles Vaccination Rate Soars But Leaves Many Behind. 

. Published July 9, 2020. Accessed August 31, 2020. https://khn.org/news/shingles-vaccination-rate-soars-but-leaves-many-behind/.

New data show that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018. 