The Evolving Landscape of Influenza Immunizations - Episode 7

ACIP Recommendations for Senior Patient Population

The panel discusses vaccination for senior patient populations, citing the most recent ACIP recommendations.

Mitchel Rothholz, RPh, MBA: The ACIP [Advisory Committee on Immunization Practices] for the CDC comes out every year with their recommendations. Give a little insight in terms of what they’re looking at. How should pharmacists utilize that in guiding [patients] on the different types of vaccines that are available? What are the differences? If one of you gentlemen wouldn’t mind touching on the recent recommendation that came out of ACIP in regard to senior patients.

John Beckner, RPh: That was a significant development. A couple of weeks ago, the ACIP voted to preferentially recommend the use of the higher-dose or adjuvanted flu vaccine for people over the age of 65. That’s over the standard-dose flu vaccine. Historically, the CDC hasn’t recommended any flu vaccine over another for any particular age group, so for them to do this for the senior population is significant. Pharmacists over the years have been doing a pretty good job of pushing that vaccine in the senior population. But having that stamp of approval from the ACIP and CDC is going to have a big impact in a couple of ways. It’s going to encourage more seniors to ask for that particular vaccine, and it’s going to result in more pharmacies stocking that vaccine. Because right now, not everybody stocks the high-dose [vaccine], even though they probably should. But with that that seal of approval, it’s going to increase the uptake of that particular vaccine.

Mitchel Rothholz, RPh, MBA: Randy, you do a lot of work in the long-term care sector. How do you see that recommendation playing out for the long-term care patients, whether it be in nursing home or adult congregate living facilities?

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: We were already using those vaccines for our older population, and we started promoting that when those first came out, especially with the high dose, and then more recently the adjuvanted. We listen to the ACIP and CDC quite frequently, and then we make sure that when those new statements come out that we promote them to other providers to make sure they understand, but also to our practice sites to make sure all of our staff are fully educated about this. We do a lot of long-term care, so we’re going to make sure all our facilities know the guidelines and recommendations, and then even whether we could come out to help do some of the vaccinations for them as well. We use that information to inform people.

Mitchel Rothholz, RPh, MBA: Jeff, could you give your perspective? One thing that COVID-19 unfortunately has done in the public’s mind is cause a questioning of federal agencies. The CDC has taken some hits through this process in terms of [people] trusting what they say. Can you give the audience insight in terms of the process that the ACIP goes through in coming up with these recommendations?

Jeff Goad, PharmD, MPH: Absolutely. The ACIP is a great example of how government and nongovernment groups work together. A lot of people don’t realize that the ACIP, the actual voting group, is nongovernmental. It is just 15 vaccine experts—minus any pharmacists, which is something we’ve got to move on—who vote on recommendations for the entire country. In fact, it isn’t only the 15; around them are 30 liaison groups representing the major medical and public health stakeholders that contribute and help shape those recommendations.

It isn’t just the FDA where they’re considering safety and efficacy. The CDC goes beyond that. They can look at the public health good, the economic implications, the clinical implications, and give some on-the-ground clinical implications and insights where there are gray areas. They’ve started to provide more insight for our providers to make better decisions. The CDC from a top-down approach has done a great job of using the nongovernmental experts to put forward recommendations. To tie it back to pharmacists, only pharmacists would take a recommendation by the CDC and write it into law. Most states use the ACIP recommendations as the pharmacy law. Medicine doesn’t do that. The good news is they make sound recommendations, but it’s an interesting observation on pharmacists.

Mitchel Rothholz, RPh, MBA: To add to that, we have pharmacy as one of the liaison organizations, and Michael Hogue, [PharmD, FAPhA, FNAP,] sits in the seat for pharmacy. The other thing is that ACIP is a recommending body, so it has to be accepted by the CDC director. We’re still seeing it play out in COVID-19, so we’ve got a new world in terms of use of advisory committees and then the politics that get played in there potentially from the director, whether it’s the CDC or FDA. Unfortunately, we need to use more of that science-based approach to these decision-making processes, and we’ll get there.

Transcript edited for clarity.