Additional Steps in Prescribing Limit RSV Vaccine Access

Jurisdictions that still require patient-specific prescriptions for immunizations are significantly limiting respiratory syncytial virus (RSV) vaccine uptake, according to a study in JAPhA Practice Innovations.¹ Although the need for prescriptions can cause delays and barriers to access, researchers’ findings underscore the need for greater pharmacist-physician collaboration.

“Since 2020, the Public Readiness and Emergency Preparedness (PREP) Act has provided temporary, expanded authority for pharmacists to administer vaccines during the COVID-19 public health emergency,” wrote the National Alliance of State Pharmacy Associations.² “Previously set to expire at the end of 2024, the PREP Act has once again been extended through 2029, allowing pharmacists to continue to…administer COVID-19 and seasonal influenza vaccines to individuals 3 years of age and older under federal authority.”

The COVID-19 pandemic was a monumental moment in the history of pharmacists’ immunization authority (PIA). However, much has changed for pharmacists, other providers, and patients during the past 5 years.

First, regarding vaccine uptake and patient outcomes since the pandemic, research shows vaccine coverage rates declined significantly in 2020 and 2021 when compared with the pre-pandemic year 2019. Alongside lower uptake, researchers also uncovered an increase in morbidity and mortality attributed to vaccine-preventable diseases (VPDs).³

READ MORE: Survey Shows Significant Gaps in Understanding of Shared Decision-Making

As of last year, a total of 19 states and Washington, DC, allowed pharmacists to administer any Advisory Committee for Immunization Practices (ACIP)–recommended vaccine. On top of that, 47 states and Washington, DC, allow pharmacy technicians to provide vaccinations in some capacity. In 2020, just 6 states gave technicians this authority.⁴

Despite the immense strides the pharmacy profession has made, there are still a variety of old and new challenges in the immunization space. Amid persisting ideas of vaccine hesitancy and unprecedented actions from government health groups,⁵ researchers, pharmacists, and providers alike are still looking for innovative ways to circumvent state-by-state restrictions and boost vaccine rates nationwide.²

“There is existing literature highlighting the impact of pharmacists on adult and adolescent vaccination rates, but there is a lack of substantial research on how PIA influences infant RSV immunoprophylaxis rates,” wrote the authors of the study.¹ Their objective was “to assess the impact of PIA on nirsevimab immunoprophylaxis rates in infants aged 0–7 months across US jurisdictions during the 2024–2025 RSV season.”

Using the CDC’s RSV data, researchers analyzed nirsevimab immunoprophylaxis rates, or vaccine rates, among infants across 28 different jurisdictions with either independent, dependent, or no PIA. The publicly available data was explored from September 2024 to January 2025.

Exploring overall authority to administer RSV vaccines across all 50 states, researchers found 14 jurisdictions where pharmacists were given independent authority, 14 more for dependent authority, and an additional 23 with none. They then focused on just the jurisdictions that consistently reported vaccine data (28), where 9 had independent authority, 8 were dependent, and 11 had none at all.

“Although the statistical analyses did not find significant differences in infant RSV immunoprophylaxis rates across the 3 PIA categories, the data still yielded some interesting findings,” continued the authors.¹ “The [independent authority] and [no authority] category immunoprophylaxis rates showed minimal differences (34.37% vs. 34.38%), while the [dependent authority] category rate was almost 6% lower.”

After statistical analysis, immunization rates went particularly unchanged. However, when separating by authority types, independent authority and no authority were significantly more impactful on vaccine rates when compared with pharmacists experiencing dependent authority.

According to the researchers, dependent-authority states are particularly threatening to vaccination rates because of patient-specific prescriptions needed for the RSV vaccine in these jurisdictions. These prescriptions can induce delays and barriers that turn patients away from seeking out the vaccine, ultimately impacting overall uptake.

On top of the jurisdictions where pharmacists rely on other providers to administer vaccines or prescriptions for them, researchers believe that more pharmacist-provider collaboration can also help fill in gaps. With greater communication and a more unified health care team, pharmacists can also utilize technology like the electronic health record to further foster relationships with providers.

“While pharmacists did not significantly impact rates during this early implementation period, their involvement still expanded access points of care and may help improve uptake over time as authority becomes more consistent,” they concluded.¹ “Given the still recent approval of nirsevimab for infants, future studies are needed to evaluate pharmacist administration rates of the RSV monoclonal antibody product, as well as the factors that influence these rates.”

READ MORE: Immunization Resource Center

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.

REFERENCES

1. Steverson C, Saiar A, Daniels R, et al. Impact of pharmacist immunization authority (PIA) on infant respiratory syncytial virus (RSV) immunoprophylaxis rates. JAPhA Pract Innov. Published online January 6, 2026:100091. https://doi.org/10.1016/j.japhpi.2026.100091

2. Pharmacist and pharmacy technician vaccination authority. National Alliance of State Pharmacy Associations. August 29, 2025. Accessed January 12, 2026. https://naspa.us/resource/2024-pharmacist-immunization-authority/

3. Cunniff L, Alyanak E, Fix A, et al. The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: a review. Hum Vaccin Immunother. 2023 Aug 1;19(2):2246502. doi: 10.1080/21645515.2023.2246502.

4. Nakayama M, Goad J. An update on state-level authority on pharmacy immunization. Drug Topics. August 11, 2025. Accessed January 12, 2026. https://www.drugtopics.com/view/an-update-on-state-level-authority-on-pharmacy-immunization

5. Nowosielski B. HHS limits vaccine recommendations for childhood schedules. Drug Topics. January 5, 2026. Accessed January 12, 2026. https://www.drugtopics.com/view/hhs-limiting-vaccine-recommendations-for-childhood-schedules