Multilevel Barriers Limit Pneumococcal Vaccination in Rural Pharmacies

In order to improve interventions for boosting pneumococcal vaccine rates in rural community pharmacies, efforts must focus on addressing individual, organizational, community-focused, and policy-level barriers, according to a study published in Vaccine: X.¹

“Approximately 90% of Americans live within 5 miles of a community pharmacy, making community pharmacies accessible points of health care even in rural communities,” wrote the authors of a study published in Vaccine.² “Vaccination appointments in community pharmacies also are typically available via walk-in, with no multiday waiting period that patients may experience in a physician office setting. While pharmacists have been delivering vaccines for decades, the role expanded substantially during the COVID-19 pandemic.”

Despite this expansion, a cross-sectional study of community pharmacists revealed a significant gap in clinical knowledge, with respondents correctly identifying vaccination recommendations in only a small fraction of specific patient cases. This lack of familiarity is often exacerbated by the complex and rapidly changing guidelines surrounding pneumococcal immunizations, which now include several conjugate vaccine options such as PCV15, PCV20, and PCV21.^3,4

These updates recently lowered the recommended age for routine vaccination from 65 to 50 years, a shift intended to capture patients before age-related medical problems increase their vulnerability to severe respiratory illness.⁴

READ MORE: Systematic Workflow Changes Can Improve Pneumococcal Vaccine Rates

At the individual level, both pharmacist and patient attitudes play a decisive role in uptake. Rural pharmacists report that vaccine hesitancy remains a formidable barrier, frequently intensified by misinformation and a spillover effect from the COVID-19 pandemic that has reduced trust in government health advice.¹

Patients often lack a clear understanding of the disease, sometimes confusing the pneumococcal shot with the annual flu vaccine or assuming the vaccines are interchangeable.

Furthermore, financial concerns continue to weigh heavily on patients, particularly those who are uninsured or under age 65 years and do not yet qualify for Medicare coverage. Even among the insured, out-of-pocket costs can deter uptake, which stands in sharp contrast to the reliable reimbursement and high receptivity seen with Medicare Part B beneficiaries.¹

Organizational challenges further complicate the delivery of these clinical services. Rural pharmacies often grapple with low staffing levels and extreme time constraints, making it difficult for pharmacists to prioritize proactive vaccine recommendations over the daily demands of prescription filling.

Although many pharmacists express confidence in their ability to coordinate new services, they report less certainty regarding the willingness of their staff to adopt these additional responsibilities. The administrative burden of paperwork and the high cost of stocking multiple vaccine variants, which are sometimes only available in bulk quantities, can lead to inventory caution among smaller, independent pharmacies.^1,3

These logistical hurdles are echoed in international studies, where service providers cited ill-defined eligibility parameters and time-intensive consultations as primary deterrents to participation in vaccination programs.²

Community and policy-level factors also create friction in rural settings. Although many local physicians support pharmacy-based immunizations as a way to alleviate their own clinical workload, some remain resistant due to concerns over fragmented care or lost revenue.¹

Additionally, incomplete state immunization registries often force pharmacists to rely on poor patient recall of vaccination history, which practitioners have described as a dark black hole that makes determining current eligibility nearly impossible.

Addressing these multilevel barriers requires a concerted effort to enhance pharmacist training and leverage tools like the CDC’s PneumoRecs VaxAdvisor app to navigate current guidelines.^1,3

As the global aging population grows, health experts emphasize that prioritizing immunization will be critical to reducing the incidence of invasive disease, such as meningitis and bacteremia, which remains a severe threat to high-risk populations.^4,5

“Effective interventions will require a multilevel approach addressing barriers at the individual (pharmacist and patient), organizational, community, and policy levels,” concluded the authors of the current study.¹ “Complementary policy changes to advance pharmacists’ and technicians’ immunization authorization, increase immunization reimbursements, and improve vaccine registry systems, combined with organizational strategies to support workflow and staffing, are essential to maximize the impact of these interventions and enhance pneumococcal vaccine uptake in rural communities.”

READ MORE: Pneumococcal Resource Center

REFERENCES

1. Vieira LEB, Marley GT, Hastings TJ, et al. Barriers and facilitators to pneumococcal vaccination in rural community pharmacy: a qualitative study. Vaccine: X. 2026;29:100786. https://doi.org/10.1016/j.jvacx.2026.100786

2. Huang J, Mak FY, Wong YY, et al. Enabling factors, barriers, and perceptions of pneumococcal vaccination strategy implementation: a qualitative study. Vaccines (Basel). 2022 Jul 21;10(7):1164. doi: 10.3390/vaccines10071164.

3. Davies A, Schreiber D, Carey C, et al. Community pharmacists’ pneumococcal vaccine knowledge and perceived barriers to vaccination. Vaccine. 2025;53:126930. https://doi.org/10.1016/j.vaccine.2025.126930

4. Should I get the pneumococcal vaccine? 5 things to know. Yale Medicine. December 12, 2024. Accessed May 26, 2026. https://www.yalemedicine.org/news/should-i-get-the-pneumococcal-vaccine-5-things-to-know

5. Meara K. Barriers that reduce pneumococcal vaccine uptake among seniors. Contagion Live. June 8, 2025. Accessed May 26, 2026. https://www.contagionlive.com/view/barriers-that-reduce-pneumococcal-vaccine-uptake-among-seniors