Childhood Vaccines During COVID-19 and Beyond

It’s nearly a year since August 2020, when the US Department of Health & Human Services (HHS) authorized licensed pharmacists throughout the country to provide childhood immunizations to patients aged 3 to 18 years during the public health emergency. This is a significant, albeit temporary, expansion of pharmacist authorization to administer pediatric vaccines in many states. Although about half of states and territories allow pharmacists to administer vaccines to patients of any age, many have age limitations and other restrictions pertaining to specific vaccines.¹

Yet it seems that most pharmacies nationwide have not gotten involved in pediatric vaccinations. “We’re trying not to bite off more than we can chew,” said Kevin Day, PharmD, president of Day’s Miami Heights Pharmacy in Cincinnati, Ohio.“[COVID-19] testing and vaccines have been plenty.”

Perhaps now that the initial rush of COVID-19 vaccination has subsided, pharmacies should consider establish- ing pediatric vaccination programs, as this is an opportunity that can benefit both individual pharmacists and the profession as a whole.

Why Should Pharmacists Vaccinate Kids?

The HHS authorization was intended to bolster childhood immunization levels after the CDC collected data in May 2020 indicating a significant drop in childhood vaccinations in the early months of the pandemic, raising fears of outbreaks of vaccine-preventable disease.² Even if vaccination levels now appear to have returned to prepandemic levels, there may remain a backlog of patients who are behind on their immunizations, according to Jeffery Goad, PharmD, professor and chair of the Department of Pharmacy Practice at the Chapman University School of Pharmacy in Irvine, California.

Administering childhood vaccines gives pharmacists the opportunity to practice at the top of their license while improving immunization rates in their communities.“Expanding into pediatric vaccines expands the range of providers that you’re able to network with, and that creates more collaboration among providers that you may not have dealt with,” Goad noted. In addition, he said, a childhood vaccination program helps build parents’ trust in pharmacists.

Know the Vaccination Schedules

Although the bulk of pediatric immunizations are given to infants up to 18 months of age, the 3-to-18-years group includes 4 recommended vaccines at ages 4 to 6, 3 at ages 11 to 12, and 1 at age 16 years (see Table).³

Goad believes the main benefit of pharmacy childhood vaccination, outside the pandemic, is to close the gap for adolescent vaccinations.“The 3 shots that are given at the preadolescent phase, 11 to 12 years, is an important area for pharmacists to help the community get their vaccination rates up,” he said.

Recommended Immunization Schedule for Children Aged 3-18 Years³

Communication and Collaboration

Setting up to provide childhood vaccines should not be a major investment for most pharmacies, Goad said, as the basic infrastructure of an immunization administration area and vendors to order vaccines and supplies are already in place.“ They just need to order the right vaccines,” he said.

What may require more attention is establishing the infrastructure to identify children who need vaccination, document appropriately, and communicate with other health care providers to ensure that children are not being under or overvaccinated. This can be accomplished easily if pharmacists have access to electronic health records or if their state has a comprehensive immunization registry that pharmacists can access (in some cases, directly through their dispensing software). But not all states mandate that all providers document vaccinations in the state registry, resulting in incomplete immunization registries. Pharmacists who cannot access vaccine information electronically must find other ways to communicate with pediatricians to share immunization information (eg, faxing records).

Pharmacists who can check immunization registries while filling prescriptions can identify children who are due or overdue for specific vaccines. In fact, COVID-19 vaccinations for adolescents may provide a key opportunity for pharmacists to identify other vaccines these teens need. Importantly, although previous recommendations were to separate COVID-19 and other vaccines by 14 days, the CDC now allows COVID- 19 and other vaccines to be administered without regard to timing.⁴ Generally, however, the major source of pediatric vaccine business is from physician referrals, so it is crucial for pharmacists to cultivate relationships with local pediatricians. Before establishing a pediatric vaccine program, pharmacists must perform a needs assessment in their community, Goad said, by reaching out to local pediatricians to find out whether “they are struggling to meet the backlog of vaccines.”

Day said a main reason his pharmacy has not jumped in on childhood vaccines is to respect relationships with pediatricians in his area who, he said, “do an excellent job.” In contrast, Travis Wolff, PharmD, owner of Med-World Pharmacy in Sapulpa, Oklahoma, reported that his local physicians find ordering and storing vaccines to be a huge barrier, so they are happy to refer their patients to the pharmacy for vaccination. Establishing which local physicians this is the case for is important.

Although the American Academy of Pediatrics came out strongly against pharmacists providing childhood vaccines at the time of the HHS announcement, Goad believes the academy’s main concern is communication and the potential for under or overvaccination.“ We have to reassure pediatricians that we are not disrupting [the normal visits pediatricians have], that we are simply acting to help them offload some of the patients where they now are behind.” For example, he said, physicians can send their patients to the pharmacy for later doses of a multidose series of vaccines, and pharmacists should encourage parents to schedule their kids for physicals if they haven’t seen the pediatrician in a while.

Compensation Matters

Before establishing a pediatric immunization program, pharmacists must ensure they’ll be reimbursed for their services. Medicaid and commercial insurance rules vary by state. “The state of Oklahoma currently does not pay pharmacies through our state Medicaid for immunizations in patients under age 19,” said Wolff. “This has proven to be a huge barrier to vaccinating those that need it most.” And, he noted, many commercial insurers cover pediatric vaccines on the medical but not the pharmacy side.

Pharmacies can apply to participate in their state’s Vaccines for Children Program, which covers vaccine costs for children 18 years and below. For more information, go to https://www. cdc.gov/vaccines/programs/vfc/provid- ers/questions/qa-join.html.

A Chance for Change

According to Goad, the emergency declaration has shown that you can enact a national standard, rather than what he calls “the patchwork of immunization laws” throughout the country.

“As the only pharmacist serving on our state board of health, I am working to educate and encourage reform in the practice privileges of pharmacists every day,” Wolff said.

“This is a window of opportunity,” Goad concluded.“ Pharmacists need to advocate to their legislators and their stakeholders that this is something they can do and they want to do, so that everyone just thinks that the pharmacy is the place to go to get a vaccine.”

Jeffery Goad, PharmD

References

1. Pharmacist administered vaccines. National Alliance of State Pharmacy Associations, American Pharmacists Association. Updated September 18, 2020. Accessed May 27, 2021. https://naspa.us/wp-content/uploads/2020/08/IZ-Authority-9_2020.pdf

2. HHS expands access to childhood vaccines during COVID-19 pandemic. News release Department of Health and Human Services. August 19, 2020. Accessed May 27, 2021. https://public3.pagefreezer.com/browse/HHS%20–%C2%A0About%20News/20-01-2021T12:29/https:/www.hhs.gov/about/news/2020/08/19/hhs-expands-access-childhood-vaccines-during-covid-19-pandemic.html

3. Recommended child and adolescent immunization schedules for ages 18 years or younger, United States, 2021. CDC. Updated February 12, 2021. Accessed May 27, 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

4. Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. CDC. Updated May 14, 2021. Accessed May 27, 2021. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html