Equity-Based Strategies Best for Improving Pneumococcal Vaccine Rates

US adults’ pneumococcal vaccine uptake points to a clear conclusion that the most consistent path to improvement runs through community partnerships, service quality, and a commitment to health equity, according to a study in Respiratory Investigation.¹

“Pharmacists are well poised to identify patients who may benefit from certain vaccinations and make clinical recommendations tailored to patient needs,” wrote the authors of a study in US Pharmacist.² “Various publications have also highlighted that many patients prefer to obtain vaccines at their local pharmacy due to their confidence in pharmacists, and other preferred factors include convenience, flexibility of hours, and ease of accessibility of obtaining a vaccine without making an appointment.”

These findings reveal a public health challenge. Despite Japan introducing a nationwide publicly subsidized program for the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in 2014, coverage among newly eligible 65-year-olds has remained stagnant at approximately 45% over a 10-year period.¹

READ MORE: Study Adds New Rationale for Pneumococcal Vaccination in At-Risk Adults

The Stagnation of Subsidy Programs

This persistent plateau indicates that financial assistance alone cannot successfully bridge the immunization gap.

When a policy relies solely on subsidies, it fails to address deep-seated, system-level barriers and the distinct social determinants of health that prevent high-risk individuals from accessing care. The study's authors emphasize that improving adult vaccination coverage requires a multifaceted approach targeting both health care providers and patient factors.¹

For pharmacists, this underscores that active, equity-driven outreach must replace passive delivery models to reach underserved and vulnerable populations.

The Confusion of Complex Guidelines

A provider-side barrier to achieving vaccination equity is the increasing complexity of adult pneumococcal vaccine guidelines. Over recent years, the introduction of multiple vaccine types has created highly complex, history-dependent schedules, including PPSV23 and various pneumococcal conjugate vaccines (PCVs) like PCV13, PCV15, and PCV20.¹

In the current study, researchers documented a significant decline in health care institutions’ awareness regarding sequential vaccine recommendations from 2019 to 2023. Crucially, the study showed that a basic awareness of vaccine options is a strict prerequisite for executing complex immunization schedules, as no institution unaware of the multiple vaccine classes administered conjugate vaccines.

This knowledge gap is not unique to medical clinics. A systematic review of pharmacists globally revealed a generally unsatisfactory level of knowledge regarding pneumococcal diseases and their prevention.³

Similarly, a cross-sectional study of community pharmacists in South Carolina found that respondents correctly identified the appropriate vaccine recommendations in only a fraction of high-risk patient scenarios, highlighting that rapidly shifting schedules create substantial clinical confusion.⁴

For community pharmacists to act as champions of health equity, they must first be equipped with robust, ongoing continuing education and digital decision-support systems to confidently navigate these complex clinical recommendations.^1,3,4

Overcoming Barriers Through Local Access

To truly achieve vaccine equity, public health systems must leverage the unique position of community pharmacists as highly accessible, trusted health care providers. Gaps in vaccination rates are frequently driven by structural barriers, including the rurality of a patient's location, income level, insurance hurdles, and limited access to primary care physicians.^2,4

Because approximately 90% of the US population lives within 5 miles of a community pharmacy, pharmacists represent the ideal bridge to reach marginalized populations who rarely visit traditional physicians’ offices.

National guidelines, such as those published by the CDC, advocate for system-level interventions to drive adult vaccination rates. Strategies compiled in the Community Preventive Services Task Force's Community Guide include reducing client out-of-pocket costs, implementing client reminder and recall systems, and utilizing provider reminders.⁵

As immunizers and advocates, community pharmacists are exceptionally well-positioned to deploy these evidence-based strategies. By actively identifying at-risk patients during routine medication dispensing, confirming their insurance coverage, and offering flexible, walk-in vaccinations, pharmacists can eliminate the administrative and geographic hurdles that disproportionately burden low-income and rural communities.^2,4

Expanding the pharmacist's clinical role from simple dispenser to equity-focused immunizer is a proven path to protecting the public from severe disease.^2,3

“Enhancing continuous education and implementing practical decision-support systems may facilitate appropriate vaccination practices,” concluded the authors of the current study.¹ “Efforts to address both provider-related barriers and system-level challenges may help improve adult pneumococcal vaccination coverage.”

READ MORE: Pneumococcal Resource Center

REFERENCES

1. Yoshihara K, Hamaguchi M, Hotta T, et al. Awareness and implementation of adult pneumococcal vaccination in Shimane Prefecture, Japan: repeated cross-sectional surveys and analysis of vaccination trends. Respir Investig. 2026;64(5):101493. doi:10.1016/j.resinv.2026.101493

2. Role of the pharmacist in expanding vaccination rates. US Pharmacist. August 20, 2024. Accessed August 17, 2026. https://www.uspharmacist.com/article/role-of-the-pharmacist-in-expanding-vaccination-rates

3. Waszkiewicz M, Wnuk K, Świtalski J, et al. Knowledge, attitudes, and beliefs of pharmacists regarding vaccinations against influenza and pneumococci - a systematic review. Hum Vaccin Immunother. 2025 Dec;21(1):2489889. doi: 10.1080/21645515.2025.2489889

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

5. Strategies for increasing adult vaccination rates. CDC. August 9, 2024. Accessed August 17, 2026. https://www.cdc.gov/vaccines-adults/hcp/vaccination-guidelines/index.html