Keep Current on Vaccines to Reassure Hesitant Patients

June 9, 2020

“As pharmacists, we must continue to recommend vaccinations to all our patients.”

Vaccines are crucial to protect public health globally, and pharmacists can play an important role in educating
patients on the importance of immunizations. The World Health Organization named vaccine hesitancy as one of the 10 global threats of 2019. The measles outbreak was largely fueled by the antivaccination movement, and between January 1, 2019, and December 31, 2019, there were 1282 confirmed measles cases across 31 states. This was the greatest number of cases reported in the United States since 1992, a majority of which occurred in patients who were not vaccinated against measles. The cases included 128 patients requiring hospitalization, with 61 patients experiencing complications such as pneumonia and encephalitis. As of May 7, 2020, there have been 12 confirmed measles cases in 7 jurisdictions. Adults and children should be encouraged to stay up-to-date on their immunizations to combat vaccine-preventable diseases. Children can be protected against 14 diseases by 2 years of age when they are up-to-date with their vaccines.

Measles and Combating the Anti-Vaccination Movement 

Pharmacists should educate families and debunk the myth that the measles, mumps, and rubella (MMR) vaccine causes autism. The CDC recommends that all children receive 2 doses of the MMR vaccine: the first at 12 to 15 months of age and the second at 4 to 6 years of age. The Wakefield study published in The Lancet in 1998 ignited fear among the public that the MMR vaccine caused autism, but it was fraudulent. The study was retracted, and author Andrew Wakefield lost his medical license. However, those opposed to vaccination continue to cite the false claim that links the MMR vaccine with autism, which has contributed to a decline in vaccination and increased the spread of measles globally. One recent large-scale study involving 657,461 Danish children over a 10-year period demonstrated that there is no link between the MMR vaccine and autism.

Pharmacists should educate families about the negative health consequences of vaccine refusal for children and adults, especially regarding the MMR vaccine. Measles can result in serious complications: pneumonia, encephalitis, permanent hearing loss, hospitalization, and death. Refusing the vaccine also puts those who are too young to receive it or immunocompromised at risk. Many social media platforms, such as Facebook, Twitter, Pinterest, and YouTube, have taken steps to counter vaccine misinformation, but inaccurate information is still spreading globally. One study based on surveys of almost 2500 US adults found that up to 20% of participants were somewhat misinformed about vaccines. Survey participants who reported increased exposure to information about measles and the MMR vaccine on social media were more likely to grow more misinformed about immunizations. However, those who reported increased exposure to these health topics in traditional media were less likely to support antivaccination claims. Some noteworthy study findings include the fact that 18% of participants mistakenly believe it is very or somewhat accurate that vaccines cause autism. Also, 20% incorrectly report that it makes no difference if parents choose to delay or spread out childhood vaccines instead of adhering to the CDC-recommended immunization schedule.

According to a study by Health Testing Centers, between 2009 and 2018, 27 US states experienced a decline in the percentage of vaccinated kindergarten-age children. Data from the CDC were used to analyze vaccine rates for kindergartners for the most common immunizations, including MMR; diphtheria, tetanus, and pertussis (DTaP); polio; hepatitis B; and varicella. The results found that MMR vaccination rates fell below the 95% target aimed at providing the best protection against measles in 26 states.

The benefits usually outweigh any risks when it comes to vaccines, said Mary Malek, PharmD, AAHIVP, a pharmacist specializing in HIV who practices in New York. “As pharmacists, we must continue to recommend vaccinations to all our patients,”Malek said.“In order to combat the antivaccination movement, we have to use logic and numbers that tell the story.”

Measles was declared eliminated in the United States in 2000, but in the past 5 years especially, there has been an increase in cases. “Reassuring parents is needed, and using data to support that, I believe, is key. If we do not learn from our past, we will never be able to have a better future,” Malek said. Pharmacists can use social media platforms to educate the public and champion vaccines. Community outreach programs and health fairs are also great ways to spread the word about being up-to-date on vaccines. Additionally, pharmacists can advocate for stricter state vaccine laws regarding religious or philosophical exemptions.

Encourage Influenza Vaccination

During the 2019-2020 influenza season, 174 influenza-associated pediatric deaths were reported to the CDC as of May 9, 2020. This past season, influenza-associated hospitalizations in the United States were higher overall than in most recent seasons, and rates for children aged 0 to 4 years and adults 18 to 49 years were the highest the CDC has on record for these age groups, ex- ceeding the rates reported during the 2009 H1N1 pandemic. The CDC’s interim report revealed that the influenza vaccine was 45% effective overall against any influenza virus. Additionally, the vaccine offered a substantial protection of 55% efficacy against the illness among children and adolescents aged 6 months to 17 years. These results are consistent with those from previous influenza seasons, which ranged from 40% to 60%. Children should receive the vaccine as soon as it becomes available, especially those receiving it for the first time as they need 2 doses. The American Academy of Pediatrics has no preference for using flu shots over nasal sprays for the 2020-2021 season. The CDC’s Advisory Committee on Immunization Practices plans to meet this summer but is not expected to make major changes for the upcoming influenza season.

Patients are sometimes hesitant to get an influenza shot because the efficacy can vary each season, so it is important for pharmacists to tell patients that an annual vaccine for everyone 6 months and older is the best way to protect against the illness. Evidence demonstrates that the vaccine protects against influenza-related complications such as hospitalization and death. One study examined the impact of pharmacy-based immunization services on the likelihood of patients receiving the adult influenza and pneumococcal vaccines. The study found that patients were likely to be vaccinated against influenza and pneumonia after receiving the im- munization services.10 As some of the most accessible health care professionals, pharmacists can play an important role in increasing influenza immunization rates.

Pregnant women are at higher risk of influenza-related complications, so it is especially important for this pop- ulation to be vaccinated. Influenza vaccination during pregnancy also provides passive immunity to the baby during the first few months of life. One CDC report revealed that only 53.7% of pregnant women received the influenza vaccine; therefore, pharmacists can play a vital role in educating pregnant patients about the importance of the vaccine.

Vaccine Resources For Pharmacists

Pharmacists can stay up-to-date with the latest vaccine information through the CDC website. The Immunization Action Coalition also includes information on all immunizations as well as frequently asked questions. Further, the CDC has a free Vaccine Schedules app that includes all recommended immunizations for children and adults. The agency also created a free app called the PneumoRecs VaxAdvisor to help determine which pneumococcal vaccines patients need based on their age and medical history.


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