Pharmacist Protocol Is Linked With More Same-Day Vaccine Coadministration

A structured, pharmacist-led vaccine recommendation protocol was associated with more multi-vaccine patients and more same-day coadministration at a community pharmacy in Poland than at two pharmacies using routine practice, according to a study published September 19 in Vaccines.¹

Investigators at the Medical University of Warsaw analyzed anonymized records from 3 pharmacies in northern Poland from August 1, 2025, to March 31, 2026. The dataset included only patients who received at least 1 vaccine, so the findings describe patterns among patients who presented for vaccination rather than uptake across each pharmacy's eligible population, the authors noted.¹

How the Protocol Worked

The intervention pharmacy in Lębork, a town of approximately 35,000 inhabitants, implemented a multicomponent, team-based protocol from August 1, 2025. Rather than vaccinating only patients who requested a specific vaccine, the pharmacy team proactively identified potentially eligible adults during routine encounters, including prescription dispensing and medication collection, by screening for age and other visible eligibility criteria.¹

Comparator pharmacies in Słupsk and Kobylnica used routine, nonstandardized practice in which coadministration was possible but depended on pharmacist judgment and patient requests.¹

The protocol had 7 sequential steps: patient identification, eligibility assessment, vaccination history review, a presumptive ("strong") recommendation, an offer of same-day coadministration, administration of all eligible vaccines during the same visit, and documentation in the national reporting system Gabinet.gov.pl.¹

Adherence to the individual steps was not formally measured. The authors said the intervention did not rely on additional staff, new reimbursement mechanisms, or expanded legal authority.¹

Multivaccine Visits More Frequent at Intervention Pharmacy

In all, 3248 patients received at least 1 of the 5 analyzed vaccines (influenza, COVID-19, respiratory syncytial virus [RSV], herpes zoster, and pneumococcal), contributing 5505 unique patient-vaccine events. The study included 931 patients at Lębork, 1424 in Słupsk, and 893 in Kobylnica.¹

Lębork patients received a mean of 2.08 vaccine types, compared with 1.53 in Słupsk and 1.55 in Kobylnica, or approximately 35% more vaccine types per patient than at the comparator pharmacies, according to the study.¹

At Lębork, 73.6% (685/931) of patients received at least 2 vaccine types, versus 42.7% (990/2317) at the comparator pharmacies. Mean age was 65.7 years in Lębork, 68.9 years in Słupsk, and 65.5 years in Kobylnica.¹

After adjustment for age and sex, the odds ratio for receiving at least 2 vaccine types at the intervention pharmacy was 4.42 (95% CI, 3.71-5.28), compared with an unadjusted odds ratio of 3.73 (95% CI, 3.16-4.41).¹

Same-day coadministration occurred in 92.7% (635/685) of multivaccine patients at Lębork, versus 73.1% (724/990) at the comparator pharmacies combined. The rates were 67.2% in Słupsk and 82.6% in Kobylnica. Triple-vaccine visits occurred only at the intervention pharmacy, where the most frequent same-day combination was COVID-19, influenza, and RSV vaccines (201 visits). All same-day visits at the comparator pharmacies involved 2 vaccines.¹

RSV vaccination reached 519 patients at Lębork, 317 in Słupsk, and 201 in Kobylnica. Relative to influenza and COVID-19 vaccinations, the intervention pharmacy had a higher RSV vaccination rate, with an incidence rate ratio (IRR) of 2.17 (95% CI, 1.67-2.84; P < .001). That analysis rested on 23 site-months of data and showed overdispersion, and the authors described it as exploratory and hypothesis-generating.¹

A sensitivity analysis excluding March 2026 suggested Lębork's relative RSV advantage narrowed over the observation period (IRR, 0.79; 95% CI, 0.70-0.89; P < .001), though the trend was not statistically significant when all months were included (IRR, 0.84; 95% CI, 0.69-1.02; P = .085).¹

Pneumococcal and Herpes Zoster Uptake Stayed Low

Pneumococcal and herpes zoster vaccines were uncommon at all 3 pharmacies. The authors said the most likely explanation is a structural barrier. Reimbursement eligibility for those vaccines in Poland depends on documented medical indications rather than age, pharmacists lack routine access to complete medical records, and pharmacists can generally vaccinate only patients who already hold a physician-issued prescription.¹

They described the barrier as unlikely to be resolved by workflow improvements alone and called for better pharmacist access to reimbursement-relevant clinical information or decision-support and referral tools.¹

Separate Survey Points to Pneumococcal Knowledge Gaps

"They're the most easily accessible health care professionals, so you can really go up to them," Megan Smith, PharmD, clinical pharmacist and health coach with Food City, told Drug Topics in a Q&A.²

Smith, discussing pneumococcal vaccination, said most pharmacies offer walk-in appointments and that new vaccines can cause confusion at first, especially when recommendations are changing.² "I think the important thing is to lean on the clear CDC guidance and help just keep the conversation straightforward, patient-friendly, so they understand what you're saying," Smith said.

A cross-sectional survey of South Carolina community pharmacists, published in Vaccine in 2025, examined the knowledge side of that equation. Of 124 pharmacists contacted by email, 58 completed the survey, for a 47% response rate; it was administered from June to July 2022.^3,4

The authors reported limited knowledge of pneumococcal vaccination guidelines. In one case, 8 of 58 respondents (13.8%) chose the correct recommendation for a 57-year-old man with HIV who had received a pneumococcal conjugate vaccine (PCV13) 7 years earlier and a pneumococcal polysaccharide vaccine (PPSV23) 6 years earlier. Further, 31 (53.4%) answered incorrectly, and 19 (32.8%) were unsure.³

Respondents rated insurance coverage a major barrier in 22.4% of cases and patient willingness to receive the vaccine in 17.2%. They also expressed less confidence in staff willingness to adopt new vaccination services than in other measures of organizational readiness. The authors said targeted education and interventions could help address key barriers and noted that the small sample and single-state scope may limit generalizability.^3,4

Single-Site Design Limits Conclusions

The Polish authors concluded that workflow organization, proactive patient identification, and systematic recommendation strategies may improve the efficiency of adult vaccination delivery in community pharmacies, but the study design limits how far the findings extend. The study was observational and nonrandomized, which precludes causal inference, and Lębork was chosen pragmatically rather than randomly.¹

The pharmacy's owner and vaccinating pharmacist judged in advance that the site had the least favorable conditions for spontaneous, patient-initiated vaccination demand, but that judgment was qualitative, and no comparable preimplementation data were available to verify it.¹

Because only one pharmacy implemented the protocol, site-specific factors, including the characteristics of the individual vaccinating pharmacist, cannot be separated from the effect of the protocol itself, according to the authors.¹

Patient identifiers could not be linked across pharmacies, and the dataset did not include adverse-event data, so the study was not designed to assess safety. The authors called for larger multicenter studies with documented baseline data, randomized or stepped-wedge allocation of pharmacies, and prospective assessment of implementation fidelity.¹

REFERENCES

1. Kuczwalska E, Dworakowska AM, Skarżyńska M, Bujalska-Zadrożny M. Structured Pharmacist-Led Vaccine Recommendation and Coadministration in Community Pharmacies: Real-World Evidence from Poland. Vaccines (Basel). 2026;14(9):823. Published 2026 Sep 19. doi:10.3390/vaccines14090823

2. Nowosielski B, Smith M. Q&A: the pharmacist's role in offering pneumococcal vaccination, education. Drug Topics. December 9, 2025. Accessed September 29, 2026. https://www.drugtopics.com/view/the-pharmacist-s-role-in-offering-pneumococcal-vaccination-education

3. 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

4. US Pharmacist. How informed are community pharmacists about pneumococcal vaccines? US Pharmacist. February 19, 2025. Accessed September 29, 2026. https://www.uspharmacist.com/article/how-informed-are-community-pharmacists-about-pneumococcal-vaccines