Q&A: Pharmacist Advocates for Evidence-Based Immunization Guidelines For COVID-19 Vaccines

Childhood immunizations have long been a cornerstone of public health, but in recent years, the landscape has grown increasingly complex. Although there has been misinformation and disinformation in the immunization landscape, particularly with COVID-19, health care providers must navigate a maze of evolving guidelines, state regulations, and insurance requirements. The American Academy of Pediatrics (AAP) vaccine schedule remains a trusted benchmark, yet the practicalities of delivering these vaccines—especially in pharmacies—are often decided by policies on vaccine schedules.

In this interview, Laura Knockel, PharmD, BCACP, clinical associate professor at the University of Iowa College of Pharmacy, discusses challenges facing both families and frontline health care workers. She highlights the importance of acknowledging parental concerns, directing families to reputable sources, and explaining the limitations of pharmacies imposed by state and federal regulations. She also discusses the behind-the-scenes advocacy efforts by national pharmacy organizations to maintain vaccine access and streamline administration.

Pharmacists navigate complex immunization challenges and address parental concerns and misinformation while advocating for streamlined vaccine access and adherence to evolving guidelines. | Image Credit: Looker_Studio - stock.adobe.com

Drug Topics®: How can pharmacists anticipate handling conversations with parents who may be confused or concerned about which schedule to follow

Laura Knockel, PharmD, BCACP: They're understandably confused. The space around vaccines is changing so rapidly. There's so much misinformation and disinformation out there, so I really think the first step is to acknowledge that concern, and again, coming from the point of they want to do what's best for their child. So explaining that the American Academy of Pediatrics [AAP], if those are the recommendations you're using, they have a long history of developing immunization recommendations using evidence reviewed by a group of knowledgeable, experienced health care providers. I would also avoid repeating recommendations that don't have basis in evidence, as words tend to stick in our heads whether they're true or not. If they would like to do their own research, it's good to provide reputable sites like AAP's website, healthychildren.org, or immunize.org's public website, vaccineinformation.org, to make sure they're getting that accurate information If they do want to do their own research.

Drug Topics: From a professional standpoint, how can pharmacists manage the legal and liability aspects of this situation, given that some state laws and insurance coverage policies are often tied to CDC/ACIP recommendations?

Knockel: Pharmacists, technicians, and students, they all need to ensure they have appropriate liability coverage, commensurate with their responsibilities, and that's just best practice, regardless of the situation. I do think staying aware of what your state's rules are is important, as well as your individual pharmacy workplace's policies on immunizations, checking to see if your ability to provide immunizations is tied with the CDC and ACIP recommendations. I strongly encourage everyone to join their state pharmacy association, as well as national organizations, as they are a great resource when it comes to dealing with this sort of issue. Multiple national pharmacy organizations have come together, in fact, to create a pharmacy-based vaccine access work group. They're working on an executive order template for state governors to use that will allow pharmacists to administer immunizations based on guidance other than ACIP [Advisory Committee on Immunization Practices]. It's only a stopgap while they're working on longer-term solutions for that legislative, regulatory policy. This group also sent a letter to insurance companies requesting that coverage and access to vaccines is maintained, and so those are great examples of why belonging to these organizations is important. They need our support in order to do the work on behalf of us.

Drug Topics: What message would you like to convey to other pharmacists, health care professionals, and the public about this situation and the role of pharmacists in the upcoming vaccination season?

Knockel: It would be helpful for the public and other health care professionals to know that there may be extra steps before you can receive your immunizations at a pharmacy, and many states, pharmacists and technicians, their authority to administer those immunizations is contingent on ACIP recommendations. So, in those cases, if an immunization is not on the ACIP schedule, we can't administer it. So just like any other FDA-approved product, these vaccines can be prescribed for off-label use or using a medication for something other than its original FDA approval, and if that's the case, we need to rely on health care providers that have a much more broad prescriptive authority, such as primary care providers and pediatricians. So a lot of it depends on your state, but the pharmacy may be able to contact that provider for a prescription in order to bill and administer that vaccine. Big thing is this takes time. It adds to the workload of both pharmacies and provider offices, and then, as pharmacists, I think we need to ensure we're explaining why we're unable to provide a vaccine in the same way that we were last year and making sure we give the patient other suggestions on how to receive that vaccine. We want to make sure that they understand that we're not the ones refusing it. It's just our hands are tied. We're unable to provide it, and then, give them those suggestions on where to go and what to do next.

Drug Topics: Is there anything else you would like to add?

Knockel: When I step back and I look at this kind of from the bigger picture, I think there needs to be a discussion, really, of should this be the way immunizations are handled, with the government making recommendations that health care professionals are required to follow. It's worked in the past, but in the current climate, we've lost focus on what's important from both the patient [at the] individual level as well as [at the] public health level. When I think of how recommendations for other health care topics are dealt with, although these aren't considered public health categories, but for example, most common guidelines for blood pressure and cholesterol developed by organizations like the American Heart Association, American College of Cardiology, [and] the American Diabetes Association create clinical practice recommendations regarding diabetes. We don't have government officials or nonexperts deciding how we treat patients. We need to take the politics out of immunizations and rely on medical experts with years of education, the experience, and the knowledge to interpret that data to provide evidence-based recommendations.

READ MORE: COVID-19 Resource Center

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