Q&A: Pharmacists Combat Vaccine Fatigue by Personalizing Recommendations for Older Adults

Consultant pharmacists are emerging as vaccine champions in long-term care facilities, where older adults face the highest risks from influenza, COVID-19, and respiratory syncytial virus (RSV). Far beyond dispensing medications, these pharmacists help design vaccination protocols, identify high-risk residents, and educate both staff and families—all while confronting vaccine fatigue and reimbursement barriers.

New guidance recommending RSV vaccines for many adults 60 years and older, and select high-risk adults aged 50 to 74 years, adds another layer of complexity to seasonal flu and COVID-19 efforts. Pharmacists are being asked to integrate multiple vaccines into routine admissions and clinical consults, making immunization a seamless part of care rather than an afterthought.

Avra Thomas, PharmD, BCGP, FASCP, senior director of pharmacy practice at the American Society of Consultant Pharmacists (ASCP), and Chad Worz, PharmD, BCGP, FASCP, executive director and CEO at ASCP, discuss the expanding pharmacist role, including advocacy for federal legislation granting pharmacists provider status and advancing age-friendly care grounded in the 4Ms framework—what matters, medication, mentation, and mobility.

Drug Topics®: As the pharmacist's role continues to extend beyond dispensing to clinical educator, what is the ideal role of a pharmacist in a long-term care immunization program?

Avra Thomas, PharmD, BCGP, FASCP: In general, consultant pharmacists are truly integrated into the long-term care facilities and interdisciplinary team. Their pharmacists are also known as trusted messengers in the community and also within the facility, so the clinical leadership not only comes to them with questions about medication and appropriateness of use but also vaccines, and our older adult vulnerable populations, facilities can work with their pharmacists and pharmacy to establish protocols to identify those residents that are appropriate for vaccinations, whether it's a vaccine clinic or just throughout an admission to the facility if they're eligible for vaccines. This is consistent with anything that they may need, just looking off of their medication history that may be available. Pharmacists are also known as clinical on-site educators. They are familiar with the guidance and up to speed with the most recent recommendations and guidance over that, but they can help support standing orders and just documentation recommendations and workflow. Pharmacists have a big role to play, and the consultant pharmacists in long-term care do hold those things in mind.

Drug Topics: How can pharmacists stay motivated to overcome the clinical and administrative hurdles, such as vaccine fatigue or reimbursement issues, that come with this aging population?

Chad Worz, PharmD, BCGP, FASCP: Number one, we have patients and residents in long-term care settings and older adult settings that there really isn't much controversy over the fact that they need these vaccines and that the conditions that we're vaccinating against are the ones that can take people's lives or put them into the hospital. I think overcoming vaccine fatigue, from a clinician’s perspective, has to do with just staying focused on providing the best care for the patients or residents that you're in front of. Reimbursement [is the] biggest challenge, without a doubt. I think integrating vaccination into the process for admitting somebody to a nursing facility or to an assisted living facility, making it part of the routine clinical consults that are done in nursing facilities, that integration into your workflow and your process, makes the reimbursement issues work better for the pharmacies and makes vaccination a little bit easier on the staff. There's lots of different ways that pharmacists can participate in vaccines, especially at the nursing home level. They can provide the vaccines to the nursing staff who administer the vaccines. They can provide the vaccines to the nursing home on the day that the consultant pharmacist is there, and they could vaccinate individuals, and they can do clinics at those nursing facilities with pharmacy staff or a combination of pharmacy staff and nursing staff. Just making it part of the routine and getting into a cadence with vaccinations, I think, is really important.

Drug Topics: The 2025–2026 guidance now suggests a single lifetime dose of RSV vaccine for all adults 75+ and those 50 to 74 years with specific chronic conditions. How can pharmacists identify high-risk candidates who fall into that 50 to 74 years bracket?

Thomas: Pharmacists can help identify these high-risk patients that are in that age group of 50 to 74 years of age by assessing their medical condition. There are lists of medication indications that were mentioned and living situations that also increase their risk for severe RSV [respiratory syncytial virus] infection. RSV vaccinations are recommended for those with chronic cardiovascular disease, chronic lung or respiratory disease, chronic liver or hematologic disorders, end-stage renal disease or dialysis dependence, diabetes with complications requiring insulin or other insulin therapies, neurologic or neuromuscular conditions affecting airways, and severe obesity, so moderate to severe immunocompromised as well, and really individuals living and residing in nursing homes, long-term care facilities, or assisted-living facilities, where contact with the number of older adults just increases the risk of severe RSV disease. Vaccinations may additionally be appropriate for patients with other chronic conditions or risk factors that really the health care provider helps determines if they're at increased risk.

Drug Topics: The CDC has moved toward shared clinical decision-making for several vaccines in older adults. How can pharmacists explain the risks and benefits of various vaccinations to their patients who might be unsure what to do due to the changing recommendations?

Worz: I think there's been a lot of controversy around vaccines, especially lately, and I think the shared decision-making component of some of the recommendations has drawn a lot of attention. But if you think about it, that's the role of the pharmacist to talk about risk-benefit. We are doing, ultimately, shared decision-making every time we answer a question about somebody that says, "I'm starting this new drug. What are the [adverse] effects?" So I think we have to make it personal for patients, and especially for caregivers that are taking care of patients and residents, and make sure they understand why this particular vaccine or therapy is right for them. Using the data, using the available information that we can get from sources like the Centers for Disease Control, like some of the guidelines, and then making it personal to that individual, we know from our experience with COVID-19 and with influenza that, again, these diseases are the ones that really hit the older adults the hardest, and they're the ones that send them to the hospital and, again, potentially take their life. So we have to make that statement to patients, making it a little bit more personal, where, you know, “You’re right this; this vaccine might not be right for you. You're 35, young, but for your mom or for your dad that are 75 or 80 years old, that might live in a nursing home or assisted living, it's a life-and-death decision, and I think it's one that people need to be comfortable making.

Drug Topics: Older patients may experience significant vaccine fatigue. What specific strategies can pharmacists implement to improve uptake for the annual respiratory vaccines?

Thomas: I really think everyone is experiencing some significant fatigue, but some suggestions for pharmacists trying to make it easy for the patients, whether it's grouping vaccines together that are appropriate—flu, COVID-19, and RSV—same-day administration of these vaccines really to give the patient while they're available and they're present, making it personal, making these recommendations really specific based on the individual, and framing the benefits around the risk and talk about some of those things that they may be fearful of: the opportunities to reduce hospitalizations and really protecting their independence and avoiding any additional setbacks that it could come if they were to get sick with 1 of these vaccine preventable diseases, and making it familiar. Encouraging a seasonal vaccination plan, whether it's a time of month or in preparation for an activity, sharing handouts and vaccine reading material, just keeping things real. The basics of what prevents vaccines, who should get it, and those general [adverse] effects, making it trusted. I think pharmacists are known as trusted messengers, but really engaging with family, patients, residents, depending on the setting that the person is, and coordinating that, and if it's in a facility, coordinating with the facilities, with clinics, just keeping it easy for staff, for the patients, and anyone that's interested in getting them.

Drug Topics: State and federal policies regarding pharmacist-administered vaccines are in constant flux. What is the importance of advocacy through organizations like ASCP in expanding pharmacists’ authority to prescribe and bill for these services?

Worz: Just off the top, it's always important for pharmacists in practice to have a professional home and to support that professional home and participate in some of the activities of organizations, such as ASCP, to promote their practice. At ASCP, we think about education, empowerment, and expansion with respect to our members. When you think about that in terms of vaccines, we're trying to expand your role. If you think about the current legislation from a federal perspective that's out there, it's the Expanding Community Access to Pharmacist (ECAP) Act. It's basically a low-level provider status regulation and legislative piece that allows pharmacists to bill directly for their vaccination services. We think a lot federally at ASCP because Medicare is the component of government-funded health care that takes care of older adults. We want to take what's going on in the states and make sure that all of the pharmacists in those states can practice at the top of their license. Oftentimes, states practice patterns and regulations are a little bit ahead of the federal government, but that only helps you in the Medicaid populations which tends to skew a little bit younger than the Medicare population. So we spend a lot of time with Medicare on pieces of legislation like ECAP to get pharmacist provider status, to expand their ability to provide vaccine services, so that they can get properly reimbursed, and it can help their practice.

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

Thomas: Something want to share, also just about ASCP and what we're working on and the importance of the Age Friendly framework. ASCP, in partnership with the Peter Lamy Center on Aging with the University of Maryland, have partnered with the John L Harper Foundation, really, to push the movement along with Age Friendly Care. We incorporate that in our discussion about vaccines but just igniting those pharmacists and pharmacies to be age friendly, equipping them with better care for older adults, and training and focusing on the 4M framework, and that is what matters to the patient, medication, meditation, and mobility, and through a structured educational program, pharmacists can earn Age Friendly education, not just continuing education but also just general education. On some of those principles and practice, we encourage all to take advantage of this that we have available, not just pharmacists, but other health care professionals interested in learning more about the age friendly movement.

Worz: Just to add to that, I mean, if you think about the age-friendly framework, what matters, medication, meditation, and mobility, even in the context of influenza and vaccinations. There's a component of that foundational thought about age-friendly care that fits things like vaccination and certainly can be as specific as things like influenza. We know that having a vaccine and making a decision about vaccine matters to people. We know that it's basically a medication or a therapeutic. We know that it can be devastating when you have the flu on your cognitive ability and a fogginess that you might feel and certainly can affect your mobility, and the consequences of things like influenza or COVD-19 or RSV. RSV obviously affects all those 4 things as well. So any way that we can acknowledge that pharmacists are prepared, they're age friendly, and they recognize this framework, I think, promotes their practice and promotes the better care of people in this age group.