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A Decade of Immunizations: Pharmacy Professionals and Vaccinations

October 25, 2022

It has been a decade since pharmacy professionals in Ontario assumed the role of immunizers. The widespread locations and extended hours of pharmacies provide clients a convenient alternative to prescribers’ offices and public health clinics to access vaccinations. Over the course of the decade, the pool of vaccines approved for administration by pharmacy professionals expanded to 13 preventable diseases plus the COVID and flu vaccines.

As students return to school in-person, there is a gap in care that is coming to light. During the pandemic, reduced access to prescribers’ offices and school closures were likely major drivers for the substantial drop in vaccine uptake among children and adolescents. In particular, the largest decline in routine scheduled vaccine uptake appears to be for those typically delivered in school settings: HPV, Hepatitis B, and Meningitis – all of which can be administered by pharmacists. A recent article published by the Globe and Mail noted: “In Ontario, less than 1 per cent of 12-year-olds had received their HPV shots, which help prevent [certain types of cancers], in the 2020-21 school year, compared with 58 per cent in the 2018-19 year, according to a report from Public Health Ontario. Uptake of the hepatitis B vaccine dropped to 16.8 per cent in 2020-21 from 25 per cent in 2019-20. And uptake of the meningococcal disease vaccine dropped to 17.3 per cent in 2020-21 from 67.2 per cent in 2019-20.” 1

Students are not the only group affected by lower vaccination rates. A survey conducted by the Canadian Pharmacists Association (CPhA) in 2021 found that 1 in 10 Canadians had either missed or had a family member miss receiving a vaccine due to the pandemic. 2 For example, the National Advisory Committee on Immunization (NACI) recommends the pneumococcal vaccine for all individuals 65 years of age and older and for those with underlying at-risk medical conditions. The uptake of the pneumococcal vaccine in this target population in Canada last year was 54.8%, below the national coverage goal of 80%. Additionally, the shingles vaccine, another publicly funded adult immunization recommended by NACI for all individuals 50 years of age and older, had an even lower uptake rate of 27.4%.3

Pharmacists, as the most accessible healthcare professionals, are in a unique position to help bridge this gap in care. Of the 17 vaccine preventable diseases targeted by the Publicly Funded Immunization Program in Ontario, pharmacy professionals currently have the scope to administer vaccines for 10 of these diseases and 13 diseases in total. However, patients are unable to access most of these vaccines under this program through pharmacies. Although many of these vaccine preparations are available at pharmacies without a prescription, patients must pay out-of-pocket for both the product and administration fee to receive them in a pharmacy setting. This creates a barrier to access, which can impact the uptake of routine immunization opportunities.

Currently, only 2 types of vaccines are provided in partnership with public health programs: influenza and COVID vaccines – these are available free of charge at pharmacies. The success of these two programs have already spoken volumes on how pharmacy professionals can play a pivotal role as immunizers and public health advocates. In Ontario, the number of flu shots provided at community pharmacies has increased from ~245,000 in 2012/2013 to over 1.3 million in 2019/2020 – that is over a 500% increase in uptake. 4 Additionally, when pharmacists were approved to administer COVID vaccines, within the first month, over ~930,000 doses were administered.5 With these impressive numbers, it comes as no surprise that over 8 in 10 Canadians felt comfortable getting their own or their child’s routine non-COVID-19 vaccines in a pharmacy setting.2

With over 90% of Ontarians residing within five kilometers of a pharmacy, it simply makes sense to enlist pharmacies as another avenue to access additional publicly funded vaccines.6 Pharmacists have already stepped up and showcased our ability to readily adapt and address public health concerns in the face of a constantly changing healthcare landscape. Expansion of pharmacies’ role to provide more publicly funded vaccines may be a sustainable solution to reduce barriers for Ontarians to access publicly funded vaccines, positively impact patient care, and bridge this widening gap.

This blog post is a part of the 10 Years of Immunizations signature learning series (SLS) developed by OPA and supported through an education partnership with Pfizer.

Pamela Ip, PharmD, RPh

Pamela is a 2020 graduate from the Leslie Dan Faculty of Pharmacy. She is a major advocate for pharmacy expanded scope, LGBTQ+ healthcare, and non-traditional pharmacy paths, working in many facets of the healthcare system herself. Currently, Pamela is the Pharmacy Care Manager at the Ontario Prevention Clinic/PrEP Clinic. She also works as a part-time pharmacist at Toronto East General Hospital, in community pharmacy, and as a freelance contractor (taking on roles and projects such as an injection assessor at OPA, conference/educational speaker, and clinical reviewer/editor).