After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Describe the rationale for offering immunizations in a pharmacy setting.
Evaluate an individual patient's need for vaccines, based on his or her specific history.
Analyze the business management aspects needed to create and maintain immunization services in a community pharmacy setting, including the initial development of the service, marketing, documentation, and reimbursement.
The advent and routine administration of vaccines are perhaps the biggest advancement ever experienced in public health. In the 20th century, the average number of reported cases of measles in the United States exceeded 530,000 annually.1 This disease leads to many complications, including diarrhea, otitis media, and pneumonia. It can also result in encephalitis, seizures, and death in a small proportion of patients.2 The vaccine for measles was licensed in 1963. In 2010, there were 61 cases reported.1 Cases of mumps decreased from an annual average of over 162,000 cases through the 20th century to 2,528 in 2010. Similar decreases are seen in nearly all vaccine-preventable diseases after the advent of vaccines and widespread immunization. There were zero reported cases of smallpox, diphtheria, and paralytic polio in 2010. Newer vaccines have also led to significant decreases in annual cases since becoming routine. In comparison with the pre-vaccine era, varicella cases decreased by 89%, hepatitis B by 83%, hepatitis A by 91%, and invasive peumococcal disease in children (5 years of age) by 74% in 2008. Hospitalizations and ER visits due to rotavirus decreased by 88%, resulting in an estimated cost savings to the healthcare system of $278 million in 2008-2009 alone.3
Clearly, immunizations are vital for improving public health and decreasing healthcare costs. They work by provoking an immune response after vaccination similar to having the actual infection, and greatly minimize the possible complications.4 The different characteristics of vaccines (such as live versus inactivated, route of administration, and presence of adjuvant ingredients, to name a few) determine how they are used and dosed, but their underlying mechanisms are the same: provoke active immunity against the natural disease, allowing the recipient to fight it off when exposed later.
The details of vaccine science or all vaccine-preventable diseases are beyond the scope of this chapter. Rather, this chapter will focus on the pharmacist's role in vaccine delivery and the establishment of a community pharmacy-based immunization service. There are many resources and references for more detailed information on the actual vaccines and diseases, some of which are listed at the end of the chapter.
Pharmacists and Immunizations
Pharmacists have served varying roles related to vaccines dating as far back as the 1800s.5 In 1993, DHHS officially recognized that pharmacists were able to assist in the areas of immunization education, distribution, access/administration, and registries/tracking systems. In 1994, the first organized formal immunization training for pharmacists took place ...