Allowing Pharmacists to Give Shots Would Improve New York's Flu, Pneumococcal Immunization Rates

BUFFALO, N.Y. -- It might not seem like it if you've recently spent your lunch hour waiting in line for a flu shot, but New York State has one of nation's lowest immunization rates for flu and pneumonia, a factor that may contribute to the more than 5,000 deaths of New York State residents every year from these diseases.

"The deaths that occur in many of these cases are preventable with immunizations, and that's the bottom line," according to Wayne K. Anderson, Ph.D., dean of the UB School of Pharmacy and Pharmaceutical Sciences.

Anderson offers a solution to the problem: Allow pharmacists to administer these two immunizations.

Blocking the way, however, is the fact that New York State is one of only 15 states that still do not permit pharmacists to do so.

The UB School of Pharmacy and Pharmaceutical Sciences is the only pharmacy school in New York that certifies students in immunization procedures for adults as approved by the Centers for Disease Control and Prevention. Consistently ranked among the top pharmacy schools in the nation, it offers New York's only public pharmacy program.

Anderson said state legislation that could have boosted vaccination rates by allowing pharmacists to give adult vaccinations was tabled this summer, a move that he noted will lead to unnecessary illnesses among those who are least able to resist them, higher health-care costs and reduced productivity.

In New York, only certain health-care providers -- including physicians, registered nurses, nurse practitioners and physician assistants -- are allowed to administer immunizations. In 35 other states, pharmacists, too, can administer flu and pneumonia immunizations.

"Our feeling is that New York State eventually will allow pharmacists to provide these immunizations, but it certainly will be one of the last in the nation," said Anderson.

A 1999 survey by the Centers for Disease Control and Prevention ranked New York State 41st out of 50 states in its flu-immunization rate for people over the age of 65 and 45th in pneumococcal immunization in the same population.

Anderson said the 35 other states that allow pharmacists to administer these shots have seen their immunization rates go up as a result.

"Allowing pharmacists to administer immunizations has a powerful, long-term impact on the quality of health care," said Karl D. Fiebelkorn, assistant dean for student affairs and professional relations in the UB School of Pharmacy and Pharmaceutical Sciences.

"That's because it brings more people into the health-care system, people who normally don't receive the quality of health care they need," he said.

Allowing pharmacists to do immunizations also would be an important step toward allowing them to participate more fully in patient care as the medication experts that they are, said Anderson.

"Including pharmacists in the traditional health-care partnership between doctors and nurses, not just in administering flu shots, but in many other areas, contributes to more positive outcomes for patients," he explained. "Pharmacists have no desire to be prescribers, but they are the only health-care providers who are trained to manage drug therapies."

He noted, for example, that for patients on multiple medications with multiple pathologies, outcomes depend on a clear knowledge of each drug and how they interact with the body and with each other.

"The pharmacist is, in fact, the provider who is most capable of doing this," he said.

The move toward including pharmacists as active collaborators with physicians and nurses has developed in large part as a result of the profession's requirement adopted during the 1990s that all pharmacists must hold a doctorate of pharmacy, the Pharm.D.

Since then, pharmacists have been assuming a much more active role in patient care, using their pharmacological expertise to act as drug-therapy and disease-state managers in cooperation with physicians and nurse practitioners.

In most states, Anderson noted, legislative changes have allowed pharmacists to bring their extensive expertise directly to patients through counseling, administration of immunizations and a broader role in patient management as part of a collaborative health-care team.

Several prominent physician organizations, including the American College of Physicians-American Society of Internal Medicine, have come out strongly in favor of expanding the scope of practice for pharmacists.

According to Fiebelkorn, a position paper published this year by that organization supports the idea of allowing pharmacists to give flu and pneumonia immunizations, noting that benefits include increased access for patients, targeting of at-risk patients and a decrease in antibiotic resistance.

"Particularly in rural and inner city areas, and particularly if there is limited transportation, the community pharmacy can play an important and necessary role here," said Anderson.

"Pharmacists have existing relationships with these at-risk patients, and already have a base of knowledge about them," he explained.

He noted, for example, that if the pharmacy contacts a 70-year-old woman to tell her that it's time to pick up her medication refill, it could, at the same time, mention that it offers flu and pneumonia immunizations in the store and that since she is at risk, she should have the shots when she comes to the pharmacy.

"Immunizations are just the tip of the iceberg in what is an ongoing effort to leverage the advanced training and expertise that pharmacists have as drug-therapy managers," said Anderson. "Not going forward is putting the health of New Yorkers at risk."