William Schaffner, MD, is professor of preventive medicine and medicine (infectious diseases) at Vanderbilt University School of Medicine in Nashville, Tenn. Additionally, he serves as a hospital epidemiologist at Vanderbilt University Hospital and is immediate past-president of the National Foundation for Infectious Diseases.

Leading by sharing the load

I’ve long been a strong supporter of vaccinations in pharmacies, the workplace, senior centers and any other reasonable place that makes it easier for adults to follow the US immunization schedule.

So, you can imagine how troubled I was to read that some doctors are opposing changes that would allow pharmacists to administer more vaccines to adults.

To any physician colleague who falls into this group, I challenge you to look critically at your practice and ask yourself: “Am I getting the vaccination job done?” You’re probably saying "yes,” but vaccination rates say "no":

·Pneumococcal disease: 61% in people 65 and older and 18% in younger adults with risk factors.

·Influenza: 40% in those aged between 50 and 64 years and 66% in people aged 65 and older (this is the best adult immunization rate we have, it’s still 24% below our public health goal). Indeed, all adults should receive influenza vaccine annually.

·Shingles: 10% in people 60 years and older.

Vaccination is clearly a challenge for busy primary care physicians who are dealing with acute care needs and a growing list of preventive care options that they need to discuss with patients. This is all the more reason to support an “all hands on deck” approach. We’re not getting the job done and we need to show our leadership by allowing others to help.

Consider how often primary care doctors see patients. Once a year? Twice a year? How often might pharmacies have contact with the same people? Once a month? Once a week? More contact equals more opportunities to engage.

According to the original story that got me thinking, doctors oppose an increased role for pharmacists because this is a “turf war over a profitable aspect of medical care.” I have a hard time believing that most physicians feel this way. It’s more likely that other concerns are driving opposition. For example, concern about maintaining a medical home. But not every adult has a medical home and they shouldn’t miss some very easy prevention opportunities because of it.

Another concern is that patients will be confused about which vaccines they need, but the recommendations are clearly spelled out in the CDC schedule. Pharmacists can surely decipher and follow this schedule as well as I can.

Others are concerned that patients will be talked into vaccines they don’t need by marketing campaigns. But pharmaceutical marketing is regulated by FDA labeling and strongly directed by CDC recommendations, so the public is getting very consistent messages.

There is not one good reason to oppose pharmacist efforts to vaccinate adults and thousands of reasons, our patients, that each of us should support these efforts.

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