AAP opposes HHS decision allowing pharmacists to vaccinate children
The AAP opposed an HHS decision authorizing all state-licensed pharmacists to order and administer vaccines to children aged 3 to 18 years.
Before the HHS decision, which came in the form of an amendment to the Public Readiness and Emergency Preparedness Act, 28 states already authorized pharmacists to administer vaccinations to pediatric patients at any age.
HHS Secretary Alex Azar II said the amendment expanding access to pharmacist-provided vaccinations would mean “easier access to lifesaving vaccines for our children, as we seek to ensure immunization rates remain high during the COVID-19 pandemic.”
In its announcement, HHS cited an MMWR report from May that identified a decline in routine pediatric vaccinations brought about by a drop in office visits due to the pandemic.
Critics of the HHS decision argued that there is more to well-visits than just administering vaccines — the visits provide pediatricians an opportunity to care for patients in ways that a pharmacist cannot.
“Although catching up and getting better immunization rates is everyone’s goal, the AAP is making a valid and important point in their objection,” said Infectious Diseases in Children Chief Medical Editor Richard F. Jacobs, MD, professor emeritus at University of Arkansas for Medical Sciences, who called the HHS decision “probably well-meaning [but] not in the best interest of our children.”
“The visit for immunizations is only part of the visit to the pediatrician,” Jacobs said. “Preventive screening, routine exam updates, counseling, parents’ questions and, importantly, getting to talk to the child or adolescent are vitally important. All of this could be lost with the new HHS directive.”
The AAP said creating a new vaccination system is unnecessary and will not provide children with the same level of optimal medical care they receive from a pediatrician who knows the child’s medical history.
“We do more at our visits than just give vaccines,” AAP President Sally Goza, MD, FAAP, told Healio. “That's when our patients come in and we can talk to them about risk taking, we can talk to the teenagers about anxiety and depression, other things that may be going on in their lives, what's happening in school, all of those things. It's very important not to just look at vaccines as being just vaccines.”
HHS outlined several requirements for licensed pharmacists and pharmacy interns to be able to administer vaccines, including that they discuss the importance of well visits with patients and adult caregivers. Vaccines must be approved and licensed by the FDA and administered according to the schedule established by the CDC’s Advisory Committee on Immunization Practices.
Goza said there is already “a very effective system to deliver vaccines for children” and noted that pediatricians can speak with parents or guardians about vaccine hesitancy during well visits.
“We're trying to address vaccine hesitancy among parents, which is one of the reasons immunization rates are dropping,” she said. “People don't really want to go and get vaccines. So, they come in and we do a lot of talking about what vaccines children need and why they need them and what they protect against. We just don't feel [that] creating a system that duplicates what we already do is going to really help get people in who are not really wanting to vaccinate anyway.”
According to the AAP, few pharmacies participate in the Vaccines for Children program, the federal program that provides immunizations at no cost to children whose families cannot afford them. This will widen health inequities even further than what children have faced during the COVID-19 pandemic, the AAP said.
“People trust their pediatricians,” Goza said. “They come to us, they ask us, ‘What do you think about that vaccine? Would you give it to your child?’ To think that giving vaccines in a pharmacy is going to decrease vaccine hesitancy ... it’s just really not.”
The AAP argued that the HHS decision superseded state laws governing pharmacist-delivered vaccinations and used the COVID-19 pandemic as justification to create policy changes that go beyond care related to COVID-19.
“Instead of creating difficult and low-quality systems to deliver that health care — those vaccines — we would love for the government to invest in the frontline physicians who are already doing this important work,” Goza said. “We're taking care of these kids. We want to get them vaccinated.”
- HHS. HHS Expands Access to Childhood Vaccines during COVID-19 Pandemic. https://www.hhs.gov/about/news/2020/08/19/hhs-expands-access-childhood-vaccines-during-covid-19-pandemic.html. Accessed August 19, 2020.