Auburn, AL—During the early days of the COVID-19 pandemic, a drop in immunization rates was recorded for conditions unrelated to the novel coronavirus. Public health officials were especially concerned about rural areas, which often lack convenient locations for vaccines.

A new study in Vaccine looked at community pharmacies in the United States and whether those continued to serve as immunization sites during the pandemic for vaccines others than those recommended to protect against SARS-CoV-2.

The study compared the types and perceived changes in non-COVID-19 vaccine doses administered at rural community pharmacies in 2020 (during the pandemic) with 2019 (prepandemic). It also looked at the overall delivery of non-COVID-19 immunization services in 2020 compared with 2019.

To do that, researchers from the Harrison College of Pharmacy at Auburn University in Alabama and colleagues conducted a mixed-mode (paper/electronic) survey of a convenience sample of 385 community pharmacies operating in rural settings, distributed from May to August 2021. Respondents were required to have administered one or more vaccines in 2019 and 2020.

Researchers pointed out that their survey development was informed by relevant literature, pretested with three individuals, and pilot-tested with 20 pharmacists.

Of the 385 community pharmacies, 86 qualified pharmacies completed the survey for a 23.8% response rate.

The results indicated that the percentage of pharmacies offering a specific vaccine in 2019 and 2020 were similar. The exception was that a higher percentage of pharmacies reported having MMR administered to adults in the pharmacy in 2020 (McNemar’s test; P = .0253).

“For each given vaccine, the majority of respondents did not perceive a change in the number of doses administered in 2020 compared to 2019,” according to the report. “Further, the majority reported no difference in how they delivered immunization services during and prepandemic. However, a small percentage of respondents (6.0–22.0%) adapted their services by adopting several measures to ensure the safety and continuity of immunizations during the pandemic.”

The authors suggested that their findings underscore the importance of community pharmacies as immunization sites during the pandemic, noting, “Community pharmacies continued immunization delivery at community pharmacies during the pandemic with almost no noticeable change to types and doses of vaccines compared to pre-pandemic nor the process of vaccine delivery.”

Background information in the study lists several reasons why the pandemic was thought to have disrupted immunization efforts, including:

• Social distancing and stay-at-home orders
• Avoidance of healthcare facilities due to fear of contagion
• Disruptions in transportation and vaccine supply chains, prioritizing care for COVID-19 patients
• Fear of inadvertently spreading COVID-19 during immunization campaigns.

“The impact on immunization rates has been significant; a study conducted by the Centers for Disease Control and Prevention (CDC) showed a significant decrease in Advisory Committee on Immunization Practices (ACIP)-recommended routine childhood vaccination rates one week after the COVID-19 national emergency declaration in March 2020,” the authors wrote. “Likewise, immunization rates among other age groups were negatively impacted. Interrupting immunization efforts might raise the likelihood that previously well-controlled diseases will reemerge, adding to the stress already placed on the healthcare system.”

The researchers pointed out that community pharmacists play an essential role in U.S. public health by providing immunization services. “As healthcare providers with immunization experiences in previous pandemics (e.g., H1N1 pandemic), community pharmacists were well-positioned to offer seasonal and routine immunization services during the COVID-19 pandemic,” the authors noted. “Community pharmacies are accessible to most Americans, especially those residing in rural areas where pharmacists may be the only healthcare provider offering healthcare services. Pharmacies are widely accepted as immunization settings, ranking second (after physician offices) for seasonal influenza immunization. As an essential business on the frontline during the COVID-19 pandemic, pharmacies remained open to the public when other healthcare settings were closed or open on a limited basis.”

The report added that licensed pharmacists, qualified pharmacy technicians, and interns received special federal authorization to administer vaccines, including those for COVID-19, to children (aged 3-18 years).

“Traditional immunization settings (e.g., physician clinics) may not have prioritized immunization services during the pandemic as they focused on acute issues of care,” the report suggested. “This was compounded by recommendations to minimize unnecessary contact, including preventative care services. Access to traditional immunization settings may have been even more problematic in rural areas during the pandemic. People in rural areas tend to be older, poorer, uninsured, and are likely to engage in unhealthy behaviors and have underlying diseases compared to people in urban areas. Further, rural areas suffer from general shortages of healthcare providers and a lack of adequate transportation. Indeed, COVID-19 incidence and mortality rates were shown to be higher among rural individuals.”

Even before the pandemic, when rural areas had lower COVID-19 vaccination rates, uptake of other types of vaccines had traditionally been lower, the authors wrote.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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