HHS Gives Pharmacists Ability to Deliver Childhood Vaccines, Upsetting AAP

An attempt to increase access to childhood vaccines and decrease the risk of preventable outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic—by giving all state-licensed pharmacists and even pharmacy interns the ability to order and give pediatric vaccines—has drawn fire from the American Academy of Pediatrics (AAP).

HHS Wednesday said that it was adding a third amendment to the March public health emergency that allows the change for patients aged 3 through 18 years, in response to a May CDC report that found a significant drop in routine childhood immunizations as a result of the crisis. This decrease is another threat to public health, HHS said in a statement.

The vaccine must be approved or licensed by the FDA and must be ordered and administered according to the CDC’s Advisory Committee on Immunization Practices immunization schedules.

The administering pharmacist must also complete a training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE), which must include hands-on injection technique, clinical evaluation of vaccine indications and contraindications, and the recognition and treatment of emergency reactions to vaccines.

Pharmacy interns who are licensed or registered with the state board of pharmacy can also administer vaccines under the supervision of a pharmacist. They must also complete an ACPE-approved program covering the same topics as pharmacist programs. Both pharmacists and interns must have a current certificate in basic cardiopulmonary resuscitation.

Many states already permit pharmacists to order and administer vaccines to children and follows HHS goals of expanding access to childhood vaccines, HHS said.

“Today’s action means easier access to lifesaving vaccines for our children, as we seek to ensure immunization rates remain high during the COVID-19 pandemic,” said HHS Secretary Alex Azar.

In a statement, the AAP said the action was “incredibly misguided” and also unnecessary, and also noted that pharmacists do not know a child’s medical history. Most children and adolescents receive vaccines during routine check-ups, when other health care is provided, it said.

In addition, the AAP cautioned, the move could exacerbate health inequities, saying few pharmacies participate in the Vaccines for Children program, which provides vaccines at no cost to children who are Medicaid-eligible, uninsured, underinsured, or of American Indian or Alaska Native descent.

Under the Affordable Care Act, vaccines are available without cost-sharing/co-pay requirements when patients see their in-network provider.

“This unprecedented expansion of pharmacies’ ability to administer vaccines to children is not a solution to the vaccine hesitancy that is driving down rates of childhood immunizations in the United States,” said Sally Goza, MD, FAAP, AAP president. “Many parents have questions about their children’s vaccines, and pediatricians are ready to talk with them. It’s what we do, every day, one-on-one with thousands of parents, as part of the long-term trusting relationships that families have with their physicians.”

The AAP said that the Vaccines for Children program has increased vaccination rates across all races, ethnicities, and income groups, as well as reduced racial and ethnic disparities.