Interview With Marty J. Feltner, PharmD: Overcoming Barriers to RSV Vaccination in Adults

There's a wide misconception that RSV vaccinations are only for the pediatric population. With the approval of RSV vaccines last year in the adult population, we're starting to see an increase in awareness in adults that we need to have this vaccine for 60 and above for the adult population.

ACIP is considered to be the bible that pharmacists will follow regarding vaccinations for the adult population in their pharmacy setting. Having ACIP make a clear and concise recommendation and not muddy the waters is very important from a pharmacist's perspective.

Shared decision-making makes it very challenging in the retail pharmacy space especially to overcome that barrier where the pharmacist has to work with the provider to maybe get a prescription because maybe that pharmacy doesn't have a collaborative agreement in place where they can automatically vaccinate. Unfortunately, when that does occur, there are times where we miss an opportunity to vaccinate an eligible patient.

Pharmacists can help identify at-risk patients by getting their team involved in their pharmacy setting, especially in a retail pharmacy setting. For example, getting your technicians or your pharmacy clerks involved in identifying patients that come into your pharmacy daily to pick up that prescription for a diabetic medication or for someone who's on heart failure medication or immunocompromised is very important for them to help the identification process and identifying those patients who are eligible for an RSV vaccine.

So it's very important to get your entire team not only educated on the RSV vaccine in regards to safety and efficacy data but to help in that selection process. Once they help identify that resident or patient at the pharmacy, then the pharmacist can go talk to that patient and actually go over the safety, the efficacy data, and the why do you need to have this vaccine. And so that's kind of how you can help identify those at-risk patients. A lot of times retail pharmacies will create data exports where they can find out residents who are on certain medications and actually call them, in the evening time, and that's been very beneficial in my retail pharmacy experience. Having posters in your pharmacy to help promote and to raise awareness is very important, bag stuffers and so on. Getting the word out that you're a vaccine provider in your community is also key with your local providers in the area. Since this is a Medicare Part D–covered vaccine, primarily pharmacies are the ones that are adjudicating this type of vaccine submission, so it's really important to work with your local community and to help promote your vaccine that you're providing at your pharmacy.

I remember back in my early days of a pharmacist in the retail side, we had a risk-based recommendation for influenza back in the day, over 20 years ago. And so I remember having to go down the list to see, does this patient have this disease state and if they do, yes, I can vaccinate. Ever since we basically said anybody 6 months and older should have a flu shot, our immunization rates have gone up. It's not to the point where we want it to be, but I'm just using it as a comparison of the shared decision-making process and how big of an obstacle it is for not only the pharmacist, but possibly also for the medical providers as well.

Another obstacle to vaccinate against RSV disease is if the resident or patient does not have a Medicare Part D plan, that's a zero dollar coverage and they have a private insurance and there is an associated cost associated with that.

You have to have a clear, concise recommendation when talking to patients. If you muddy the waters, when you're talking to your patients, they're probably 9 times out of 10 going to decline that RSV vaccine, unfortunately. That's just what I've seen in my years of practice in 25 years as being a retail pharmacist and now long-term care pharmacist.

Early RSV vaccination should be encouraged with our patients, especially during our start-up influenza season in August [and] September. We're immunizing against influenza earlier than what we ever have in the past. It's important to do, to recognize that RSV vaccination for our patients as well as the influenza vaccine.

Will RSV vaccines become an annual immunization is yet to be determined by ACIP. We're still evaluating post-marketing data from all 3 manufacturers. And at this time, [the] ACIP recommendation is a 1-time-only dose of RSV vaccine. And the long-term care pharmacy marketplace, we are evaluating this. We are watching what ACIP recommendations are. It's changing daily, it seems like, so we hope to find out some more recommendations from ACIP moving forward if the schedule is going to change from a 1-time-only dose to an every 2 or 3-year recommendation schedule. More to come regarding that.

The health and economic impact of RSV disease will continue to grow as our population ages. As healthcare provider[s], we need to make sure that we educate our teams and our patients and our community on the benefits of RSV vaccinations. Vaccine-preventable diseases are only preventable if we vaccinate.

For other articles and videos in this AJMC® Perspectives publication, please visit "Vaccinating Older and At-Risk Adults Against Respiratory Syncytial Virus"