As Covid emergency expires, states want to let pharmacists give vaccines

The looming expiration of federal emergency measures that made it easier for pharmacies to deliver routine vaccinations during the Covid pandemic has prompted states across the country to consider permanently expanding access to drug store jabs. 

Proponents, including state lawmakers and public health experts, say that data collected during the Covid pandemic show that more people will get shots – especially among low income and rural populations – if they don’t have to travel to a doctor’s office. 

“It’s important that Nebraskans that live in rural areas of our state have equal access to immunizations,” said Nebraska state Sen. Lynne Walz, who sponsored a bill that would extend vaccine administering authority to pharmacy technicians.  “Oftentimes pharmacies are the only healthcare facility in a community, making this even more important.”

More than a dozen states have passed laws in the past two years to expand state pharmacist vaccine-administration authority before a pandemic-era exception expires at the end of the Covid Public Health Emergency, which is expected on May 11. 

Still more are considering bills this year. In Republican-controlled Texas, a bill sponsored by state Rep. Philip Cortez (D) in 2021 passed the House but died in the Senate. This session, state Rep. Four Price (R) has introduced a similar measure. 

Maryland’s Democratic-controlled legislature passed a temporary measure in 2021 that authorized pharmacies to administer vaccination to children starting at age 3 without a prescription. Supporting documentation filed with the state legislature pointed out that children who don’t have primary care physicians often miss routine vaccinations required by their schools, and that most travel immunizations are not carried by physicians. 

The sponsor, state Rep. Malcolm Augustine (D), has introduced a bill this session that would make the change permanent. 

“This has always been, for me at least, a matter of health equity and access,” Augustine said. “We know that pharmacies are the closest to our families. They are the ones that people have the most access to.” 

While every state allows pharmacists to administer vaccines, dozens impose restrictions – including prescription requirements, age limitations and limits on what type of shots pharmacists can administer. Still more states, like Nebraska, allow pharmacists but not technicians or interns to give shots, making it difficult for pharmacists to meet the demand while they attend to other duties. 

In recent years, those restrictions have been superseded by the federal Public Readiness and Emergency Preparedness Act (PREP Act), a temporary pandemic relief measure that allowed pharmacists in all 50 states to order, prescribe and administer all routine childhood immunizations and Covid-19 vaccines to ages 3 and older and influenza vaccines to ages 19 and older. 

The measure also allows pharmacy interns and technicians to administer shots.

The resulting change in Americans’ vaccination habits was dramatic.

A study released last month by IQVIA Institute for Human Data Science found sharp increases in the number of vaccines delivered at pharmacies compared to other medical settings. 

Nearly 90% of vaccines commonly administered to adults were offered at pharmacies, as opposed to non-pharmacy medical settings, in both 2021 and 2022. That compared to 50% to 60% in 2018 and 2019. 

The study also pointed out that previous reports have found higher vaccination rates in states that offer pharmacists full vaccination authority. 

“It’s a no-brainer for us that we need to have policies that continue this expansion of pharmacies to be able to immunize patients,” said Robert Popovian, chief science policy officer at the Global Healthy Living Foundation. He pointed out that vaccinations are widely considered one of the most effective and affordable public health interventions available. “States that have not expanded the ability of pharmacists to immunize, they’re really short-changing their patients, particularly patients in low-income communities. ”

Overall vaccination rates declined during the Covid pandemic. 

Popovian and other public health experts say it is a lot easier for most people to go to the pharmacy than a doctor’s office. Recent studies show about 90% of the U.S. population lives within five miles of a pharmacy.

“It’s hard to argue with the numbers,” said Michael Murphy, an advisor to the American Pharmacists Association. 

Murphy pointed to a June study that found that pharmacists and their teammates provided more than 270 million vaccinations between February of 2020 and September of 2022. 

“It’s really become part of the societal norm to receive your vaccinations in community pharmacies. So because it’s become more of the norm, there’s definitely concern that once these authorities go away, what are our patients going to do? Are they going to immediately transition back to receiving vaccinations at other health care professional locations, or could there be a decrease in vaccination rates?” He said.

Lawmakers, aides and advocacy groups in some states that have not expanded pharmacy vaccination authority said they had encountered opposition from physician groups, who worry that patients will be less likely to schedule routine check-ups if they don’t have to come in for shots. 

But the only opposition at a hearing on the Nebraska bill last month came from two people who cited fears of “vaccine injury,” which is exceedingly rare. Supporters included the president of the state medical association and the state nurse’s association. 

“As a family physician, I value the opportunity for my patients to get their vaccines wherever they can,” said Nebraska Medical Association President Daniel Rosenquist.