Expert: Pharmacists Play Critical Role in Vaccination, Public Health Amid Ongoing Viral Risks

In an interview with Pharmacy Times®, Donald Middleton, MD, vice president of family medicine at the University of Pittsburgh, reflects on the 5-year anniversary of the COVID-19 pandemic, explaining how vital a role pharmacists have played and continue to play as the spread of COVID, influenza, RSV, and norovirus constitutes serious health threats.

As the "quad-demic" of those 4 viruses rages, Middleton explains how pharmacists can help by actively recommending vaccines for illnesses where they are available, maintaining communication with primary care providers, and ensuring patients track their immunization records. Additionally, clear and confident vaccine recommendations from pharmacists—rather than simply offering them as an option—can improve uptake, particularly for high-risk populations, according to Middleton.

Pharmacy Times: What can pharmacists do to help protect patients and prevent severe illness?

Key Takeaways

1. Pharmacists were instrumental in COVID-19 vaccination efforts and continue to be frontline advocates for immunization.

2. RSV vaccines are critical for those 75 and older, flu shots are essential for everyone 6 months and older, and COVID vaccines should be received regularly, especially for high-risk individuals.

3. Adults should keep track of their immunizations, just as pediatric patients do, to ensure proper protection and medical coordination.

Donald Middleton, MD: This is a very interesting question. The issue is that COVID in the US was, by and large, controlled by pharmacists, and you all need to give yourself a pat on the back. It's just crystal clear that without pharmacists taking an active role in vaccinating the population, we would be in dire straits still. So again, give yourselves a pat on the back. I got my COVID vaccines at the pharmacy. I know that you guys are experts at giving people shots just the way nurses are in physicians’ offices. In the United States, the RSV vaccine is recommended for people aged 75 and older, and it's not approved by Congress to be given by physicians in the office. So, it's up to the pharmacist to remind their older patients that, look, you haven't had an RSV vaccine, and you really need to get one. I haven't been to my local pharmacy lately, but sadly, the CDC is under some new constraints because of our political situation. It may be that the bigger pharmacy chains or individual pharmacists may want to put up some sort of reminder sign for people to get COVID vaccines still. The issue with not being vaccinated is, sadly, a markedly increased risk of hospitalization, increased risk of death, and increased risk of long COVID if you've not been vaccinated. Look to get [a] COVID vaccine, and for those who are 75 years of age and older, getting an RSV vaccine. If you can say “goo goo,” you need a flu vaccine. So, everybody ages 6 months and older needs to get a flu vaccine. One caveat to that is that pregnant women should probably get a flu vaccine towards the end of pregnancy, if they can, so that the antibodies cross the placenta and will protect the newborn from getting influenza during the first 6 months of life. It's true for the RSV vaccine, which is given between 32 and 36 weeks of age to pregnant women, and likely for [the] COVID vaccine, we'll see the same benefit. So, the mom generates antibodies across the placenta and protects infants between the ages of zero and 6 months.

Pharmacists were key to controlling COVID. We're talking 4000 deaths a week, and, sadly, because people are not getting vaccinated now, we still have 1000 deaths per week. But if the pharmacy community can put it on their shoulders to remind people to get [a] COVID vaccine, that would be extremely helpful to control this epidemic.

Pharmacy Times: Can you reflect for a moment on the approaching 5-year anniversary of the COVID-19 pandemic? How have pharmacists played—and continue to play—a central role in treating and aiding patients?

Middleton: The issue, again, that I will bring up, is that COVID vaccines were approved for everybody to give, but the pharmacy, particularly the bigger pharmacy chains, were able to get to the vaccine manufacturers and get vaccines into the pharmacy early, and that really put the foot down on COVID and stopped it from being as severe. What we're facing now is that people think, “Oh, it's gone.” I mean, the statistics from 2024 are that 46,000 people died from COVID. It's about 1½% to 2% of the deaths in the US [that are] still from COVID, and it's not gone. People need to recognize that it is a really weird virus, as well. It changes all the time. It's made up of amino acids, and it's not a very good replicator, so it makes mistakes when it replicates. And that changes the configuration of the virus. So, a virus that looks like this, with 1 amino acid change, may look like this, and the antibodies you have for this don't work as well for this. That's the trouble with COVID, and over the past 3 months, it's changed; 80% of the COVID strains are new now, and we're hoping that the current vaccines—which are recommended to be given to people aged 65 or older, twice every 6 months—are still effective against the new strains of COVID. People are trying to keep data to inform us of whether it is or whether we will need to make another change shortly. So again, coming back to what pharmacists did, it was fabulous, but what they need to do now is keep their foot on the pedal and remind people that these 3 vaccines are critical to remaining in good health: RSV, COVID, and influenza.

Pharmacy Times: How can pharmacists work with other members of the patient’s care team to ensure an accurate diagnosis and proper treatment?

Middleton: It's a little tough with the big chain pharmacies to keep a good connection going, Luke. Here where I am locally, I even know some of the pharmacists, and we talk to each other to make sure medicine doses are proper and make sure people are given advice to keep up on their vaccines; most big pharmacies have some technique to either fax or text information back to the primary care doctor's office. When you go to the pharmacy to get a vaccine, a form is filled out that always asks for the primary care doctor's name, so hopefully the pharmacist will be able to fax back to the physician's office exactly what they gave. In pediatrics, every child gets a record of the vaccines that they got, but adults typically don't do that, and I don't know why. There are so many adult vaccines now; adults need to keep track of the vaccines that they've gotten. So, when pharmacists give a vaccine, make sure that they remind the individual to put the date and type of vaccine either into their cell phone or on a record of vaccines that were given. I have a little wallet card that I keep my vaccines on so that when the person does see some other professional, and the professional says, “Have you had a flu vaccine?” Instead of saying, “I think so,” you can actually pull up information and say, “This is what I got, and this is the day I got it, and this is where I got it.” I think that would be very helpful if the pharmacy community would add that final step to giving vaccines in the store.

Middleton: Yeah, just one last thing. There is treatment for influenza—it doesn't work very well—but there's no treatment for RSV, medical treatment, and there's really very poor treatment for COVID. About 10 to 20% of people [who] get COVID get some sort of long-lasting problem related to it—thinking or something like that. So, when you give vaccines—I feel like I'm in church and I'm the preacher and I'm trying to get the congregation to make the right decision—when you offer someone a vaccine, you say to them, “I think you need to get this vaccine because of your age or the underlying condition you have.” There are 2 papers now that show that the influenza vaccine is as important to preventing heart attacks as is a statin. Is that not something? It's amazing. When you offer it, don't say, “Do you want a flu vaccine?” Say, “You need a flu vaccine. And we have it here for you today, and we can give it to you now.”