Community pharmacists have been delivering flu vaccines in some parts of Europe for well over a decade. Not only do they provide convenient access to vaccination services for people at higher risk of severe complications – including older people and those with conditions such as diabetes and heart disease – they are trusted members of the community.
That’s why the number of countries that involve pharmacists in immunisation programmes has been growing. However, while the direction of travel was heading towards more pharmacy-based vaccination, the speed at which this trend was slow – until the COVID-19 pandemic.
The urgent need to vaccinate millions of people against COVID and flu prompted dozens of countries to turn to their pharmacy networks for help. The green lights of community pharmacists stayed on, even as some retail units closed.
Countries with existing pharmacy-based vaccination programmes ramped up quickly; others embarked on a rapid rollout of training schemes and expanded immunisation infrastructure such as fridges for storing vaccines.
Pharmacists in Belgium can offer COVID-19 vaccines
But where do pharmacists stand now? Are they a permanent piece of immunisation architecture? And is there more they could do if they were better connected to immunisation information systems?
A new interview with Dr Catherine Duggan, CEO of the International Pharmaceutical Federation (FIP), looks at pharmacy-based immunisation. It is, she says, ‘a story of incremental success as well as some sizable changes.’
The case for pharmacy-based vaccination is strong. The experience of countries that have embraced this approach shows it can improve access to vaccination for at-risk groups who would otherwise not be vaccinated. At the heart of this is convenience.
Dr Duggan says pharmacists are uniquely positioned to expand vaccine coverage. ‘We are highly trained healthcare professionals with close, frequent and trusted relationships with communities,’ she says. ‘Pharmacists recognise the specific risks and barriers faced by older people, children, people living with chronic non-communicable diseases, people with disabilities, people in lower socio-economic status – and we can provide targeted services to them, allowing us to reach people who might not necessarily go to the GP.’
France gives pharmacists new vaccination powers
During the pandemic, pharmacists across Europe played a key role in the technical side of vaccination, helping to ensure vaccines were correctly stored, handled and distributed. Now, they want to become a fixture of the system rather than an emergency support service in times of crisis.
‘Pharmacists are an integral part of the health system and need access to health records to reduce errors and duplicated vaccination,’ Dr Duggan says. ‘We want to expand on the approach taken in several countries during COVID when pharmacists were connected with the system.’
Pharmacy vaccination in numbers
In 2016, pharmacists provided vaccination in 19 countries and territories.
By 2020, that had increased to 33.
By 2022, 40 countries involved pharmacists in vaccination.
The number has now hit 57 and continues to grow.
At least 25 countries in the European region now involve pharmacists in vaccination. Nineteen of those 25 countries authorise pharmacists to prescribe some vaccines, but there are differences across the continent. Thirteen countries allow pharmacists to prescribe influenza vaccines, but only ten allow them to prescribe COVID vaccines; five allow them to prescribe pneumococcal vaccines; and just one permits pharmacists to prescribe the vaccine for RSV.
‘We don’t see the rationale for this difference,’ Dr Duggan says. ‘We need to think about this especially as the risk groups are the same.’
While each country has its own immunisation system, the experience of early adopters provide inspiring lessons on how it can be done. Portugal began involving pharmacists in flu vaccination in 2007 and, since the winter of 2023-2024, allowed pharmacists to offer flu and COVID vaccines.
A study by the Portuguese National Association of Pharmacists (ANF) shows that this has generated €2.4 million euro in savings and saved 310,000 hours of work for NHS staff. ‘Pharmacy-based vaccination can be cost-saving for the population and resource-saving for health systems,’ Dr Duggan says. ‘We don’t often see programmes that are cost-effective, that reduce the burden on health systems, and that patients love.’
Portuguese pharmacists on the front line against flu
Research shows that in Ireland, where pharmacists have administered flu vaccines since 2011, many of those vaccinated in pharmacies have never been vaccinated against flu before. Pharmacie are reaching new patients, many of whom are at high risk of complications if infected with flu.
The Irish Pharmacy Union says that since the COVID-19 vaccine was introduced, approximately 380,000 primary doses of vaccine, and 1.35 million booster doses, have been administered by pharmacies across Ireland.
Case study: Irish pharmacists embrace flu vaccination
Since last September, one third of all Covid vaccines in Ireland were administered by pharmacists. At the same time, the 2023-2024 autumn-winter campaign saw 325,000 public flu vaccines administered, with 27% of the program delivered by pharmacists.
‘Since the introduction of pharmacy-based vaccination in Ireland, vaccination has increased across all providers,’ Dr Duggan says. ‘This shows that pharmacists contribute to overall awareness and administration of vaccines.’
