Pharmacy-Based Immunization Delivery: A Comprehensive History and Current Challenges

Pharmacists and their teams have a long history of involvement with vaccines. This paper describes the contributions of pharmacy-based immunization delivery in the United States from the 1800's to date. Early activities centered around storage and distribution of antitoxins and vaccines. From the 1950s through the early 1990s, pharmacists were facilitating administration of vaccines by other health care providers. In the early 1990s, efforts began to allow pharmacists to administer vaccines, with the first pharmacist immunization training in 1994. By 2009, all 50 states allowed pharmacists to administer vaccines. From the 1990s onward, pharmacists increasingly contributed to national vaccine policies and guidelines, and states expanded their authority to a broader range of patient ages and vaccines. The coronavirus disease 2019 (COVID-19) pandemic opened more opportunities for pharmacy-based involvement, including federal expansion of immunizing authority to children aged 3 years and older, and the authority for pharmacy technicians and student pharmacists to administer vaccines. Pharmacists and their teams administered more than 50% of the COVID-19 vaccines. Today, the majority of adult vaccines are administered in pharmacy-based settings. Even with pharmacy's substantial contributions to immunization delivery in the United States, challenges persist for providers and patients, including inconsistent state-to-state immunizing authority by age and disease and payor payment. Pharmacy-based immunization delivery has become a significant contributor to improving public health by protecting against vaccine-preventable diseases.