Expanding adult immunization in low- and middle-income countries through pharmacist-provided vaccination

Adult immunization is increasingly recognized as an essential component of life-course vaccination strategies that improve population health, promote healthy aging, and strengthen pandemic preparedness. Despite recommendations from the World Health Organization (WHO) to expand seasonal influenza vaccination and other adult immunization programs, vaccine coverage among adults in low- and middle-income countries (LMICs) remains substantially below global targets. This shortfall is largely due to insufficient healthcare infrastructure, shortages of trained immunization providers, inadequate financing, and barriers to accessing healthcare services. Community pharmacists represent an underutilized health workforce that could substantially expand adult vaccination capacity in many LMICs. Evidence from high-income countries consistently demonstrates that pharmacist-provided vaccination improves vaccine uptake, expands access, and reduces pressure on overstretched healthcare systems. Emerging evidence from LMICs similarly suggests that pharmacist-provided vaccination is feasible, acceptable, and supported by pharmacists when appropriate regulatory frameworks, training, and operational systems are established. Pharmacists played a critical role during the COVID-19 pandemic by expanding access to vaccination, testing, treatment, and public health education, demonstrating their value as health system force multipliers during public health emergencies. This review synthesizes current evidence supporting pharmacist-provided vaccination for adults in LMICs, summarizes emerging implementation experience, and discusses policy, regulatory, workforce, and operational considerations for integrating pharmacists into national immunization programs. Expanding pharmacists' role in vaccine delivery represents a practical, scalable strategy for improving adult vaccination coverage, advancing life-course immunization, and strengthening preparedness for future epidemics and pandemics.