The US health system is bracing itself for the peak season of influenza and other upper respiratory infections. For the 2024-2025 season, the CDC estimates that at least 1 million individuals were hospitalized due to a respiratory illness, with as many as 70,000 deaths.¹ For both health care providers and patients, wait times at physicians’ offices, hospitals, and pharmacies are becoming increasingly longer. Community pharmacists have a role to play in all these challenges.

Although there are many ways that patients can reduce their risk of getting sick (eg, washing hands properly, avoiding sick individuals, wearing masks, and social distancing), the most effective way is getting and staying up to date on routinely recommended immunizations. Community pharmacists are key to expanding access to immunizations across the country. Each year, they administer tens of millions of immunizations—including those for influenza, pneumococcal disease, COVID-19, and travel-related illnesses.²

Patients also interact more often with their pharmacist, visiting their community pharmacy 12 times more per year than their primary care provider.³ This illustrates the critical role the community pharmacist has in improving immunization rates. The accessibility of pharmacies due to their convenient locations, extended hours, and trusted relationships within communities positions them to be reliable and convenient immunization sites.⁴ In today’s vaccine landscape, barriers to immunization rates include limited provider access, confusion over updated guidelines, and concerns with service reimbursement.^3-5

The closure of community pharmacies is a major barrier for patients not only to get their prescription care but also their preventive care, including immunizations. Most concerning is that decreased access to health care disproportionately affects racially and ethnically minoritized populations as well as those who fall into economically, socially, and geographically disadvantaged groups. Structural barriers include a low number of health care providers, including pharmacists, in a certain area; lack of access to transportation; and lack of or gaps in health care coverage. These barriers contribute to inequities that exist in access to care.⁵

In a 2017 study, researchers found that more than 90% of Americans live within 2 miles of a community pharmacy.⁶ In another more recent study, researchers reported that 48% of the population live within 1 mile of a pharmacy, 73% within 2 miles, 89% within 5 miles, and 97% within 10 miles.⁴ These are statistics that the public health community has relied on for decades, yet we know these numbers are changing rapidly with reduced access to local pharmacies.

The National Association of Chain Drug Stores (NACDS) recently highlighted the need for pharmacy benefit manager (PBM) reform due to the number of pharmacies closing daily in the US. According to an NACDS news release from July 10, 2025, more than 5800 pharmacies have closed their doors since 2018, with more closing every day.⁷ The NACDS estimates that close to 4 pharmacies per day are closing their doors, with more than 800 zip codes losing access to a local pharmacy.⁷ With news of the third-largest retail chain, Rite Aid, closing,⁸ this impact is expected to continue if PBM reform is not prioritized. The closing of many pharmacies nationwide only further exacerbates existing inequities by contributing to fewer providers, further travel to receive care, and lack of affordability, particularly for those who are uninsured.⁵

Patients today encounter both physical and psychological barriers to preventive care. Misinformation and inconsistent guidelines across federal, state, and medical organizations influence immunization hesitancy. Patient misinformation is not new but is an increasingly concerning barrier to adequate immunization rates.⁹ Traditionally in the US, immunization guidelines are provided by the Advisory Committee for Immunization Practices (ACIP) and then adopted by the CDC director.⁹ With recent changes to both the CDC director and the ACIP committee, the recommendations for COVID-19 and some childhood immunizations have been adjusted. The change from previous years’ guidelines and childhood immunization schedules has sparked debate between government agencies and science experts, leading to public confusion. Many in the medical community are looking beyond the CDC and ACIP toward guidelines from the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Pharmacists Association, and others for guidance on providing immunizations and making evidence-based decisions.

Health care providers, including pharmacists, now face the challenge of staying informed about the evolving ACIP recommendations while managing conflicting recommendations from various sources. They are tasked with this while still trying to make strong recommendations to their patients. A study by Gilkey et al found that high-quality recommendations were positively associated with vaccine uptake.¹⁰ This reinforces the need for clinicians to listen to their patients’ concerns, help reduce confusion, provide strong clinical recommendations with clear communication, and keep state and federal regulations in mind.

It is no secret that reimbursement will continue to be a challenge for community pharmacies without PBM reform. With the support of legislation such as the Affordable Care Act (ACA) and the Coronavirus Aid, Relief, and Economic Security Act, reimbursement models for community pharmacies increased without transferring that cost to the patient.^11,12 That in turn increased access to preventive care for patients. The CDC stated in an October 7, 2025, news release that individual-based decision-making allows for reimbursement and coverage under Medicare, Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children Program as well as insurance plans regulated by the ACA.¹³ These payments from payers, however, are based on the vaccine schedules for children and adults approved by the ACIP. If recommendations continue to change, some payers might refuse to pay for vaccines if the indication isn’t age or condition based. Therefore, it is important for pharmacists to continue to monitor changes that may impact their practice and their reimbursement.

It is clear that pharmacists play an important role in maintaining and improving vaccination rates. The COVID-19 pandemic further reinforced the need for and importance of community pharmacists’ role in promoting public health. Pharmacists are in areas where many other providers are not; they provide access to health care when patients need it most and are key to debunking misinformation and increasing immunization rates. Patients are increasingly turning to pharmacists for accurate vaccine information, recommendations on what vaccines they should receive, and guidance on changing recommendations. Now more than ever, it is crucial for every community pharmacist to be a vaccine advocate for their community.

About the Author

Annette E. Owili, PharmD, RPh, is an assistant professor in the Department of Pharmacy Practice at Hampton University School of Pharmacy in Hampton, Virginia.

REFERENCES

1.Respiratory illness season toolkit. CDC. August 27, 2025. Accessed November 14, 2025. https://www.cdc.gov/respiratory-viruses/php/toolkit/index.html

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7. NACDS hails introduction of the Pharmacy Benefit Manager Reform Act of 2025. News release. National Association of Chain Drug Stores. July 10, 2025. Accessed November 14, 2025. https://www.nacds.org/nacds-hails-introduction-of-the-pharmacy-benefit-manager-reform-act-of-2025/

8. Bacon, A. Rite Aid closes all remaining stores after 63 years in business. ABC7. October 6, 2025. Accessed November 18, 2025. https://abc7.com/post/rite-aid-closes-remaining-stores-more-60-years-business/17937848/

9. Hill A, Arvin R, Beitelshees M, et al. Stakeholder perspective and sentiment in a rapidly growing United States adult vaccination environment. iScience. 2025;28(3):112009. doi:10.1016/j.isci.2025.112009

10. Gilkey MB, Calo WA, Moss JL, Shah PD, Marciniak MW, Brewer NT. Provider communication and HPV vaccination: the impact of recommendation quality. Vaccine. 2016;34(9):1187-1192. doi:10.1016/j.vaccine.2016.01.023

11. Affordable Care Act. American College of Obstetricians and Gynecologists. Accessed November 14, 2025. https://www.acog.org/education-and-events/publications/managing-costs/affordable-care-act

12. CARES Act, HR 748, 116th Cong (2020). Accessed November 18, 2025. https://www.congress.gov/bill/116th-congress/house-bill/748

13. The CDC immunization schedule adopts individual-based decision-making for COVID-19 and standalone vaccination for chickenpox in toddlers. News release. CDC. October 6, 2025. Accessed November 14, 2025. https://www.cdc.gov/media/releases/2025/cdc-immunization-schedule-adopts-individual-based-decision.html