Hotshots: Contemporary Vaccine Topics for Pharmacy Practice

[00:03:17]

Up to Date: Integrating the Latest Recommendations for Adult Vaccines

Dr Dang: Thank you. All right. Hi everyone. So this first section, Up to Date: Integrating the Latest Recommendation for Adult Vaccines.

[00:03:24]

Federal Agencies Governing Human Vaccines

So before we jump into the recommendations, we just want to get talking a little bit about the background, about who's involved in making these recommendations. And I know many of you are very familiar with the different agencies that may be involved in issuing vaccine recommendations, but over the last 6 to 12 months, there's been a lot that's really happened in the background that we need to be aware of and to discuss for consideration. So the 2 primary federal agencies that govern the use of vaccines is the FDA, the Food and Drug Administration, and the CDC, the Center for Disease Control.

The FDA has a committee called VRBPAC that is composed of various experts that review the clinical trial data, that then makes recommendations to the agency on whether a specific product should be approved or authorized. And that's the same process for medications as well as vaccines. As a part of the approval, the FDA determines the official packaging information that goes along with each product, which typically includes the indications, the dosing, administration, and the storage. They primarily look at clinical trial data focused on safety and efficacy, Phase 1, Phase 2, Phase 3 clinical trials.

CDC is the second agency. There's a committee underneath the CDC called ACIP, the Advisory Committee on Immunization Practices. That's another group of scientific and healthcare experts that then issue recommendations for how do you use vaccines now that they are available on the market.

So there's a – there's a key difference and key distinction in kind of the FDA and CDC's function. CDC issues an annual immunization schedule that publishes its recommendations for use of vaccines for children, adolescents, and adults on annual basis. They may also issue vaccine‑specific recommendations throughout the year as well.

CDC looks at not only clinical trial data, but it also considers a wide variety of issues, including disease epidemiology, burden of disease, post‑marketing effectiveness data, post‑marketing surveillance data, quality of evidence, public health implications, economic analysis, cost effectiveness, as well as implementation and practicality of using their recommendations. So it's a pretty holistic consideration from ACIP.

And ultimately, the CDC will evaluate and determine, is this vaccine worth utilizing in a population health, public health perspective for the benefit of the health of the United States? And so they consider many factors. FDA just looks at clinical trial data to see if a product should be available on the market based on safety and efficacy but CDC looks at everything to see is the benefits of this vaccine greater than the risk for individuals and for the general population? So sometimes the CDC does issue recommendations that are, quote unquote, “off‑label” because it's not an indication that is – that is approved by the FDA, but because of the public health benefits and the data presented before them, they may issue a different recommendation that could be broader or could be narrower than what you see on the label indication. Most of the time, there is alignment, but sometimes, again, there is a difference where you might see that off‑label recommendation coming from the ACIP.

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ACIP Composition and Operations

All right. So just to talk a little bit more about the ACIP, since they are the main driving force behind vaccine recommendations. ACIP is composed of 19 voting members. They are – they are typically qualified individuals who are knowledgeable about vaccines and immunizations, and those are external members who are not part of the federal agency or federal government. So they're, you know, medical physicians, public health experts, pharmacists, nurses, etc., who may be a part of the voting committee.

In addition to the voting members, there are several other non‑voting members who participate in the meeting, but again, they don't have a vote. So we have 6 ex‑officio members from other federal agencies, including the FDA, NIH, CMS, HRSA, HIS, and OIDP, as well as 31 liaison members, who are representing other professional organizations who have an interest in immunizations. And so these organizations might include AAP, the American Academy of Pediatrics, AAFP, the Association for Family Practitioners, ACOG, the Association and College for Obstetricians and Gynecologists, and also APhA, the American Pharmacists Association, plus other medical societies and organizations for PAs, NPs, nurses, midwives, etc., who lend their expertise to the discussion.

Typically, ACIP is scheduled to meet for 3 regular meetings throughout the year, as well as any ad hoc or additional meetings in between as needed. The committee then appoints workgroups, which are basically subcommittees of ACIP, and the workgroup is composed of other external experts and members, and liaison groups as well, to then in further investigate the question that the committee has. So if the committee is thinking about issuing a recommendation or addressing a certain question, they assign that task to the work group, who then does the hard work of looking at the data, evaluating, and putting it all together. And ultimately, the work group makes a recommendation on a policy question to the committee, and the committee discusses and makes the final vote on whether that recommendation should move forward or not.

So that is the standard operations for ACIP, and that's been in place for many decades now and so that is how we expect the ACIP to function and to operate.

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ACIP: Evidence to Recommendations Framework

So as I mentioned earlier, the ACIP looks at a whole lot of different data. They also have a very defined framework that they must utilize, and they have utilized for the past several decades to further evidence‑based recommendations. And this framework is the Evidence to Recommendations framework along with the GRADE. And GRADE is how they rate the quality of evidence. But on the evidence of the framework – Evidence to Recommendations framework, they look at all the various factors I mentioned before, like public health problems, benefits and values, equity issues, feasibility, acceptability, etc. And it's a very standardized kind of format to address a question, to gather the data, and to evaluate the data to come to a consensus on a policy recommendation. So it's a very established, standardized process to provide evidence‑based recommendations.

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Federal Actions and Confidence in ACIP

Now, as I mentioned, these were operations and standards that have been in place for decades. But unfortunately, in the last 6 to 12 months, we've seen some deviations from these standards that have led to a concern amongst the medical community about the confidence in the recommendations that are being put forth by federal agencies, most specifically the ACIP and CDC.

So, since May of 2025, there have been a number of actions that have affected the confidence that the medical societies have in the recommendations that are put forth. Some of these actions include dismissing the entirety of the ACIP committee members to replace them with other individuals, bypassing their regular meeting schedule, disbanding work groups, and not following – not following the Evidence to Recommendation framework, not utilizing GRADE to evaluate data that's presented at meetings, as well as HHS issuing recommendations that have bypassed ACIP evaluation.

And so for these reasons, there is concern that some of the vaccine recommendations being put forward by the CDC may not be entirely grounded in evidence and that has resulted in, as I mentioned, that declining confidence and concern about the recommendations coming from this group. Where ACIP used to be the gold standard, unquestionably amongst all medical professionals, there is now doubt about that level of confidence in these types of recommendations.

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Waning Confidence in ACIP Recommendations

So prior to 2025, the ACIP immunization schedules were all co‑endorsed by every liaison organization who was a part of the committee. I mentioned there were 31 liaison organizations. So organizations like AAP, AAFP, ACOG, APhA and others had all endorsed the immunization recommendations and schedules that came from ACIP, and that resulted in a unified, harmonized vaccine recommendations all across the board. Everyone was on the same page.

But currently, as of now – after May 2025, because of all the issues that we have mentioned, one of the other issues was that liaison organizations were also removed from the workgroups and not allowed to participate in the meetings and the discussions. And so, as a result of all of that, we now see a divergence in vaccine recommendations, where various medical societies and organizations, like the ones previously mentioned, have refused to co‑endorse the ACIP schedules because of their concern about the lack of potential quality data and the deviation from the Evidence to Recommendation framework.

So now we're coming into a situation where different organizations are issuing their own vaccine recommendations, and they may be different from each other, and they may be different than what is being recommended by ACIP. So instead of having 1 unified, harmonized recommendation for how we should use various vaccines, we're now seeing different recommendations pop up from different groups, and that causes confusion amongst healthcare providers and as well as amongst patients, as far as what is needed to protect their health.

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2025 Adult ACIP Immunization Schedules

So I want to talk a little bit about the ACIP recommendations because that is kind of our foundation, our starting point, and we'll talk a little bit about what some of those deviations are from the other groups and how to navigate the current landscape. So you might be familiar that every year, as I mentioned, ACIP releases its immunization schedule. So on this slide, we see an example of the recommended adult immunization schedule for 2025, and we do want to point out that there are different versions that are released throughout the year. And so I want to point your attention to the blue box on the bottom left corner of that chart, where it has a revision date. In this example, it says revised August 7, 2025.

So it's important to take a look at that revision date, because that will help us determine whether the current immunization schedule that we are reviewing has been co‑endorsed by liaison organizations or not. So the January 2025 immunization schedule was the very last version that was made using the Evidence to Recommendation and GRADE frameworks and it is the last version that was co‑endorsed by liaison organizations. Any subsequent revision after the January 2025 version is not co‑endorsed by the liaison organizations like AMA, AAP, AAFP, etc. So the May, August, and even the most recent October and November revisions are not co‑endorsed.

So, as you're navigating the ACIP recommendations, and if you're thinking about whether these are also recommended by other liaison groups or not, take a look at the revision date to help you come to your decisions.

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Recommendations for Adults

Now, as far as the current ACIP recommendations on the adult schedule, we’ve summarized some of the recommendations on the slide here. It is important to note that we've only summarized the vaccines that have routine, universal recommendations for adults in ACIP. So the information on this slide does not include any vaccine recommendations that might be recommended based on comorbid conditions, high risk, or shared clinical decision making. As you're navigating the chart, the ones we put on this slide here are the ones that are colored in yellow, and the ones that are not included on this slide are the ones that are colored in blue or in purple. So that's just to kind of level set what we have here.

So these are the recommendations for all adults based on age – routine recommendation based on age. Influenza, 1 dose annually for all adults. RSV, 1 dose for adults aged 75 and older. TD/Tdap, 1 dose of TD or Tdap every 10 years. MMR, 1 or 2 doses, depending on the year you were born. Varicella, 2 doses, depending on the year you were born. Zoster, 2 doses for adults 50 and older. HPV, 2 or 3 doses for adults 19 to 26. Pneumococcal for adults age 50 and older. Hepatitis B, 2, 3, or 4 doses, depending on the brand of the product, for adults age 19 to 59. And polio, a complete 3‑dose series if incompletely vaccinated. Now, again, there may be additional recommendations based on risk factors and other clinical scenarios that are not included here.

Now we want to focus in on RSV because it has a very recent change that is notable for us to be aware of. Everything else on this slide, as far as routine adult recommendations, has been pretty consistent over the years. So for RSV, there was a recent addendum that changed the recommendation for the lower age cutoff. So, previous to this, it was 60 to 74 based on shared clinical decision making. And in the July addendum, the age range was updated to 50 to 74 for those individuals who are at increased risk. And so that's an important thing to note, because that is a change in the lower age cutoff for when RSV vaccination can be recommended, especially if the individual has 1 or more risk factors that places them at high risk for severe disease.

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Recommended Adult Immunization Schedule by Medical Condition or Other Indication

In addition to the routine age recommendations, this is the immunization schedule that summarizes the adult vaccine recommendations based on medical conditions or other indications. And so if your – if your patient has diabetes, lung disease, HIV, if they're pregnant, or if they meet any other criteria listed on this chart, they may have additional recommendations beyond the routine age‑based recommendations for the different vaccines.

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2025 ACIP Recommendations for Adults: Addenda

All right. Some of the other recent changes or updates to the 2025 ACIP recommendations are summarized here on this slide. So, as I mentioned earlier, RSV was the one that has the most notable change, with the group now saying 50 to 74 being recommended if you have an increased risk.

The other changes had to do with meningococcal recommendations. There was a new pentavalent product that was introduced onto the market, and so the ACIP now has a recommendation to use that pentavalent meningococcal product when it is indicated at the same visit.

And then for influenza, the ACIP reaffirmed its annual – routine annual recommendation for the influenza vaccine for the 2025‑2026. And then they also issued a new recommendation that all single‑dose formulations of influenza must be thimerosal‑free as their preferred product, especially in pediatric population, pregnant women and all adults. But otherwise, the prime – the core of the recommendations remain the same as far as routine annual vaccine recommendations.

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Posttest 1

All right, so let's jump back to our pre‑test question that we saw earlier. If following current recommendations, would you recommend an RSV vaccine for a person age 59 years who has an increased risk for severe RSV disease?

1. No, not recommended for people younger than 60 years;
2. No, not recommended for people who are 75 years;
3. Yes, recommended for people who are 50 years of age with shared clinical decision making; and
4. Yes, recommended due to age and risk factors.

So go ahead and take a moment to submit your answers.

Josh Schechtel: Okay, a lot of answers are coming in there, so I think we can go ahead.

Dr Dang: All right. Great. So the vast majority answered D. Yes, recommended due to age and risk factors. And that is the correct answer, so great job. So remember that was a very recent change to the ACIP recommendations, and so now the recommendations are any adult age 70 years and older as a routine age‑based recommendation, and then adults 50 to 74 are recommended if they have a risk factor for severe RSV. So they shifted away from shared clinical decision making and they lowered the age from 60 to 50 as a part of their most recent change. Great job, everyone.

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2025 ACIP Vaccine Recommendations for Adults: COVID‑19

All right. Some other routine vaccine recommendations that have been – have recent changes or updates include the COVID‑19 vaccine. So at its most recent ACIP meeting, they did reaffirm the annual dosing of an updated COVID‑19 vaccination for all individuals 6 months and older. However, they did update it from a routine age‑based recommendation to a shared clinical decision‑making process, and it is especially recommended for those individuals who have various risk factors, such as advanced age or other comorbid conditions that are listed on the slide. There are some estimates that nearly 80% of the American population meets one of these risk factors though, so there are still a lot of people who are indicated to receive the vaccine, even with a shift to a shared clinical decision‑making process.

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Additional Societies With Vaccine Recommendations

All right. So those were the ACIP recommendations. Over the last few months, a lot of, you know, concerns about those recommendations coming in but ultimately, those are the recommendations that are put forth by ACIP. And as I mentioned, there are other societies or other groups that are now issuing their own recommendations that may be the same as what's recommended by ACIP or may be different. So that is going to introduce some confusion for healthcare providers in a layer of complexity for you to navigate, to make sure you're recommending the best recommendations for your patients for the greatest benefit.

So some of those societies with their own recommendations include AAFP, the American Academy of Family Physicians. These are the individuals who typically take care of our adult populations, family medicine, and primary care. We also have recommendations from American Academy of Pediatrics. These are the pediatricians with expertise in children and adolescents. And then we have ACOG, the American College of Obstetricians and Gynecologists, the experts in pregnancy care and that patient population. So those links are where you can find some of those immunization schedules from the different societies.

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Maternal Vaccination Against COVID‑19: ACOG Recommendations Differ From ACIP

And so here's an example of differing recommendations. So let's look at maternal vaccination against COVID‑19. So ACIP recommendation currently is that COVID‑19 vaccine is recommended for all individuals aged 6 months or greater, determined by shared clinical decision making, especially if you have a high‑risk factor, and pregnancy is currently listed as one of the high‑risk factors.

Now, for some added background, earlier in the summer, before the October ACIP meeting, so from approximately May to October, ACIP removed its recommendation for the pregnant population. That was a unilateral decision coming from the HHS secretary that bypassed the ACIP committee. So for a period of time in 2025, we did have a few months where there was no recommendation for pregnant patients for COVID‑19 vaccine. After the October ACIP meeting, it was brought back under shared clinical decision‑making. So that's what we have for ACIP.

Now, for ACOG, ACOG has maintained since June or – since the summer, that the COVID‑19 vaccine is recommended for every pregnant patient. And so, for the ACOG recommendations, it is a routine recommendation for all pregnant women.

So you can see there's a difference here. For ACIP, for a period of time, there was no recommendation, and now it's only through shared clinical decision making. But for ACOG, it is a routine recommendation for all women who are pregnant. And so as you take a look at these different recommendations, depending on your – your ability and your state authority will determine which one you might follow and which one might be the most evidence‑based recommendations.

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What Is the “Gold Standard” Reference?

So with those differences, what is the gold standard? And for the longest time, ACIP was considered the gold standard. And the other thing to think about, too, is that FDA approves the vaccines and labeled information, but it's ultimately ACIP that determines how a vaccine should be used. And so for most providers, we have followed ACIP recommendations for many, many years. And for many, many years, those were harmonized with recommendations from medical societies. However, those are no longer harmonized.

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Clinical Pearls for Pharmacists: Initiating Conversations and Shared Clinical Decision‑making

So what is the gold standard, and how can we figure out what that might be? I will – I will say that it really depends on – it really depends on your state laws. So I would defer to your state laws and local regulations on which entity you need to follow to issue evidence‑based recommendations. So I know that in many states, there is very explicit statutory language that you must follow ACIP recommendations. In those situations, you are obligated to follow what's being recommended by ACIP. But in other states where there is no statutory requirement, for example, in California, as of this year, we are no longer tied to ACIP recommendations, we can follow any evidence‑based recommendations, so then it's up to the clinician's discretion to utilize recommendations from AAP or ACIP or a combination of both. So I would defer to your local regulations on which to follow but knowing that in general, the medical societies have had a concern about the quality of evidence being put forth by ACIP, and that is why they are making their own recommendations.

The other thing to think about is pharmacists can participate in shared clinical decision making. And so many of our vaccine recommendations do have a shared clinical decision‑making component and pharmacists are explicitly listed as providers by the CDC, as far as those who can participate in that activity. And really, shared clinical decision making is just a fancy term to say, talk to your patients, and that's what you're doing already. Talk to your patients about the risks and the benefits and determine if they have any risk factors where the benefits of vaccination would exceed the risk.

That's really what you're doing already when you're doing your assessments. So it's just encouraging you to have a conversation and to evaluate the patient's specific risk profile to determine the vaccine recommendation, but pharmacists can engage in that activity.

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Clinical Pearls for Pharmacists: Implementing Risk‑Based Vaccine Recommendations

So, as you're implementing risk‑based or shared clinical decision‑making recommendations, some clinical pearls for you to consider is to utilize self‑attestation of conditions and risk in your consent form. So if there's a recommendation to use COVID‑19 vaccine in patients who might have various conditions, that you can collect that through a self‑attestation of the patient's medical conditions. You can also scour your medical records or pharmacy records for diagnosis codes, documented conditions, or patient demographics. You may also be able to infer diagnoses from dispensed medications. So if a patient is picking up medications for diabetes or inhalers for asthma, that you can infer that they have those diagnoses that may then meet a qualification for a risk‑based vaccine recommendation. You can also proactively screen your patients and have auto‑generated alerts based on pharmacy data, so that you are proactively offering vaccines to patients, and then also accepting referrals and prescriptions from other healthcare providers for those vaccines that have risk‑based recommendations.

[00:28:40]

Keeping Up With Vaccine Recommendations

All right. So that was just a brief summary of kind of where we're at and what the current recommendations are. There's a whole lot of news to keep up with. Everything is changing on a daily, weekly basis. And so these are some of my favorite resources of keeping up with vaccine recommendations that I recommend that you keep in your toolkit.

So the Children's Hospital of Philadelphia has a – has maintained a really great repository of updated news about what is happening, especially in the last year. So they've had – they've been a great place to locate the latest information and they do also compile all the different recommendations from the different medical societies on their page as well.

IAC has been a long‑standing great resource for many decades, and it continues to remain a great resource.

The University of Minnesota has a great center for infectious disease research and policy that's also putting out something called the Vaccine Integrity Project, that's also sharing information about the different – the different medical societies and their evaluation of the evidence.

And then the Evidence Collective is a great place that has some recommendations on how to talk to patients about some vaccine myths and misinformation that may be out there. So I found them to be a helpful resource as well.

[00:29:52]

Contemporary Challenges: Addressing Vaccine Misinformation and Hesitancy in Pharmacy Settings

All right. So with that, I'm going to pass it over to Dr JAM for the rest of our session.

Dr Abdul‑Mutakabbir: Thank you so much, Dr Dang. I appreciate it. I'm so happy to be here, excuse me, with you all for these last 2 sections of the presentation. And also, I just want to let everyone know that we will stay over for about 10 minutes or so to continue to answer questions in the event that we do not get to all of them at the conclusion of this presentation, just so you all have that in mind.

So we're going to talk about contemporary challenges and addressing vaccine misinformation and hesitancy in pharmacy settings. My apologies.

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Pretest 2

Okay, so for our pretest question, I would like to start with, I'm asking you all: I feel confident guiding conversations with patients who are hesitant to receive vaccines.

1. The first choice being strongly disagree;
2. Second, being disagree;
3. Third being neither agree nor disagree;
4. Fourth being agree; and
5. Then the last one being strongly agree.

So I'll leave you all some time to answer that.

Josh Schechtel: Okay, results look good.

[00:31:09]

Pretest 3

Dr Abdul‑Mutakabbir: Righty. So I'll click to our next question. I am aware of effective strategies to improve vaccine uptake in underserved populations.

1. Our first choice is strongly agree;
2. Our second choice is disagree;
3. Our third is neither agree nor disagree;
4. Our fourth is agree; and
5. Then finally we have strongly agree.

So I'll leave you all to answer that.

Josh Schechtel: Okay. People jumped right on that one. Great.

[00:31:47]

Misinformation Is Going Viral

Dr Abdul‑Mutakabbir: All righty. Okay. So now I get to get into the fun stuff, which is the – the content of the section. So misinformation is going viral. I think Dr Dang did a phenomenal job kind of summing up the climate that we're currently in.

So first and foremost, the share of adults who say they have heard the false claim that the measles vaccines are more dangerous than measles has increased since 2024. At least half of the public are uncertain when it comes to false claims about measles, saying such claims are either probably true or probably false. And then we have parents who say false claims about measles are definitely or probably true, are more likely to have skipped some recommended vaccines for their child.

So, a conversation we had directly before we came on the line with you all is that the climate of vaccine uptake has severely changed, even so much as from COVID‑19 time until this present time. We really are in, you know, a very tumultuous and different time but I think that it, you know, it really brings to the occasion and brings up the importance of pharmacists in these spaces.

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Sources of Misinformation

So when we think about just those sources of misinformation from that previous slide, well, false claims are intentionally or accidentally amplified through various channels. There was actually research that came through the Pew Institute, and what they said was that, you know, folks are more likely to gather information from social media, that being YouTube, Facebook, Twitter, now known as X. So, you know, when we have information that's disseminated – disseminated through those pathways, you can have someone send it to someone else and now if that information is not adequately or appropriately relayed, now we have all of this information that may not be adequately true being sent across to everyone.

Also, we can have word of mouth. We can have podcasts, trusted messengers. So folks may be looking to individuals alternative to health care providers to gather their health‑related information and then that can go ahead and be connected to what we see in terms of the propagation of misinformation.

[00:33:54]

Barriers to Vaccine Uptake Among US Adults

So, in addition to that misinformation that we discussed, or misinformation can support what we see in terms of vaccine hesitancy or just a lack of confidence with vaccination, and then we can see a lack of disease related education, and that can amplify vaccine hesitancy or just that – that lack of willingness to go ahead and receive that vaccine.

And then accessibility. So folks may have the education, they may be on board to get the vaccine, but if you don't know where to get the vaccine or if maybe individuals don't – aren't covered by insurance or if they fear that there may be a cost associated with the vaccine, then that can also be a barrier to what we see in terms of vaccine uptake.

[00:34:36]

Vaccine Confidence Archetypes

So when we think about vaccine confidence, I always like to say, you know, this world and we as human beings are not black and white. We often have a lot of gray or a lot of in‑between. So we can have those folks that are vaccine enthusiasts, meaning that every time that that flu vaccine comes out, they are the first people that we see in line, or we can have those folks who they say they got a flu vaccine in 1960 and had a poor reaction, and they haven't had one since. So we have our skeptics.

But in the middle there, that's where we have our gray area, right, our persuadable or folks that we can really talk to and maybe try to mitigate with those limitations to vaccine uptake, maybe. So we have our folks that may be watchful, meaning they really want to sit. They want to – they want to – they want to have information or they want to really watch that vaccine safety. Is this something that's safe for me to get? And really kind of follow those community norms.

I actually do community‑based vaccine uptake education and with that, I have research attached to it, and it really, you know, was so surprising to me because I asked a question about flu vaccine uptake. And I’d say, how many people in the United States do you think get the flu vaccine? And I have about, you know, they say they think that many people in the US get the flu vaccine. And then I say specifically, how many people in your community do you think get the flu vaccine? And that drastically dropped. So they say some or maybe none get that flu vaccine. So folks follow the community norms, and it could be that they’re really – if someone in their immediate community says, hey, you know, the flu vaccine is something you can consider, that can really change someone's mind.

So when we think about those folks that may be cost anxious, so they will definitely also consider vaccine safety. But then they also think about the fact of, you know, will insurance be able to cover this for me? Is this a vaccine I can receive – I can receive for free? If I do get vaccinated, can I get this maybe on a weekend where I may not have to miss time for work, because we know some folks are paid hourly, not salary? So they may not be able to afford to take that time off to recover from those vaccine‑related effects.

And then we have our system distrusters. So those folks that may not have the complete confidence in the United States health care system and those folks that manufacture vaccines. So they are definitely going to be looking at that safety. But they're going to need some – some things in terms of trust, you know. Are these – is the information they're receiving, you know, regarding those vaccines, is it coming from a trustworthy source? You know, what are we doing to make sure to let them know all the processes that are involved in this vaccine production?

And then access and inequity. Are these folks that are able to get to the vaccines? You know, do – do we have the vaccines placed in their communities? Do we have coverage for those vaccines that they receive?

So something for us to consider when we think about those archetypes related to vaccine confidence.

[00:37:19]

Vaccine Discussion Roadmap: Guiding Conversations for All Vaccine Confidence Archetypes

And then in addition to this, or when we think about just, you know, how do we navigate within that gray area of individuals, for those vaccine archetypes, we have some things to guide us, you know, when it comes to starting those conversations.

So step 1, we want to engage. We want to establish a partnership, build a rapport. Build that relationship with the patient. I think that's one thing innate to our profession that we are so able to do, is to really connect with our patients. I always tell my students, the heart of each pharmacist, irrespective of where you practice, is with the community.

Step 2, we can guide, you know, that conversation. We can open a discussion about vaccines. Ask the patient to share concerns. “Hello, you know Mr. So and so, I'm so happy to have you here today. Could you – could you walk me through, you know, your – your willingness to receive the flu vaccine?” Or something along those lines.

Share info. We can ask permission to share that information related to the vaccine. Really invite the patient into that conversation.

And then summarize and plan. Assess the patient's confidence at the conclusion of that conversation and determine what the actions can be. One thing that I always like to tell folks is, you know, that first conversation may not lead to someone getting that vaccine. And we have to take that as, you know, that's not a failure on anyone's part. What that does, though, is it opens the door for another conversation that we can have for the patient. Every single opportunity of engagement is opportunity to increase confidence surrounding vaccines.

[00:38:44]

RULE: Motivational Interviewing Principles

We also have motivational interviewing and the RULE principles that are associated with that. So we have Resist, that being the R, the righting reflex or risk and increasing the patient’s hesitant – and increasing vaccine hesitancy, or that patient’s commitment to the status quo.

And then we can understand the motivation. So once again, asking those open‑ended questions, really inviting that individual into that conversation.

We listen not to respond, but to understand. One of my colleagues, she uses an approach with the students, which I think has, you know, which I've now adopted – Dr Rabia Atayee at UCSD, I'd like to give her a prop there – but she says “Yes, and…” So what she does is she listens not to – not to respond, but to understand. And then she – after that “and” she provides factual information to go ahead and supplement, you know, what that individual may believe. I've adopted that approach and I see that it really opens that door for the patient and I to build that trustworthy relationship and that trustworthy conversation. But I also allow for them to, you know, bring me into their thought process, and then I can provide factual information to supplement what it is that they've – what they've given me.

And then we empower our patients. I think that's the best thing that we can do, because we want this to be a sustainable – a sustainable commitment that they make to being vaccinated. We don't want it to be a one‑and‑done. So we want to empower them to continue to seek information and to continue to – to come to us as pharmacists as an information source. So we want to be empathetic, patient‑centered, collaborative, and explore those reasons for vaccine – for vaccine‑hesitancy, because like I said, we want this to be a sustained commitment to vaccine uptake, not a one‑and‑done process here.

[00:40:28]

CDC SHARE Framework: Another Approach to Facilitate Conversations About Vaccination

And along with motivational interviewing, if you didn't have enough examples on how to lead these conversations, we got one more for you. So the CDC share framework is another approach to facilitate conversations about vaccines.

So first and foremost, we can seek or initiate conversation, similar to what we saw there in that first slide to describe conversations or that engage step in our first framework.

We can help. So we can provide clear and understandable information.

Assess the patient's values, preferences situation. If there's a monetary barrier, then we can talk about opportunities for them to be supported, you know, when it comes down to them getting the vaccines.

Reach. Explore options to make a decision aligning with the patient's values and preferences. Oftentimes, we'll have to talk to individuals, and they'll tell me, you know, I only have this one time to get vaccinated. So then that's a – that's an opportunity for me to bring up co‑administration. You know, well, hey, we have you here at this one appointment, you know, while you're due for the flu vaccine, I also see that you haven't received a pneumococcal vaccine. Is that something you'd like to do here today? So then you won't have to come back and forth, and then, you know, you can go ahead, you can get these vaccines and now you're protected against 2 diseases rather than just the one. A lot of times, you know, that can go ahead and help facilitate a sustained decision, you know, that that patient makes.

And then evaluate. We want to regularly review that decision and its impact on the patient's well‑being. This goes back to the point that I said, or the point that I made previously, that one conversation may not lead to that person being vaccinated on that day, but we want to continue to use that as a mechanism of re‑entry to that conversation with the patient, we can continue to revisit and treat them, you know, with the respect and honor that this – and agency that this deserves.

[00:42:10]

Downloadable Guide: Helping Your Patients Understand What Is in Vaccines

So we also have a resource available for you all. Please feel free to scan this QR code. And what this does is it helps our patients understand what is in the vaccine, because that is often a question I know that I receive as a pharmacist. So here we have an explanation of the various vaccine technologies like mRNA, traditional vaccines, recombinant, so on and so forth. And then just those other components that are in vaccine formulations. Please feel free to download this, and please use this as a resource to support you all in these conversations related to vaccines.

[00:42:44]

Panel Discussion: Vaccine Clinical Encounters

So I do want to invite Dr Dang back. And here, you know I will go ahead. Due to our time constraints, we will talk about 2 points here, and should we have time and should folks want to continue this conversation, we can go ahead and bring up those remaining 2 points in the Q&A session. But one thing that I really want to talk about, and this is something that I'm hearing, you know, right now as I interact with my community, is grandparent claims natural immunity is better than vaccines. Dr Dang, I would love to hear how you would navigate this patient encounter.

Dr Dang: Well, yeah, I think I might ask them you know, what is it about – well, a few things. What's their motivation? So what is it about the vaccine that they might be concerned about, and then are they aware of the disease? So let's say, for example, maybe it's chickenpox, right. “I don't think they need to get the varicella vaccine.” You know, “I – I think chickenpox disease is perfectly fine.” So we might just ask them like, what is it that they understand about chickenpox? What – are they aware of some of the facts about it? And then if they're amenable, to share with them some of the complications that occur with chickenpox.

And, you know, not just focusing on, hey, you know, the symptoms that you might get as a kid when you're infected right now, but also bringing up, you know, if you are infected with chickenpox, the virus stays in your body, dormant for your whole life and eventually it comes back as shingles, which is something that's more painful and, you know, and something that is preventable if you don't get infected in the first place.

And so seeing if they might understand that process and even just bringing up that if the virus does get – and if they are infected with the virus at a later age, that is actually more of a severe disease, it can lead to disability and other issues. And so, trying to see if they understand kind of those potential complications and trying to put that into context with the risks vs benefits. And if there's any numbers we can provide to them about the rates at which these things happen, is how I might kind of go about it.

And, you know, even with COVID, this is a common one that we see, too. “Oh, I'd rather get sick with COVID than get the vaccine.” Then we might have the conversation and something that's becoming clearer is that, hey, were you aware that if you get COVID, you might get exposed to long COVID, and a lot of people are reporting that now. You can't get long COVID from the vaccine, right. So if that's something that they're worried about, just kind of having that conversation. So there's lots of risks that we can point to. We just have to see what it is that they understand the natural disease to be.

Dr Abdul‑Mutakabbir: I agree, Dr Dang. I have no notes. I would – I would interact in the exact same way and I think that providing that education about the disease itself can be so impactful for getting folks to understand the importance of being vaccinated.

And then we got about 1 more minute. So, the patient insists the flu vaccine gives you the flu. As we head into flu season, I know that we are not the only folks that get this question. So Dr Dang, once again, I would love to hear how you would answer this.

Dr Dang: I mean, with this one, I would definitely acknowledge their concerns and say, “You know what? It sounds like you didn't have a great experience with the previous flu shot. Can you tell me a little bit more about that?” And kind of based on their answer, figuring out what the reaction might have been, because they could have just very well been a side effect, right. “Oh, I felt a little sick afterwards. I was a little bit tired, had some headaches.”

“Well, that's actually a side effect of the vaccine. And we do expect that that might occur and I'm sorry that you felt that way, but did you get the flu?” Right. And they might also misinterpret, “Oh, like I just felt bad for 1 day” as the flu as opposed to actually being infected. So we might try to tease that out.

We might also try to tease out the timing. Oh, when did you start feeling sick after the vaccine? Was it a day after? A few days after? Was it a week or a month afterwards? And kind of educating about the timing of how it takes 2 weeks for the vaccine to fully kick in before they have protection. How, you know, they might have been exposed to the virus shortly before or after they were vaccinated, and that's how they might have gotten sick and it wasn't from the vaccine.

So just kind of educating about those kind of points. But again, really honing in on what is it that the patient has a specific concern about, as opposed to making an assumption about what it is that they believe or experience.

Dr Abdul‑Mutakabbir: Absolutely. Once again, no notes. Also, that point about, you know, looking at the timing and really explaining, you know, how long it takes to actually form immunity against the flu. And also talking about the fact that we are in the midst of flu season, so they could have very well been infected before they received that vaccine, as it takes about 2 weeks for them to go ahead and develop immunity to it. So really, really phenomenal points. And honestly, thank you, because these are some things that I will take with me as I continue to move forward through this vaccine – this respiratory viral season.

[00:47:38]

Posttest 2

Okey‑dokey, so we will go ahead to our posttest question number 2. So we want to go ahead and assess how you all feel in terms of your confidence in guiding conversations with our patients. So the question reads, I feel confident guiding conversations with patients who are hesitant to receive vaccines.

1. Our first choice being strongly disagree;
2. Our second being disagree;
3. Our third being neither agree nor disagree;
4. Our fourth being agree; and
5. Then finally strongly agree.

Josh Schechtel: Okay, we've got lots of answers there.

Dr Abdul‑Mutakabbir: Okay. So I will say that we're doing a phenomenal job. So with that being said, we see the bulk of folks have stated that they either agree or strongly agree that they feel confident in guiding conversations. I am wishing you all the best as we all navigate this different climate in vaccine uptake, and I am confident that we will continue learning and growing together. But more importantly, let's remember to put the patient at the forefront and remember that agency is a good way for us to promote that sustained decision for vaccine uptake.

[00:49:00]

On the Frontlines: Why Pharmacy Professionals Are Critical for Reducing Disparities in Vaccine‑Preventable Diseases

Okay, so we will go ahead and we'll launch into On the Frontlines: Why Pharmacy Professionals are Critical for Reducing Disparities in Vaccine‑Preventable Diseases. This is my favorite section because I love being a pharmacist, so this gives me an opportunity to shed light on what it is that we do.

[00:49:15]

Pretest 4

So, for our pre‑test question number 4, which of the following strategies has been shown to improve vaccine uptake in underserved populations?

1. The first choice being offering vaccination services at large academic centers;
2. The second being engaging faith and community leaders to promote vaccine education and access;
3. The third being allowing online‑only registration for vaccine appointments; and
4. The fourth being providing vaccination exclusively during routine physician office visits to ensure continuity of care.

We'll give about 30 seconds or so to make sure that we can progress through the – the section.

Josh Schechtel: Yeah. A lot of people have answered already. So yeah, I think we're ready to go.

[00:50:08]

Vulnerable Populations May Be More Susceptible to Vaccine‑Preventable Diseases

Dr Abdul‑Mutakabbir: Alrighty. Off to the races, party people. Okay, so when we think about the – the vulnerable populations that may be more susceptible to vaccine‑preventable diseases, so immunosenescence, we have to think about the fact that as we age, you know, our bodies just don't work the way we – that they used to, and our immune systems are also a part of that. So the older that folks get, the less protection that they may have had to diseases that they were exposed to in youth over their life cycle.

Also, individuals with comorbidities, we know that chronic illnesses like diabetes and hypertension can cause us to have decreased immunocompetency, and then that can go ahead and make folks more susceptible to vaccine – excuse me to vaccine‑preventable illnesses.

Are racially and ethnically minoritized groups. Well, they may be disproportionately impacted a lot of times because they're more likely to be diagnosed with a chronic illness.

Or maybe those individuals are – are defined by low socioeconomic status, and they may then contribute to them having lower education surrounding the topic or income related to having insurance or the funds to pay for receiving a vaccine. So things for us to keep in mind as we move forward.

[00:51:23]

Vaccine Uptake Inequities Across Vulnerable Populations

So when we think about just inequities across populations for influenza, less than 50% of non‑Hispanic, Black, Hispanic, Latino, and Indigenous individuals were vaccinated in the past 10 flu seasons. We continue to see a reduced number of uptake as we progress forward past 2021. For RSV, vaccine uptake is extremely low. Only about 16% of eligible adults have received the RSV vaccine from August to February – from August 2023 to February 2025. And with herpes zoster, less than 30% of eligible non‑Hispanic Black or Hispanic Latino individuals were vaccinated, irrespective of these racial and ethnic groups being more likely to experience post‑herpetic neuralgia when compared to any other racial group.

[00:52:11]

Social Determinants of Health Drive Vaccine Uptake Inequities

When we think about why this is, we have to consider that social determinants of health drive vaccine uptake inequities. And when we think about that, oftentimes a marginalized status is met with – with oppression or a system of oppression like racism, ageism, homophobia, ableism, classism. Well, that can have direct impacts with our social determinants of health like education, socioeconomic status, environment, access to health services. And consequently, that can then have an impact on what we see in terms of vaccine equity, as shown here.

I'll go through one example to make sure that we can be timely in how we do this but one thing that I would really consider is just our access to health services. When we consider areas of lower socioeconomic status, they are less likely to have access to a health care provider. That would mean that they then are less likely to have access to those vaccines, so then that means that those individuals are now at a disadvantage when it comes to vaccine uptake. So let's keep that in mind.

[00:53:08]

Pharmacists and Pharmacy Personnel Can Increase Vaccine Uptake in the US

So when we think about the things that we discussed previously, pharmacists can increase vaccine uptake. So the bulk of the vaccines that we've seen administered since the COVID‑19 pandemic have been given in pharmacy. And you can see this information here listed, and it continues to climb each and every vaccine season. So I'm so happy to see that.

[00:53:30]

Pharmacists Can Proactively Optimize Vaccine Uptake

And pharmacists can proactively continue to optimize vaccine uptake. We can identify ideal candidates. That can look like reviewing patient records, reviewing records for prescriptions for health conditions that would make them more susceptible to vaccine‑preventable illnesses.

We can provide education. I think Dr Dang really brought up that importance of educating surrounding – surrounding the disease, and we can do that as pharmacists.

And then we can encourage and provide vaccination. We can give that strong recommendation. We can determine whether co‑administration is possible. So like that example that I gave, if you have someone that is eligible for the flu vaccine, then they're likely eligible for another respiratory viral – viral preventable vaccine, and we can offer them that right then. We can also allow walk‑in appointments so that folks can go ahead and they don't have to sit – they don't have to have a set appointment. They can come in, you know, in the time that they have to receive that vaccine.

So different mechanisms that we can have in place.

[00:54:25]

Pharmacists Can Increase Vaccine Uptake Regardless of Care Settings

So pharmacists can increase vaccine uptake irrespective of setting. We don't have to just be in the communities, in the traditional community setting to provide, you know, information or that strong – that strong recommendation to receive it. So with ambulatory care, in our outpatient settings, we can also, you know, offer vaccines. We can coordinate with our community pharmacies to go ahead and prompt that vaccine for an individual. I would often call the community pharmacy that was nearby, or the one the patient gave me, to go ahead and also encourage them to recommend the patient with when they come in for that vaccine. Transitions of care. We have a lot of just TLC opportunities for pharmacists. We can once again engage in those vaccine conversations for eligible patients. So, irrespective of where we are, we can still make that strong recommendation.

[00:55:13]

Pharmacy Technicians and Trainees Can Assist in Immunization Efforts

We can also involve our technicians and trainees. So I like to say that, you know, it isn't just on that pharmacist or one person to be that checkpoint. We have many different folks that service and work in the pharmacy, we can engage everyone for that conversation. Every single person that the patient interacts with can be someone that makes that recommendation. So folks can – the supporting staff that we have can help us identify ideal candidates.

We can have synchronized education that we provide. They may also be able to aid in vaccine administration. I know in the clinics that I run, if folks are certified pharmacy technicians, they have supported, and we have pharmacy interns that support and pharmacy students, and it's been such a great time for them and a great learning opportunity, and also relieves some of the stress, you know, from the pharmacists having to drive all efforts.

[00:56:01]

Pharmacists and Pharmacy Personnel Also Have a Role in Promoting Vaccine Equity

Pharmacists can also have a role in promoting vaccine equity. So, we can provide community‑tailored vaccine education and then we can also develop low‑barrier vaccine models.

[00:56:11]

A Model of Care: Addressing Equitable Vaccination Access in Vulnerable Communities

So when we think about what that looks like I have a tiered approach that I use, and we won't spend a lot of time here because I do understand that we are a little bit compromised for time, and I want to make sure you all have time to ask questions. I use a 3‑tiered approach, and that looks like me engaging with faith and community leaders. And then I provide education, and I tailor that education to the community's needs. A lot of my work is focused in the Black community. And then also we – I developed a low‑barrier clinic. So I provide education, and directly after that education opportunity, I do have a clinic that goes on directly afterwards, so folks can receive blood pressure, blood glucose screenings, and also vaccines if they would like it. I actually partner with an independent pharmacy to complete this.

[00:56:57]

Results: Community‑Based COVID‑19 Vaccination Clinics Using the 3‑Tiered Approach

So when we look at the outcomes, so after we provided tailored education, what we can see in our mobile vaccination clinic, which you can see here with the 417 folks in this last column, we were able to increase vaccine uptake amongst Black individuals, which was previously underrepresented, in our mass vaccination clinic site at Loma Linda. So this clinic was done in San Bernardino County, which is right – which is the county that Loma Linda serves. We were seeing reduced uptake in our mass effort, but when we took a more tailored approach, we saw a necessary increase in vaccine uptake because that is the beauty that pharmacists have. We can understand a disparity, and we can go ahead and we can work to mitigate that. So I'm very thankful for the team that I work with to get that done.

And then we also continue to see an increase in second‑dose return rate. And then we also saw an increase in those folks that came to the mass vaccination clinic site, because we were able to inform them that this clinic site existed while we had our independent community clinic. So a lot of benefits here.

[00:58:02]

RESPECT Model of Cross‑Cultural Communication

I often get that question of, well – my apologies – I often get that question of, “Well, what if I'm not representative of the community? Is there still a way for me to equitably promote vaccine uptake?” And my answer to you is yes. We can connect with anyone if we open our minds and open our hearts to it, and we can increase vaccine uptake against any and every group. I think that is just such the beauty of the pharmacist profession.

So I have a model for you all. Feel free to adapt. RESPECT model of cross‑cultural communication. Here we have, you know, these areas listed here: Rapport, Empathy, Support, Partnership, Explanations, Community humility, and finally Trust. So we want to build that rapport. We want to approach it with empathy. We want to support our patients. We want to let them know this is a collaborative partnership and their decision‑making. We want to provide education because we want this to be a sustained commitment. We want to understand where people may be coming from in the event that they aren't readily – ready to – to provide uptake. We want to allow them that space to make that decision, and then we continue to forge a trusting relationship.

[00:59:09]

Summary

So with all of this, I want to wrap this up with ensuring vaccines are easy to access is crucial for improving public health outcomes. We want to make strong evidence‑based recommendations. We want to expand access through community pharmacy and on‑site in‑house programs. There are so many equitable things that we can put in place. Online and only appointments can help those that are disadvantaged, and we can also help folks that come in on a walk‑in basis. We can collaborate, as I gave in my – in my example with community and faith leaders, to act as our chaperones and guide us into, you know, those – those communities to go ahead and provide our services. And pharmacists can increase vaccine access by providing convenient and community‑focused services.

[00:59:55]

Posttest 4

So we will go ahead and revisit this post‑test question. Which of the following strategies have been shown to improve vaccine uptake in underserved populations?

1. The first choice being offering vaccine services at a large academic medical center;
2. The second being engaging faith and community leaders to promote vaccine education and access;
3. The third being allowing online only registration for vaccine appointments; and
4. The last being providing vaccination exclusively during routine physician office visits to ensure continuity of care.

Josh Schechtel: Okay, lots of votes there.

Dr Abdul‑Mutakabbir: Fabulous. Great job. So the bulk of the participants have selected B, engaging faith and community leaders to promote vaccine education and access. Absolutely. So that is definitely something that we can do to go ahead and engage our underserved populations. And I can tell you, they would love to have you. So if you have the bandwidth and the time and the – and the support, please engage in that way. Alrighty.

Perfect. So, you have community partnerships improve trust, counter misinformation, and they create low‑barrier vaccine models. And our large academic medical systems can often exclude underserved populations. You may have folks that aren't able to get there, they may not have a primary care provider, so on. So we want to make sure that we are thinking about how can we get into the community and engage the community in this vaccine uptake process.

[01:01:40]

Posttest 3

And then for our final question, I am aware of effective strategies to improve vaccine uptake in underserved populations.

1. So our first choice being strongly disagree;
2. Our second being disagree;
3. Our third being neither agree nor disagree;
4. Our fourth being agree; and
5. Then finally we have strongly agree.

Josh Schechtel: Okay great. People got – that went really fast.

Dr Abdul‑Mutakabbir: Alrighty, here we go. So it looks like we have – the bulk of our folks that have voted answer either agree or strongly agree. So with that being said, I wish you all the very best, like I said, as we continue to try to increase vaccine uptake, especially in our underserved populations.

I did see a question here, so I'll slide that in as we are talking through this. If you all would like any more information, excuse me, regarding my approach that I discussed in the slide deck, I do have several published manuscripts. The – I believe that the references are actually included here in the slide deck, so please feel free to reach that on the menu. If you – also, if you put my name into PubMed, those manuscripts will pop up and generate – they've published papers every year since 2022, so please feel free to access it. And I'm also available through email and would love to meet with anyone interested in learning more.

Q&A

So there we go. With that being said, I will go ahead and lead us to these questions that we have. We have about 5 of them. I think in 7 minutes, Dr Dang, I think we can do it. So we're going to go ahead and get started here with these questions. I can go ahead and take the question. It looks like we have a question about the COVID vaccine. Maybe the updates related to that. I believe that Dr Dang may have actually gotten to the COVID updates directly after the question was posted. So I don't know, Dr Dang, if you want to just kind of like, quickly refresh us on where – where they stand. Thank you.

Dr Dang: Yeah. So just a reminder, ACIP does recommend the COVID vaccine for all individuals age 60 months and older with the current updated booster of the 2025 to 2026 formulation through shared clinical decision making, and especially recommended if they have a high‑risk factor, which might be advanced age or other comorbid conditions.

Dr Abdul‑Mutakabbir: Thank you so much. I appreciate it. As Dr Dang said, and also one thing that I will say is continue to keep your eyes open because these vaccine recommendations, I believe, are fluid. So we want to make sure that we continue to go back to those resources that Dr Dang gave for – for any more updates.

So now we have, does an older patient above 50 years old need a shingles vaccine if they have never had chickenpox – chickenpox, excuse me, but has had the varicella vaccine?

Dr Dang: That's a great question. As of right now, the recommendation is yes for that particular patient, even if they've never had chickenpox before and have received the vaccine, the shingles vaccine is still recommended at this time, although in future – future recommendations down the line with more long‑term data as the younger population gets older to become adults, as they look at the new data, that may change, right. But as of right now, there is a recommendation, and there is still a small risk of developing shingles, even from the vaccine without an infection.

Dr Abdul‑Mutakabbir: So and to supplement with Dr Dang said, is really from a mechanistic standpoint that, irrespective of them seeing the virus in a live form, they would still be seeing it in an inactivated form or by way of the vaccine. So it's still them seeing varicella, and they could still potentially have a reactivation as they age. So we do want to keep that in mind, you know, as to why it is that we recommend that shingles vaccine. Alrighty.

So with our next question, we have, how do you address people who want to take more natural, holistic approaches to medicine or health care? Is it worthwhile to have a conversation?

I can start with this because this is actually, I think a place where – where I often get, you know, questions and so on. For me, one thing that I like to tell individuals is that I appreciate that they want to consider a holistic approach to their health. There are many things that we can do to engage, you know, our bodies to ensure that we are able to go ahead and you know, support ourselves and build our immune competency. Nonetheless, these viruses can, you know, can infect anyone irrespective of, you know, whether they took X amount of vitamin D or not. So I always like to tell them, you know, to supplement your preventive health endeavors, it is smart to consider receiving a vaccine. So I always leave that, you know, open to conversation. I do think it's worthwhile to have a conversation.

[01:07:04]

Go Online for More ProCE Coverage of Contemporary Vaccine Topics!

I'll give you an example, my uncle is a staunch, you know, he – a staunch – a staunch natural – naturalist is what he calls it. So anything from echinacea to – something else that he uses, you know, oil of oregano. But he will do everything that he can naturally. However, when I was able to have conversations with him about how he can also use vaccines as a mechanism of prevention, think about it, you know, as a boost to your natural herbalist perspectives, he eventually, you know, with years of conversation, was able to go ahead and also add that as a part of his preventative mechanism – his preventative approach to his health care.

So I think it's worth the conversation. And like we said, that first conversation may not, you know, result in the person having changed behavior, but sustained – sustained conversations may help move that along. So, Dr Dang, I don't know if you have any other things to add there.

Dr Dang: No, that's a good approach. All right.

[01:08:14]

Thank You for Attending

And I think we'll take one last question as we are over. But I think there's some information on the slide about claiming your CE. Thank you for everyone for attending.

Are there any resources to help pharmacists navigate some of the more common examples of vaccine misinformation?

Great question. I think some of the resources I included on the previous slide, including from Children's Hospital of Philadelphia, and the Evidence Collective, and Immunization Action Coalition, IAC, have some really great resources that you can utilize to help address some of the most common vaccine myths that are out there. So I definitely recommend taking a look at those. JAM, do you have any other resources that you use?

Dr Abdul‑Mutakabbir: I would say the very same. Yeah, so APhA has a phenomenal toolkit that you all can – can visit. I will say the Vaccine Integrity Project is phenomenal. And the Infectious Diseases Society of America has just released their vaccine recommendations by way of VIP. And then also something that you all can consider, a New England Journal of Medicine article just came out where they summarized articles related to COVID, RSV, and I believe, influenza to provide updated recommendations on respiratory viral illnesses. So there are so many different areas that we can go. I think Dr Dang gave such a great – well, great information regarding, you know, how to navigate vaccine information based on your state. I think that the state organizations also have some really good support in terms of vaccine‑related information.

Dr Dang: Yeah. Thanks for bringing up that New England Journal of Medicine. That's a very hot off‑the‑press in the last week or so. They're really going to be filling the hole left by the MMWR. So a lot of the publications that were typically in that MMWR before will likely now be in the New England Journal of Medicine through that new initiative, so.

Dr Abdul‑Mutakabbir: And if any of you follow me on LinkedIn, I'm often amplifying the updated information around the vaccines. So feel free to look at my posts if you need to figure out where to find the links.

Dr. Dang: All right.  Well, Josh, we'll pass it back to you. 

Josh Schichtel: Yes, thank you both so much for your expertise and for just going over an amazing amount of material here.  An amazing amount of really useful information.  So thank you for – for doing that.  And to our learners, thank you for joining us.  You can see on your screen how to claim your credit for attending today and in the resources you can get the slides and a lot of other things.  I know, I think there was a little trouble for people getting the resources because so many people were trying to go in at the same time, but if you just keep trying, you will get through to that, and you can download from there as well.  So thanks again for joining us today, and take care, everybody.