Vaccines | Free Full-Text | The Role of Pharmacists in Counteracting Vaccine Hesitancy: Effectiveness of the 2019 Carnia Project in Improving Adherence to Influenza Vaccination among Target Population

Even though there had already been an increasing trend in vaccination adherence in the whole LHA and in the province of Udine since 2016, when comparing the increase in vaccination compliance between the districts of Carnia and Gemona since 2018, we found that the performance of the former district was better. This is true despite the similar geographic context, low population density, and the fact that the two districts belong to the same LHA. Therefore, the increase in vaccination adherence observed in the Carnia district between the 2018–19 and 2019–2020 campaigns may be due to the pharmacy-based intervention. Nonetheless, the effectiveness of this project may have benefited from the provision of an economic incentive to pharmacists, the long-term sustainability of which will need to be carefully evaluated in order to transition this evidence-based practice into a standardized process. However, there may have been other factors that contributed to the increase in vaccination rates in the Carnia district during the 2019–20 campaign. For example, the fact that the vaccine offered to persons 65 years of age and older was, for the first time, a quadrivalent adjuvanted vaccine, rather than the trivalent vaccine previously offered, and that the availability of doses in the Friuli Venezia Giulia region was greater (+50,000 doses compared with the previous year). The finding that more than 80% of people sought counseling by the end of November may be related to the recommendation of the health authority to vaccinate the population early that year, as the peak of influenza was expected in early December [23]. On the other hand, our study showed that some people who were vaccinated during the 2018–19 campaign (276 people aged 65 years or older) decided not to get vaccinated the following year. Analyzing the possible reasons for this decision, we found that influenza in 2018–19 actually affected the pediatric age group the most and spread mainly in central and southern Italy [24]. This particular distribution may have led older people in the northern part of the country, where the FVG region is located, to believe that they would not get the disease or that vaccination was not necessary. Moreover, some may believe that vaccination was ineffective because their vaccination anticipated the peak of the epidemic too much and so they became ill with influenza because of reduced vaccine effectiveness. After two seasons in which the epidemic peak occurred early (about four weeks in advance), it returned in 2018–19 to its usual timing between late January and early February [24]. In order to prevent this phenomenon from consolidating as a trend, it is important to underline the importance of carrying out positive reinforcement on subjects who had already been vaccinated in previous years.

Vaccine hesitancy remains a public health problem that needs to be addressed to improve vaccination coverage and health outcomes in the population. Therefore, strategies to address vaccine refusal should be carefully tailored to the target population, their reasons for hesitating, and the specific context [25]. One such strategy that is increasingly being used worldwide is to involve pharmacists in immunization campaigns to leverage their role in the communities in which they work, which is a powerful mix of expertise and close contact with the population, sometimes enriched by a potential liaison role between the patient and the referring specialist [15,26]. Indeed, in small communities, it may be easier to establish a trusting relationship with people because pharmacists know patients and their families and can better contextualize problems and potential solutions to specific issues [27]. As outlined in the literature, the role of pharmacies has changed profoundly in recent years, moving from simply preparing and distributing medications to an increasingly central role in patient management. This change was accelerated by the COVID-19 pandemic, in which pharmacists were at the forefront of infection prevention and control programs by providing swabs, distributing medical supplies, caring for patients, and, in some cases, administering vaccines [28,29], making more evident the variety of services pharmacies provide to the general population [29]. The provision of preventive services by pharmacies has been shown to be particularly effective in areas where the population has less ready access to other healthcare providers because of geographic characteristics and the existing distribution of services [15,30,31,32]. In addition, the new range of services offered by pharmacies that were traditionally provided only by hospitals and general practitioners can be seen as a key element for ensuring equitable and timely health care [29,30,33]. In our study, we focused on the potential impact of influenza vaccination counseling on vaccination adherence, but the role of pharmacists as public health providers has been successfully tested in many other settings, including immunization against diseases other than influenza [29,34,35], counseling and provision of dietary supplements [36] and generic substitution [37], HIV rapid testing sites [26], and checkups for vascular diseases [29]. In agreement with the reports of other authors [26,34,38], we believe that adequate training is crucial to enable pharmacists to perform these “new public health roles” effectively and safely. Specific training from both a medical and communication perspective would enable pharmacists to become influential figures in their communities: popular, established, and respected figures capable of influencing the behavior and decisions of their audiences [39]. This is especially true in small rural and mountain communities, such as those of the Carnia district we studied, where the pharmacist is often the point of reference for many health issues. For these reasons, we believe that pharmacist involvement is critical to improving adherence to vaccination campaigns. Specifically, by adding to their expertise the personal, cultural, and linguistic knowledge of the area in which they work, an “influencer” pharmacist can increase Confidence in the efficacy and safety of vaccines and in the healthcare system that provides vaccinations, reduce Constraints by increasing the accessibility of the service and improving understanding through the use of easily understandable language, decrease Complacency by educating people about the potential benefits of vaccination, influence the outcome of the Calculation process by providing users with truthful and complete information, and increase the sense of Collective responsibility because of their central role in the community [5]. In Italy in particular, in the new scenario emerging with Legislative Decree 77/2022 and the National Recovery and Resilience Plan (Piano Nazionale di Ripresa e Resilienza, PNRR), which aim to reform the organization of primary care at the national level, the role and competences of pharmacies could soon be integrated with their greater involvement in health promotion and disease prevention activities. Thus, these health professionals could contribute to public health efforts by helping to identify patients with risk factors or unhealthy lifestyles, providing evidence-based education and counseling, countering common misconceptions and fake news, and ultimately empowering the community and individuals to achieve their best health outcomes [40].