Dr. Monica Trivedi
Each year, the CDC’s Advisory Committee on Immunization Practices (ACIP) holds meetings to decide on the most effective composition of that year’s flu vaccine. Production of the vaccines typically takes place from May to June, and distribution begins in August. Across the nation, pharmacies large and small must make decisions about which flu vaccine options will best match their specific needs and the resources they have to procure their supplies.
All flu vaccines available in the 2024-2025 season in the United States are trivalent, containing the three strains of influenza. The primary difference among vaccine options lie in dosage and composition. For individuals 65 years of age or older, a high-dose version is recommended. Meanwhile, the stranded-dose vaccine comes in two forms: a preservative-free single-dose syringe and a multi-dose vial, which contains preservatives to maintain effectiveness.
There are two main factors that a pharmacist must take into consideration when making the decision about which flu vaccines to procure. These factors are the needs of their specific patient populations and pricing and market availability.
Patient Needs
It is important for pharmacists to get the right supply for their patient populations. If they are located in an area where they have a large number of older patients, they will obviously be administering more of the high-dose vaccine options, of which there are two this year: Fluzone and Fluad.
In terms of the general population, pharmacists have to consider their pediatric population. There are multiple vaccines available for children aged 6 months and older, such as Fluarix, FluLaval, Fluzone, Afluria and Flucelvax. Patients typically in the age range of 6 months- 3 years of age are often administered in pediatrician offices. However, it is certainly possible to offer them in a pharmacy if there is space and privacy and if a parent can be present to assist. Pharmacists are there as an access to provide vaccines to the entire population.
Pricing and Market Availability
Often large pharmacy chains will prepurchase their entire stock of flu vaccines for the whole season, buying in bulk from one brand to reduce their overall cost. Small pharmacies must make slightly more nuanced buying choices, as on the one hand they do not want to over purchase, but on the other, they do not want to run out, as flu vaccines are produced once a year and they do not make more.
A good option for smaller, independent pharmacies is to come together with other independent pharmacies to create a larger buying group. Since they’re buying more doses, this results in a cost reduction. Pharmacists should also do research on reimbursement rates for specific vaccines.
It’s important to note the one option which has limited utilization to pharmacists: the FluMist nasal spray. The nasal spray is only FDA approved for ages 2-49, limiting the utilization across all patient populations.
Education and Access
Crucial to the conversation around the different options for flu vaccines is the reality that vaccine uptake is declining year after year, according to the Center for Disease Control. The question of which flu vaccines to administer may be moot if we have no patients to receive them because of misinformation and mistrust. Whether they’re working at a large retail pharmacy or a small independent one, it’s important for pharmacists to increase their efforts to educate the community around them about the safety and effectiveness of flu vaccines in preventing illness in many cases and preventing hospitalization in others.
Dr. Monica Trivedi, PharmD, at Marshall B. Ketchum University
