Senior jabs neglected, but pharmacy can help

With so much focus on encouraging parents to vaccinate their children, senior Australians have been neglected when it comes to immunisation, say experts.

But pharmacists can have a significant role in improving their access to vaccination for several preventable diseases, even if they don’t have the vaccine itself administered in pharmacy, says QUT’s Professor Lisa Nissen.

Writing in MJA Insight this week, Jane Barratt and Raina MacIntyre highlight that vaccination rates are significantly higher in infants than their grandparents, despite both groups being eligible for free vaccines.

They point out that the attitudes of health providers are key in determining whether or not senior Australians are even aware of the benefits of being vaccinated against communicable diseases such as flu or pertussis.

“The most common response given by elderly patients when asked why they haven’t been vaccinated is ‘because my doctor never told me’,” they write.

QUT’s Lisa Nissen, who led the QPIP pilot, told the AJP that even if they’re just raising awareness, pharmacists can have a significant role to play in changing this situation.

“Having pharmacists vaccinating has led to a greater voice in pharmacy around preventative care in the vaccination space,” she says.

Promotion of vaccination services tend to be shaped as questions such as “How’s your vaccination status?” or suggestions like, “Ask your pharmacist about vaccination”.

“So it’s not targeted specifically for flu, it’s raising general awareness,” says Prof Nissen.

“But we’ve certainly found that we’ve had enquiries from NIP eligible patients about vaccination for things like flu and whooping cough, and where they are eligible for NIP pharmacists are referring them to their GP.

“Certainly in the QPIP pilot we had a number of older people who were NIP eligible but elected to have their flu vaccination in pharmacy because of the convenience; there’ll always be a proportion of eligible people who will prefer to pay because pharmacy is more convenient than their GP.”

Consultant pharmacists can also talk about vaccination when they are doing MedsChecks and HMRs, Prof Nissen says.

“They’re generally checking whether people are up to date during those reviews, particularly with the shots that aren’t yearly, and giving reminders when they’re due. So there’s lots of ways pharmacists get an opportunity to talk about this.”

Whooping cough is a particularly interesting area for seniors, Prof Nissen told the AJP, due to new parents increasingly adopting a “cocooning” strategy whereby parents, grandparents and other close family members get a pertussis booster shot to try and shield the newborn from whooping cough.

“There’s a number of jurisdictions paying for the cost of vaccination at least for the mother; and certainly the QPIP pilot had a number of examples where there’d be a cluster of the dad and in-laws – everybody came in a pack to get their vaccination.

“On balance for them it was a more convenient and cost-effective way to do it. And pharmacists have also been able to say, ‘Your wife’s having a baby, have you looked at your vaccination status?’ and that’s triggered dads to have conversations about whether they and the grandparents need whooping cough vaccination as well.”

Barratt and MacIntyre highlight several factors influencing the neglect of vaccination for seniors on top of health provider attitudes.

Another reason is the lack of an adult immunisation register; Prof Nissen told the AJP that “the sooner we get an electronic record to share information about vaccination, the better”.

Health provider concern about vaccine efficacy in older people is another barrier.

“Much of the poor uptake is simply down to negative health provider attitudes,” write Barratt and MacIntyre. “Vaccines in patients over 65 just don’t work that well, so why bother, they may think.

“While it is true that cell mediated immunity wanes exponentially after the age of 50 years, the real question is, does it really matter?

“A vaccine waning to unacceptably low levels in 10 years is important if you have 80 years ahead of you, but less so if you’re looking down the barrel of 10. Besides, most vaccines have acceptable efficacy in the elderly, and novel research and strategies can improve vaccine immunogenicity in the elderly.”

Prof Nissen adds that there’s another demographic who need to think more about vaccination: Generation X adults who were children in the 1970s, and who may have missed out on the measles vaccine before it was incorporated into the national immunisation program, but may not have caught the disease in the wild.

“There’s a cluster of people who missed out on having that one, and that’s why the Queensland Government was keen to have pharmacy able to provide the measles vaccine for people who don’t have a record of having received it or their parents don’t remember.

“It’s better to be sure. We do have problems now where people come from other countries or visit areas in the world that are not well covered by vaccination programs, and that’s where we’ve seen a few outbreaks – people travel away and bring measles back and cause a small outbreak. It’s most common with FIFO workers and foreign students.”

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