Pharmacy U

Improving immunization rates one shot at a time


The rates of adult immunization in Canada are far from optimal.

By Mike Boivin BSc.Phm.


A 2006 Canadian report found that less than half of Canadian adults were properly immunized against tetanus and only 17% of patients with chronic diseases other than asthma were immunized against pneumococcal disease.1 At the same time, studies with influenza vaccine have shown that pharmacists can significantly increase uptake in patients who would not otherwise receive the vaccine.2

Pharmacist John Schulmeister of Parksville, B.C. has seen firsthand the impact of pharmacist immunization on vaccine uptake. “Our pharmacy has become the immunization destination centre for our community. Not only do our patients actively support this service, but we are consistently receiving immunization referrals from other healthcare professionals.”

It was not always this way. John was one of the first pharmacists in British Columbia to complete the training required to administer vaccines. “In 2009, when I was in Prince Rupert, I received the ability to immunize, but the public did not yet think of pharmacy when they considered immunization. We also did not have the strong relationships with public health to develop a coordinated effort to increase vaccine uptake.”

Things changed significantly when he relocated Pharmasave Parksville, where a dedicated pharmacy team looks at immunization from both a public and business perspective.

“We have fully integrated immunization in all aspects of our pharmacy services,” John says. “For example, at medication reviews we actively discuss vaccines. Our goal is to ensure that each of our patients is receiving every routine immunization on schedule.”

John and the Pharmasave Parksville team have taken their immunization practice to the next level. “When public health stopped their travel health service in our community, the team recognized a service gap and started integrating travel consultations in their practice. The team introduced some simple travel consults and as their knowledge and confidence increased, they were able to provide information for more complicated travel itineraries.”

John feels that pharmacists can play a key role in the uptake of vaccines not covered by the routine immunization program. “We discuss herpes zoster and pneumococcal conjugated vaccine with all our patients who are candidates,” he says. “These are very serious infections, and although the vaccines are not covered in B.C., we feel that it is our obligation to offer each patient the opportunity for protection.”

While some pharmacists struggle with discussing the costs involved, this has not been an issue for John, who believes strongly in the value of these vaccines for patient health.  “When discussing the herpes zoster vaccine, we acknowledge the cost but frame it compared to the cost of treating shingles and the burden of the pain and neuropathy of the infection. We work with an older community, and those who have seen friends or family members suffer from shingles are happy that we discuss the vaccine and frequently accept our immunization recommendation.”


John Schulmeister’s top tips to help other pharmacists in Canada improve immunization rates:

  1. Discuss vaccines as often as you can. “We integrate vaccine discussions into counselling and other pharmacy services. The more frequently you discuss them, the higher your uptake.”
  2. Know the guidelines and patient targets. “We know what vaccines are due and when. This makes it easy to identify and promote vaccines to the right patients.”
  3. Focus on your staff. “The staff at our pharmacy play a crucial role in delivering vaccines. They are instrumental in finding the patients and helping with the workflow.”
  4. Think beyond your four walls. “We actively discuss immunizations with physicians and nurse practitioners in our community. We notify them when we administer vaccines and through this regular dialogue, they regularly refer patients to our pharmacy. This interprofessional collaboration will only help with patient care and grow the pharmacy.”


  1. Brown V. Adult immunization Last on the list. Can Fam Physician. 2011;57(12):1377-1378.
  2. Kwong J, Cadarette S, Schneider E, Campitelli D. Community pharmacies providing influenza vaccines in Ontario: A descriptive analysis using administrative data. In: Ottawa, Ontario. Accessed May 3, 2016.


Mike Boivin BSc.Phm. is a clinical pharmacist consultant, continuing education developer, and president of CommPharm Consulting Inc.