A healthy dose of good government: Flu shots at the pharmacy

One afternoon last week, I walked into the pharmacy in my local supermarket. Twenty minutes later, I left after receiving a needle’s worth of this season’s influenza vaccine. The cost? $20.  For those in line behind me (lucky enough to have better insurance than I have), the cost was nil or $5.

When I first walked in, I was asked to fill out the necessary forms.  While completing them, I noticed that my fellow vaccinees seemed, like me, to be quite relaxed and even a bit jovial. And why wouldn’t we?  No waiting on hold at home to make an appointment weeks in advance. No sitting in stuffy waiting rooms—breathing in germs spread by the coughing and sneezing of fellow patients—just to see the blur of an over-scheduled doctor for a few moments.

My pharmacy visit spared me all that. The experience revealed something that deserves our attention and should be celebrated:  a health-care success story and an example of good government.

It took all of a minute for the pharmacist to swab my arm and administer the shot.  When I left, I found myself wondering just how such an effective innovation—now generally taken for granted—had come about.

Expanding access to healthcare

If you ask whether I was surprised to discover that the initial push for offering an alternative to vaccination at a doctor’s office had its origins in a Democratic administration, my answer would be “of course not.”  Since the days of FDR’s New Deal, Johnson’s Great Society, and now Obamacare, progressive Democrats have been at the heart of the fight to expand access—whether in the workplace, health care, or civil and legal rights.

This latest expansion originated during the Clinton administration, when then–Secretary of Health and Human Services, Donna Shalala, proposed to the American Pharmacists’ Association (APha) that the organization develop a plan to train pharmacists across the country to deliver immunizations.  At the time, Shalala and others in the administration were alarmed by low vaccination rates, particularly among the uninsured and rural populations underserved by the medical community.

Remember that 1993 was the year in which President Clinton focused his domestic agenda on health care and unleashed a task force (headed by First Lady Hillary Rodham Clinton) that tried nobly—and failed miserably—to take on the entrenched interests of a health-care industry that was (and is) costing the public and private sectors dearly and delivering poorly on services.

Shalala, one of the unsung crusaders of the Clinton administration’s focus on health care, hoped that convenience and lower cost might boost vaccination rates and provide a more broadly based entry point to the front lines of preventive health care—the vaccination.

Secretary Shalala’s efforts paid off when her proposal was embraced by APha.  The organization responded by developing a rigorous program to train and certify an army of pharmacists who would be available to administer vaccinations.  Although at the time a few states already had existing laws on the books allowing vaccination in pharmacies, implementation had been slow or nonexistent. Shalala was determined to change that.

Although the Clinton administration laid the groundwork, administering vaccinations in pharmacies really began to take off in the 2006–2007 influenza season.  The number of vaccines delivered by pharmacists that year comprised seven percent of total vaccinations.  By 2011 the rate had increased to eighteen percent.

Lest this seem like a success story unmarred by controversy, it’s important to remember that doctors were hardly on board.  Their lobby pushed back and pushed back hard. Even today, state medical societies continue to fight against ceding vaccination delivery to pharmacists.  Their objection holds that vaccination by pharmacists disrupts the doctor/patient relationship and complicates record keeping in doctors’ offices. Talked about less often is the loss of doctors’ fees from patients, insurance companies, and Medicare and Medicaid.


Which vaccines may be administered by pharmacists continues to be controversial as well.  Each state determines its own regulations, and those regulations are all over the map.

It was not until 2009 that all fifty states allowed some or all of the CDC-recommended adult vaccinations to be delivered by pharmacists. (Maine being the last state to pass the necessary laws.) Only six states—Massachusetts, Washington, Connecticut, Colorado, Minnesota, and Kentucky—have passed regulations allowing all CDC-recommended adult vaccinations to be made available at pharmacies, supermarkets, and big-box stores.

In New York State, pharmacists are authorized to administer the adult influenza, pneumonia, and, just this year, shingles vaccinations but have not yet been authorized to administer the adult whooping-cough vaccination.

(In an unexpected move on January 12, 2013, Governor Cuomo, responding to an influenza rate of infection of epidemic proportions in the state, issued an executive order permitting pharmacists to temporarily administer seasonal influenza shots to children between the ages of six months and eighteen years.)

Pro-active, good government

There’s another important dimension to this story that goes beyond health benefits. And this brings me back to the concept of good government (an idea nearly extinguished by conservative Republicans but, thankfully, robustly revived by President Obama in his recent inaugural speech).

The success story of pharmacist-delivered vaccinations is an example of what can happen when a government agency pro-actively identifies a problem and then works aggressively, innovatively, and nimbly to craft a solution that yields results not for a single special-interest group but for the benefit of all.

And so I find myself asking: How many of the cheerful vaccinees that day in my local pharmacy realized that they should be thanking former President Clinton and Donna Shalala for sparing them time out of their busy days and saving them money by going to the pharmacy rather than a doctor’s office? In fact, every day in pharmacies, supermarkets, and big-box stores in cities, suburbs, and rural areas, individuals are unknowingly experiencing up close the intersection of their daily lives with the benefits of good government.

How altered our political discourse would be if only we all realized it.