Pharmacist-Led RSV Immunization Strategies: Leveraging Trust to Overcome Vaccine Hesitancy

Co-Chairs, Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, and Richard Dang, PharmD, APh, prepared useful Practice Aids pertaining to RSV vaccine education for this CPE activity titled “Pharmacist-Led RSV Immunization Strategies: Leveraging Trust to Overcome Vaccine Hesitancy.” For the full presentation, downloadable Practice Aids, and complete CPE information, and to apply for credit, please visit us at https://bit.ly/3Xw99oi. CPE credit will be available until September 20, 2025.

1. RSV Burdens and Risk Factors in Older Adults
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 RSV in Adults: Clinical Symptoms and Complications
1-5
RSV reinfections are possible throughout life and may cause
complications in certain high-risk groups
RSV as a Public Health Problem in Older Adults
6
• Common virus that can cause infection in the upper and
lower respiratory tract
• Symptoms usually appear in stages and usually last
<5 days but can linger for up to 2 weeks
• Progression typically causes acute bronchitis or
pneumonia
– Severe RSV can also cause CHF and exacerbate
asthma and COPD
• Annual rate of RSV-associated hospitalization
increases with age, with a steep rise at age 75 years
• Certain chronic medical conditions also increase the
risk of RSV-associated disease; age and chronic medical
conditions are independently associated with increased risk
• RSV is associated with severe disease and has
significant post-hospitalization sequelae among
older adults
Therefore, the following should receive a single dose of an
RSV vaccine
• All adults aged ≥75 years
• All adults aged 60-74 years with certain chronic medical
conditions or other factors that increase the risk of severe
RSV disease
Upper Respiratory Tract
Lower Respiratory Tract
Sputum production
Voluminous rhinorrhea
Respiratory failure
Wheezing or rales
Headache
Cough
Nasal congestion
High fever
Dyspnea

2. RSV Burdens and Risk Factors in Older Adults
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 a
List of immunocompromising conditions would match the existing list from the COVID-19 vaccination Interim Clinical Considerations.
13
b
Long-term care facilities do NOT include retirement communities or senior independent living communities in which residents are able to perform activities of daily living without assistance.
1. https://www.cdc.gov/rsv/index.html. 2. https://www.drugs.com/health-guide/acute-bronchitis.html. 3. https://www.nfid.org/publications/reports/rsv-report.pdf. 4. https://www.cdc.gov/rsv/high-risk/index.html. 5. Falsey AR, Walsh EE. Clin Microbiol Rev. 2000;13:371-384.
6. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-06-26-28/11-RSV-Adult-Melgar-Roper-Britton-508.pdf. 7. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-06-26-28/12-RSV-Adult-Melgar-508.pdf. 8. https://www.cdc. gov/vaccines/
covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised. 9. https://www.cdc.gov/flu/about/ burden/2019-2020.html. 10. McLaughlin JM. Open Forum Infect Dis. 2022;9:ofac300. 11. Branche AR, Falsey AR. Drugs Aging. 2015;32:261-269. 12. Branche AR
et al. Influenza Other Respir Viruses. 2022;16:1151-1160. 13. Thompson WW et al. JAMA. 20 03;289:179 -18 6 .
Chronic Medical Conditions and Other Risk Factors
for Severe RSV Disease in Older Adults
7, 8
US Burden of RSV vs Influenza:
Adults ≥65 Years of Age
9-13
• Chronic cardiovascular disease (eg, heart failure, coronary
artery disease, congenital heart disease; excluding isolated
hypertension)
• Chronic lung disease (eg, chronic obstructive pulmonary disease,
emphysema, asthma, interstitial lung disease, cystic fibrosis)
• Chronic kidney disease, advanced (eg, stages 4-5, dependence
on hemodialysis or other renal replacement therapy)
• Diabetes mellitus with end-organ damage (eg, diabetic
nephropathy, neuropathy, retinopathy, or cardiovascular disease)
• Severe obesity (body mass index ≥40 kg/m2)
• Decreased immune function from disease or drugs
(ie, immunocompromising conditions
a
)
• Neurologic or neuromuscular conditions (eg, neuromuscular
conditions causing impaired airway clearance or respiratory
muscle weakness; excluding history of stroke without impaired
airway clearance)
• Liver disorders (eg, cirrhosis)
• Hematologic conditions (eg, sickle cell disease, thalassemia)
• Frailty
• Residence in a nursing home or other long-term care facility
b
• Other chronic medical conditions or risk factors that a
healthcare provider determines would decrease the risk of
severe disease due to respiratory infection
Influenza
16,000
deaths/year
170,500
hospitalizations/year
1.05 million
outpatient visits
9,500-
12,700
deaths/year
159,000
hospitalizations/year
1.4 million
outpatient visits
RSV

3. RSV Vaccination: Patient Education
and Shared Decision-Making
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 Pharmacists’ Role: Proactive Approaches
to Optimizing RSV Vaccine Uptake
1,2
Educating Older Adults About RSV: Key Talking Points
3
Barriers to Shared Clinical Decision-Making in Older Adults
4
• Run reports at your practice for all patients ≥60 years
of age
• Review records for prescriptions for health conditions
listed as indications for RSV vaccination: DM, heart
disease or HF, kidney or liver disease, COPD, or asthma
• Inquire about RSV vaccine needs when patients request
influenza and COVID-19 vaccines
• Offer disease and vaccine information
Identify Candidates
Provide Education
• Provide strong RSV vaccine recommendations
• Determine whether coadministration with other vaccines
is possible
• Offer incentives for being up to date with vaccination
Encourage and Provide Vaccination
RSV
Complications
Older adults are
at increased risk
for RSV-related
complications
No therapies for
RSV infection
aside from
supportive care
RSV vaccines
are now
recommended
for older adults
aged ≥75 or 60-74
years with risk
factors for
severe disease
No RSV
Treatment
Vaccine
Availability
Vaccine
Hesitancy
Lack of
Disease-Related
Education
Minimal Vaccine
Awareness

4. RSV Vaccination: Patient Education
and Shared Decision-Making
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 Strategies to Boost Immunization Rates and Vaccine Uptake:
Shared Clinical Decision-Making
5,6
Effective Shared Decision-Making
5
3-Talk Model of Shared Decision-Making
5
• Increase vaccine-related discussions
– Utilization of various HCPs (eg, primary care and
specialist physicians, nurse practitioners, physician
assistants, nurses, and pharmacists)
• Improve methods to identify patients
– Discuss vaccination with all eligible individuals
– Provide patient-centered care
• Team approach: HCP and patient determine if RSV
vaccination would be beneficial
– Individualized recommendation
• Discuss considerations and options
– Health status, concomitant medical conditions
– Risk for severe RSV disease
• Focus on patient preferences
Vaccine hesitancy
is not unique to RSV vaccines
Team Talk
“Let’s work as a
team to make a
decision that suits
you best”
• Indicate choice
• HCP support
• Identify goals
Option Talk
“Let’s compare the
possible options”
• Compare
alternatives
• Discuss harms and
benefits
Deliberation
Thinking
carefully about
options when
facing decision
Active
Listening
Paying close
attention and
responding
accurately
Decision Talk
“Tell me what matters most to
you for this decision”
• Get to informed preferences
• Make preference-based
decisions

5. RSV Vaccination: Patient Education
and Shared Decision-Making
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 1. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html. 2. https://www.thecommunityguide.org/findings/vaccination-programs-health-care-system-based-interventions-implemented-combination.html. 3. https://www.cdc.gov/rsv/older-adults/. 4. Pel-Littell RE et al.
BMC Geriatr. 2021;21:112. 5. Scalia P et al. J Intern Med. 2022;291:408-425. 6. https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html#scdm. 7. https://www.cdc.gov/vaccines/covid-19/hcp/engaging-patients.html. 8. Gagneur A. Can Commun Dis Rep. 2020;46:93-97.
Promoting Vaccine Confidence:
CDC Example From COVID-19
7
Motivational Interviewing Strategies
8
• Embrace attitude of empathy and collaboration
• Ask permission to discuss vaccines
• Respond to questions about vaccines, health, or
mental health
• Motivational interviewing
Method of
interacting
with patients
Objective: To
move patient or
care partner to
adopt health-
related behavior
Aimed at
exploring
reasons for
hesitancy
and changing
attitudes and
behavior
Ask
open-ended
questions
Reflect and
respond
Affirm strengths
and validate
concerns
Summarize
interaction and
determine action
Ask →
Provide →
Verify

6. The Pharmacist’s Role in Addressing Health Disparities
and Vaccine Equity
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 Vaccine Equity: Role of Social Determinants of Health
1-3
Vaccine Inequities Across Marginalized Racial and Ethnic Communities in the United States
4,5
Historical medical mistreatment and misinformation, resulting in vaccine hesitancy,
and social determinants of health are likely contributors to reduced vaccine uptake 
Racism and other systems
of oppression
(eg, homophobia, ableism)
Social Determinants
of Health
Education
Socioeconomic status
Environment
Access to health services
• During initial phases of COVID-19 vaccine rollout, Black and
Hispanic individuals were less likely to be vaccinated
• Compared with their White counterparts, COVID-19 mortality
rates were
• Influenza vaccination rates of Black, Hispanic, and American
Indian/Alaska Native individuals from 2012-2022
Impact on Vaccine Equity
Language barriers and low health literacy on respiratory
diseases and their prevention
Public transportation, workplaces with increased
exposure to viruses
Housing can be multigenerational and
overpopulated—ease in infection transmission
Healthcare professional shortages decrease
opportunities to receive vaccinations 
1.6x higher among Black individuals and
1.7x higher among Hispanic individuals
Less than 50%

7. The Pharmacist’s Role in Addressing Health Disparities
and Vaccine Equity
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40
 Pharmacists’ Role in Promoting
RSV Vaccine Equity
6-8
Pharmacists’ Role Across Care Settings
9,10
Percentage of Vaccines Administered by Pharmacists
or at Pharmacies in the United States
11,12
Provide community-tailored vaccine
education to promote agency in
decision-making
Develop low-barrier
vaccination models
• Vaccinate in house or send to pharmacy that can
• Outpatient (primary care, cardiology, pulmonology, endocrinology) or
community based
• Vaccine indication when new diagnosis is made
• Community-based pharmacies often partner with clinics in their community
• Referrals for medication management post discharge
• Partner with local health systems
• Recommend vaccines to prevent rehospitalization due to respiratory illness
Ambulatory Care
Transitions of Care
>50% 60%-70% 40%-50%
COVID-19
vaccines
Influenza
vaccines
Pneumococcal
vaccines

8. The Pharmacist?s Role in Addressing Health Disparities
and Vaccine Equity
Full abbreviations, accreditation, and disclosure information available at PeerView.com/MFD40 A Model of Care: Addressing Equitable Vaccination Access in the Black Community
6
Principles from this COVID-19 vaccination project can be extrapolated to address vaccine disparities in other communities
Tier 1
Engage faith/community leaders
• Leveraged existing relationship with
two religious organizations and
gained access to their congregation
– Inland Empire Concerned African
American Churches (IECAAC)
– Congregations Organized for
Prophetic Engagement (COPE)
• Education sessions were offered
alongside community vaccination
clinics, intentionally focusing on
– Translating the pathophysiology of
the disease
– Mechanism of vaccines
– Race/ethnicity-specific clinical
trial information
• An increase in post-session
awareness and acceptance of
the vaccines was reported
Barriers to Vaccination
in the Black Community
• Lack of digital readiness
• Limited transportation options
• Distance to healthcare facility or clinic
• Discrimination and stigmatization
Low-Barrier
Community-Based Clinics
• Paper-based registration
• Pop-up, mobile clinic held on partner
church grounds
• Inclusion of community health
workers and volunteers in the
vaccination clinics
• Faith/community leaders organized
platforms to
– Disseminate information
– Manage major processes
necessary for vaccine clinics
Tier 2
Educate individuals using HCPs
from their specific community
Tier 3
Develop low-barrier clinics to increase
access within the community
1. Sangster AV, Barratt JM. Vaccines (Basel). 2021;9:1378. 2. Mamelund SE et al. PLoS One. 2021;16:e0244346. 3. Adapted from https://www.boston.gov/government/cabinets/boston-public-health-commission/racial-justice-and-health-equity#framework. 4. https://www.cdc.gov/
mmwr/volumes/71/wr/mm7143e1.htm?s_cid=mm7143e1_w#F3_down . 5. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-deaths-and-vaccinations-by-race-ethnicity-as-of-winter-2022. 6. Abdul-Mutakabbir JC et al. Lancet Glob Health. 2021;9:e749.
7. Shen AK, Tan ASL. J Am Pharm Assoc (2003). 2022;62:305-308. 8. Terrie YC. US Pharm. 2021;45:28-31. 9. https://www.pharmacytimes.com/view/pharmacists-are-vital-to-transitions-of-care. 10. https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/
ambulatory-care/ambulatory-care-career-tool.ashx. 11. Grabenstein JD. J Am Pharm Assoc (2003). 2022;62:1929-1945. 12. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/trends-in-vaccine-administration-in-the-united-states.