Adam C. Welch, PharmD, MBA, FAPhA: It sounds as if what we’ve learned from COVID-19 and annual influenza, and the strategies we used to get our patients vaccinated against flu, can be applied to RSV [respiratory syncytial virus]. What are some of the things we’ve learned from other upper-respiratory vaccines that we can use for RSV?

Wanda Filer, MD, MBA, FAAFP: From my perspective, you make it routine. It’s not a special circumstance. Vaccines are a routine part of medical care. They’re incorporated into your personal goals. They’re incorporated into what’s best for you. I’m going to give you your medication refills, we’re going to give you your mammogram order slip, we’re going to give you your flu vaccine, and now we’re going to give you an RSV vaccine. This is all part of the standard of care geared to keeping you as healthy as possible. If you have diabetes, we’re going to make sure we get your A1C [glycated hemoglobin] tightly controlled. That’s a different form of prevention. RSV vaccine is primary prevention. All of them have a place in the home and in medical care.

Laurene Mascola, MD, MPH: Also, you have to start at the top. It’s good in medical care, but you have to have systems established from the top down. That way, it’s not an option. It comes up as a flag. It’s part of your HEDIS [Healthcare Effectiveness Data and Information Set] measures. Your office looks upon this as something very important to get high coverage rates. It comes down from the CEO [chief executive officer] of the organization through your IT [information technology] system, down to the provider who’s talking to patients. But you need to make it—I hate this word—routinized. You need to make it routine. You need to have that flag come up. You need to have it in your system, so it’s not based on a physician remembering to do it, but it’s part of what the system says they have to do.

There are some carrots attached to getting these coverage rates up, like with HEDIS measures or some other ways of having competitions between offices. But it’s very important because there are a lot of things you need to do per visit. An older patient who comes in might have a list of 6 or 7 problems. By the time you get to prevention, you’re walking out the door. It’s very important to have that routinized so that you remember to ask about public health prevention.

Wanda Filer, MD, MBA, FAAFP: I’ve found it to be particularly helpful. We talked earlier about having a team, making sure everybody on your team is aligned. I’ve been in a circumstance where someone in the organization was undercutting the message to patients. You’ve got to find that. You’ve got to root that out and say, “We’re all pulling in the same direction.” If I’ve got a medical assistant who said, “I’m not going to offer a flu shot,” guess what, you’re not working with me today. You’re not going to see my patients because I care about those people, and this is important. We all need to pull in that same direction of what’s best for that patient.

Adam C. Welch, PharmD, MBA, FAPhA: It sounds as if having providers on the same page and making it part of the routine is what’s going to help improve RSV vaccinations.

Marty J. Feltner, PharmD: We need to use technology to our advantage. I like how you said tickler because we use that term in the pharmacy. Have a pop-up window is helpful. Look at interface ability with your local registry. There are registries that you can interface with—not in the state of Nebraska but in other states—where if you have a patient profile in front of you as a pharmacist or a technician, you have all the recommendations right there as far as vaccines. Using technology to our benefit to identify patients is key. I’m not sure how that plays out in the health care system, but when you’re hospitalized or having a well check or any visit, they’re asking you those questions. That’s so important.

Adam C. Welch, PharmD, MBA, FAPhA: It sounds as if when we leverage our electronic health records, when we make this routine in our process, it can be incorporated into our workflow and absorbed with all the other activities that we’re doing to keep our patients healthy.

Laurene Mascola, MD, MPH: Exactly.

Marty J. Feltner, PharmD: Adam, when you look at the workflow in the pharmacy, giving a vaccination is no different from filling a prescription. Your technician enters the order, and the pharmacist or technician reviews it. If there’s a nurse working in the pharmacy to help immunize, especially during flu season, they can help out with that process. Setting realistic goals in your practice is important. I heard you say have a competition. I helped oversee 9 pharmacies with my previous employer, and we always had a competition. Who could do the best? You reward that team for how well they’ve done during flu season.

Adam C. Welch, PharmD, MBA, FAPhA: Ms Singleton, how could payers then help determine the eligibility of a patient who may need this RSV vaccine?

Abby Lynne Singleton, PharmD, BCPS: It’s a tricky situation for payers. You don’t want to appear that you’re promoting certain therapies—even though I’m fully on board with vaccinating patients—especially when a payer doesn’t know a patient’s full medical history. It’s important for payers to have information available for their patients so they can make an informed decision with their provider and make sure they’re able to talk to their patients about where they can get the vaccine in the most convenient place.

A lot of payers have programs where nurses and pharmacists call you. They’ll come to your house, they’ll review your medications, and they’ll talk to patients about vaccines. That’s a great place for payers to get involved and have those conversations. If there’s something missing in a vaccine history, encourage the patient to talk to their doctor about this. Tell them to ask “Do you know why you didn’t get this?” Have a good conversation with them. As you’ve talked about, I’ve done these medication reviews with patients, and I’ve found the most successful thing to do is to get them with somebody they trust and have this conversation about getting a vaccine.

Adam C. Welch, PharmD, MBA, FAPhA: We’re seeing a common theme about having someone whom a patient trusts as part of your routine. It’s going to go a long way to improving these RSV vaccines. What about the obstacles? What are some potential obstacles to administering the RSV vaccine?

Marty J. Feltner, PharmD: Yes, we’ve talked about quite a few obstacles already. Vaccine hesitancy and fatigue are definitely some. Staffing challenges is another big 1. What often happens in the pharmacy is they’ll say “I don’t have time to do it.” That’s not an excuse. You have to educate your team on the value of the vaccines and why we’re here to help prevent disease. Staffing is definitely an obstacle. What’s it going to look like as far as education? There’s going to be a time frame where we’re going to have a lull of maybe 12 weeks. That doesn’t mean we’re not going to push forward, but we need to make sure we have an implementation plan for education with our public and our teams.

Laurene Mascola, MD, MPH: I forgot to mention that there’s another group that’s at risk for RSV infections, and those are the people who don’t have access to care and are living in socioeconomically disadvantaged neighborhoods. The data show that individuals of different ethnicities and living in different backgrounds have a higher risk for RSV infection than their counterparts in affluent areas. Access to care is very important. Not everyone has a pharmacy around the corner or a doctor’s office that’s close to them. We need to make sure those disparities are erased if we want to get this disease under control and give patients equal access to vaccinations across the board.

Marty J. Feltner, PharmD: We also need to make sure we have adequate training for our team. How do we communicate to our patients the benefits and adverse effects that are going to happen with an RSV vaccine? When I went through pharmacy school—I’m sure you can attest to this—I learned that you’ve got to be a salesman. You’ve got to be able to sell that vaccine to your patient. Don’t make it hard, but have a clear and concise recommendation.

Transcript edited for clarity.