One morning at the pharmacy, my 72-year-old patient, Mrs. Whitmore, consults me for an insulin adjustment. During our conversation, I realize she has not received the shingles vaccine. In fact, she was treated for shingles two years ago. I then suggest the recombinant shingles vaccine (RZV), which she would have to pay for out of pocket. Several questions immediately come to her mind: “If I’ve already had shingles, wouldn’t I already be immune? If it’s so important, why doesn’t the government cover it? I’ll be 75 in three years; should I wait until it’s covered?”
I take the time to walk her through the benefits and limitations of the vaccine, allowing her to make an informed decision.
This case perfectly illustrates a challenge my colleagues and I have been facing since we started offering vaccination services in Canada: finding the right balance between scientific recommendations, available coverage, and the realities of each patient.
In this article, I share some reflections from my own experience, as well as practical information and tools to support our decision-making. Let’s dive in!
Benefits Across the Board
The advantages of pharmacy-based vaccination are numerous and reach many stakeholders:
- For the pharmacy: an additional source of revenue, differentiation, customer loyalty, and a way to highlight the expertise of the staff. It positions the pharmacy as a true healthcare destination.
- For pharmacists: strengthens the frontline role, broadens clinical skills, increases professional satisfaction, and builds stronger trust with patients.
- For patients: greater accessibility thanks to the wide pharmacy network and extended hours, all within a familiar and reassuring environment.
- For the healthcare system: boosts vaccination capacity and frees up medical resources for more complex care.
- For society: improved vaccine coverage, stronger herd immunity, reduced absenteeism, and a population better equipped to face epidemics.
My Perspective as a Quebec Pharmacist
As a pharmacist, I encountered a variety of challenges when I began vaccinating in Quebec, which required me to quickly adapt and become familiar with many aspects of the practice. Here are some of my personal reflections on those experiences.
Addressing Vaccine Hesitancy
As a frontline professional, it’s essential to address concerns and uncertainties about vaccination by breaking down the science into clear, practical advice. This means being not only a clinician but also an educator and a guide, capable of reassuring patients while giving them the tools to make the right choice.
Navigating the Information
One of my first challenges was learning to navigate the many references available. Despite the mandatory PIQ (Quebec’s immunization protocol) training, it took time to get comfortable with its structure and use it efficiently.
The PIQ is thorough, well organized, and full of reliable information. Still, I remember moments, in the middle of a busy vaccination day, when I knew the answer was in there somewhere, but just couldn’t find it fast enough.
Building Clinical Confidence
Often, I already knew the answer, but I wished I could quickly get a clear validation. Building true clinical confidence takes both experience and a strong familiarity with the tools available.
Getting to Know the Resources at Our Disposal
Each province has its own immunization manual. In Quebec, the Protocole d’immunisation du Québec (PIQ) sets clinical practice standards, eligibility rules and which vaccines are publicly funded.
Here are the references that guide my decision-making:
- The provincial guide (e.g., PIQ in Quebec, BC Immunization Manual in British Columbia): your first stop for coverage details and operational requirements.
- The Canadian Immunization Guide: best for additional details or answers on consistent clinical points (like dosage, contraindications, or co-administration).
- Expert committee recommendations (e.g., NACI, CIQ, OIAC): essential for staying on top of scientific evidence and emerging guidelines.
Together, these resources form an indispensable toolkit. Please note that the Canadian Guide and expert statements complement, but don’t replace, the provincial manual.
Clinical Sidebar: Balancing Public Programs and Individual Choices
Mrs. Whitmore’s question is a valuable reminder: public immunization programs fund vaccines based on population-level factors (impact, feasibility, cost effectiveness). But for an individual, the best option can vary depending on age, medical conditions, or even personal preferences.
Take shingles vaccination in Quebec, for example. At the time of writing this article, the Programme québécois d'immunisation (Quebec's immunization program) funds shingles vaccination for immunocompetent individuals aged 75 and older, as well as adults of any age with conditions leading to immunosuppression. By contrast, NACI strongly recommends the recombinant shingles vaccine for all immunocompetent adults aged 50 and older.
It’s important to recognize that a vaccine must pass through several steps before being included in a provincial program. This means a vaccine can be strongly recommended by expert committees but not immediately funded publicly. That gap underscores the importance of staying aware of guidance beyond the provincial program, so we can properly inform patients and help them make well-informed choices.
My Go-To References
My essentials from the PIQ (as a Quebec pharmacist):
Intervention Opportunities: A Clinical Support Tool
With constant new developments, frequent updates to vaccination schedules, and the daily pressures at the counter, it’s easy to miss opportunities for vaccination in pharmacy practice.
That’s where a tool like the optional “Intervention Opportunities” module in RxVigilance (integrated version) proves invaluable. Its vaccination section is designed to help pharmacy teams quickly identify patient needs and proactively offer relevant services.
Rather than replacing clinical judgment, the tool provides practical support: it highlights patients at risk according to current recommendations and offers concrete prompts to guide discussion. The suggestions are adapted to each province’s schedule and legislative framework.
And What About Mrs. Whitmore?
Her story reminds us that when it comes to vaccination, pharmacists play an essential role.
Vaccination is far more than just giving a shot. Each of us can guide patients through their vaccination decisions and provide a complete care experience, informing, educating, advising, and reassuring them along the way.
This is where our expertise as pharmacists truly makes a difference, and why vaccination has become an integral part of our practice.
👉 To learn more about the Opportunities for Interventions module, download our supplementary document by filling the following form.
