Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Barriers to Implementation of Vaccine Standards

Vaccine; ePub 2018 Sep 20; Srivastav, et al

Many clinicians and pharmacists reported implementing most of the individual components of the revised Standards for Adult Immunization Practice; however, discrepancies remain in providers reported actual practices as well as their beliefs/perceptions remain. Researchers analyzed data from non-probability-based Internet panel surveys of US clinicians (n=1,714) and pharmacists (n=261) conducted in February to March 2017. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in state/local immunization information systems (IIS) were calculated. Provider perceptions regarding their adult patients’ attitudes toward vaccines were also evaluated. Among the findings:

  • A high percentage of clinicians and pharmacists (70.0-97.4%) routinely assess, recommend, administer, and refer adults for vaccination.
  • However, only one-third of clinicians and pharmacists routinely document adult vaccinations.
  • Reported barriers to vaccinating adults remain, including: inadequate reimbursement for vaccinations, lack of staff to manage/administer vaccines, and uncertainty if state/city had IIS that includes adults or not sure how their electronic system would link to IIS.


Srivastav A, Black CL, Lutz CS, et al. U.S. clinicians’ and pharmacists’ reported barriers to implementation of the Standard for Adult Immunization Practice. [Published online ahead of print September 20, 2018]. Vaccine. doi:10.1016/j.vaccine.2018.09.024.


The use of vaccines has eliminated many common infections from the lives of patients in the United States. We have seen the eradication of smallpox and elimination of polio from North America. It is not surprising that physicians and pharmacists see the benefit of primary prevention achieved with immunizations as a good thing. The study also highlights that there are many practical issues that prevent physicians and pharmacists from implementing vaccination programs for the patients. We should continue to work to try to simplify and integrate vaccination programs regardless if the they occur in ambulatory offices, pharmacies, or hospitals. —John Russell, MD

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