Impact of pharmacy-based interventions on vaccination coverage among vulnerable and underserved populations: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Vulnerable and underserved adult populations: adults ≥65 years or individuals aged 18-64 years with chronic conditions or limited healthcare access |
| I — Intervention | Pharmacy-based vaccination interventions including eligibility assessment, counselling, administration, and documentation |
| C — Comparator | Standard care or pre-intervention vaccination rates |
| O — Outcomes | Primary outcome: vaccination coverage. Secondary outcomes not specified in abstract |
Bottom Line
This systematic review provides compelling evidence that pharmacy-based vaccination interventions significantly improve vaccine uptake among vulnerable adult populations. The nearly two-fold increase in vaccination odds (OR 1.88) in pre-post comparisons represents a clinically meaningful improvement. The most effective strategies involved comprehensive pharmacist roles including eligibility assessment, counselling, direct administration, and documentation integrated into routine care. While the case-control analysis showed even larger effects (OR 4.87), the wide confidence intervals suggest caution in interpretation. The large sample size (1.3 million participants) supports generalisability, though heterogeneity assessment and certainty of evidence grading would strengthen confidence in findings. For Australian practice, these results support expanding pharmacist vaccination roles, particularly in underserved communities where traditional healthcare access is limited. The multicomponent approach aligns well with existing Australian pharmacy vaccination frameworks and could inform policy decisions about resource allocation for improving vaccination coverage in vulnerable populations.
Key Findings
P Value: Not reported in abstract
Effect Size: Pre-post comparison OR 1.88; Case-control comparison OR 4.87
Primary Outcome: Vaccination coverage among vulnerable and underserved adult populations
Nnt Or Sensitivity: Approximately 88% increase in vaccination odds with pharmacy interventions in pre-post analysis
Confidence Interval: Pre-post: 95% CI 1.68-2.12; Case-control: 95% CI 2.23-10.64
Clinical Application
High feasibility in Australian context given established pharmacy vaccination programs and pharmacist prescribing rights Aligns with Australian National Immunisation Program goals and pharmacy vaccination services already available through PBS. Particularly relevant for improving coverage in underserved communities where GP access may be limited Australian adults ≥65 years and those 18-64 with chronic conditions or limited healthcare access, particularly relevant for rural and remote communities
Abstract
BACKGROUND: Vaccination coverage remains suboptimal among vulnerable and underserved adult populations. We investigated the effectiveness of pharmacy-based interventions in improving vaccine uptake in high-risk groups and the most effective strategies. METHODS: A systematic search (PubMed/MEDLINE, Embase, Scopus; 26 July 2025) identified experimental and observational studies evaluating pharmacy-led vaccination interventions targeting adults ≥65 years or individuals aged 18-64 years with chronic conditions or limited healthcare access. The primary outcome was vaccination coverage. Odds ratios (ORs) were pooled using fixed- and random-effects models. Sensitivity analyses were conducted by intervention type and setting. Risk of bias was assessed using ROBINS-I, RoB 2, and NOS tools. RESULTS: A total of 35 studies were included, encompassing over 1.3 million participants. In pre-post comparisons, pharmacy-based interventions nearly doubled vaccination uptake (random-effects OR = 1.88; 95% CI: 1.68-2.12). In case-control analyses, individuals exposed to pharmacist interventions were almost five times more likely to be vaccinated (random-effects OR = 4.87; 95% CI: 2.23-10.64). Multicomponent strategies and direct vaccine administration by pharmacists produced the most consistent improvements. CONCLUSIONS: Pharmacist-led vaccination interventions significantly increase vaccine uptake among vulnerable adults. The most effective approaches involved pharmacists included eligibility assessment, counselling, administration, and documentation, integrated within routine care workflows.
References
- 1.Borlini, S., Pennisi, F., Pinto, A., De Ponti, E., D'Amelio, A. C., & Signorelli, C. (2026). Impact of pharmacy-based interventions on vaccination coverage among vulnerable and underserved populations: a systematic review and meta-analysis. Vaccine, Article 128426. https://doi.org/10.1016/j.vaccine.2026.128426
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