If you're looking for a flu shot, you can walk into a Walgreens, CVS or Rite Aid in any state and get one from a pharmacist.
For the vaccine against the blistering skin condition shingles, however, you can go to a drugstore in San Francisco but not in Sioux Falls, S.D. And for the whooping cough vaccine, options include Nashville, Tenn., but not North Conway, N.H.; Brookline, Mass., but not Brooklyn, N.Y.; Gainesville, Ga., but not Gainesville, Fla. It's a geographic hodgepodge.
Vaccines have long been the province of doctors, and as the role of pharmacists has expanded in the past few years, many state medical societies have fought the trend. They argue moving shots to pharmacies disrupts the doctor-patient relationship and complicates record keeping.
Hence the odd compromises: In New York state, for instance, the rules essentially tell pharmacists: Influenza? Yes. Whooping cough? No.
It's time to end these silly inconsistencies. Pharmacists have played a key role in providing flu shots and are increasingly doing the same with other vaccines, making them more accessible and convenient. This is critical at a moment when whooping cough cases are surging and adult immunization rates are dismally low.
Not everyone has a primary care doctor or will go to one to get their shots. Nor do all doctors even offer vaccines. Pharmacists can and should be allowed to help - with all CDC-recommended adult vaccines in every state.
Pharmacies operate at a high level of professionalism. Many keep their own records, give patients written receipts and sometimes even notify patients' doctors. Many states also require all vaccination providers to enter shots in a state registry.
Yes, some people may get an extra dose by accident. But even that may not be so bad: Duplication is unlikely to cause side effects other than redness, swelling or a passing low-grade fever, said Elizabeth Rosenblum, a family medicine doctor at University of California, San Diego.
Pharmacists are already crucial to the annual flu shot push. During the swine flu surge in 2009, the CDC recommended the pandemic vaccine for everyone 6 months of age or older. The following year, for the first time, they also recommended the seasonal flu shot to the same broad range of people.
This vastly boosted demand, and pharmacists were increasingly allowed to step in. In 2006-07 they administered roughly 7 percent of adult flu shots. By last year that number was more than 18 percent. Carolyn Bridges, associate director for Adult Immunizations at the Centers for Disease Control, says she's not sure the country could have kept up without the help of the pharmacists.
There's no shortage of work to be done on other vaccines either. In California during the 2010 whooping cough outbreak that killed 10 babies, pharmacists and pharmacy students at UCSD offered free shots to all household contacts of newborns. Because newborns can't receive the whooping cough vaccine themselves, this is one of the best ways to protect them.
They made it easy, with Saturday and evening hours in a little-used waiting room on the postpartum floor. And fully 84 percent of the newborns' family members received Tdap vaccinations before the baby was discharged, according to Rosenblum.
Yet across the country, only 8.2 percent of adults got a Tdap shot, according to a survey in 2010. Rates are also disturbingly low for shingles (14.4 percent of adults age 60 and older in 2010) and for the pneumococcal vaccine, which protects against a bacteria that is a common cause of pneumonia and other infections.
So we need more states to pull pharmacists into the vaccination loop.
There are signs of progress. Earlier this year, Florida passed a law allowing pharmacists to administer vaccines protecting against shingles and pneumonia, Illinois allowed them to give the vaccine against whooping cough to children age 10 and older, and Massachusetts permitted them to give all CDC-recommended adult vaccines.
Other states, including Washington, Connecticut, Colorado, Minnesota and Kentucky, already do the same. But until we can stop pathogens from crossing state lines, they all need to get onboard.