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Institute Report
Assessing the Impact of State Pharmacist Vaccination Authority on Vaccine Uptake in the U.S.
An Analysis of State-level Policies and Adult Vaccination Rates
Feb 25, 2025
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Report Summary

Vaccination is one of the most cost-effective public health interventions and has been noted to have had a significant effect on reducing not only mortality but also disease, hospitalization, disability, and disparity. Despite these benefits, adult immunization rates in the U.S. consistently fall short of public health goals. Structural access barriers, such as limitations in vaccine availability and patient travel/time commitment, can serve as bottlenecks in vaccine uptake. While pharmacists are the most accessible healthcare professionals in the U.S., states still vary in their policies on vaccine administration authority for pharmacists. Therefore, it is essential to understand the variance and impact of state vaccination authority on vaccine uptake and where improvements can be made.

This report collates state-level research on pharmacist vaccination authority policies and analyzes state-level adult vaccination rates for the RSV, Pneumococcal, and Shingles vaccines. By examining these data, the report highlights differences in overall vaccination rates among groups of states with varying levels of restrictions on pharmacists’ ability to prescribe and administer adult vaccinations independently. This assessment also estimates the number of people who may not have received vaccinations due to their state policies, based on relative differences in vaccination rates between these groups of states. By shedding light on state regulations that limit pharmacists' ability to provide immunizations, the findings intend to guide policymakers in making informed decisions to optimize pharmacists’ role in the adult immunization process.

Key Findings:


2023 RSV State Pharmacist Vaccination Authority Map
  • For the RSV (Respiratory Syncytial Virus) vaccines in 2023, 20 states allowed pharmacists to prescribe and administer to adults independently or through a statewide standing order (SSO), which are generally considered the least restrictive policies regarding pharmacists’ autonomy in vaccination.
  • Additionally, 27 states allowed pharmacists to prescribe and administer through a physician protocol, which is more restrictive because it only allows pharmacists to administer vaccines to patients when a written authorization between a physician and pharmacist exists.
  • States that require a prescription for pharmacists to vaccinate are considered the most restrictive, as a prescription is a singular authorization specific to one vaccine and patient; for RSV, 4 states only allowed pharmacists to administer with a physician's prescription.

2023 PCV20 and Shingles State Pharmacist Vaccination Authority Map
  • For the PCV20 (Pneumococcal 20-Valent Conjugate) and Shingles (or Zoster) vaccines in 2023, 23 states allowed pharmacists to prescribe and administer independently or through a statewide standing order (SSO)
  • The remaining 28 states only allowed pharmacists to prescribe and administer either of these two vaccines through a physician protocol.
  • In contrast with the RSV vaccines, there were no states with a prescription requirement for pharmacists to administer the PCV20 or Shingles vaccines in 2023.

Vaccinated Population per 100,000 by Vaccine, State Pharmacist Vaccination Authority, and Age Group
  • For RSV vaccinations in adults age 60+, states with protocols have a 3% lower average vaccination rate, and states that require physician prescriptions have a 14% lower average vaccination rate than states that allow independent/SSO pharmacist vaccination.
  • For PCV20, states with protocols have a 13% lower average vaccination rate for adults 18+, while for adults 65+, the average vaccination rate is 9% lower. For Shingles vaccinations in adults age 50+, states with protocols have a 10% lower average vaccination rate than states that allow independent/SSO pharmacist vaccination.
  • If the vaccination rates for states that require protocols for pharmacists to administer vaccines were comparable to states that allow pharmacists to administer vaccines independently/through an SSO, around 534,000 additional people age 60+ may have received an RSV vaccine, 828,000 additional people age 18+ may have received a PCV20 vaccine, and 953,000 additional people age 50+ may have received a Shingles vaccine.
  • Similarly, if the vaccination rates for states that require physician prescriptions were comparable to states that allow independent/SSO pharmacist vaccination, then an additional 123,000 people age 60+ may have received an RSV vaccine.

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