12/21/2018

For Kids, State Flu Shot Rules Vary

4:47 minutes

a calm child receiving a flu shot
A child receiving a flu shot. Credit: CNK02, via Shutterstock.

state of science icon

This segment is part of The State of Science, a series featuring science stories from public radio stations across the United States. Alex Olgin is a reporter at WFAE, the NPR station in Charlotte. This story originally appeared on WFAE.org


What is the right age to get a flu vaccination at a pharmacy? In North Carolina, apparently, it’s 14. The age limit was written into state law a few years ago. Across the country, age limits for pharmacists to give vaccines range from 3 years old in some places to 18 in others.  But why?

Since the 1990s, states have been changing laws to allow pharmacists to give more and more vaccines to patients at younger ages. In 26 states and Washington D.C., pharmacists can give vaccines to people at any age. The rest have varying limits starting as young as 3-years-old in Arizona and as old as 18 for vaccines in North Carolina—except for the flu shot. Texas A&M Health Law Professor Cason Schmit has studied these changes for years.

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“There are many of these laws that have patient age restrictions that prevent pharmacists from vaccinating many patients before they’re exposed to these preventable diseases,” Schmit said, “And if that’s the case, many age restrictions are acting as a barrier to effective vaccinations.”

In North Carolina, pharmacists can give five different types of vaccinations to adults with a prescription from a doctor. There are more conditions: pharmacists have to notify the patient’s primary care doctor. If the patient doesn’t have one, pharmacists have to explain the importance of having one and share information prepared by medical associations including the North Carolina Academy of Family Physicians. Greg Griggs is the executive vice president of that organization. He says the doctors’ concern is that everyone’s medical needs are different and some people with other illnesses or weakened immune systems should consult a doctor before getting vaccines.

“There’s a lot more that goes on at that visit than just an immunization,” Griggs said.

And Griggs points out many times those shots are given during annual visits when other medical issues are discussed. But why is the age limit 14 for flu shots in North Carolina?

“I specifically do not know why 14,” Griggs said.

A little history. In 2009, during the H1N1 swine flu pandemic, the state granted emergency authority to pharmacists to give the seasonal flu and H1N1 vaccine. That authority was made permanent in 2013. Griggs says the vaccine is very safe and physicians can’t vaccinate everyone.

“We’ve all got to be working together to get everyone vaccinated every year,” he said. “The pharmacists can’t do it all. The physicians can’t do it all.”

The state pharmacy association says it has heard from frustrated parents who try and get their kids vaccinated at the same time they get their annual flu shot at the pharmacy, but can’t. Schmit adds that if the public health goal of changing these laws is to get more people immunized by making it more convenient for patients, adding age limits or requirements—as North Carolina has done for patients to get a doctor’s prescription before getting a shot at the pharmacy—isn’t really helping.

“It’s far more convenient to them, I imagine, to get simply get that immunization from the original prescriber,” Schmit said. “So the states that require these individualized prescriptions aren’t really making pharmacists a more convenient vaccination provider.”

Schmit said it’s hard to figure out whether states that allow pharmacists to give the shots have increasing vaccination rates because there isn’t good data on where people get them. But he expects states to continue to give pharmacists more vaccination authority. In some places, that’s extending to other medical professionals. The American Dental Association says Illinois and Minnesota are now allowing dentists to give the flu vaccine to adult patients.

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Segment Guests

Alex Olgin

Alex Olgin is a health reporter at WFAE in Charlotte, North Carolina.

Segment Transcript

IRA FLATOW: Now it’s time to check in on the state of science. 

SPEAKER 2: This is KPRE. 

SPEAKER 3: For WWNO. 

SPEAKER 4: St. Louis Public Radio. 

SPEAKER 5: Iowa Public Radio news. 

IRA FLATOW: Local science stories of national significance– OK, picture this. Flu season is coming, so you decide to drive the whole family over to the local pharmacy to get vaccinated. But when you get there, your teenager is denied the shot. Why is that? 

Well, the rules for vaccinations differ from state to state. And in some states, there’s an age cutoff for getting a pharmacy vaccination. Joining me to talk about that is Alex Olgin, health reporter at WFAE in Charlotte, North Carolina. And welcome to the show, Alex. 

ALEX OLGIN: Thanks, Ira. 

IRA FLATOW: So why can’t everybody get a flu shot at the same place 

Because of state laws, like you said, each state has different rules about vaccines pharmacists can give, if they can give vaccines at all. Like in North Carolina, they even list out which five vaccines, other than the flu shot, pharmacies can give, and then they have this like special exception and special age limit for the flu shot. And the expert I talked to has been studying this. And said since the 1990s, states across the country have been expanding pharmacists’ vaccine authority. 

IRA FLATOW: So what is the age limit in North Carolina for the flu shot? 

ALEX OLGIN: So for the flu shot, you have to be 14 or older, and that was relatively recently changed. If you remember back to 2009, the swine flu pandemic, I actually got swine flu, although I was not living in North Carolina. So the state medical board said we need to grant some emergency authority, and let pharmacists give these flu vaccines to people as young as 14. And then in 2013, the state lawmakers said, all right, let’s codify this, and they put it into state law. 

IRA FLATOW: So how many other states have these kinds of rules? 

ALEX OLGIN: So all across the board and they vary. So some states say, well, pharmacists can give vaccines, but then you also have to have like a prior authorization from a doctor or primary care physician. Or they can give the flu shot, but they can’t give other vaccines. 

So it’s really all over the map. So last we checked, in 26 states and DC, pharmacists can give vaccines to people at any age. But like I said, there’s all kinds of different limits. 

IRA FLATOW: Mm-hmm, so you have varying limits. Three-year-olds can get them in some states but not in other states? 

ALEX OLGIN: Yeah, Arizona allows people as young as three to get vaccines at the pharmacy. It’s kind of a public health question. If you want lots of people to get vaccinated, should we make it easier for them to get vaccinated? AKA, like you said, take the whole family to the pharmacy and get it all done at once. 

IRA FLATOW: I heard a story that a doctor and a dentist can give the vaccine too? 

ALEX OLGIN: Yeah, so I asked the American Dental Association about this, and they said that in Illinois and Minnesota– those states are now allowing dentists to give the flu vaccine to adult patients. Again, there’s that age limit. You got to be 18 or older. I think some of the public health theory behind this is if someone is coming to the dentist every six months but they’re not going to their primary care doctor, let’s just get it to them while we can. 

And let’s not forget the economic side of things because with the ACA as it is, I guess before it was declared unconstitutional, all preventive care is covered. And so insurance companies have to pay for the flu vaccine. So whoever gives the vaccine can get reimbursed. 

IRA FLATOW: Now that makes a lot of sense because if you think about it, people do go to the dentist for a cleaning or something much more than they probably go to the doctor. People wait 5, 10 years to go to the doctor sometimes. And so do you think that states are going to basically change their rules about the vaccination and when they can then allow teenagers to be vaccinated? 

ALEX OLGIN: So it’s funny you mention that. I just looked it up. And earlier this week, New Jersey– the governor there signed a law expanding vaccination authority to pharmacist interns. Of course, they have to be supervised by a fully licensed pharmacist, but that was, to my knowledge, the most recent expansion. 

I know there has been some murmurs around the state that pharmacists are not thrilled that there are these age limits. But the state law here actually says that if someone goes to get a vaccine, the pharmacists are supposed to tell their primary care doctor. And if a patient says, well, I don’t have a primary care doctor, then the pharmacist is supposed to tell the patient about the benefits of having a primary care doctor written by some of the doctors associations in North Carolina. 

IRA FLATOW: If you’re 13, try to tell a teenager. 

ALEX OLGIN: Exactly. Exactly. 

IRA FLATOW: Thank you, Alex. 

ALEX OLGIN: You’re welcome. 

IRA FLATOW: Have a happy holiday. Alex Olgin is health reporter at WFAE in Charlotte, North Carolina.

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