During the COVID-19 pandemic, pharmacies emerged as critical vaccine access sites, overtaking physicians’ offices, community health centers, and local health departments. Before then, pharmacies administered more than a quarter of all adult flu vaccines. By early 2024, pharmacies provided just under half of flu vaccines and more than 70 percent of COVID boosters. However, recent federal policy actions have substantially narrowed COVID vaccine recommendations for healthy people under age 65, contrary to clinical evidence. These changes have created confusion and disrupted access — particularly at pharmacies — for people seeking vaccines as the country enters the cold-weather virus season. In this blog post, we explore how pharmacies became key vaccine providers, why they are well-suited for this role, and how current federal policy actions are impeding their ability to effectively deliver vaccines.
Americans’ increased reliance on pharmacies for vaccines began during the COVID pandemic response. Launched in February 2021, the Federal Retail Pharmacy Program expanded national vaccination capacity by creating partnerships among the federal government, states, national pharmacy chains, and independent pharmacy networks. The program leveraged pharmacies’ expertise to encourage rapid, widespread immunization. By June 2021, nearly three-quarters of pharmacies nationwide — or more than 46,000 — participated. These pharmacies administered slightly less than half of all COVID vaccine doses nationwide by September 2023, with 46 percent of vaccinated older adults and 38 percent of vaccinated children receiving doses at pharmacies.
Pharmacies are accessible and trusted vaccine providers, particularly in rural areas. Receiving vaccines at pharmacies is convenient; about 90 percent of U.S. residents live within five miles of a pharmacy. During the COVID response, West Virginia, a state with few pharmacy chain locations, developed a separate program that relied on independent community pharmacies. Connecticut, New Mexico, and North Dakota subsequently adopted this approach, relying on local independent pharmacists to reach their most rural, at-risk, underserved residents. Similarly, community pharmacists in Pennsylvania were important COVID vaccine access points. They built patient trust, fostered community partnerships, and dispelled misinformation. Pharmacists also have been recognized for reducing vaccine waste through immunization uptake initiatives and putting evidence-based policy into practice through patient counseling and health promotion in their local communities.
Recent federal policy changes have created confusion and barriers for people who depend on pharmacies as convenient and trusted vaccine providers. Until May 2025, the Centers for Disease Control and Prevention (CDC) recommended the COVID vaccine as a routine immunization. Restrictions began when U.S. Health and Human Services Secretary Robert F. Kennedy Jr. unilaterally removed the CDC recommendation for healthy pregnant women and children. Subsequently, the CDC retained the vaccine on the children’s immunization schedule, though it scaled back its previous routine recommendation to “shared clinical decision-making” between patients and providers. Next, the Food and Drug Administration limited its labeling approval for this year’s booster to older adults and people with certain preexisting health conditions. Then, the Advisory Committee on Immunization Practices recommended the booster for everyone older than 6 months old based on shared clinical decision-making and the CDC adopted those recommendations. This should open the door for healthy people under age 65 to seek the booster off-label after consulting with a health care provider. Despite the uncertainty, most health insurance plans will continue to cover the booster without cost sharing.
Nevertheless, the conflicting 2025 COVID vaccine recommendations have disrupted access in states that only allow pharmacists to administer vaccines included on the CDC immunization schedules.1 If a state’s “scope of practice” law does not authorize pharmacists to provide vaccines over the counter, healthy people under age 65 who want this year’s COVID booster may need a prescription to obtain it at a pharmacy, creating a potential barrier to access. In response, 25 states and the District of Columbia have authorized pharmacists to administer the booster without a prescription as of September 2025. Some states, like Oregon, have teetered between requiring and eliminating the need for prescriptions.
As we head into the colder months, many people who want the COVID booster have been unable to get one at their local pharmacy as they have in previous years. Instead, depending on where they live, they have faced delays and obstacles. The web of recent federal policy changes has confused the public, states, and pharmacy practitioners; sowed mistrust; and introduced tangible barriers to community-based vaccine administration. Along with the variation in state responses, this endangers vaccination rates and threatens to drive up COVID case rates, costs, and mortality. Although Secretary Kennedy assures us that anybody can get the COVID booster, federal agency actions have complicated vaccine access for many people.
