The Impact of Portuguese Community Pharmacies on Influenza Vaccination Accessibility and Coverage

Abstract Background Vaccination reduces influenza infections. Non-adherence often stems from external barriers like distance to vaccination sites. To counteract the projected coverage decrease for 2023/24, Portugal’s Government expanded free Influenza vaccination to those ≥ 60 and to community pharmacies (CP), enhancing proximity and availability. This study aimed to assess the impact of CP inclusion on the distance to vaccination sites and on Influenza vaccine coverage in the 2023/24 campaign. Methods Analytical study, evaluating the average distance (km) from population to the nearest vaccination site per municipality using GPS coordinates from National Health Service (NHS) sites and CP. The Global Human Settlement resident population grid was derived from Eurostat 2011 Census, Corine Land Cover Refined 2006 and European Settlement Map 2016. Scenarios with and without CP were compared. The difference (%) in distances between 2022/23 (NHS sites) and 2023/24 (NHS sites and CP) and the coverage for the top and bottom 10% of municipalities with the highest and lowest distance reductions were calculated. Results In the 2023/24 Influenza vaccination campaign, 844 NHS sites and 2487 CP participated. Excluding CP, the average distance to the nearest NHS site was 2.4 km, decreasing to 1.2 km with CP inclusion (-50.5%). As of March 31, 2024, influenza vaccine coverage for those aged ≥65 was 72.1%, decreasing 0.1 percentage points (pp) compared to 2022/23 (72.2%). For the top 10% municipalities with the highest distance reduction (up to 66.5%), coverage increased by 1.3 pp compared to 2022/23. Conversely, the bottom 10% (reduction under 10.3%) experienced a decrease of 4.5 pp. Conclusions The inclusion of pharmacies has effectively reduced access barriers, filled geographical gaps, and improved proximity to vaccination. This strategy appears to have a positive impact on influenza vaccination coverage, particularly amid growing hesitancy, with potential for broader public health strategies. Key messages • The inclusion of community pharmacies in the 2023/24 Influenza vaccination campaign reduced the average distance to the nearest vaccination site by 50.5%, from 2.4 km to 1.2 km. • In 2023/24, for the top 10% municipalities with the highest distance reduction (up to 66.5%), coverage increased 1.3 pp compared to 2022/23.