This town ain’t big enough for the two of us – except, it is.

“This town ain’t big enough for the two of us” says Woody in Toy Story. Remember the storyline of the Pixar–Disney Film Toy Story where Woody, the lanky cowboy, starts the story feeling threatened by the new toy in Andy’s room, Buzz Lightyear. We are right in the middle of a Toy Story narrative with physicians once again feeling threatened by pharmacists recommending and administering vaccines. Even going as far as questioning pharmacist training and abilities…

Pharmacy associations support educating student pharmacists on immunizations and conducting pharmacist continuing education on the topic.[i] The Accreditation Council for Pharmacy Education (ACPE) Appendix 1 of the 2016 Standards includes required Doctor of Pharmacy program curricular elements for public health including immunization delivery certificate training.[ii] According to a recent survey, 91.3% of schools offer the APhA Pharmacy-Based Immunization Delivery Program with the remaining offering another equivalent training.[iii] The APhA certificate training program includes 20 hours of training comprised of hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and recognition and treatment of emergency reactions to vaccines.[iv] In addition, all responding schools indicated that they incorporate immunization training and skills through the certificate training program or directly into required curricula – for an average of 16 “contact hours” (live training) and additional independent home study.ⁱⁱⁱ Pharmacists who graduated prior to immunization training being a required Doctor of Pharmacy curricular element have completed an immunization certificate training program as directed by their state scope of practice. Similarly, many have completed the APhA Immunization Delivery Program with the same required components as student pharmacists.

While medicine and nursing curricula includes components of vaccine development and immune response through immunology and other coursework, the number of course hours plus focused training and education on vaccine recommendations, administration technique, and vaccine storage and handling are far fewer than in the pharmacy curricula. In fact, there is no standardized immunization training for those professionals – only for pharmacists!

It is amazing that with more than 300 million COVID-19 vaccines administered, more than 1 million lives saved, and $450 billion in health care dollars saved[v], pharmacist immunization training and ability is still coming into question.

In the Core Principles & Values of Effective Team-Based Care, the following quote appears, “The clinician operating in isolation is now seen as undesirable in health care—a lone ranger, a cowboy, an individual who works long and hard to provide the care needed, but whose dependence on solitary resources and perspective may put the patient at risk.”[vi] Physicians should take heed from Toy Story…eventually Woody and Buzz Lightyear work through their differences and form an alliance. The core principles are reflected by Woody and Buzz Lightyear’s shared goals, clear roles, mutual trust, effective communication, and measurable process and outcomes to get back to Andy’s room.

Physicians and pharmacists must work together! We need supportive and collaborative partnerships within the vaccine neighborhood for patients and our communities. These partnerships ensure that patients have ready access to their recommended vaccines and are protected against vaccine-preventable diseases. Andy’s reflection in Toy Story 2 is “You should never tangle with the unstoppable duo of Woody and Buzz Lightyear!”  Pharmacists and physicians working together are that unstoppable duo.

Adult vaccination rates in the United States continue to be lower than recommended by Healthy People 2030.[vii] Data from 2016–2020 reveal that fewer than half of adults have received recommended vaccines.[viii] Furthermore, vaccine hesitancy and fatigue are real issues for patients and healthcare providers. Early work around vaccinations found that when pharmacists were immunizing in communities, total vaccination rates increased, validating that access and consistent messaging are important.[ix]  

For our physician colleagues, the town is definitely big enough for the two of us… our mutual patients need vaccines and access is crucial. Our patients would certainly agree with the aliens in Toy Story, “You have saved our lives. We are eternally grateful.”

Pharmacists are the most well-educated vaccine experts on the team and the contributions of the nation’s pharmacists are irreplaceable. To quote Buzz Lightyear,

“To infinity and Beyond.” Together, physicians and pharmacists can protect our patients and communities against vaccine-preventable diseases.

Guest authored by:

Jean-Venable “Kelly” R. Goode, Pharm.D., BCPS, FAPhA, FCCP

Virginia Commonwealth University School of Pharmacy

Liaison Representative for the American Pharmacists Association to the Advisory Committee on Immunization Practices

Former President, American Pharmacists Association

Brigid K. Groves, PharmD, MS

Vice President, Professional Affairs, American Pharmacists Association