Evaluating access to COVID-19 vaccines for children and adolescents in North Carolina through community pharmacies, 2021-2023.

INTRODUCTION: Pharmacists' impact on adult immunization access is well-documented, but limited data exist supporting involvement in vaccination efforts for individuals under 18 years. This study examined trends in child and adolescent COVID-19 vaccinations delivered by pharmacists in North Carolina. METHODS: COVID-19 Vaccine Management System (CVMS) data were analyzed to assess pharmacy utilization for vaccinations across 1,747,790 children and adolescents aged 3-17 years between January 1, 2021, and June 26, 2023. Logistic regression analysis evaluated whether age, rurality, race, and ethnicity influenced the likelihood of pharmacy-based vaccination for the first dose. A multi-level logistic model examined the relationship between pharmacy utilization and number of doses administered. RESULTS: Pharmacies accounted for 42% of initial COVID-19 vaccinations administered among children and adolescents in North Carolina between 2021 and 2023. Overall, COVID-19 vaccination coverage rates for the first vaccine dose were 59.1% among those 12-17 years, 37.4% among those 5-11 years, and 3.5% among those 3-4 years. Compared to children aged 3-4 years, children aged 5-11 years and 12-17 years were 19.7 and 30.5 percentage points more likely, respectively, to be vaccinated at pharmacies. Pharmacy-based vaccination reach was consistent across rural (42.0%), suburban (42.9%), and urban (42.2%) areas. Racial disparities were noted, where lower proportions of Black and Hispanic children received their first COVID-19 vaccination at pharmacies compared to White and non-Hispanic counterparts, respectively (p < 0.001). Children receiving their second dose were 0.6 percentage points more likely to be vaccinated at pharmacies compared to those receiving their first dose, increasing to 5.7 and 11.8 percentage points for third and fourth or more doses, respectively. CONCLUSION: Pharmacies played a pivotal role in increasing vaccination access for individuals under 18 years in North Carolina. Broader authority for pharmacy-based vaccinations, training, and other targeted initiatives would likely improve access to pharmacy-based vaccination services for children and adolescents.