Systematic Review of Pharmacist-Administered Paediatric Vaccinations in Low- and Lower-Middle-Income Countries.

BACKGROUND: An estimated 25 million children globally miss routine vaccinations each year, with 14.3 million classified as zero-dose and the majority residing in low- and lower-middle-income countries (LMICs). Pharmacies are recognised as accessible healthcare delivery points, yet their role in paediatric immunisation in LMICs is not well defined. This literature review sought to evaluate pharmacist-provided vaccination services for paediatric patients in LMICs. METHODS: A systematic review was conducted following Cochrane and PRISMA guidelines. Five databases and grey literature were searched for articles published between January 2005 and June 2026. Studies were reviewed by multiple authors to reduce the risk of individual bias and included if they reported original research involving pharmacists in LMICs delivering vaccination-related services to children aged 12 years and under. For each study, items intended for extraction included country, pharmacy setting, specific vaccines administered, patient age range, and specific roles for the pharmacist in the vaccination administration process. The protocol for this systematic review was registered with the Nelson Mandela University Faculty of Health Sciences Postgraduate Studies Committee and the Research Ethics Committee for Humans (H23-HEA-PHA-007). RESULTS: Of 162 identified records, four studies from Bangladesh, Ethiopia, India, and Jordan met inclusion criteria. No study described pharmacists routinely administering paediatric vaccines. Instead, findings focused on indirect involvement, system readiness, and public perception. Significant barriers included limited infrastructure, inadequate training, and lack of regulatory authority. Study results were limited by a lack of information published and inclusion of only articles available in English. CONCLUSIONS: Evidence on pharmacist-administered paediatric vaccinations in LMICs is scarce. Expanding pharmacist roles could improve access and reduce zero-dose prevalence, but would require policy support, infrastructure investment, and further implementation research.