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You Have To Be 14 To Get A Flu Shot At A Pharmacy In North Carolina — Why?


What is the right age to get a flu vaccination at a pharmacy? In North Carolina, apparently, it’s 14. The age limit was written into state law a few years ago. Across the country, age limits for pharmacists to give vaccines range from 3 years old in some places to 18 in others.  But why?

Since the 1990s, states have been changing laws to allow pharmacists to give more and more vaccines to patients at younger ages. In 26 states and Washington D.C., pharmacists can give vaccines to people at any age. The rest have varying limits starting as young as 3-years-old in Arizona and as old as 18 for vaccines in North Carolina — except for the flu shot. Texas A&M Health Law Professor Cason Schmit has studied these changes for years.

“There are many of these laws that have patient age restrictions that prevent pharmacists from vaccinating many patients before they're exposed to these preventable diseases,” Schmit said, “And if that’s the case, many age restrictions are acting as a barrier to effective vaccinations.”

In North Carolina, pharmacists can give five different types of vaccinations to adults with a prescription from a doctor. There are more conditions: pharmacists have to notify the patient’s primary care doctor. If the patient doesn’t have one, pharmacists have to explain the importance of having one and share information prepared by medical associations including the North Carolina Academy of Family Physicians. Greg Griggs is the executive vice president of that organization. He says the doctors’ concern is that everyone’s medical needs are different and some people with other illnesses or weakened immune systems should consult a doctor before getting vaccines.

“There’s a lot more that goes on at that visit than just an immunization,” Griggs said.

And Griggs points out many times those shots are given during annual visits when other medical issues are discussed. But why is the age limit 14 for flu shots in North Carolina?

“I specifically do not know why 14,” Griggs said.    

A little history. In 2009, during the H1N1 swine flu pandemic, the state granted emergency authority to pharmacists to give the seasonal flu and H1N1 vaccine. That authority was made permanent in 2013. Griggs says the vaccine is very safe and physicians can’t vaccinate everyone. 

“We’ve all got to be working together to get everyone vaccinated every year,” he said. “The pharmacists can’t do it all. The physicians can’t do it all.”  

The state pharmacy association says it has heard from frustrated parents who try and get their kids vaccinated at the same time they get their annual flu shot at the pharmacy, but can’t. Schmit adds that if the public health goal of changing these laws is to get more people immunized by making it more convenient for patients, adding age limits or requirements — as North Carolina has done for patients to get a doctor’s prescription before getting a shot at the pharmacy — isn’t really helping.   

“It’s far more convenient to them, I imagine, to get simply get that immunization from the original prescriber,” Schmit said. “So the states that require these individualized prescriptions aren’t really making pharmacists a more convenient vaccination provider."

Schmit said it’s hard to figure out whether states that allow pharmacists to give the shots have increased vaccination rates because there isn’t good data on where people get them. But he expects states to continue to give pharmacists more vaccination authority. In some places, that’s extending to other medical professionals. The American Dental Association says Illinois and Minnesota are now allowing dentists to give the flu vaccine to adult patients.