Due to their demographic reach, accessibility, and existing infrastructure for vaccine distribution, pharmacies offer viable alternate sites for human papillomavirus (HPV) immunization. However, in the United States, pharmacies are rarely utilized for teenage HPV vaccination. By mapping process evaluation results onto key implementation science constructs such as service penetration, acceptability, appropriateness, feasibility, fidelity, adoption, and sustainability, we aimed to document the challenges and opportunities of implementing pharmacy-located HPV vaccination services in five US states. Pilot programs with various processes and recruitment techniques were planned in North Carolina, Michigan, Iowa, Kentucky, and Oregon. The sites were open for enrollment for a total of 12 months. Despite significant efforts in these jurisdictions, just 13 HPV vaccination doses were delivered to adolescents and three doses to young adults of legal drinking age. Researchers discovered two key causes for this poor performance. First, poor service penetration and appropriateness results pointed to engagement barriers: low parent demand and pharmacy staff involvement. Second, low feasibility, acceptance, and sustainability results appeared to be the result of administrative barriers, such as a lack of third-party reimbursement and inadequate integration into primary care systems. In summary, experimental studies in five states all had difficulty administering HPV vaccinations.
Expanding third-party reimbursement to cover all vaccines administered by pharmacists, increasing public awareness of pharmacists’ immunization training, and improving care coordination with primary care providers are all possibilities for making pharmacies a successful setting for adolescent HPV vaccination.