Perhaps under acknowledged in the adult immunization delivery system are pharmacists. Depending on the state, pharmacists can assess and administer vaccines to patients under vaccination protocols, standing orders or with a physician’s prescription for vaccination. As most individuals live within miles of a community pharmacy that offer accessibility, broad operating hours, and lack of visit fees or few requirements for appointments, the role of the local community pharmacy and pharmacists has evolved. Many pharmacies have embraced immunizations as a service offering seasonal influenza and often a range of Advisory Committee on Immunization Practices-recommended vaccines across the lifespan. Pharmacists are moving away from strictly product distribution to supporting public health and prevention, experiencing tremendous growth and expansion of services across the public health and primary care spectrum. Pharmacies are using vaccination services as a strategy to transform and advance community pharmacy, shaping a model that provides greater convenience and access to vaccines and other preventive services benefiting population and public health while seeking to optimize health outcomes and control health care costs.

Aspects of the COVID-19 vaccination campaign differed from routine vaccines, including emergency use authorizations, the prioritization of access, and the politicization of messaging. Subsequently, many parents reported lower vaccine confidence relative to routine vaccines, and vaccination coverage stalled below targets. This study aimed to understand parental vaccine decision making and compare COVID-19 versus routine vaccine decision making. We conducted nine virtual focus groups between 25 February 2022–11 March 2022 with parents (n = 41) of the Children’s Hospital of Philadelphia’s patients, recruited via email and stratified by vaccine hesitancy status (non-hesitant vs. hesitant). Transcripts were analyzed using the vaccine hesitancy matrix domains. Of 41 total participants, 25 (61.0%) were non-hesitant, 16 (39.0%) were hesitant or their children were not up-to-date on adolescent vaccines, and most self-identified as female (95.1%) and White/Caucasian (61.0%). Most participants (87.5%) were fully vaccinated against COVID-19 and many of their first children (n = 26, 63.4%) were vaccinated against influenza. Several themes emerged regarding decision making: individual influences, group influences, vaccine and vaccine program influences, and contextual influences. While some influences were similar for routine and COVID-19 vaccine decision making (e.g., needing evidence-based information), other factors were vaccine- or situation-specific. Building trust requires a multi-faceted concerted effort that involves addressing the complex vaccine decision-making process.