Do community pharmacies add value to immunization programs? A systematic review from the UK between 2015-2024

BackgroundCommunity pharmacies (CPs) have played an increasing role in the delivery of influenza and COVID-19 vaccination in recent years. This systematic review updates an analysis conducted in 2015, looking at the acceptability and cost-effectiveness of CPs and their impact on inequalities and improving vaccine uptake. MethodsWe searched MEDLINE, Embase, Scopus, Web of Science and CINAHL (09/10/2025) for English-language papers (2015-25) and identified unpublished literature through NHS regional teams, UKHSA, and pharmacy associations. Studies on NHS-commissioned community pharmacy immunization services were included, private/travel vaccinations excluded. Quality of identified literature was appraised using the Mixed Methods Appraisal Tool. The AACODS checklist was completed for non-peer-reviewed grey literature. A narrative synthesis categorized outcomes into acceptability, vaccine uptake, cost-effectiveness, and impact on inequalities. ResultsEleven peer-reviewed articles and five grey literature reports of evaluations of CP delivered influenza, COVID-19, Measles-Mumps-Rubella, Mpox, Polio and Respiratory Syncitial Virus (RSV) immunisation programmes were included. While CPs account for a growing share of vaccination delivery for certain seasonal programmes, there was no evidence of an increase in coverage rates or reduced inequity in vaccine uptake. User acceptability of CP-delivery was high, with convenience and accessibility cited. The few studies reporting comparator data suggest similar levels of favourability to GP-led delivery. Barriers included fragmented data systems, logistical constraints, and high wastage rates. No studies included evidence on cost-effectiveness. Some papers suggested CPs had the potential to reach underserved and multi-ethnic communities, but there was a lack of robust evidence for this. ConclusionsCPs can support immunisation delivery, with impact varying by context. There is no cost-effectiveness analysis that incorporates a comprehensive assessment of all relevant clinical, economic, and contextual factors. Evidence suggests CPs may strengthen capacity during periods of peak demand but require better integration and support to improve equity and contribute meaningfully to routine vaccination programme delivery. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSCommunity pharmacies (CPs) have increasingly contributed to vaccination delivery in the UK, particularly for influenza and COVID-19, but the broader impact, cost-effectiveness, and equity implications of CP-led programmes remain unclear. An earlier review published in 2015 highlighted limited evidence on these outcomes. What this study addsThis systematic review finds that while CPs play a growing role in vaccination delivery, there is no robust evidence that this has improved overall vaccine uptake or reduced health inequalities. Acceptability among users is high, but reported issues include poor data integration and logistical barriers. The lack of cost effectiveness evaluations limit assessment of impact and scalability. How this study might affect research, practice or policyFindings highlight the need for more comprehensive evaluations of CP-led vaccination services, particularly on cost-effectiveness and equity impact. Policymakers should consider investing in better integration and infrastructure to support CPs in contributing more meaningfully to routine and targeted immunisation efforts.