PUBH 1000 Week 10 Population Proposal Example

Defining the Group Before Proposing Anything: A Population Proposal to Offer Pneumococcal Vaccination at Community Pharmacies to Adults Aged 50 to 64 With No Usual Source of Care in a Composite County

Student Name

Walden University

PUBH 1000: Foundations of Public Health

Instructor Name

Month Day, Year

Defining the Group Before Proposing Anything: A Population Proposal to Offer Pneumococcal Vaccination at Community Pharmacies to Adults Aged 50 to 64 With No Usual Source of Care in a Composite County

The Group

This proposal concerns one bounded population: adults aged 50 to 64 who live in a composite county of about 410,000 residents and who report having no usual source of health care, meaning no clinic or doctor they normally go to when sick or for advice. The group is defined first because everything else, the size of the effort, the place it happens and the measure of success, depends on who is included.

Why This Group

In October 2024, the Advisory Committee on Immunization Practices recommended a single dose of pneumococcal conjugate vaccine for all adults aged 50 and older who have not received one, extending an age-based recommendation that previously began at 65 (Kobayashi et al., 2025). Adults aged 50 to 64 are therefore newly eligible on the basis of age alone. Those without a usual source of care are the least likely to hear about the change, since a regular clinician is often the person who recommends vaccines. Research on primary care has long linked a usual source of care to receiving preventive services (Starfield et al., 2005), so this group is likely to fall behind as others are vaccinated.

How Many People Are in the Group

The arithmetic is shown so that a reader can change any assumption and see the effect. If the share without a usual source of care were 15% rather than 11%, for example, the reachable group would rise to about 7,950.

Table 1

Estimating the Reachable Population (Composite Figures)

Note. Composite figures for a county of about 410,000 residents.

The Proposal

Twelve community pharmacies spread across the county would offer the vaccine without an appointment during evening and weekend hours, when adults with jobs and no regular clinic are most able to come. The county health department would supply vaccine for uninsured adults, and pharmacists would record each dose in the state immunization registry. Outreach would reach the group where it already is: notices at the pharmacy counter, in food bank lines and at the county's two community colleges' evening programs. A systematic review found that vaccination coverage rose in every included study when pharmacists were involved in immunization, whether as educators, facilitators or administrators of vaccines (Isenor et al., 2016), which supports using pharmacies rather than creating new clinics.

One Measure of Success, Fixed in Advance

Success will be measured by a single figure: the share of the reachable group with a recorded conjugate pneumococcal dose 12 months after the program begins, drawn from the state registry. The registry currently shows about 15% of adults aged 50 to 64 in the county with a dose, and the proposal sets a target of 30% within the group. The figure is fixed now so that the program cannot later be judged by whichever measure happens to look best.

Why Pharmacies, Evenings and Weekends

Adults without a usual source of care often lack one because of cost, work schedules or distance, and a program that asks them to make an appointment at a clinic during working hours repeats the barrier. Community pharmacies are already open in the evenings and on weekends, are located in most neighborhoods and are visited by people for prescriptions, groceries and household goods. Walking in without an appointment removes the need to arrange time off work. The county health department's role is to supply vaccine for uninsured adults, provide the outreach materials and track progress through the registry. Pharmacists in every participating store would follow the same standing order, so a person turned away at one location would not be accepted at another.

How the Program Would Run

In the first month, the department would recruit pharmacies in the census tracts with the highest shares of adults without a usual source of care, train staff on the new age-based recommendation and confirm that each store can report doses to the registry the same day. Outreach would begin in the second month. The department would check registry counts each month and move outreach to areas where uptake lags. At six months, it would report progress to the county board and decide whether to add pharmacies.

What the Proposal Does Not Do

It does not address adults with a usual source of care, who can be reached through their clinics, or adults aged 65 and older, who were already covered by earlier recommendations. It does not claim that vaccination will prevent a particular number of cases, since the county's data do not support such an estimate.

Equity Check

Because the group is defined by having no usual source of care, it is likely to include more uninsured adults, more adults with low incomes and more adults who recently moved to the county than the age group as a whole. The program would track registry doses by the census tract of each person's address, so the department can see whether uptake is reaching the tracts with the highest shares of adults without a usual source of care, not just the tracts nearest the busiest pharmacies.

Limits

The share of adults with no usual source of care comes from a survey and carries uncertainty. Registry records may miss doses given outside the state. Some people in the group may distrust pharmacies or vaccines, and the proposal's reach may be lower than the table suggests.

References

Isenor, J. E., Edwards, N. T., Alia, T. A., Slayter, K. L., MacDougall, D. M., McNeil, S. A., & Bowles, S. K. (2016). Impact of pharmacists as immunizers on vaccination rates: A systematic review and meta-analysis. Vaccine, 34(47), 5708-5723. https://doi.org/10.1016/j.vaccine.2016.08.085

Kobayashi, M., Leidner, A. J., Gierke, R., Xing, W., Accorsi, E., Moro, P., Kamboj, M., Kuchel, G. A., Schechter, R., Loehr, J., & Cohen, A. L. (2025). Expanded recommendations for use of pneumococcal conjugate vaccines among adults aged ≥50 years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2024. Morbidity and Mortality Weekly Report, 74(1), 1-8. https://doi.org/10.15585/mmwr.mm7401a1

Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83(3), 457-502. https://doi.org/10.1111/j.1468-0009.2005.00409.x