Pharmacy vaccine records don't sync to state registries

When a parent gets their child vaccinated at CVS, Walgreens, or a grocery-store pharmacy, that dose often never appears in the state Immunization Information System (IIS). The pediatrician, who checks the IIS before the next well-child visit, sees no record of the dose. So what? The pediatrician either skips the dose (leaving the child under-protected) or re-administers it (exposing the child to an unnecessary injection and wasting a dose). So what? Multiply this across millions of pharmacy-administered doses per year, and you get systematic inaccuracy in the national immunization picture -- public health officials cannot reliably measure coverage rates or identify under-vaccinated pockets. So what? Outbreak response becomes slower because the data showing who is actually protected is wrong. Why does this persist? Each of the 64 US jurisdictional IIS systems was built independently in the 1990s on different technology stacks. Only 38% of jurisdictions expressly allow interstate data sharing. Pharmacies use different EHR vendors than pediatric practices, and bidirectional data exchange requires HL7 integration that many independent pharmacies lack the IT budget to implement. A 2025 study in JACM found that independent community pharmacies frequently do not even query the IIS before administering vaccines, let alone report back to it.