As vaccination issues have emerged so have answers

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Our jobs are very different, though we are both pharmacists contributing to the COVID-19 response, and we are proud of the way our profession has stepped up to help. Perhaps it should be no surprise that Americans have turned to pharmacists when deciding whether or not to get a COVID-19 vaccine. According to the National Center for Chronic Disease Prevention and Health Promotion, nearly nine in 10 Americans live within five miles of a community pharmacy. And studies have shown that pharmacists are often the most trusted and easily accessible members of a patient’s health care team.

Diana Kwan

When COVID-19 vaccines first became available, pharmacies were some of the first locations selected to receive them, though it’s important to remember that distribution wasn’t equal from pharmacy to pharmacy. The January 8, 2021, chaindrugreview.com article, “Pharmacies front and center in vaccine rollout,” captures what we have heard from colleagues, which is that, as part of the early vaccine distribution efforts under Operation Warp Speed, many chain drug pharmacies were among the first to vaccinate, especially vulnerable populations.

Rollout challenges and solutions

As priority groups expanded and mass vaccination clinics were established, we began to hear reports from pharmacists on the front line about challenges and informational gaps where clarification would be helpful. For example, as the vaccination program expanded, pharmacists said scheduling and access became an issue for many. Vaccine administrators pointed to a need for specific information about pre-drawing and labeling syringes, or storage and transportation of the vaccines.

Further, there were reports of being able to get more vaccine doses out of each vial due to manufacturer overfill, though the best ways to maximize these amounts weren’t clear. At a time when many health care practitioners, including pharmacists, were new to supporting mass vaccination sites, no one could afford additional confusion and missing information.

Melody Ryan

Melody Ryan

Rather than serving as a deterrent, such issues motivated pharmacists, and presented opportunities for all of us to identify and resolve related challenges. It was clear that all of this information needed to be assembled in one place to ensure consistency while increasing operational efficiencies. Very quickly, pharmacists and other health care practitioners came together and worked toward this goal. The result was the U.S. Pharmacopeia’s COVID-19 Vaccine Handling Toolkit, which continues to evolve and is guided by input from pharmacists and other practitioners alike.

The pharmacist’s trusted voice in addressing vaccine hesitancy

Since the start of the vaccine rollout, many operational inefficiencies have been found and addressed. However, quite possibly the largest issue facing health care practitioners is vaccine hesitancy among some members of the broader population. This is fueled in part by misinformation that continues to swirl around COVID-19 vaccines.

Pharmacists have an opportunity to be center stage when so many people are looking for answers. Chain drug and community pharmacists in particular are critical to addressing vaccine hesitancy. Whether a patient comes in to refill their inhaler or pick up a new prescription, pharmacists have a captive audience not only to address the issue at hand but to move people from contemplative about the COVID-19 vaccine to properly informed and prepared for vaccination.

Challenges and opportunities ahead

As pharmacists on the front lines, our experience with COVID-19 has provided good preparation for how to get ahead of special handling processes and procedures for the next pandemic. Also informed by experiences related by colleagues and other health care professionals, pharmacists have greatly expanded their expertise with mass vaccination sites. This knowledge can carry forward into seasonal needs surrounding the use of flu vaccines, or if/when COVID-19 booster vaccines are needed. For example, we are going to have to plan for yet another shift as we move from mass vaccination sites to eventually the majority of COVID-19 vaccines/boosters being administered at local pharmacies.

If vaccines continue to be packaged in multidose vials containing five to 15 doses each, with fairly limited “beyond-use dates,” minimizing vaccine waste has the potential to be a major challenge. If we move to vaccine on demand, as with the flu vaccine, how will pharmacists be able to vaccinate one or two people without wasting doses and resolve scheduling issues? As the percentage of people who have received vaccines goes up, will there be fewer people going to vaccination sites at any one time? New on-the-ground storage, handling and administration experiences and training can and should become a regular part of pharmacists’ training to help navigate these likely challenges.

A likely scenario is where your pharmacy may have two or three different types of COVID-19 vaccines, and the staff needs to be knowledgeable on how to handle each one. Currently, scheduling of vaccine appointments is handled by others, creating distance between pharmacists and their community. One opportunity for efficiency, equity and consistency in care would be to bring the scheduling function within the purview of the community pharmacists.

The demands and limitations of COVID-19 have led to a boom in telehealth and online education. These represent additional areas of opportunity for consideration — beyond the immediate needs of COVID-19 — for pharmacists to help patients manage medication therapy, teach patients to self-inject medication, provide chronic care management, conduct initial consultations, and more. Widespread pursuit of these opportunities in community settings is currently limited by reimbursement and provider status, though telehealth is currently being utilized in clinical ambulatory care settings where pharmacists have established protocols with positive patient reviews. It is possible that the resulting increase in communication between pharmacists and patients could help grow pharmacist/patient relationships, foster increased trust and reduce vaccine hesitancy.

Although we have long known that a pandemic was possible, neither we, nor our pharmacist colleagues, could imagine the extent to which we would be able to help our community through this global health crisis. There have been many issues that came to light during the COVID-19 vaccine rollout, but also many solutions. Perhaps most importantly, though, are the opportunities that lie ahead.

Diana Kwan is the scientific liaison for the Healthcare Safety & Quality Expert Committee at U.S. Pharmacopeia. Melody Ryan is chair of the U.S. Pharmacopeia Healthcare Safety & Quality Expert Committee and director of international professional student education with the University of Kentucky College of Pharmacy.


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