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Community pharmacies in countries across the globe have used their unique abilities as the most accessible health service to help patients during the Covid-19 pandemic. Community pharmacies have remained open and accessible to the public, and at times have been the only healthcare practitioner available for face-to-face advice. Throughout the crisis, there has been growing recognition of pharmacy’s role in public health, in the management of chronic conditions and common ailments, as local health hubs and triage points, and as an essential, frontline pillar of a collaborative primary health care workforce.
Community pharmacy’s existing role with national immunisation programs, including for seasonal influenza, means that it has established protocols, recording mechanisms and communication channels to ensure countries achieve safe, fast and optimal uptake of Covid-19 vaccines (including any follow-on doses required).
There is very high patient satisfaction with pharmacist vaccination services, as well as high levels of trust in community pharmacists. In England, 99.4% of patients stated in a survey conducted in January and February 2020 that they would recommend the influenza vaccination service to their friends and family, with 98.7% happy for their pharmacist to give them other types of vaccinations in the future[i]. This echoed results from Ireland, where an evaluation carried out in 2016[ii] found that 99% of respondents would be likely to go to their pharmacist for their influenza vaccination again, and also from Portugal, where a survey showed higher patient satisfaction with pharmacy-based influenza vaccination services than with those conducted in other settings[iii].
There is a wealth of evidence showing that community pharmacy involvement in immunisation programs has a positive impact on uptake rates and on coverage efficiency. Factors contributing to this positive impact include pharmacies offering patients greater convenience (compared with alternatives) in terms of time and location, and pharmacies being well positioned to serve under-vaccinated populations, including in rural communities[iv]. Due to the well-documented high level of public trust in pharmacists, vaccine hesitancy can be overcome by promoting accurate, evidence-based information through pharmacies.
A systematic review of studies on the effectiveness of vaccinations administered by pharmacists indicated that the vaccination coverage rates in these models are higher than in traditional systems of vaccinations[v],[vi]. Further, a pandemic simulation model study conducted in the USA in 2017 concluded that the use of community pharmacy capacity would reduce the timeframe for reaching a national immunisation coverage rate of 80% by a full seven weeks[vii]. The report stated that “these results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning”.
With the total number of deaths attributed to Covid-19 increasing by hundreds per day in many countries[viii], reducing the coverage timeframe to this extent could save many thousands of lives in each country. Community pharmacy must be represented in Covid-19 vaccination planning and coordination at all levels of government.
World Pharmacy Council President George Tambassis said: “In almost all WPC member countries community pharmacies already have a significant and expanding role in administering vaccinations for influenza and other diseases. For Covid-19 vaccines that are amenable to administration in primary care settings, community pharmacy must be included as an integral part of each country’s national immunisation strategy. Involvement of community pharmacy will save lives and accelerate the economic recovery, as the timeframe for reaching target population coverage of the vaccine will be significantly shorter with community pharmacy involvement than without it.”
Well distributed and accessible to all, community pharmacies are capable of administering large volumes of vaccinations. Often this is done opportunistically, when patients are visiting the pharmacy for their prescription medicine or for other products, advice or services – capturing sectors of the population that may otherwise go unvaccinated. Using all contact with patients by medical professions to actively promote vaccinations can greatly increase vaccination coverage[ix]. The number of influenza vaccinations administered in the community pharmacy setting in Australia, as one example of high growth and acceptance, increased four-fold in 2019[x], and a further four-fold in 2020[xi], to well over one million doses.
Pharmacists are well trained and qualified, and in many countries are being provided access to administer a growing scope of immunisations. For example, in all 50 states of the USA pharmacists can now provide childhood immunisations[xii], which was partly precipitated by a need to ensure that childhood immunisation rates did not fall as a result of the pandemic.
The USA Department of Health and Human Services has already authorised state-licensed pharmacists to order and administer Covid-19 vaccines to persons three years of age and older[xiii]. To ensure swift and effective Covid-19 vaccination programs, other countries must follow this example, and ensure they take all necessary steps to use the skills, capacity and capabilities of community pharmacy. Community pharmacists globally are ready to be part of the vaccination effort in 2021, just as they have been an irreplaceable part of continuity of healthcare and pandemic management in 2020.
[iii] Center for Health Studies and Evaluation (CEFAR) Portugal, 2019-20 survey, results supplied by National Association of Pharmacies (ANF).
[iv] Winegarden W., Pacific Research Institute, Promoting Access and Lowering Costs in Health Care: The Case of Empowering Pharmacists to Increase Adult Vaccination Rates, April 2018, https://www.pacificresearch.org/wp-content/uploads/2018/04/AdultVaccination_F_web.pdf
[v] Isenor, J.; Edwards, N.; Alia, T.; Slayter, K.; MacDougall, D.; McNeil, S.; Bowles, S. Impact of pharmacists
as immunizers on vaccination rates: A systematic review and meta-analysis. Vaccine 2016, 34, 5708–5723, https://pubmed.ncbi.nlm.nih.gov/27765379/.
[vi] Edward M. Drozd, Laura Miller, Michael Johnsrud, Impact of Pharmacist Immunization Authority on Seasonal Influenza Immunization Rates Across States, Clinical Therapeutics, Volume 39, Issue 8, 2017, Pages 1563-1580.e17, ISSN 0149-2918, https://doi.org/10.1016/j.clinthera.2017.07.004. (http://www.sciencedirect.com/science/article/pii/S0149291817307713)
[vii] Schwerzmann J, Graitcer SB, Jester B, et al. Evaluating the Impact of Pharmacies on Pandemic Influenza Vaccine Administration. Disaster Med Public Health Prep. 2017;11(5):587-593. doi:10.1017/dmp.2017.1
[viii] Johns Hopkins University & Medicine Coronavirus Resource Center, https://coronavirus.jhu.edu/data/new-cases, accessed 7 December 2020.
[ix] https://www.mdpi.com/1660-4601/17/21/7945/pdf
[xi] https://ajp.com.au/news/additional-flu-vax-supplies-now-in-pharmacies/
December 10, 2020
Community pharmacy vaccination services ensure optimal use of Covid-19 vaccines
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