COVID-19 Vaccinations: It Takes a Village

The coronavirus disease 2019 (COVID-19) vaccination program, once completed, will be the largest vaccination effort in history. Given the steadily increasing death rate and emergence of variant strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is becoming a race against time.

As of press time, approximately 65 million doses have been administered in the United States, with approximately 13.4% of the population having received at least 1 dose.¹ Although much of the focus in the media has been on the limited supply available in the early weeks of this campaign combined with the frustration of individuals eligible for vaccination being unable to secure an appointment, those of us directly involved with getting vaccine into arms understand the remarkable efforts expended to go from 0 to more than 40 million doses. Once the vaccine arrived, this effort required the expertise of supply chain experts, scheduling staff, pharmacists, nurses, providers, and health informatics professionals—truly a village of health care workers. At the same time, health systems were dealing with the largest surge of COVID-19 cases since the start of the pandemic, overwhelming bed and intensive care unit capacity, driving up acuity, and stressing nearly every acute-care facility in the country. Frontline clinical staff shortages due to patient volume and COVID-19 illness among health care workers were another important dimension of the crisis overlapping with planning to get those same health care workers vaccinated as priority 1A recipients.

The contribution of health-system pharmacists has been nothing short of outstanding and was sorely needed as other health care workers were consumed with bedside care of patients with COVID-19. The storage and handling requirements of the 2 vaccines available under emergency use authorization at this time, especially the Pfizer-BioNTech vaccine, demanded close involvement of pharmacy.

When it was learned that ultracold storage and a 5-day shelf life after leaving those conditions were required for the Pfizer-BioNTech vaccine, the only response I heard from pharmacists was, "Yeah, we got this."

In addition, we have moved tens of millions of doses from freezers into arms with remarkably minimal waste. At my institution, we have administered more than 31,000 doses of COVID-19 vaccine at press time, and every single dose has been handled and prepared by a pharmacist, pharmacy intern, or pharmacy technician. In addition to managing the logistics of inventory and preparation, many doses also were administered by pharmacists. We have embedded pharmacists in our mobile vaccination teams that go into the community to vaccinate the residents and staff of congregate living facilities for individuals who are developmentally or intellectually disabled or dealing with mental health issues. Pharmacy also has contributed to cold chain transport expertise, informatics support to meet tracking and reporting requirements, and supply management to ensure an ability to maximize vaccine dose per vial dependent on needle/syringe combinations to minimize dead space volume waste. This story was repeated at nearly every health system and hospital in the country.

In addition to the operational contributions, pharmacy leaders across health care systems have been called upon by system leadership to play a central and very visible role in overall planning and execution of a multifaceted vaccination strategy. As we pivot to vaccinate different prioritized patient groups, the pharmacy profession will be heavily relied upon in the community setting at health clinics and local health departments, in addition to health care systems. As pharmacists, we have so much to be proud of when considering our contributions as members of a larger collaborative team to this historic vaccination effort, and we are just getting started.

The 2 biggest challenges to broad vaccination of the public are vaccine hesitancy and shortages. There is encouraging news related to production efficiency improvements,² the Defense Production Act invoked by President Joe Biden's administration,³ and the expected introduction of 2 additional vaccine products in the next several weeks,⁴ which should begin to ramp up vaccine inventory. Recent evidence indicates that vaccine hesitancy is declining as more individuals are vaccinated. However, significant reservations continue in communities of color.⁵ Vaccine hesitancy is a complex issue, and it is incumbent on health care professionals to listen to patients who are hesitant and have a plan to be respectful of the concerns expressed, dispel myths, and provide information.⁶ Pharmacists are trusted health care professionals who have frequent patient interactions and can be an important source of assurance and information when it comes to overcoming vaccine hesitancy. A legacy of this unprecedented vaccination effort is undoubtedly going to be the importance of the pharmacist in all aspects of the ultimate success of changing the course of this pandemic, and every pharmacy should be very proud of the profession.

REFERENCES

1. Randall T, Sam C, Tartar A, Murray P, Cannon C. More than 213 million shots given: COVID-19 tracker. Bloomberg News. Updated February 25, 2021. Accessed February 25, 2021. https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

2. Weise E. Pfizer expects to cut COVID-19 vaccine production time by close to 50% as production ramps up, efficiencies increase. USA Today. February 7, 2021. Accessed February 7, 2021. https://www.usatoday.com/story/news/health/2021/02/07/pfizer-expects-cut-covid-19-vaccine-production-time-almost-50/4423251001/

3. Stanley-Becker I. Biden harnesses Defense Production Act to speed vaccinations and production of protective equipment. Washington Post. February 5, 2021. Accessed February 7, 2021. https://www.washingtonpost.com/health/2021/02/05/biden-vaccines-tests-gloves/

4. Zimmer C, Corum J, Wee SL. Coronavirus vaccine tracker. New York Times. February 6, 2021. Accessed February 7, 2021. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

5. KFF COVID-19 vaccine monitor dashboard. Kaiser Family Foundation. Accessed February 7, 2021. https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor/

6. Henry TA. COVID-19 vaccine hesitancy: 10 tips for talking with patients. American Medical Association. February 1, 2021. Accessed February 7, 2021. https://www.ama-assn.org/delivering-care/public-health/covid-19-vaccine-hesitancy-10-tips-talking-patients