How the COVID-19 Pandemic Continues to Shape Immunization in Pharmacy

Jeffery Goad, PharmD, MPH, associate dean of Academic Affairs in School of Pharmacy at Chapman University discusses the future of pharmacy when it comes to immunizations.

Q: How has the COVID-19 pandemic impacted immunizations and immunization strategies in the pharmacy?

I think pre-pandemic, a lot of pharmacies were focusing in on influenza primarily, and then trying to branch out, depending on the state where they practice, into other immunizations. I think what really changed in the focus is developing a larger scale strategy to handle the masses of people who need a vaccination, need a COVID vaccination. So that required a lot of infrastructure, changing staffing, through the prep back, getting technicians involved in getting vaccines. It had to be a total system revise just by the sheer volume, not really the training. The administration of vaccines, the structures in place to train pharmacists, and to document, were pretty much already in place. It was really handling the sheer volume of patients that were coming through that pharmacy had to get a strategy in place quickly, very quickly, to be able to handle not only the initial surge, but the multiple changes in population, so learning to give vaccines to an adolescent, and then, you know, not too long after that, learning how to give it to a 5-year-old.

There were also some changes that had to take place in privacy areas and things like that, and parental consent that they may not have been used to. There were strategies that pharmacy had to engage very quickly, to be able to manage just the sheer volume of patients coming through.

Q: How have digital systems helped to advance immunization scheduling and coordination in the pharmacy?

I think digital systems were already on their way, but like many things, the pandemic just accelerated their adoptions. One of the things that has helped pharmacy is the scheduling aspect. I think maybe larger chains had already started to implement scheduling software to get their patients scheduled for various immunizations or other services. Independent pharmacy had to figure that out pretty quickly, how to deal, again, with the masses of people to avoid lines out the door.

So instead of doing the walk in, which was really the hallmark of what pharmacy offered for immunization services, allowing patients to while they're in the store, in a grocery store, whatever setting the pharmacy is located, being able to go into the pharmacy and get a vaccine, there was something that was really important in our early days to make a case for access, and pharmacy.

Now, flash forward to the pandemic, and the sheer volume of patients meant that pharmacy needed to revert back to an appointment-based system, and that's where the digital systems come in, so everything from scheduling software, to online consent forms, and online vaccine information statements that can be delivered to patients. A lot of different systems had to be put in place to accelerate the process of getting a patient in and then decreasing the amount of time they spent in the pharmacy.

Because again, if you remember early on the pandemic, it was more about not keeping people in a place too long in a small environment, which most pharmacies, by definition, are small environments that they work in, and keep them six feet apart. Sometimes we forget about the early pandemic mitigation strategies we had in place that made it difficult to have lots of people coming through for service. Our digital systems were incredibly important just to manage, again, the volume of patients coming through. I think this is 1 of those things that will last, going beyond the pandemic, as people got used to being able to easily go online, make an appointment, fill out their form, so that when they come to the pharmacy, it's a much more streamlined process for them.

Q: What further technological assistance would be beneficial as we move forward with current immunization practices?

I think 2 areas that would really enable pharmacy to take advantage a lot of the digital transformation. One is an interoperability and really sometimes just connection to the electronic health record. So as states, either through the federal Prep Act or through changes around state laws, have allowed pharmacists to give many vaccines. In fact, according to the Prep Act, being able to give pediatric vaccines means that connection and collaboration and communication with pediatric colleagues, for example, are is incredibly important. It's very difficult to do that by fax. People don't have faxes like they use to anymore. So having the ability to connect to a physician's electronic health record, to be able to transfer that information back and forth is going to be vital, but that still continues to be a problem.

Everything from state laws and access to information or corporate policies, down to just the computer interoperability, our systems talking to their system, so that remains a challenge. But it's something that is going to be incredibly important going forward, not only for immunizations, but for other clinical services.

Then the other digital piece, I think, is the immunization information systems. The IIS or registries as they're sometimes called. Pharmacies have had to learn in states where maybe they weren't mandated to enter into the registry before how to connect, and actually to learn what the value of that is. Now that patients know that their immunization records are in the registry from the pharmacists, it really helps the patient to know where to go to get their immunization record if they went to different pharmacies, different clinics. So having pharmacy be a part of that digital revolution, and particularly around the immunization information systems, is incredibly important to making sure patients realize that pharmacy is part of their team, their health care team, and it allows pharmacy to have that backend documentation system.

But just like the EHR, there are also interoperability challenges in different states because there is no federal immunization information system currently, even after COVID. There still is no federal system, it's still state by state, and every state does a little different, and everyone's system is a little different. So something that pharmacy is still working toward, but the pandemics certainly accelerated their processes.

Q: What advancements have been made possible in the immunization space due to the tireless work of pharmacy professionals during the pandemic?

I think patients had a very visceral response in seeing that their pharmacists were still on the front lines. So as medicalclinics were shutting down and elective procedures were going away, the 2 places that consistently remained open, the hospitals and the pharmacies. So I think that's something that people will remember, you know, their pharmacists and face shields and mass, but still there and coming out to give them immunizations, coming out to talk to them about their medications. I think that's something that patients hopefully will see going forward that pharmacy could manage this in a pandemic in such a stressful environment. What else can they manage? So I think there are lots of different services and opportunities that patients now we'll start expecting from pharmacy, the federal government, even, as recently as our president, saying that we want pharmacists to be involved in test-to-treat for COVID vaccine. I think all of these, this role changes, these visible changes that people have seen, are definitely going to help pharmacy in the future, to get people to realize that during this pandemic, our pharmacists were there, they were caring for you. And they can do a lot more than you think they can.

Q: What are your hopes for the future of immunizations in the pharmacy?

I think if you look at the evolution of immunizations and pharmacy, and just other services from medications, and being dispensed at physician's offices, the turn of last century to now being a staple that you only get your medications from pharmacies, right? I think immunizations is probably heading in that direction. Just the sheer access issues, that ability to access on a weekend or late nights, the computer systems, the digital systems we have in place to manage immunizations and other services for patients and having that pharmacist right there, that health care professional who can now supervise technicians and giving vaccines.

I think all of these coupled together mean that we're going to see pharmacists as a quintessential figure in immunization delivery, and maybe in decades to come. It may be the place that you go to get an immunization. Again, it's a preventative health care service. It's not a sick care service, and pharmacists do preventative health care services, I think, better than any other system. So, the future I think we should be thinking, immunization and pharmacy as being synonymous.