One Year Later: Key Issues Impacting Health System Pharmacies During the COVID-19 Vaccine Rollout

Nearly 1 year after the start of the global pandemic, the number of COVID-19 cases and deaths in the United States continues to be problematic, but another key statistic is emerging: the number of Americans who are vaccinated. According to the Washington Post (at the time of writing), more than 44.1 million people in the United States have received at least 1 of the 2 required doses, and more than 19.4 million people are fully vaccinated.

This vaccine rollout has become even more crucial for the US health care system, as new mutations of the coronavirus continue to emerge. Although the vaccines that have been granted Emergency Use Authorization by the FDA appear to be somewhat effective¹ at containing the threat of these variants, the vaccination rate needs to pick up in order prevent further mutations and achieve much needed herd immunity.

Unfortunately, a range of logistical and technical issues have arisen during the first phases of the vaccination rollout. These concerns, along with a lack of a national coordination strategy, mean it is largely left up to individual states and hospital systems to procure, store, and distribute the vaccine in a safe and effective manner. As more people become eligible to receive vaccines, a few key issues will continue to inhibit the rollout, possibly threatening the Biden administration’s plan to vaccinate 300 million Americans by the end of the summer, and get back to a more normal semblance of everyday life.

Lack of Resources
Early on in the Pfizer vaccine supply fulfillment, hospitals were faced with a worldwide shortage² of freezers that reach between -60 and -80 degrees Celsius, the critical threshold necessary for that vaccine to be appropriately stored for up to 6 months. However, unopened vials can survive for up to 2 weeks at a standard medical freezer temperature of -25 degrees Celsius.

In addition, many pharmacies lack the personnel and resources to manage the vaccine supply and distribution process, and pharmacies across the nation are hiring thousands of people³ to keep up with demand. Attempting to vaccinate members of the community and manage the complex storage requirements increased the burden of work for pharmacy staff while they continued to deal with their regular responsibilities, such as navigating drug shortages and managing drug diversion programs, and treating an ongoing influx of sick patients.

According to a survey by health care software company CoverMyMeds,⁴ more than two-thirds of pharmacists reported that they had taken on new job responsibilities since the onset of the pandemic. When we consider how thinly spread hospital resources are, we cannot discount the fact that health care professionals are our greatest resource. When it comes to tackling the issues impeding mass vaccination, it is crucial that the people at the center of the process are adequately supported.

Lack of Standardization and Best Practices
Another issue facing the health care system is that scheduling and coordinating resources has been mainly left up to hospitals and local or state governments. For instance, Florida has been using Eventbrite⁵ to schedule vaccination appointments. Across the nation, people have been camping out⁶ in front of hospitals hoping for the chance of a walk-in vaccination or to receive a dose resulting from a no-show patient. It is clear that the country needs an easily accessible, user-friendly, and stable tech system to determine vaccine eligibility and availability.

At some sites, anecdotal evidence depicts challenging scenarios requiring providers to keep up-to-date with new information as state and health system leaders share updates and changing processes daily. These constant adjustments, without the accompanying systems needed to track vaccine and appointment availability, are contributing to the chaos and confusion around the distribution process.

These scheduling issues are also a primary driver of vaccine waste.⁷ If enough eligible recipients cannot be identified and scheduled, or if people do not show up for their appointment, prepared vials of thawed vaccines expire and must be tossed. Thousands of vaccines have been thrown away because of this problem.

Underutilizing Overfills
Once the FDA gave clearance to use vaccination overfill⁸, health care professionals were faced with another hurdle: determining whether they had the ability to effectively prepare extra doses with the overfill volume. As a result of the extra doses in each vial, Pfizer has promised to provide 200 million doses to the United States by May, earlier than its initial forecast of July. It will become even more crucial that those giving out the vaccine can extract all the doses available in each vial to ensure it reaches as many people as possible.

However, successfully using the overfill requires a 1cc syringe needle to prepare an extra dose. The mechanics of this can be a challenge if technicians are not trained or if the supply of the syringe size is not available. This is yet another logistical hurdle that many hospitals are now combatting under increased scrutiny from the government and their own communities.

Technology is the Solution
Technologies that streamline pharmaceutical practices across the hospital system are already in use, providing insight into the supply of hundreds of medications. However, since vaccine distribution has not been a coordinated effort on the national or state levels, it is difficult to integrate these solutions to streamline the process from end to end, from manufacturer to the patient’s bedside.

Over the next several weeks and months, as millions more people become eligible for the COVID-19 vaccine, there needs to be concerted effort to leverage innovative technologies to provide better transparency, visibility, and predictability to the vaccine deployment initiatives.

About the Author
Beju Shah is the Director of Clinical Solutions at Kit Check, the leading provider of automated medications tracking and diversion detection solutions for hospital pharmacies in the U.S.Shah cemented himself as a healthcare IT leader by co-founding the Pharmacy Informatics Academy9 in late 2019. The organization’s goal is to pave the way for the future of pharmacy informatics and train the next generation of pharmacists. Beju earned his Bachelor of Science in management information systems from the University of South Carolina in 2002, his Doctor of Pharmacy from the Medical University of South Carolina in 2010, and his Master of Business Administration from The Citadel in South Carolina in 2013.

REFERENCES

• Vaccines Adapted for Variants Will Not Need Lengthy Testing, F.D.A. Says. New York Times. Published February 22, 2021. https://www.nytimes.com/2021/02/22/health/covid-vaccine-variants.html
• ‘We’re being left behind’: Rural hospitals can’t afford ultra-cold freezers to store the leading Covid-19 vaccine. STAT News. Published November 11, 2020. https://www.statnews.com/2020/11/11/rural-hospitals-cant-afford-freezers-to-store-pfizer-covid19-vaccine/
• With Vaccines in More Drugstores, Pharmacies Go on Hiring Sprees. New York Times. Published February 10, 2021. https://www.nytimes.com/2021/02/10/business/coronavirus-vaccine-pharmacies.html
• Two-thirds of pharmacists have taken on new job responsibilities since COVID-19, survey finds. Becker’s Hospital Review. Published February 16, 2021. https://www.beckershospitalreview.com/pharmacy/two-thirds-of-pharmacists-have-taken-on-new-job-responsibilities-since-covid-19-survey-finds.html
• Covid Vaccination Appointments. Event Brite. Published 2021. https://www.eventbrite.com/d/united-states--florida/covid-19-vaccine/
• Coronavirus vaccine has arrived, but frustrated Americans are struggling to sign up. The Washington Post. Published January 23, 2021. https://www.washingtonpost.com/health/2021/01/02/coronavirus-vaccine-has-arrived-frustrated-americans-are-struggling-sign-up/
• Thousands of Covid-19 vaccines wind up in the garbage because of fed, state guidelines. NBC News. Published January 15, 2021. https://www.nbcnews.com/news/us-news/thousands-covid-19-vaccines-wind-garbage-because-fed-state-guidelines-n1254364
• Some Vials Of COVID-19 Vaccine Contain Extra Doses, Expanding Supply, FDA Says. NPR. Published December 16, 2020. https://www.npr.org/sections/coronavirus-live-updates/2020/12/16/947386411/some-vials-of-covid-19-vaccine-contain-extra-doses-expanding-supply
• Pharmacy Informatics Academy. https://pharmacyinformaticsacademy.com/