Pharmacists Face Critical Changes to Immunization Practices During the COVID-19 Pandemic

Pharmacists’ ability to provide services has been hindered throughout the coronavirus disease 2019 (COVID-19) pandemic. In a Pharmacy Times’ webcast on immunization practices during the pandemic, thought leaders discussed considerations and best practices regarding the administration of vaccinations.

The key opinion leaders in the discussion included Jeff Goad, PharmD, FAphA, FCPhA, FCSHP, of Chapman University School of Pharmacy; Brian Hille, RPh, of Albertsons Companies; Lauren Simko, PharmD, of Pharmacy Development Services; and Suzanne Soliman, PharmD, of Pharmacists Moms™ Group.

Hille noted that pharmacists are a critical element of the country’s ability to immunize its citizens.

“We, as a profession, provide such a large percentage of the total immunizations across the country, not just flu but others. So, it was really important for us to make sure that we could maintain immunization services during the pandemic,” Hille said. “We never fully stopped providing immunizations, but we definitely slowed down.”

The decline of regular vaccinations is of particular relevance in relation to the upcoming flu season. Speakers during the webcast explained that regardless of what the flu season will be like this year, it will remain critical for people to be immunized to keep them healthy and limit potential comorbid issues with COVID-19.

In order to ensure that patients stay up-to-date with vaccinations, Simko explained that many pharmacists have begun using the tactic of reaching out directly to patients regarding upcoming vaccinations.

“Every pharmacy has had to make adjustments,” Simko said. “These pharmacists, pharmacy owners, technicians, and staff have a responsibility to their community, and they feel that responsibility very heavily right now. They’re very concerned that patients are missing immunizations, yet at the same time there’s a focus on how to protect themselves and their staff.”

Simko explained that pharmacists are not only concerned about patients missing immunizations, but they are also concerned about getting infected themselves. Such an infection would render pharmacists unable to serve their patients, which would impact the communities they serve.

Without the support of pharmacists, it can become far more difficult for patients to receive necessary services, especially in rural communities, Simko said. Some pharmacists have also adapted by finding specific ways of helping some of their more vulnerable patients avoid exposure to COVID-19 in the pharmacy setting, such as scheduling appointments or having elderly patients come in at specific times in the morning that are only available for them to book, Soliman noted.

Additionally, Soliman explained that there are some common best practices that pharmacists have observed and discussed in her Pharmacists Moms™ Group.

“Overall, some of the best practices that came up were that patients should fill everything out online, over email and fax, or pre-fill it in their car,” Soliman said. “A lot of pharmacies are not accepting walk-ins and are setting up a space around the vaccine room so that people can socially distance from each other.”

Soliman noted that pharmacists are having patients attend the clinic, which requires scheduling appointments in advance. She said that some pharmacists have been using social media and other advertising methods to promote the clinic as a safe method to receive services at pharmacies due to the ability to promote social distancing practices.

Additionally, immunization registries, also referred to as immunization information systems, are also of critical importance during the pandemic due to their role in facilitating communication among pharmacies and their allowance of immunization tracking. Every state has an immunization registry, Goad explained, but it may not be used to the fullest extent possible.

“Some states require pharmacists and physicians to enter the doses they give into the registry, and some don’t. So, unfortunately, there’s a patchwork of it,” Goad said.

Goad explained that immunization registries are highly beneficial in tracking immunizations since chain pharmacy systems and independent pharmacy systems don’t communicate with each other. This lack of communication can make it difficult to know which vaccines a patient has and hasn’t received if that patient doesn’t go to the same pharmacy every year.

The registry acts as a central hub for this information, which can be used as a resource in each state by pharmacists.

“For information sharing, it’s incredibly invaluable. But it’s not only important for people to just put the doses in there,” Goad explained. “You also have to look at it.”

Simko added that since the tracking of information varies between states and pharmacies, it is critical to stay current with the information that is coming out of various states’ boards of pharmacy and boards of health. With the current pandemic, information from these organizations is changing extremely frequently.

For example, Simko said that in Pennsylvania, the state temporarily changed the age population that pharmacists can immunize for flu, at a time when other states were not making this same change. In light of this, a state’s immunization registry becomes even more critical. Simko noted that a standardization of immunization registry practices across states may be something to further develop in the future.

Looking toward the flu season with an estimated 190 million flu vaccine doses manufactured in the country, Hille explained that pharmacies have been pre-booking the vaccine. These flu vaccine doses are also getting completely booked due to more pharmacies pre-booking for this flu season than ever before in history, Hille said.

Additionally, there has been differing information regarding the appropriate timing for administering vaccines. Goad said that the CDC would probably admit that their messaging over the years has been unclear regarding when pharmacies should administer vaccines. For example, some years the CDC has recommended that pharmacies should administer vaccines as soon as they are available, whereas other years that recommendation has changed.

Currently, the CDC has stated that if a pharmacy has the vaccine available and there is a patient who needs it, then it should be administered at the discretion of the pharmacy. Otherwise, Goad noted that the CDC has recommended to plan for immunizations to start on October 1 and for the administration of the vaccine to continue until the supply is depleted in order to ensure its access to everyone who needs it.

Goad also commented on the eventuality of a COVID-19 vaccine, explaining that the release of a vaccine for the virus by the end of 2020 seems unlikely. However, he said that he predicts perhaps March or April 2021 as being more probable for the successful release of a vaccine, as that would allow the time for larger sample sizes of up to 50,000 patients to participate in trials studying that vaccine.

“Larger studies are important because small adverse events get magnified when you vaccinate a lot of people,” Goad explained. “Eventually, they’ll get to these high numbers of patients, and we’ll have a better idea of how the candidate vaccines are doing.”

Watch the Pharmacy Times’ webcast to learn more.

REFERENCE

Cohen E, Goad J, Hille B, Simko L, Soliman S. Immunization Practices During the COVID-19 Pandemic. Pharmacy Times virtual webcast. July 16, 2020. pharmacytimes.com/webinars-webcasts/immunization-practices-during-the-covid-19-pandemic. Accessed August 3, 2020.