The Pandemic Brought Pharmacy to the Fore as Essential Public Health Infrastructure

As the COVID-19 pandemic disproportionately affects rural, low-income, and ethnic minority populations, community pharmacies have become essential public health infrastructure.^1,2 The ability to receive vaccines in community pharmacies—as well as locations where people live, work, play, and pray—has contributed to well over 500 million doses of COVID-19 vaccinations administered in the United States.^3,4 Pharmacy staff are accessible, reliable, and well-trained and should feel proud of their efforts, especially through all the changes or alterations in workflow instated to accommodate the pandemic surge for the delivery of vaccination administrations, testing, and infusion services. Those workflows and capacities will not recede following the pandemic so long as pharmacies remain economically viable. Pharmacies are a new national strategic reserve of public health services.

VACCINATION RATES WORSENED, PROVIDER ACCESS REBOUNDED INSUFFICIENTLY, MISTRUST FESTERERED

Despite pharmacies’ efforts and our health care system’s near full reopening for non– COVID-19–related services, routine screenings and vaccinations continue to lag at alarming rates. For example, the CDC found that pediatric vaccination rates fell in the first 3 months of the pandemic in 2020, especially for those older than 2 years of age: in this group, rates of vaccination for tetanus, diphtheria, and pertussis (Tdap), measles, mumps, rubella (MMR), and human papillomavirus (HPV) fell by 60% or more compared with the same months in the previous 2 years.⁵ Even when the health care system opened up in the late summer and fall of 2020, children and adolescents were not being vaccinated at pre-pandemic rates: Tdap administration among patients aged 13 to 17 years, for instance, fell by 30% compared with the same period in 2018 and 2019. In the words of the CDC study authors, “across all age groups and across all vaccine types, none of the jurisdictions [studied] demonstrated a sustained or prolonged increase in the number of weekly doses administered above pre-pandemic administration levels.”⁵

In adults, save for some populations in certain categories, vaccination rates also dropped substantially at the beginning of the pandemic and did not rebound sufficiently through August 2020 compared with rates during the same periods in 2019.⁶ Even the exceptions to this trend may not reflect Americans’ desire for basic vaccinations: the uptick in influenza vaccinations for Medicare Advantage from July 2020 to August in 2020 relative to the same period in 2019,6 for example, was likely associated with co-administration of the influenza vaccine and the COVID-19 vaccine and by patient perceptions that the influenza vaccine would inoculate against COVID-19. Bottom line: Americans are way behind with vaccination relative to prepandemic levels, and our rates were not spectacular to start with.

Add to these headwinds a festering mistrust of vaccines. Although many experts and officials lament not having 100% vaccination for COVID-19, the near 90% coverage for first dose administration for those aged 18 years and above⁴ is well above the mere 50% coverage for influenza vaccination achieved during the 2020-2021 flu season.⁷ Social media has led some to distrust vaccine benefits and safety; however, its continuous reporting of poor outcomes in the unvaccinated—and especially its use of hyperlocal data (eg, hospitals, local health departments, local officials)—has helped others
to realize the consequences of the virus. Whether COVID-19 vaccine hesitancy is impacting other vaccination rates remains an open question.

PHARMACIES NEED TO STEP UP AND STEP IN TO FULFILL PUBLIC HEALTH ROLE

All this should compel pharmacies and pharmacy staff to make a purposeful and everlasting commitment to vaccine administration and education. Our role as trusted health care providers in touch with and embedded within our communities is more important than ever. The health of our communities depends on providers’ abilities to close gaps in care. Pharmacies are well positioned to expand equity through vaccination and, increasingly, through screening services for chronic disease, mental health, and infectious diseases other than influenza or COVID-19.

HEALTH PLANS AND POLICY MAKERS NEED TO STEP UP TO ENSURE VACCINATIONS ARE A REIMBURSEMENT PRIORITY

Of course, these essential public health functions cannot be sustained without proper policy, recognition of the roles of the pharmacy, and reasonable reimbursement. Although reimbursement for COVID-19 vaccination services has generally been ubiquitous, claims administration and contracting for other COVID-19 services, such as testing and infusions, have lagged substantially. Moreover, many plans do not pay anything for the service of administering non–COVID-19 vaccinations, let alone for other testing and screening services. To facilitate equity and overall public health, payers, plans, and policy makers must make pharmacy reimbursement a priority.

About The Auhtor

Troy Trygstad, PharmD, PhD, MBA, is the Executive Director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He has recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation.

References

1. Dobis EA, McGranahan D. Rural residents appear to be more vulnerable to serious infection or death from coronavirus COVID-19. Washington, DC: U.S. Department of Agriculture; 2021. Accessed February 6, 2022. https://www.ers.usda.gov/amber-waves/2021/ february/rural-residents-appear-to-be-more-vulnerable-to-serious-infection-or-death-from-coronavirus-covid-19

2. Rutgers University-New Brunswick. The impact of COVID-19 on underserved communities. Newswise. November 9, 2020. Accessed April 18, 2022. https://www.newswise.com/coronavirus/the-impact-of-covid-19-on-underserved-communities2

3. The federal retail pharmacy program for COVID-19 vaccination. Centers for Disease Control and Prevention. April 8, 2022. Accessed April 18, 2022. https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index.html

4. COVID data tracker: COVID-19 vaccinations in the United States. Centers for Disease Control and Prevention. Accessed April 18, 2022. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total

5. Patel Murthy B, Zell E, Kirtland K, et al. Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations - 10 U.S. Jurisdictions, March-September 2020. MMWR Morb Mortal Wkly Rep. 2021;70(23):840-845. doi:10.15585/mmwr.mm7023a2. https://www.cdc.gov/mmwr/ volumes/70/wr/mm7023a2.htm

6. The COVID-19 pandemic: impact on US adolescent and adult vaccine utilization across markets. Avalere Health. Accessed March 25, 2022. https://avalere.com/wp-content/uploads/2021/02/The-COVID-19-Pandemic_Impact-on-US-Adolecent-and-Adult- Vaccine-Utilization-Across-Markets_White-Paper.pdf

7. Flu vaccination coverage, United States, 2020–21 influenza season. Centers for Disease Control and Prevention. October 7, 2021. Accessed April 18, 2022. https://www.cdc.gov/flu/fluvax-view/coverage-2021estimates.htm