The Role of Student Pharmacists in the Immunization Process at Northeastern University

The Accreditation Council for Pharmacy Education’s Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (“Standards 2016”)¹ emphasize the preparation of “practice-ready” pharmacy graduates. Although immunization training at schools of pharmacy can be optional for student pharmacists, the SARS-CoV-2 (COVID-19) pandemic illuminated the crucial role of pharmacist and student pharmacist immunizers on the front lines of health care, particularly those serving in community pharmacy and outpatient or ambulatory care settings. Student pharmacists in all 50 states may administer immunizations under the supervision of a pharmacist if both have completed immunization training.² Colleges and schools of pharmacy have been deliberate in integrating immunization training into their curricula and cocurricular activities so that student pharmacists and graduates can support public health needs.

The American Pharmacists Association (APhA) has recognized immunizing as a critical skill set for pharmacists and student pharmacists, and offers the Pharmacy-Based Immunization Delivery certificate training program “to prepare pharmacists with comprehensive knowledge, skills, and resources necessary to provide immunization services to patients across the life span.”³ Successful completion of the APhA program involves 20 hours of training, including didactic study on topics such as vaccine indications, contraindications, and adverse effects (AEs); and hands-on injection technique demonstration and assessment.³

Colleges and schools of pharmacy, including the School of Pharmacy and Pharmaceutical Sciences (SOPPS) in the Bouvé College of Health Sciences at Northeastern University (NU) in Boston, Massachusetts, have provided student pharmacists with a curriculum to learn the knowledge and skills necessary to be effective immunizers, as well as cocurricular opportunities to apply what they have learned in the classroom and begin to support the public health needs of their communities.

STUDENT PHARMACISTS: PUBLIC HEALTH AND IMMUNIZATION

Public health topics and advocacy are integrated throughout the NU SOPPS doctor of pharmacy curriculum. The SARS-CoV-2 pandemic presented an opportunity for real-time advocacy. During the 2021 spring comprehensive disease management seminar course, small student groups developed specific public service announcement videos on TikTok targeting the SARS-CoV-2 pandemic that addressed vaccine education, transmission/infection prevention, addressing racial and ethnic disparities, the pandemic’s impact on mental health, and countering vaccine misinformation.

The foundational knowledge of virology and immunization practice applied to patient care are also woven into the doctor of pharmacy curriculum at NU SOPPS in courses such as immunology and anti-infectives; the comprehensive disease management series of courses, seminars, and labs; and on community introductory pharmacy practice experience rotations (called “co-op” at NU SOPPS). The APhA certificate training program on Pharmacy-Based Immunization Delivery has been delivered by a cohort of trained faculty since 2015 and is currently offered biannually, in the spring semester of the first professional year (P1) and the fall semester of the second professional year (P2). Historically, student participation in the training program was optional as an additional opportunity to integrate their knowledge and skill on co-op, advanced pharmacy practice experience (APPE) rotations, public health projects, and service-learning opportunities. Given the evolving needs for pharmacists to provide immunizations as part of their practice, the NU SOPPS faculty recommend as part of their curricular revision that all stu-
dent pharmacists be required to complete APhA’s Pharmacy-Based Immunization Delivery certificate training program.

Before the SARS-CoV-2 pandemic, students completed the home study component of the immunization training program independently before attending an all-day, in-person session consisting of didactic training and hands-on technique assessment. In response to pandemic restrictions, didactic training was shifted to a series of online synchronous Zoom sessions, and hands-on technique was assessed during in-person time
slots in accordance with the capacity/spacing restrictions defined by the university. Proper personal protective equipment was supplied for students and faculty observers. These adaptations allowed NU student pharmacists to gain the skills needed to combat the SARS-CoV-2 pandemic by administering vaccines to members of the community.

The SARS-CoV-2 pandemic presented unique challenges for experiential education during an unprecedented public health emergency and changed the way clinical practice sites had to function. In the spring of 2020, NU SOPPS APPE clinical practice sites pivoted from full-time, in-person experiences to fully remote patient care. Since that time, most clinical sites have transitioned to varying degrees of hybrid clinical care. Nevertheless, despite these barriers, new opportunities emerged for students to implement their immunization skills as health care extenders to address the rapidly evolving conditions in the community.

ROLES FOR STUDENT PHARMACISTS AS IMMUNIZERS IN EXPERIENTIAL EDUCATION: INFLUENZA AND COVID-19

Students and faculty in the Bouvé College of Health Sciences at NU have historically worked together to address the health and wellness needs of the campus community, including via the administration of influenza vaccines. Originally envisioned in 2006 by a small group of motivated student pharmacist members of Phi Delta Chi, a professional pharmacy fraternity, the Bouvé Health Fair and Flu Shot Clinic, now in its 15th year, offers attendees free influenza immunizations, blood donation opportunities, biometrics testing, and wellness displays. The 1-day event, held each fall, typically draws about 5000 people, including up to 3000 students, faculty, and staff who line up for their yearly influenza vaccine.

The Bouvé Health Fair and Flu Shot Clinic serves a dual role of protecting the relevant needs of the NU campus community while providing interprofessional learning opportunities for students in pharmacy, nursing, and physician assistant programs to apply their classroom skills in a hands-on learning environment with supervising faculty. Each discipline provides students with the foundational knowledge of basic life support, blood-borne pathogen training, and immunization certification. As part of the training for the health fair, students also learn key skills related to patient screening, assessment, education, needle safety, and vaccine storage and handling.

The event runs over the course of a full day, with about 12 vaccination booths. In accordance with Massachusetts regulations,⁴ an immunization-certified, licensed pharmacist provides supervision for the 2 to 3 student pharmacists assigned to each pharmacy-designated booth. Students are responsible for patient screening before vaccine administration, proper aseptic technique when handling single-dose vaccines, providing proper documentation to patients, and counseling on potential AEs. The vaccination component of the event runs on a first-come, first-served basis, with student pharmacist volunteers working at a check-in area to provide attendees with screening questionnaires and to direct patients to open booths.

During the fall 2020 semester, the Bouvé Health Fair and Flu Shot Clinic took place despite numerous challenges with planning and social distancing amid the SARS-CoV-2 pandemic. To ensure density limits were followed and for the safety of attendees and immunizers, the event was extended over 2 days and reduced to 6 vaccination booths, and an appointment scheduling system allotting 10 minutes per appointment was used. These measures allowed for proper sanitizing of each booth between patients; additionally, the event was held outdoors under a tent to allow for improved air-flow and ventilation. With most students, faculty, and staff continuing to work remotely during this time, the downsized event was a success with over 1000 influenza vaccine doses administered.

During the spring 2021 semester, NU offered COVID-19 vaccinations to members of the university community in accordance with Massachusetts state vaccine eligibility requirements.⁵ Immunization-trained NU SOPPS faculty and APPE student pharmacists played a key role in this effort alongside other health care professionals and students from the Bouvé College of Health Sciences. NU faculty and students from the nursing, nurse practitioner, physician assistant, and other health programs joined pharmacy faculty and students to volunteer 2 days per week (January through February) to prepare and administer COVID-19 vaccines and counsel patients on vaccine efficacy and potential AEs. Through these efforts, student pharmacists, supervised by NU SOPPS faculty, helped immunize campus first responders, frontline health care workers, and community members with high-risk medical conditions against COVID-19 illness.

In addition, several NU SOPPS ambulatory care practice faculty pivoted their daily clinical responsibilities into designing and implementing designated COVID-19 vaccination programs at their practice sites. Student pharmacists who were precepted by faculty on APPE rotations at these sites gained experience administering COVID-19 vaccines and interacting with patients to address vaccine hesitancy and misinformation. Student pharmacists learned firsthand that effective communication is just as necessary as knowing the pharmacology of the vaccine. With this realization, students were able to use their skill sets more effectively and play a vital role in the enormous vaccination effort.

CONTINUING TO PREPARE STUDENT PHARMACISTS TO MEET COMMUNITY NEEDS

As SARS-CoV-2 virus variants persist and the rate of vaccinated individuals remains too low to end the pandemic,^6,7 pharmacists and student pharmacists must continue to play a major role as advocates and participants in educating, dispelling medical misinformation, and immunizing all who are willing to be vaccinated. Federally, the US Department of Health & Human Services (HHS) has identified the need to engage all eligible immunizers in efforts to vaccinate against both COVID-19 and influenza.^8,9 This is critical given that a rampant flu season—with similar symptoms to COVID-19 illness—could derail much of the “new normal” that our society has begun to transition back to, including plans for in-person instruction at higher-education institutions. In accordance, HHS released guidance in September 2020 per the Public Readiness and Preparedness (PREP) Act, to expand federal authorization to allow licensed pharmacists to administer vaccinations to all adults and children over the age of 3 years, regardless of state regulations.^10,11 In August 2021, HHS again expanded this authorization under the PREP Act to allow pharmacy technicians and students to administer seasonal influenza vaccines, in addition to COVID-19 vaccines, regardless of state regulations.⁸ Purposefully integrating this opportunity into student pharmacist education, both didactically and experientially, is critical for the immunization public health mission and ensuring practice-ready pharmacy graduates.

MICHELLE JACOBS, PharmD, RPh, BCACP, CDCES, is an associate clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

MACAYLA A. BARTUCCA, PharmD, BCPS, BCGP, is an assistant clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

MARK A. DOUGLASS, PharmD, is an associate clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

MICHAEL J. GONYEAU, PharmD, MEd, BS, BCPS, FNAP, FCCP, assistant dean of academic affairs and assessment, is a clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

THOMAS M. MATTA, PharmD, CDCES, AE-C, is an assistant clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

DANIELLE M. MILLER, PharmD, MEd, RPh, BCACP, director of undergraduate and professional education, is an associate clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

TAYLA N. ROSE, PharmD, MEd, RPh, BCACP, CDCES, is an associate clinical professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

DAVID P. ZGARRICK, PhD, FAPhA, is a professor of pharmacy in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy and Pharmaceutical Sciences in the Bouvé College of Health Sciences at Northeastern University in Boston, Massachusetts.

REFERENCES

1. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy
   degree (“Standards 2016”). Accreditation Council for Pharmacy Education. February 2, 2015. Accessed July 27, 2021. https://www. acpe-accredit.org/pdf/Standards2016FINAL.pdf
2. Pharmacist administered vaccines based upon APhA/NASPA survey of state IZ laws/rules. American Pharmacists Association. Updated January 2019. Accessed July 27, 2021. https://media. pharmacist.com/practice/IZ_Authority_012019.pdf
3. Pharmacy-based immunization delivery. American Pharmacists Association. Accessed July 27, 2021. https://www.pharmacist. com/Education/Certificate-Training-Programs/Immunization
4. Board of Registration in Pharmacy; Drug Control Program; Immunization Program. Policy 2020-11: vaccine administration. Massachusetts.gov. September 4, 2020. Accessed August 2021. https://www.mass.gov/doc/2020-11-vaccine-administration-0/ download
5. Massachusetts’ COVID-19 vaccination phases. Massachusetts. gov. Accessed August 2021. https://www.mass.gov/info-details/ massachusetts-covid-19-vaccination-phases
6. COVID data tracker: COVID-19 vaccinations in the United States. CDC. Accessed August 30, 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total
7. COVID data tracker: Variant proportions. CDC. Accessed August 30, 2021. https://covid.cdc.gov/covid-data-tracker/#variant-proportions
8. Eighth amendment to declaration under the Public Readiness and Emergency Preparedness Act for medical counter- measures against COVID-19. Federal Register. August 4, 2021. Accessed August 30, 2021. https://www.federalregister.gov/ documents/2021/08/04/2021-16681/eighth-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for
9. Vaccines: national strategic plan for the United States 2021-2025. US Department of Health & Human Services. 2021. Accessed August 30, 2021. https://www.hhs.gov/sites/default/files/HHS-Vaccines-Report.pdf
10. Office of the Assistant Secretary for Health. Guidance for licensed pharmacists and pharmacy interns regarding COVID-19 vaccines and immunity under the PREP Act. US Department of Health & Human Services. September 3, 2020. Accessed August 30, 2021. https://www.hhs.gov/guidance/sites/default/files/ hhs-guidance-documents/licensed-pharmacists-and-pharmacy-interns-regarding-covid-19-vaccines-immunity.pdf
11. Third amendment to declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID-19. Federal Register. August 24, 2020. Accessed August 30, 2021. https://www.federalregister.gov/ documents/2020/08/24/2020-18542/third-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for-medical