Pharmacists continue to protect communities during COVID-19

APhA–APPM

Immunizing pharmacists: Partnering, catching up, and being active

For years now, America’s pharmacists have been administering more than 30 million vaccinations each year. Ten or 15 years ago, it may have been accurate to refer to pharmacists as nontraditional vaccinators. It has been many years now that pharmacists have stopped being “nontraditional.”

Each vaccination by a pharmacist is a contribution to public health. These contributions accumulate, one by one, in many thousands of communities across the country. Amid our current pandemic, America is struggling to protect its people against multiple preventable infections. Pharmacists have been growing their vaccination skills for 25 years, since the mid-1990s. Now, more than ever, America needs pharmacists to pick up syringes, vaccinate, and

• •add their talents to their local immunization coalition,¹
• •help their community catch up with vaccinations (across all age groups) that were postponed,2, 3, 4
• •help their local influenza vaccination efforts to be the broadest yet,⁵ and
• •add to the general principles of vaccination they already know, so they are ready for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine(s).

Based on my experience in vaccine delivery since 1983, these can be accomplished by the following:

Partner with coalitions

Be a vocal and active partner with your local health department and immunization coalition.¹ Help them understand how pharmacists can contribute to information sharing, education, identification of the vulnerable, vaccine delivery, documentation, and adverse event surveillance.^{6 , 7} Optimize your pharmacy’s ability to communicate with your state or local immunization information system.

Catch-up

In May, the Centers for Disease Control and Prevention (CDC) reported drastic declines in routine vaccinations across the country and sounded urgent calls for catch-up.^{2 , 3} Coronavirus disease (COVID-19) precautions kept people of all ages away from routine sources of vaccination. In June, the CDC issued guidance to help vaccine providers across a variety of clinical settings plan for safe vaccination during the pandemic.⁴ In August, the Department of Health & Human Services expanded authorities for properly prepared pharmacists to vaccinate children in all 50 states.⁸ Additional suggestions have been compiled by the Immunization Action Coalition in its Repository of Resources for Maintaining Immunization during the COVID-19 pandemic.⁹ Pharmacists and pharmacies should be familiar with the most recent guidance, act on it, and be back to vaccinating routinely. Be alert for subsets of people who may need extra advocacy or support among the people you serve: ethnic minorities, those in isolated communities, those in rural settings, and people who speak languages other than English. Reach out to all your patients. Pay special attention to the pneumococcal vaccination of those aged 65 years or older in addition to those with chronic underlying health conditions¹⁰ to reduce the burden of this respiratory pathogen during the COVID-19 pandemic.

Influenza 2020-2021 season

Influenza vaccination will be especially important in the 2020-2021 season for several reasons.⁵ First, there is the usual value inherent in preventing influenza infection and complications in any year. Second, preventing influenza hospitalizations and outpatient visits will reduce the total burden on the health care system at a time when the care of patients with COVID-19 imposes extra stresses. Third, if there is any pathologic interaction associated with simultaneous infection with influenza virus and SARS-CoV-2 virus, influenza vaccination could ameliorate the problem. Partnering with your local immunization coalition on local influenza programs will bear fruit.

Preventing COVID-19

A remarkable variety of vaccine technologies is being tested in the search for safe and effective vaccines against the SARS-CoV-2 virus. A subunit vaccine would be similar in formulation to vaccines that pharmacists have administered for years. Pharmacists should become familiar with the immunology and pharmacology of mRNA and adenoviral-vector vaccine approaches. Be alert for information about products that need frozen storage or other special handling requirements. Relationships with local public health officials and community leaders will help strengthen the health of whole communities, including their most vulnerable members. The American Pharmacists Association (APhA) offers a wide range of support materials to all pharmacists on its COVID-19 website.¹¹ APhA–Academy of Pharmacy Practice & Management members should take advantage of 2 relevant special interest groups (SIGs): the Immunizing Pharmacists SIG and the new Public Health SIG.¹²

Human nature and communication

Crucial to successful vaccination is the sociology of how people evaluate whether to accept or decline the offer of any vaccine, including the impending COVID-19 vaccines. It is possible that some locations or groups of people may be offered COVID-19 vaccination while the product is in the relatively unusual status of Emergency Use Authorization (EUA). The Food and Drug Administration (FDA) website explains in detail the criteria FDA considers before granting EUA status.¹³ Explaining the level of evidence supporting a COVID-19 vaccine available under EUA, before phase 3 trial results are in hand, will take more time than usual.

In summary, help your patients “fill up their tanks” with all the vaccines they need to resolve their susceptibilities to preventable infections. Many of your patients have multiple such vulnerabilities, such as influenza, pneumococcal, zoster, and others. Pharmacists are not trained solely as influenza-injection-givers. Pharmacists are trained in the general principles that apply to all vaccines. Prepare now to step up and help protect your community.

Grabenstein

Biography

John D. Grabenstein, RPh, PhD, FAPhA, President, Vaccine Dynamics, Easton, MD