Table 2.

Decision makers (CMOCs 1–4)

CMOC 1— support a public health role23–27 62 66–69	When the government, pharmacy regulators, professional bodies and the public endorse and support a clear role for community pharmacy in public health services (C), community pharmacists will be more likely to adopt vaccination services (O) because they see it as their professional role and duty (M).
	‘Distribution and administration of the COVID-19 vaccination programme will require concerted action across the NHS. With unique insight and expertise in medicines and the delivery of vaccination programmes, pharmacists have a clear role in contributing to the success of this programme.’ (Great Britain) 66 ‘55% of the public have visited a pharmacy during the COVID-19 crisis…89% of people believe pharmacies are playing an essential role in the COVID-19 crisis.’ (UK National Pharmacy Association) 27 ‘Pharmacists…have been called on to coordinate the administration of COVID-19 tests…providing ongoing COVID-19 surveillance to communities by allowing walk-in testing at community pharmacies…[This] might be more sustainable and convenient than the large-scale public screening being done as of the summer of 2020.’ (USA) 23 ‘Given the past success of community pharmacists with increasing annual seasonal influenza uptake and their accessibility, pharmacists will need to be central in administering COVID-19 vaccines in order to achieve rapid population-wide coverage.’ (Canada) 26
CMOC 2—clarify legal and professional liabilities24 28 66 70–76	When pharmacy regulators and the NHS clarify community pharmacists’ legal and professional liabilities arising from the administration of a novel and potentially unlicensed COVID-19 vaccine (C), community pharmacists are more willing to give the vaccination (O) because they feel reassured regarding liability (M).
	‘The role of pharmacists in the COVID-19 vaccination programme must be made clear to the pharmacy profession itself. Professional and representative pharmacy bodies have an important role to play in providing the right level of information to the profession to support their roles in the vaccination programme.’ (Great Britain) 66 ‘Indemnity insurance for individual healthcare professionals needs to be amended to cover this activity and be state-funded. There also needs to be clear communication to healthcare professionals, so they clearly understand that they are covered and under which circumstances this applies.’ (Great Britain) 77
CMOC 3—Codevelop feasible service specifications1 28 37 54 78–82	When COVID-19 vaccination policy and service specifications have been developed with input from diverse community pharmacists and staff tasked with administering and supporting the administration of the vaccine (C), community pharmacies are more likely to deliver the service (O) because they believe the service specification is feasible (M).
	‘Pharmacists ideally want input into future policy changes before they are finalized, so that these can reflect capacity and preparedness on the ground and be publicized accurately.’ (Great Britain)1
CMOC 4—issue clear, relevant and timely guidance23 24 28 31 35 37 46 67 71 83–92	When government, pharmacy regulators and professional bodies provide consistent, clear, relevant and timely guidance for the delivery of the COVID-19 vaccines (C), community pharmacies are more likely to deliver the service (O), because the guidance is helpful and simplifies implementation (M).
	’… it is good to see that NHSE/I have provided the information we have been waiting for to review the resources we have nationwide and decide how we can bring them to bear to help the NHS defeat this virus.’ (Great Britain)28

CMOC, context-mechanism-outcome configuration; NHS, National Health Service; NHSE, National Health Service England.