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Everyone will have a different confidence level based on their experience with vaccines in the past, and their comfort level with their local hospital, pharmacy chain or pharmacy. But once we get to the point where there are enough vaccines, Dan Rodriguez, R.Ph, BS, Pharm, believes “this process will run like a flu clinic – I don't think there's going to be that level of distrust or unease.”
As a nurse for over 30 years, I’ll admit I was frustrated when my 81-year-old mother asked me what should be simple questions about how and when she should get the COVID-19 vaccine. Which vaccine is best? Can I trust the distribution process? Should I go to a hospital or pharmacy? When can I get the vaccine and where?
Currently in many states, anyone over 65 is currently eligible to receive the vaccine, but with decentralized operations varying from state to state, and initial supplies running lower than expected, many concerns are rising within this age group, in particular, and other age groups.
Dan Rodriguez, R.Ph, BS, Pharm, a healthcare thought leader/strategist, facilitator of pharmacist training programs and provider of “medication management education” for patients, sheds some light on these questions from a pharmacist’s perspective.
In short, Rodriguez believes what’s needed for hospitals and pharmacies to administer the COVID-19 vaccines safely is a laser focus on operations and organization, and the “OK” from federal or state authorities.
The last 20 years in pharmacies, according to Rodriguez, have set the precedent for vaccinations – “it’s where you go to get your flu, shingles, pneumonia and travel vaccinations,” he said. “They have the processes in place. All that’s missing is the information they need to communicate to their communities (where, when, safety precautions, side effects, etc.), as well as direction from federal and state authorities. Of course, there must be enough vaccine supply so that pharmacies can start that 'machine' – once they are given the ‘green light’ they know how to operate.”
In April 2020, HHS recognized pharmacists and pharmacy staff members as front-line healthcare workers who can make a meaningful difference in combating COVID-19, including administering vaccines, and monitoring and treating patients immediately post-vaccination. Pharmacies already have policies and procedures in place to let pharmacy staff know the rules of the road when it comes to vaccine administration. Pharmacists and pharmacy technicians are provided Basic Life Support (BLS) training and know what to do should any adverse reactions occur immediately post-vaccination.
For health systems that have pharmacies in their networks, coordination is key. Hospital pharmacies can work with community pharmacies to create a plan for administering vaccines to their populations.
According to Rodriguez, pharmacies play a large role in COVID-19 vaccine administration as hospitals are already overwhelmed caring for COVID-19 patients.
“Pharmacists around the country are ready, including traditional chain pharmacies (both national and regional) and especially independent pharmacies.” he said. “They’re just waiting for the go-ahead from state and federal agencies.”
Supermarket pharmacy chains such as Publix and Wegmans are already successfully administering doses of the Moderna vaccine (which does not require costly freezer units) at hundreds of supermarkets around the country. Walmart is training thousands of employees as it gears up to deliver 10 to 13 million doses per month. Some of the regional pharmacy chains that have already been providing first-dose vaccinations to residents and staff at long-term care and assisted living facilities include Coborns and Thrifty White in Minnesota and North Dakota. While Value Drug has been actively vaccinating those 65 and older in their communities, and Discount Drug Mart is vaccinating based on Ohio’s phased 1B approach, others like Weis Pharmacy and Balls Foods are simply waiting on vaccine supply to get going.
The faster supply, allocations, and government authorizations allow, the sooner we will see greater progress being made to combat the virus.
Combating Vaccine Hesitancy
Like myself, Rodriguez was also concerned about a trend that’s been around for some time but gaining power in light of COVID-19: vaccine hesitancy. As clinicians, we share the same concern over the degree of hesitancy surrounding COVID-19 vaccines and how it potentially could upend efforts to reach herd immunity – which is necessary to ensure the virus is dramatically curtailed or eradicated.
“Generally speaking, 30% of the population has some degree of vaccine hesitancy, and in many cases, that’s because they don't fully understand what the vaccine is or how it works," he says. "The biggest challenge right now is trust, both in the science and the process.”
To combat vaccine hesitancy, he points to information and education being standard practice in his immunization training programs for pharmacists.
“By helping people understand the science behind vaccines, they’re more likely to trust their efficacy, especially if they already have trust in their healthcare providers – such as physicians, nurses, and pharmacists," he adds.
Having those established, trusted relationships is an important piece of clearly communicating the importance of vaccinations.
Rodriguez also points out that as more members of the community get vaccinated and people see that it’s safe, levels of hesitancy should decrease, despite a tendency in the media to highlight rare cases of adverse reactions.
“We know the adverse reactions to expect with vaccines, and while it’s important that we understand these, what patients are really looking for is transparency from us,” he says.
Everyone will have a different confidence level based on their experience with vaccines in the past, and their comfort level with their local hospital, pharmacy chain or pharmacy. But once we get to the point where there are enough vaccines, Rodriguez believes “this process will run like a flu clinic – I don't think there's going to be that level of distrust or unease.”
More challenges ahead
Ironically, the elderly are the most vulnerable to the virus, and at the same time, the ones least likely to understand how to communicate through their hospital’s portal. In fact, recent estimates indicate that 42% of adults, age 50 to 80 years old, said they had not set up an account with their health provider’s portal system. In order to ensure we keep all populations informed, we need to understand these limitations and address them as part of any pre-vaccine rollout discussions, along with how to best use technology to reach all demographics, especially those impacted by social determinants of health.
Another challenge will be managing second dose distribution. People may not understand that they have to receive the same vaccine at a prescribed length of time depending on the manufacturer (21 days for the Pfizer vaccine, 28 days for the Moderna vaccine). That’s where pharmacies and hospitals can come in using their pharmacy management software systems and hospital communications outreach programs to schedule, document and alert patients when their second vaccine is due. Asking patients about allergies and history of previous anaphylactic reactions is essential. The CDC has also recently posted warnings against getting the flu vaccine 14 days before or after getting the COVID-19 vaccine. Screening prior to vaccination and informing patients of this warning is also essential.
Pharmacy chains have layered clinical software elements on top of their existing medication dispensing systems to accommodate patient management and second dose compliance. They have the infrastructure and experience to manage the patient prep and follow-up that is so essential.
These are just a few areas in which we need to pivot as an industry to operationalize and mobilize quickly to get shots into more arms. But if there’s one thing the healthcare industry has learned from COVID-19, it’s that we must think differently to treat a virus that acts so differently than anything we’ve seen before. We must use the lessons from this initial vaccine rollout to sustain the vaccination effort until herd immunity is achieved, and be prepared should we ever have to face this kind of crisis again.
A Holistic Approach to Vaccinations
When people from different backgrounds come together to tackle some of the biggest healthcare issues of our time, this makes the work we do that much more rewarding. Rodriguez's current work with CHC Health is important and inspiring work. It also brings a broader perspective to the work we are doing at CipherHealth to empower purposeful healthcare conversations between hospitals and their patients and families, staff, and the community.
Navigating the vaccine rollout places additional burden on all providers to coordinate efforts and obtain necessary resources - it requires work with federal and local governments, staff, patients, and each other to get this done.
“I cannot overstate how critical communication and coordination is to the success of any initiative, especially one of this magnitude,” he said. It’s a true community effort that will reap huge rewards in terms of lives saved and illnesses prevented.
Author Lisa Romano, MSN, RN, is chief nursing officer of CipherHealth. She brings more than 25 years of experience in clinical practice, healthcare IT strategy, and healthcare operations to her current role. Prior to previous CNO roles, Lisa spent 19 years as a nurse and hospital administrator at Lehigh Valley Hospital and Health Network in Allentown, PA, where she was responsible for all patient flow and transfer center operations as well as numerous quality and patient satisfaction initiatives.