At the time of this writing, the Department of Health and Human Services (HHS) just announced that booster shots would be necessary to “maximize vaccine-induced protection” against COVID-19 infection. While rates of administration of first and second doses remain lower than desired, it is clear that those who have received these doses will need a third dose, especially in the context of the surging Delta variant.
This news comes in the context of continued disparity in vaccine access, especially among poorer countries. From a global perspective, experts suggest that policy must support development, dissemination, and deployment of vaccines to countries with limited access. Specifically, regulatory and government policies must encourage research and development to provide the quantity of vaccines necessary on a global scale, as well as development of vaccines to address the emerging virus variants. Recent history has demonstrated inequities in delivery of promised doses of vaccine to poorer countries. Policy must address this disparity. Lastly, deploying the vaccine focuses on getting the vaccine “the last mile” to the providers who will administer it, as well as addressing vaccine hesitancy among the general public.
Simply stated, the pandemic provided the ideal use case for bidirectional standards-based data exchange. Again, the looming round of booster shots will underscore this need in community pharmacies.
For those who may have been skeptical or simply unaware, the pandemic has served as an explicitly clear example of the connectedness of today’s global society and economy. While I recognize the critical nature of the global society, I am going to focus on community pharmacies in the United States. Specifically, I am going to explore several insights that have risen to the forefront of my mind as I consider community pharmacy’s role in rolling out the vaccine.
While the vaccines were under development, the initial focus in community pharmacies and other settings was testing. In April 2020, HHS authorized pharmacists to order and administer COVID-19 tests. Known as POC (point of care) testing, the COVID tests received CLIA waiver status, which authorized the tests to be performed outside of a clinical laboratory setting. There are more than 100 tests with CLIA (Clinical Laboratory Improvement Amendments) waiver status, including for influenza and strep. From a patient’s perspective, there is significant value — in the form of convenience — in going to a single location for testing and treatment. Similar to the management of prescription drug monitoring programs (PDMPs), “test/treat” authority for pharmacists is regulated at the state level. As an example, collaborative practice agreements with physicians are a common method under which pharmacists are able to perform test/treat patient care services. The lesson from COVID-19 testing is that pharmacy has an opportunity to tap into the yet largely unexplored opportunity of test/treat.
Scheduling was a challenge that spanned POC testing procedures and the subsequent administration of the vaccine. ComputerTalk readers are surely familiar with the stories — and many have their own scars — of trying to schedule patients to come for POC testing, vaccine doses, or both. Some pharmacies hired pharmacy students. Some pharmacies propped up web-based scheduling, only to have it crash under the demand. Other pharmacies experienced overloaded phone systems that were unable to handle the call volume. In clinic settings, reports describe successful methods of HL7 FHIR-enabled (Fast Healthcare Interoperability Resources) application programming interfaces (APIs) that automated scheduling with minimal information from patients. It is worth acknowledging that pharmacies, health systems, IT vendors, and virtually all groups involved had inadequate time to prepare for the demand that was placed on the healthcare system in 2020. But as we face a particularly contagious variant and an impending demand for booster doses, are systems going to be in place to schedule patients? I believe pharmacy has learned what to expect and will meet the challenge head-on.
While all of this was happening, community pharmacists still needed to meet patients’ routine needs for chronic meds, short courses of antibiotics, oral contraceptives, and the full range of medication dispensed in customary operations. Similar to scheduling, additional staff were sometimes hired. Above all, this was an opportunity for automation to shine. Pharmacies that were able to shift routine, manual processes were better positioned to meet the nonroutine demands that arose from the pandemic. Med sync also proved to be of considerable value, as it allowed pharmacists to reduce patients’ trips to the pharmacy. Besides the obvious convenience it provided, med sync allowed pharmacies to address patients’ concerns of potential exposure to the virus in public settings. For similar reasons, medication delivery services grew in popularity.
Previous columns in this series have touched on the importance of immunization information systems (IIS) or registries. Vaccine administration data (including that from pharmacies) is critical to public health tracking purposes. Those pharmacies that reported to an IIS via manual methods faced an uphill battle to submit data in a timely manner. Simply stated, the pandemic provided the ideal use case for bidirectional standards-based data exchange. Again, the looming round of booster shots will underscore this need in community pharmacies.
The need goes beyond booster shots, however. Data from the CDC highlights the pandemic’s impact on routine vaccination procedures for vaccines such as HPV, DTaP, and MMR (see link above). Specifically, there were fewer childhood and adolescent vaccines administered in 2020 compared to both 2018 and 2019. This decrease was most striking during the period from March to May 2020 and among those 13 to 17 years of age. Of note, vaccination rates in June–September of 2020 increased compared to March–May, but they remained lower than rates from 2018 and 2019. As demand for routine vaccinations increases among these age groups, pharmacies will be called upon again to meet patients’ needs. It is critical that this information is readily accessible from and shared with state registries.
As the country faces a second wave of COVID-19 infections, we must leverage the lessons learned during 2020. Pharmacies and pharmacy staff were resilient in their efforts to meet an unprecedented and unexpected public health demand. Here, I’ve explored a few of the lessons that may help U.S. community pharmacies better respond to the current wave. I have tremendous respect and appreciation for my colleagues who have served and continue to serve their patients and their communities. CT
Brent I. Fox, Pharm.D., Ph.D., is an associate professor in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University.
He can be reached at firstname.lastname@example.org.