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Marsha K. Millonig
Marsha K. Millonig B.Pharm., M.B.A.

MANY OF US MAY NOT have imagined the global situation with COVID-19. It is impacting all aspects of our professional and personal lives. Getting accustomed to the “new normal” of social distancing and stay-at-home orders during the COVID-19 pandemic is likely challenging for many Americans. Addressing the pandemic has turned homes into classrooms and places of business on a widespread basis, and the role of technology as a backbone cannot be understated.

When we are able to move through managing the pandemic response and emerge on the other side, there must be some lessons to learn from this pandemic, both in the near and long term. And I would like to challenge all of us to think about how our personal and professional lives may become better as a result of what we are learning from this unprecedented experience. Also, consider how our states and country may take what we’ve learned and apply it to enhancing health business and care processes and practices in the future.

We are witnessing new measures being implemented in the pharmacy (and all retailing) and healthcare community that may serve to provide better access to care, at lower cost and in a more sanitary environment. Examples include more flexibility for patients to visit with their providers through a variety of technologies and media, the emphasis and expansion of telehealth visits, and expanding pharmacy delivery services.

We are learning to change and adapt more quickly. In the past four weeks, in the pharmacies where I have been working, numerous innovative preventive measures have been implemented rapidly, including:

• Emphasizing curbside and drive-thru usage.

• Implementing social distancing procedures using a variety of visual markings/ signage and clear barriers to contact.

• Using new protocols to manage and control viral exposure in the pharmacy, including processes to minimize frequent surface contact, including signature logs.

• Rapid updating of systems to ramp up medication delivery services.

• Hourly handwashing and workstation sanitizing.

• Using personal protective equipment.

• Working with patients to manage medication needs to avert creating shortages.

• Providing remote counseling, education, and ongoing follow-up.

Out of necessity, pharmacists have now created an environment that is more attuned to infection control but that still allows us to provide patient care. Perhaps some long-term improvement and efficiencies will be the result of this new normal?

Pharmacy stands to benefit as well from states easing access to pharmacist-provided services and from other waivers that will allow us to “step up to the plate” during these challenging times. I believe patients are becoming more appreciative of our advice and counsel as they seek to assess their situation and home environment. Pharmacists are using their compounding skills to ease the shortage of hand sanitizer. They are providing careful assessment and recommendations to patients to ease panic and hoarding behavior. They have been approved to order and administer COVID-19 tests to their patients by the Department of Health & Human Services (HHS). And the profession will be on the front lines of providing immunizations when a COVID-19 vaccine is introduced.


The rapid development of a COVID-19 vaccine is underway by several firms, and the Gates Foundation is directing funds to an innovation generator. When a vaccine is approved, pharmacists stand ready to put their immunization services into overdrive to meet what will no doubt be high demand throughout the globe. I reflected on this important role in my January/February ComputerTalk column.

Not everyone agrees, however. During a recent Minnesota Pharmacy Legislative Day in Saint Paul (with COVID-19 not yet declared a pandemic) we shared our day with the anti-vaccine parental rights group that was lobbying for expanded choice in whether to vaccinate their children. We were prepared to have a respectful conversation and had a genuine interest in listening to their concerns without judgement and sharing the Capitol’s halls with respect. Unfortunately, the other group was not as respectful. While they did give us a wide berth and refused to engage in any conversation, they had no issues “photobombing” our group picture on the Capitol steps with their placards and signs and shouting negative statements at us for our role in providing immunizations.

In many of our meetings, legislators expressed concern about the group’s lobbying and messaging and thanked us for being there and for our support of public health. They showed us the primary talking points from the anti-vaccine group, including their concern about the rigorousness of the vaccine approval process, the inability to directly sue vaccine manufacturers, and the slowness of seeking relief through the National Vaccine Injury Compensation Program (VICP). The VICP is a federal “no-fault” system designed to compensate individuals or families of individuals who have been injured by covered childhood vaccines, whether administered in the private or the public sector. The protesters have abandoned arguments about vaccines and autism because of the scientific evidence that has emerged showing no links between them, so they have substituted other arguments in their place. Expanding immunization exemptions for parents is unlikely to happen in our state, especially in light of the continued occurrence of measles cases and now the coronavirus outbreak.

All states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, in order to attend public school. These laws often apply to those in private schools and day care facilities as well. There are often medical exemptions, and the majority of states also allow exemptions for religious reasons. Seventeen states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons. California, Mississippi, and West Virginia prohibit nearly all exemptions.

The recent COVID-19 outbreak and the related health risks have made many wonder, where is the balance between the protection of public health (and herd immunity) and personal liberty? The courts have repeatedly held that when a public health intervention is necessary to safeguard the majority of the populace, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school. Regardless of the protests against stay-at-home orders, the fact remains that widespread testing and vaccination will be necessary for us to get beyond the new normal.

When a COVID-19 vaccine is introduced through this amazing innovation, I wonder how the anti-vaccine parental rights group will react and if they will continue to protest against immunization mandates. Perhaps that will be determined by how close to home COVID-19 strikes. Stay tuned. CT

Marsha K. Millonig, B.Pharm., M.B.A., is president and CEO of Catalyst Enterprises, LLC, and an associate fellow at the University of Minnesota College of Pharmacy Center for Leading Healthcare Change. The author can be reached at