Concerns raised over pharmacists’ role in COVID vaccine rollout

Anastasia Tsirtsakis

7/01/2021 3:18:27 PM

Queensland Health has taken steps to include pharmacies in the vaccination program. But will it come at the cost of patient safety?

Pharmacist administering a vaccine.
There are safety concerns over the delivery of COVID vaccinations in pharmacies and whether vaccination data will be reported to the Australian Immunisation Register.

Alarm has been raised over the proposed role of pharmacists in the rollout of the COVID-19 vaccine program, which has been brought forward by the Federal Government to begin mid-February, following Queensland Health’s calls for expressions of interest.
RACGP Vice-President and Chair of RACGP Queensland, Dr Bruce Willett told newsGP the prospect is a safety issue.
‘Patients should really consider having these COVID vaccinations in general practice if possible,’ he said.
It’s a new vaccine, it’s come out quite quickly and so general practice is a far safer environment.’
Following a teleconference with the Department of Health (DoH) on Wednesday to discuss logistics of the rollout, RACGP President Dr Karen Price revealed to newsGP a key concern is that vaccine sites have the setup to adhere to strict infection prevention and control standards, with separate spaces for those being vaccinated and patients who are unwell.
With many pharmacies located in crowded environments such as shopping centres, Dr Willett argues the set-up is less than ideal, especially in a pandemic environment.

‘Pharmacies are retail spaces, they’re essentially shops,’ he said.
‘The pharmacist is at the back of the pharmacy always for a reason, because they want you to walk through and buy things. They’re not really clinical spaces for administering vaccines.’
Dr Price agrees that maintaining patient safety is paramount, as well as continuity of care.
‘The safety profile of the vaccine has to be worked through,’ she said.
‘There’s a certification process and a whole lot of logistical processes, so it’ll be very much dependent upon whether or not those skills are available.
‘We need to get most of the population vaccinated, and we need to do so safely.’
The Therapeutic Goods Administration (TGA) is expected to finalise emergency approval of a COVID vaccine in late January, with around 80,000 vaccinations a week expected to take place from mid-February with frontline healthcare workers among the first in line.
The most promising candidates secured by the Federal Government developed by the University of Oxford/AstraZeneca, Pfizer/BioNTech and Novavax are all likely to require two doses.
Dr Willett said patient communication will be key to ensure patients are recalled for their second dose, and has doubts there would be follow through in pharmacy.

‘GPs are used to and have the systems for making sure patients are recalled for their second vaccine, recording the vaccines and making sure that they go to the national immunisation registry,’ he said.

‘I’m certainly concerned that that may not happen in pharmacies.’

A review of pharmacist vaccination reporting to the Australian Immunisation Register (AIR) released in May found underreporting is rife, with only half of pharmacists supplying valid vaccination data to the AIR from July 2018 to June 2019.
This could have severe implications form a public health perspective, Dr Willett says, as well as inconveniencing patients once international borders are eased.
‘Recording immunisations is going to be a really important piece in knowing what percentage of the population we’ve got vaccinated, and how we’re going in terms of approaching herd immunity,’ he said.
‘If those figures don’t go through to the national immunisation registry then there won’t be good data on that.
‘We’ve also got airlines saying that, in future, patients may not be allowed to travel on airlines if they’re not vaccinated. So if those vaccinations are not recorded in the national immunisation registry, then those patients may not be able to travel.’
Despite the concerns however, Queensland’s Chief Health Officer Dr Jeannette Young said in August that the Government would be using the state’s network of community pharmacies when a COVID-19 vaccine became available.
‘It’s very important that when we do get a vaccine that everyone has access as quickly as possible, and it would be great for them to go to their community pharmacy,’ she said.
The commitment was also affirmed by a DoH spokesperson to the Sydney Morning Herald last month, but said that pharmacists would be part of the vaccination program in line with Australia’s COVID-19 vaccination policy, indicating that they will likely play a role later in the year.
‘As outlined in the policy, key vaccination sites for the vaccine priority groups are expected to initially include hospitals, respiratory clinics and general practices,’ the spokesperson said.
‘Pharmacists are expected to play a role in the wider COVID-19 vaccination rollout, occurring from mid-2021.’
As well as ensuring patient safety, GPs are also expected to play an important role in helping to educate and reassure patients about the COVID vaccines, and address any hesitancy within the community.
During talks with the DoH, Dr Price also proposed the idea of a specific Medicare Benefits Schedule (MBS) item number for the vaccine rollout to recognise time and skill required.
‘I emphasised that for me, as a GP, a patient coming in for a COVID vaccination would need to be triaged to a COVID-safe area, and they’ll need to be educated and consented – that takes time,’ she said.
‘Then they have to have the vaccination and wait post-vaccination for observation. So that’s going to be at least 30 minutes under my care where I’m on call for any vaccination reaction, including resuscitation from anaphylaxis.
‘This is not just a quick in and out, this is something that needs 30 minutes of general practice time.’
Dr Willett agrees.
‘A lot of GPs are concerned that that may put them in breach of the 80/20 rule by using the level three,’ he said.
‘So a different item number for use for the COVID vaccines would be really helpful in terms of rolling this out, and having GPs able to do the volumes of vaccines that are needed.
‘It would also provide another useful measure for the Government to know just how many of these vaccines are being given.
‘The resources that governments would have to pour into educating and training pharmacists would be of better use in general practice.’
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Dr D   8/01/2021 8:23:59 AM

Yet another win the for the pharmacies

Dr MTP   8/01/2021 10:23:57 AM

I cannot understand why our college is so desperately afraid of vaccinations being given by other institutions, and I don't buy the safety argument.
If we're telling the population that the vaccines are safe, we contradict ourselves with this inflated argument on safety.

I submit that:

It is not technically difficult to give a vaccine. It is not an insurmountable challenge to document administration or arrange follow up.

It is easy to train staff to monitor for anaphylaxis and initiate emergency treatment. Further, anaphylaxis is not managed in a surgery, these patients require transfer to an emergency department.

We need a concerted and rapid response to vaccinate against COVID, and it isn't the time to draw lines in the sand and be precious about jurisdiction.

We're busy people already and we don't rely on vaccines for the viability of our practice or relevance to patients. We don't need to embarrass ourselves by being this petty.

Dr Nicholas Nicola   8/01/2021 10:35:08 AM

If the accompanying photo is real, showing an im injection, then there are big safety concerns. That needle is nowhere near the deltoid and possibly close to the radial nerve.

Dr Irandani Anandi Ranasinghe-Markus   8/01/2021 11:52:09 AM

The issue of safety is a valid concern, as is appropriate follow up. Would it not make sense for the patient to be immunised by their Primary health care provider who would more often than not have knowledge of past history and comorbidities? In case of adverse reactions, the patient would naturally present to their GP. Saves having to chase up immunisation provider. Also welcome Dr Price’s suggestion of a special time appropriate item number.

Dr Malcolm Robert Tilsley   8/01/2021 4:16:53 PM

There is obviously a lot of bad blood between GPs and pharmacists in parts of Australia.I have a very good working relationship with local community pharmacists.
Vaccinating patients is not rocket science but does require appropriate knowledge and care.
Where various state governments are so keen on assisting pharmacists take over GP’s work we should look no further than the large political donations made to both major parties by The Pharmacy Guild.
Let’s just get on with our work there is plenty of it.

Dr David Zhi Qiang Yu   8/01/2021 9:36:33 PM

COVID-19 vaccine should be done at the general practice in stead of at any pharmacies. To maintain patient safety is paramount, as well as continuity of care for all patients.

Dr Neil Warren Donovan   9/01/2021 12:49:55 AM

This is time for General Practice to step up and own primary health care. This is our chance to drive and be remembered for one of the biggest health initiatives of our time.
It is not petty,. It is the sharp edge of public health, and we can show that this noble profession is agile and able to create new models to reach all out patients.
Step up, own it or YES, you will be busy, entering data to the register on behalf of pharmacist. No one will thank you and no one will pay you.

Dr Nirmala Ben Patel   11/01/2021 7:39:42 PM

-Our college should do more to protect Primary care with more public education about how going to a GP and how going to the Pharmacist differs for medical treatment or vaccinations and the record keeping we do for thier future needs - Its our own fault we dont have the leavarage they have - Their Guild looks after their interests , mostly monetary ,that is why Primary care has slowly been eroded or invaded by pharmacists ,who are educating the public and the goverment that they can do our work equally well and some do a better job too but the main care of the patients health should remain with the GP so we need to upgrade our skills to be better than them if we want to stop further invasion by would be doctors .