Concerns raised over pharmacists’ role in COVID vaccine rollout

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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COVID-19 general practice pandemic pharmacists vaccine rollout