© The Author(s) 2022Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/17151635221128223
When Washington State first introduced pharmacist vaccination back in 1994, with British Columbia following in 2009,1 we had no idea the impact it would have on pharmacy practice and public health nationwide. Fast forward to 2022, and pharmacy professionals have administered more than 17 million doses (and counting!) of COVID-19 vaccines2 and helped move Canada toward the end of a pandemic. The number of lives saved and hospitalizations prevented because of pharmacy is remarkable.
And this didn’t just occur in certain regions—pharmacists in all Canadian provinces and the Yukon territory have the ability to vaccinate,3 as do pharmacy technicians in British Columbia, Saskatchewan, Ontario, New Brunswick and Nova Scotia.3 And it is not just COVID-19 vaccines: in 2019, pharmacies surpassed physician offices as the most frequent location for the administration of influenza vaccines.4 The uptake of pharmacy-based vaccinations by both pharmacy professionals and the public has been impressive. Across provinces publishing statistics on the proportion of pharmacists with authorization to administer injections, approximately 70% of practising pharmacists have registered training to administer injections with their regulatory body.5-9
This success is not surprising. Evidence has consistently shown that pharmacy professionals are competent and confident vaccinators who offer a service that is valued by the public.10-14 Research has found improvements, although varied in magnitude, in overall population immunization rates following the introduction of legislation supporting pharmacistadministered vaccinations.15,16 Convenience has regularly been cited as a key factor influencing patient decisions to be vaccinated at a pharmacy,13,14 with evidence from the United States prior to the COVID-19 pandemic showing that nearly onethird of vaccines administered within a community pharmacy chain were in evenings, on weekends or holidays—times when other vaccine providers are often unavailable.17
Offering vaccination services has not come without challenges. Patient expectations of walk-in availability can significantly impact workflow. Remuneration, when available, differs significantly across jurisdictions18 and may not be sufficient to offset costs. Constantly evolving vaccine eligibility criteria during the COVID-19 pandemic was confusing and frustrating for pharmacy staff and the public alike. Addressing vaccine hesitancy takes time from an already hectic workday; it can take an emotional toll on us and isn’t remunerated. We recognize it hasn’t been easy.
Despite progress, there are barriers yet to be addressed.
First is the harmonization and expansion in scope to include all vaccines across all jurisdictions. Restrictions on which vaccines pharmacy professionals can and cannot independently administer are not based on science. As is evident in provinces with broad injection authority, patient safety is not compromised with access to a wide range of vaccines through their community pharmacy.
Second, the inability for pharmacists to prescribe vaccines in some jurisdictions creates an accessibility barrier for our patients, especially the 4.6 million Canadians without a family physician.19 The Canadian Immunization Guide states that “all vaccine doses for which a person is eligible should be administered at a single visit to increase the probability that the individual will be fully immunized”20—a recommendation that cannot be upheld when a Schedule I vaccine cannot be ordered by a pharmacist when indicated.
Finally, pharmacies need access to publicly funded vaccines. Many public health offices and medical clinics have scaled back or paused their immunization programs, and vaccination programs did not run in schools during the pandemic. This has led to a backlog of individuals who have fallen behind on the publicly funded vaccines they are eligible for—putting them, their families and their community at risk. Throughout the pandemic, pharmacies have stayed accessible and have stepped up when called upon. And yet, when the health system is still struggling to function, pharmacy professionals’ hands have been tied, as we can’t help Ontario seniors get the publicly funded shingles vaccine, for example, or adolescents in Alberta receive publicly funded human papillomavirus vaccine, even though these individuals are in our pharmacies every day. If public health and optimized vaccination rates are truly government priorities, then access to publicly funded vaccines by pharmacies must also be a priority.
We also call on more provinces and territories to enable pharmacy technicians trained in injection administration to practise to their full scope and for pharmacists to embrace this opportunity to delegate the nonclinical aspects of injection administration. Research out of the United States, where technicians in Idaho have been authorized to administer injections since 2017,21 has reported workflow efficiencies when pharmacy technicians adopt vaccine administration roles, allowing pharmacists to focus on other clinical tasks like case finding and patient assessment.22,23 Such a team-based approach to vaccination services improves professional satisfaction and team morale22 while also supporting the provision of other medication management services.
Providing vaccinations may not be easy or your favourite aspect of pharmacy practice, but it has made a difference in the health of your community. The number needed to vaccinate to prevent 1 case of influenza ranges from 71 among those aged 16-65 years to 40 among community-dwelling older adults.24,25 This means that every shift during influenza vaccination season, you may be protecting a patient from lost productivity, the exacerbation of chronic disease or worse. Your commitment to public health and patient care as vaccinators is a success story worth celebrating. Watch for much more on pharmacy-based vaccinations in future issues of CPJ.