6 Operations & Management
Pharmacy Practice News • May 2021
COVID-19 Pandemic
Expanding the COVID-19 Vaccinator Pool V
accination against COVID-19 in the United States is at an all-time high, but to maintain this pace, the nation still needs more experienced vaccinators to stay ahead of SARS-CoV-2. There still are not enough people vaccinated to reach herd immunity, according to CDC Director Rochelle Walensky, MD. “The key to getting us back to our lives is increasing vaccinations, and to do that, we need more vaccinators,” said acting Health and Human Services (HHS) Secretary Norris Cochran in a statement. The Public Readiness and Emergency Preparedness Act (PREP Act) has expanded its list of people who can administer the vaccines. The act includes pharmacists, pharmacy technicians, pharmacy students and now retired pharmacists. Tom Kraus, MHS, JD, the vice president of government relations at ASHP, said such measures are well-timed. “We are, as a country, going to find ourselves with more vaccine supply coming online, and we’re going to need every potential vaccinator available to be vaccinating patients,” Kraus said. “Anything we can do to get additional vaccinators [on board] is a step in the right direction.”
Retired Pharmacists a Resource Any retired pharmacist who had a valid state practice license within the past five years and is trained to provide intramuscular injections and cardiopulmonary resuscitation (CPR) can volunteer, Kraus explained. If the licensing state does not specify vaccination training, an Accreditation Council for Continuing Pharmacy
Education–approved practical training program of at least 20 hours is required, according to the American Pharmacists Association (APhA). Their CPR certificate should be current, the APhA added. Hospitals, community pharmacies and mass vaccination centers can feel confident in taking advantage of this labor pool because the PREP Act provides liability protections under federal and state law with respect to all claims for loss resulting from the administration or use of COVID-19 vaccines, according to HHS. The PREP Act preempts state laws and regulations by state boards of pharmacy that would restrict or prohibit an active or retired pharmacist from administering the vaccine, but Kraus said he has not heard any concerns about allowing retired pharmacists to practice in this limited capacity. Hospital and community pharmacists have been very engaged in the fight against COVID-19. “Pharmacists in those settings might be running the vaccination program on behalf of a health system, as well as serving as vaccinators,” he said. There are about 300,000 pharmacists nationally, as well as pharmacy technicians, students and now retired pharmacists, so this could be a substantial number of people who can help vaccinate Americans. “This is a potentially significant source of vaccinators, particularly for mass vaccination sites,” Kraus said. On campuses, many schools are “leveraging pharmacists or encouraging their schools of pharmacy to form relationships with health systems or with public
health departments. And most students will have had vaccination training as part of the school curriculum. So that’s another great resource of potential additional vaccinators.” (For more on the colleges of pharmacy COVID-19 response, see page 1.)
Leveraging Pharmacy Students In addition to allowing retired pharmacists to participate, changes to the PREP Act also provided additional flexibility for engaging pharmacy students. Originally, they had to work under a licensed pharmacist, but now they can work under any licensed health care provider. This is going to be pivotal to using these students in mass vaccination and other sites, outside the pharmacy school, Kraus said. Although the vaccines are free, facilities can charge an administration fee. Effective for vaccines provided on or after March 15, 2021, the payment rate will increase from $28.39 to $40. For two-dose COVID-19 vaccines, the rate is $40 per dose, a significant increase over the previous $16.94 for the first payment and $28.39 for the second. ASHP has advocated for reimbursement sufficient to support the additional costs associated with COVID-19 vaccine provision. “With additional resources, providers will be better equipped to provide vaccines safely and quickly to more patients,” Kraus said.
Setting Up a Mass Vaccination Site
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new resource from ASHP outlines the essential elements of successful mass immunization programs and emphasizes evidence-based best practices in the safe handling and preparation of vaccines for mass administration. The pharmacy profession is well-positioned to offer such guidance, noted ASHP CEO Paul Abramowitz, PharmD. “Pharmacists have a deep understanding and expertise regarding the therapeutics, handling, preparation, distribution and monitoring of all vaccines, drugs and biologics.” Drawing from the experiences of health-system pharmacy leaders from across the country who have coordinated vaccination sites responsible for the administration of up to 10,000 vaccines per day, ASHP recommends the following as essential elements of an effective mass immunization effort: Leadership: Centralized leadership—pharmacist, physician and nursing—as well as leaders from operations, medical informatics, logistics, facilities,
Image source: St. Joseph Mercy Ann Arbor.
environmental services and security, are critical. Planning: Scaling mass immunization programs requires deliberate and iterative planning. Pharmacy leadership supports the planning of vaccine storage and accountability, ancillary supplies, vaccine preparation and medication waste. Communication, coordination and collaboration: External communication amplifies awareness of successful mass immunization efforts. A public relations
Kraus hopes that as the pandemic winds down, both state and federal legislators recognize the contributions that pharmacists are making in the areas of testing, medication management and vaccine delivery. The best way to do that, he noted, is by passing provider status legislation. “There is no doubt that over the past year, we have seen both state governments and the federal government turn to pharmacy and say, ‘We need help, and you are a capable provider that we’re going to turn to,’” Kraus said. “ASHP and many of the pharmacy organizations are absolutely in alignment that we should be extending some of the flexibilities and making permanent some of the authorities to maintain the roles that pharmacists are playing” during the pandemic. “If the federal and state governments want pharmacists to be a provider they can turn to, they also need to make sure there’s a payment mechanism that’s going to work to support those services. The pandemic actually has been a case study that demonstrates the value that pharmacists bring as providers.” For information from HHS about volunteering to administer COVID-19 vaccines, visit bit.ly/3taDGGw. —Marie Rosenthal The sources reported no relevant financial disclosures.
team can ensure the public is aware that the mass immunization site is active and share resources for scheduling appointments. Regulatory and reporting compliance: For a mass immunization program to be effective, it must comply with state or local health department requirements related to COVID-19 vaccine reporting and personnel credentials. Supply chain management: Vaccine and ancillary supply accountability, storage and security will avoid loss or waste of scarce resources. Pharmacy leaders can support efforts to train and supervise personnel who handle and prepare vaccine doses. Vaccine safety: Safe vaccine handling and preparation practices will promote efficiency and reduce the risk for harm. Vaccine doses should be prepared in a dedicated location away from patient administration areas, restrooms or other environmental factors that may affect air quality. Staff resources: Personnel should be trained and assigned roles according to their qualifications. Staff also should receive resources to support organized workflows. These elements (bit.ly/3t4w8Fd) should be a welcome resource for the growing numbers of pharmacies that already have become sites for COVID-19 vaccinations. More than 20 national and regional pharmacy program partners were participating as of late April, according to the CDC (bit.ly/3evSXLF). —M.R.
