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Are pharmacists proficient vaccinators?

Flu has been responsible for the world’s most deadly pandemics having once killed 50 million people in a single wave (Spanish Flu, 1918). The technology to produce flu vaccines at a low cost and at scale, to protect the public only emerged in response to the “avian flu” pandemic which broke out in Hong Kong in 1997. To contain this pandemic, scientists invented new techniques of genetic rearrangement which enabled a vast number of vaccine doses to be produced in a short period by applying recombinant DNA technology to the influenza A/H5N1 virus¹.

In the UK, a couple more seasons with even more intense A(H3N2) activity associated with substantial morbidity followed, culminating in a peak over the turn of the Millenium (See figure 1). In mid-2000, this led to the creation of a universal influenza vaccine programme for those aged 65 years and older². The plan was created in order to reach herd immunity targets set by the World Health Organization (WHO) at 75% of at-risk patients.

Figure 1:Excess Winter Mortality in England and Wales, 2014/15 (Provisional) and 2013/14 (Final) Release

With a limited capacity of doctors resulting in a vaccination rate hovering around 36.7%³, the UK government increased supply capacity by proactively amending to the Medicines Act in late 2000 to allow specific classes of healthcare professionals to supply and administer the vaccine (via Patient Group Direction). Over the next few years, there was a steady increase in vaccine rates until 2005/06, when the majority of healthcare professionals were suitably trained England hit its 75% target. Year on year the UK has been consistently seated at the top of the table relative to all European countries, furthermore, the top 4 countries all offer non-doctor vaccinations.

Pharmacist vaccine rate in UK.

Now amid the COVID-19 pandemic, it is estimated that the level of flu vaccines required by the public will triple⁴. The beginning of this has already been shown in the UK which started its flu vaccination season last month. Community pharmacists have already vaccinated more than 650,000 NHS patients in the first four weeks, which is four times average rates from 2018-19⁵.

So why have pharmacy-based flu vaccines proven to be so successful?

One key factor is Pharmacists have consistently proven clinical excellence, ease of use and availability around the world. One of the most substantial pieces of evidence comes from a peer-reviewed meta-analysis from the College of Pharmacy Canada which reviewed thirty-six studies assessing the role of pharmacists in immunization. It is noted that “increased vaccination rates for influenza vaccines were observed with the addition of pharmacists as immunizers” and concludes that:

Pharmacists should be involved with immunization in whatever ways their legislation allows and however they are competent and comfortable. Those pharmacists without legislative authority or who are not comfortable injecting can play an important role in providing immunization education and facilitating immunization, as these roles have also been shown in this systematic review and meta-analysis to increase vaccine coverage.

Canadian Pharmacists Journal, 2018⁶

In fact, the success of pharmacist-led influenza clinics has led to the UK government to consult on the possibility that pharmacy technicians will be able to administer the vaccine…⁷

An expanded workforce eligible for administering the flu vaccine may be required, given the recent announcement of an expanded flu vaccination programme this winter. Millions more could receive the flu vaccine than received it last year, so there is a need to ensure the workforce comprises enough people to deliver these additional vaccinations.

Department of Health & Social Care⁸

So what’s next for pharmacists?

As convenient healthcare demand sores and pharmacists competence is no longer questioned, where next? The key to these new capabilities is clinical governance, to make ensure new services are contained within a framework to avoid medico-legal complications. On top of this data collection is needed to prove to health commissioners and the public the safety and efficacy of the pharmacist workforce. Voyager medical provides such a service via its hubnet.io platform.

References

  1. History and evolution of influenza control through vaccination: from the first monovalent vaccine to universal vaccines. Journal of preventive medicine and hygiene. Published Sep 2016, accessed Oct 2020.
  2. Uptake and effectiveness of influenza vaccine in those aged 65 years and older in the United Kingdom, influenza seasons 2010/11 to 2016/17. Journal of preventive medicine and hygiene. doi: 10.2807/1560-7917.ES.2018.23.39.1800092. Published Sep 2018, accessed Oct 2020.
  3. Influenza vaccine uptake and distribution in England and Wales using data from the General Practice Research Database, 1989/90–2003/04. Journal of Public Health. Published October 2005, accessed Oct 2020.
  4. Community pharmacists vaccinated more than 650,000 NHS patients in the first four weeks of the flu vaccination service. Pharmaceutical Journal, published Oct 2020, accessed Oct 2020.
  5. Influenza vaccine data 2018-19. Pharmaceutical Services Negotiating Committee. Published Sep 2019, accessed Oct 2020.
  6. Canadian Pharmacists Journal [doi 10.1177_1715163518783000] Isenor, Jennifer E.; Bowles, Susan K. — Evidence for pharmacist vaccination. Published Jun 2018, accessed Oct 2020.
  7. Pharmaceutical Journal: Government consults on allowing pharmacy technicians to administer COVID-19 and flu vaccines. Published 28 Aug 2020, accessed Oct 2020.
  8. Changes to Human Medicine Regulations to support the rollout of COVID-19 vaccines: Department of Health & Social Care. Published 28 Aug 2020, accessed Oct 2020.