COVID-19 vaccination: why it’s a marathon not a sprint
By Dr Ian Maidment
Reader in Clinical Pharmacy
Aston Pharmacy School
COVID-19 has been the most pressing health emergency in perhaps the last 100 years. A co-ordinated response from the NHS, local authorities and voluntary care sector has started to address the emergency, but it is likely that COVID-19 will be with us for many years and a long-term sustainable response is required. A key part of the response has been the vaccination programme, which has been widely acknowledged as being successful.
Role of community pharmacy in the current vaccination programme
Community pharmacy can be involved in COVID-19 vaccination in two ways. Firstly, the staff can provide vaccinations in the central hubs and secondly, vaccinations can be delivered on community pharmacy premises. At present, the vast majority of COVID-19 vaccinations have been delivered in the larger central hubs, sometimes involving community pharmacy staff. Whilst - due to the need to vaccinate the whole population at speed - this approach is understandable in the short-term, it may be less sustainable longer-term particularly if the decision is taken that vaccination needs to be annual or boosters are required.
Managing “variants of concern”
Viruses regularly mutate meaning that vaccines need to be tweaked and boosters given (as seen with the annual flu jab). At-risk groups regularly receive these annual flu vaccines. And preparations are already underway for a third COVID-19 booster jab in the autumn. Like flu, people may need to receive regular, potentially annual, COVID-19 vaccinations to cover so-called “variants of concern.”
The current model of the big hubs, whilst effective in the “sprint” acute response, may not be sustainable for a “marathon” involving potentially annual vaccination which may include significant numbers of people, plus there is the flu vaccination to consider. This model, with dedicated staff is also likely to be costly and may take staff away from frontline services. Involving a larger number of community pharmacy premises and making them into vaccination centres may be more sustainable and cost-effective in the long term “marathon” response.
Community pharmacy frequently has strong links with the local communities it serves, including minority ethnic communities and deprived communities where there are generally lower rates of vaccination.
Future role of community pharmacy in COVID-19 vaccination
Community pharmacy is the most accessible healthcare resource and, with a community pharmacy on most high streets, it is a very convenient location for the public. Vaccine hesitancy is at least partly related to convenience and access. Community pharmacy frequently has strong links with the local communities it serves, including minority ethnic communities and deprived communities where there are generally lower rates of vaccination. Overall, the average high street community pharmacy offers an ideal site for longer-term vaccination campaigns.
What needs to change?
With colleagues I have just completed a research project funded by UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR) which made a number of recommendations for policymakers on working with community pharmacy to support COVID-19 vaccination. Key recommendations included:
- Have a clear role for community pharmacy in response to the public health agenda, with that role championed by policymakers
- Involve frontline community pharmacy staff in the development of policy and service specification in relation to vaccination
- Provide prompt, clear, consistent guidelines with adequate detail and enough flexibility to allow community pharmacies to adapt the guidelines to meet the needs of their local population
- Provide adequate funding and reimbursement for the delivery and necessary adaptations of any new services community pharmacies are asked to deliver
- Provide pharmacy teams with adequate systems to deliver this new role and then trust them to deliver.
Overall, the key recommendation for practice and policy was the need to focus on the clinical aspects rather than the retail aspects, of community pharmacy. With a suitably innovative approach, barriers to community pharmacy COVID-19 vaccination can be addressed. For example, the cited difficulty in social distancing could be reduced if the premises were opened up; this might entail removing retail space (for example, shelving). The community pharmacy contract could be structured - and remunerated - to drive such innovation towards a more focused clinical role.
Focusing on community pharmacy as a clinical resource, sustainable long-term vaccination models for COVID-19 for all communities can be developed.
This key recommendation, to focus on clinical services, is in line with other policy related to community pharmacy. Indeed, the COVID-19 pandemic could be a key driver for a more clinically focused community pharmacy. I graduated from university in 1986, the same time that the landmark Nuffield Report on the future of pharmacy was published. Whilst much has changed in pharmacy, particularly hospital and general practice, the future mapped out in Nuffield has not yet been fully implemented within community pharmacy. However, the COVID-19 crisis could help drive this long overdue implementation.
Overall, by focusing on community pharmacy as a clinical resource, sustainable long-term vaccination models for COVID-19 for all communities can be developed.
Dr Ian Maidment led the PERISCOPE study, which was jointly funded by UKRI and NIHR. Andrea Hilton and Hadar Zaman were members of the PERISCOPE team and co-authored this opinion piece. All three (Ian, Andrea and Hadar) are experienced community pharmacists. The views expressed are those of the authors and not necessarily those of the NIHR, UKRI or the Department of Health and Social Care.