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Monday, April 24, 2017

The Safety Implications of Pharmacists Giving Vaccines by Rishma Parpia


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The Safety Implications of Pharmacists Giving Vaccines

pharmacistStory Highlights
  • A recent survey reports that 62 percent of Americans prefer the convenience of going to their local pharmacy to get vaccinated.
  • In 1995, pharmacists were officially recognized as vaccine providers.
  • There are serious safety implications of vaccines administered in pharmacies.
A new survey conducted by healthcare communications solutions firm PrescribeWellness LLC of Irvine, CA found that 62 percent of respondents preferred visiting their local pharmacy to get vaccinated rather than going to their doctor’s office. In its 2017 Vaccination and Preventive Care Survey, PrescribeWellness interviewed 1,000 Americans over the age of 35 on their views of vaccination and neighborhood pharmacies.1 The reasons given for this preference was predominantly based upon convenience.

Twenty-six percent of respondents said that their local pharmacy is a “one-stop shop” for all their health and wellness needs. Twenty-four percent stated that their local pharmacy was easier to get to than their doctor’s office and twenty-one percent reported that going to the pharmacy was more convenient when they had their children with them.1 However, although local pharmacies may be convenient locations for receiving vaccines from the perspective of families, the expanding role of pharmacists in administering vaccines has serious implications.
In 1993, U.S. Secretary of Health and Human Services Donna Shalala asked the American Pharmacists Association (APhA) to help define the role of pharmacists in the national vaccine program for children.2 Given that pharmacies offer convenience, accessibility, and extended hours of operation, in 1995, the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid Services (CMS), recognized pharmacists as vaccine providers.2
In 1996, the APhA initiated its nationally recognized 20-hour training program for pharmacists on pharmacy-based vaccine delivery.2 According to a review published in the Journal of the American Pharmacists Association:
By 2004, an estimated 15,000 pharmacists and student pharmacists had been formally trained through recognized programs as vaccine experts, and the practice of pharmacist-administered immunizations, particularly for adult patients, has become routinely accepted as an important role of the pharmacist. Arguably, few initiatives have done more to move the pharmacy profession forward in direct patient care than the pharmacist-administered immunization movement.3

When Pharmacies are Allowed to Deliver Vaccines

While there are numerous issues regarding the role of pharmacists in vaccine delivery, one of the most serious concerns relates to safety resulting from the growing corporate pressure for pharmacists to work faster in order to meet quotas.4
The pressure to work faster has led to increases in prescription drug errors. In an investigation led by The Chicago Tribune in 2016, half of the 255 pharmacies tested in the Chicago area failed to warn prescription users for potential drug interactions that could be harmful or fatal.4 5 The investigation found that pharmacists frequently hurry through legally required drug safety reviews, omit them altogether and/or and fail to ask patients whether they are taking other medications.4 In fact, pharmacists are required to work at such a high speed that many have complained they are hesitant to drink liquids during their shift because they do not have the time for a bathroom break.4
Initially states in the U.S. only authorized pharmacists to administer the influenza vaccine. However, today nearly every state allows pharmacists to administer almost all vaccines.6 Given what is already known about corporate quotas and their effect on medication dispensing speed and prescription drug errors, there is legitimate reason to be concerned about the safety of vaccine delivery by pharmacists. Although pharmacists are required to assess and screen patients for contraindications and take precautions before administering a vaccine,7 this is unlikely to occur given the time constraints and quota requirements, all of which creates a potentially dangerous situation for children and adults getting their vaccines in pharmacies.
This leads to another question: Are most pharmacists monitoring and reporting serious reactions, hospitalizations, injuries and deaths that follow vaccinations they administer to people to the federal Vaccine Adverse Events Reporting System (VAERS)? Are they keeping patients in the drug store long enough to monitor for anaphylaxis or syncope (fainting)? Since pharmacists are now administering a substantial portion of vaccines, they do have the responsibility of reporting vaccine adverse events to VAERS, but is this actually occurring given that they are working at high speeds to meet their quotas?
Rep. Mary Flowers (D-Chicago) is sponsor of a bill in the Illinois House of Representatives supported by pharmacy workers that would restrict the hours pharmacists can work each day, limit the number of prescriptions they can fill each hour, require break time during their shifts and provide whistleblower protection if they expose safety problems. Rep. Flowers states that “It is just a matter of time before there will be a major catastrophe.”4 Not surprisingly, the bill has received heavy opposition from corporate lobbyists representing owners of pharmacies.4
Additionally, states are now beginning to authorize pharmacists to play a role in recommending and prescribing vaccines. According to the APhA:
Through the years, many states’ laws have evolved from requiring a prescription from a physician for the pharmacist to administer vaccines, to allowing for protocol-based administration, to some states finally allowing pharmacists to serve as the vaccine prescriber. By allowing for an additional health care provider—in this case a pharmacist—to serve as the screener, recommender, prescriber, and administrator of the vaccine, access is increased, and patients are more likely to actually receive the vaccine that is recommended for them. As of July 2015, eight states allow pharmacists to prescribe or administer, without a prescription, all recommended vaccines (many states don’t allow this for young children); and another nine states allow this for the influenza vaccine.6
Assigning pharmacists the role of vaccine prescriber ultimately removes the physician as the middleman. The entire process of prescribing, selling and administering vaccines in one location i.e., the pharmacy, is a value added product and service that ultimately saves costs on extra labor charges, storage facilities, etc.—an efficient business strategy. So what appears to be a move in the best interest of public health is merely a disguise for expanding the profits of owners of pharmacies and the pharmaceutical industry.

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