John O. Beckner, RPh

 Before we conclude today’s discussion, I’d like to ask each of you for a final thought or some key advice you’d like to share with our audience. Jen, would you like to go first?

There are so many things I want to say. How do I condense it down into 1 final thought? I think, as pharmacists, we’ve known for a long time what role we play in our communities. We’ve known how we help keep our communities healthy, and we’ve known how we help keep our patients safe. Nearly every pharmacist I know cares so much about their patients and their communities, and this is another way we’re able to support the health of our communities. We should try to capitalize on this opportunity for more pharmacy advocacy, so that more pharmacists, across more states, can provide these types of services and get paid for them—that’s another conversation for another day. But it’s so important that the visibility we’ve achieved as a profession over the course of the last year, that we continue to capitalize on that opportunity. Hopefully, the pharmacists out there working on the front lines every day can feel that as well and have that same kind of hope, looking at this as an opportunity rather than a burden.

 Jen was too articulate, it’s tough to follow her. One of the things that comes to mind is that I’m incredibly proud of the way pharmacy, and pharmacists, have stepped up during an unprecedented health care crisis, such as the COVID-19 pandemic. There are so many examples of pharmacists going the extra mile, pharmacists and pharmacy staff; I don’t want to leave out technicians because they’ve played a critical role. In terms of showing others, whether they’re in health care or outside of our profession, I think we’ve been able to showcase our value, and there have been lots of lessons learned. One of the things I mentioned earlier is pharmacy having a big role in public health, whether it’s a pandemic, a natural disaster, or whatever situation, pharmacists play a critical role in public health. We need to continue to work with our colleagues in the public health sector to collaborate.

 First, I want to thank every pharmacist and every pharmacy technician out there who has been working so hard to protect our communities, and so tirelessly giving so much of themselves for the greater good. You guys have truly changed our world and our communities, so thank you for that and for all of your hard work there. The second thing I’d like to say is to continue to nurture the relationships that have been built. We’ve built relationships with physicians, health departments, and in a lot of different ways that we didn’t previously have. So continue to nurture those relationships because those are the ways we will continue to grow, to learn, and to be included and considered in different initiatives. Remember and nurture those relationships moving forward.

 I think everything’s been stated already, but I want to echo what everyone else has said about pharmacists stepping up. We are recognized now by all of our patients. I think maybe in the 1990s or in the early 2000s, it was more questionable, “Where are we going to get our vaccines and where are we not?” Coming out of this pandemic, pharmacists are now recognized as the major provider for vaccinations. I’m going to echo in thanking everyone for everything they’ve done this year. We also have to work with our boards of health, I think it’s imperative for pharmacy to get more involved with our local boards of health. I think it’s critical to take this to the next level, and to help with pharmacy. I agree about the reimbursement, and I think that should be another topic because pharmacists want to get paid for what they’re doing, and rightly so, they deserve to be paid. I think we need to talk about that and continue that discussion as well.

Thank you, Suzanne. Thank you all for your final thoughts, comments, and for the last hour of great conversation. To our viewing audience, we hope that you found this 

 webcast to be rich and informative. Thank you.

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Panelists share final thoughts and advice regarding the critical role pharmacy has played and continues to play in public health initiatives.

Pharmacy’s Role in Public Health Initiatives

 We’ve addressed the fatigue and the stress on our staff, and we’ve talked about creating the urgency for patients to continue getting the flu vaccine from our pharmacy teams. We talked about balancing COVID-19 immunizations with other immunizations. We focused initially on pharmacy playing a central role, and being key to successful immunization campaigns, but there are a few other things. We talked about pediatricians, but collaboration with the medical community at large is important. We have to spend a minute or two on that, and then planning and executing a successful, comprehensive program. How do we help some of the independent stores understand how to do that and provide guidance as well? John, I’m going turn to you about that collaboration with the medical community at large, and then we’ll go from there.

 Yes, when I think about collaboration with the medical community, I know you and I go way back with immunizations, and I think back to when pharmacies started immunizing patients in the mid to late 1990s. Those were the days when there were vaccine shortages. I remember one plant got shut down, people had planned clinics, and there weren’t a lot of vaccines to go around. Pharmacies prebooked patients, but physicians didn’t necessarily do any planning around ordering of vaccines, so oftentimes, they were left wanting. I remember the company I worked for, we made a lot of friends in the medical community by sharing the vaccines we were able to get with our physician colleagues. We were able to demonstrate a willingness to work with them for the greater good, and that’s similar to what’s going on today. I know there are a number of concerns on the part of the pediatric community, particularly with catch-up vaccinations for adolescents and children. One of their primary concerns has been about well-check visits going away if patients come to the pharmacy to get immunized. So, if there’s a way for pharmacy to work collaboratively with the medical community, particularly with the pediatric groups, I think that would be very beneficial. We need to figure out a way to bring the groups together to make that happen.

John Beckner, RPh, discusses the importance of collaborating with the medical community on the provision of immunization services.

Collaborating With Medical Community on Immunization Services

 A couple of things that we’ve touched on briefly during our discussions have to do with opportunities to coadminister with the flu vaccine. We’ve seen, in the literature, that we can coadminister the flu vaccine with COVID-19. If somebody comes in for a COVID-19 shot, they can get a flu shot, or possibly other vaccinations. Liz, are you promoting coadministration with the flu vaccine, including the combinations of the flu and pneumonia, the flu and shingrix, and the flu and COVID-19? That’s it. John, please touch on this from an independent community perspective, which is a priority in both environments. Let’s turn it to Liz first.

 Coadministration is always very important. We look at it as “flu plus 2.” When you have somebody in your pharmacy, they’re ready to get a shot. Sometimes they have to get themselves worked up or plan for a day off or whatever they feel they need to do—it’s a great opportunity to talk to that patient about other immunizations that they may be eligible for. Our pharmacists screen every patient for different disease states that may qualify them for other immunizations. They review the patient history for immunizations and then make a recommendation to the patient. The most common recommendations that we see are with the flu, pneumonia, shingrix, and tetanus. Those are the biggest ones. We also are seeing an increase in the recommendation for HPV [human papillomavirus], which is given to expanded age groups for that immunization. Of course we’re going to look at COVID-19. We have a heavy emphasis to make sure that if somebody comes in to get a flu shot but hasn’t received their COVID-19 vaccination, then we’ll have a conversation with them about that piece and make that recommendation. It’s always a great opportunity. In pharmacies, most pharmacists can give any patient any immunization can be given with a flu shot, so we’re not limited to the top 4 or 5 I listed. It’s a great opportunity to take care of patients and get them more up to date on immunizations if they’ve gotten behind.

Coadministration of the flu vaccine with other immunizations traditionally offered during flu season that pharmacies should continue to encourage.

Coadministration of Flu Vaccine with Routine Immunizations

 Last year, we hardly saw any flu. We stayed home most of the year. When we went out, we wore masks. We didn’t get near one another. We didn’t have family gatherings. Everybody was, as we are today, on Zoom, Microsoft Teams, or some other virtual platform of communicating and gathering, but it’s not going to be the same this fall. Jen, what do you think it’s going to look like when we take the masks off and we’re not social distancing? We’re going to start getting together for the holidays, and we’re going to return to in-person schooling and other things. What do you think we’re going to see, and how do we carry that message to our patients and encourage them to get protected from the flu?

 Some of the predictions for what flu season will look like aren’t great, and there are a couple of reasons. They predicted that part of the reason we didn’t see as much flu last year [2020] was because COVID-19 overcame the flu and was a bigger thing. But social distancing and masks also prevented the spread of the flu. Early on with COVID-19, we knew that it was airborne, so we also overly cleaned. Everywhere has been overly cleaning for quite some time. If we continue with some of that overcleaning, that might help us, at least a little, with this next flu season.

It was so mild last year. There are predictions that the flu season is going to be much more severe this year. People’s behavior has changed. On the spectrum, there’s the person that probably didn’t wear a mask, even during COVID-19, vs the person who will continue to wear a mask during the next flu season because they didn’t get sick with anything last year. There are people on both ends of the spectrum. Are there things you can do besides getting the flu vaccine that will help protect you against the flu? Absolutely, including the same things we did with COVID-19. But if you want to continue to live the new normal that we’ve seen in a lot of places—as states have begun to open—then the flu vaccine can be really important.

Yes, the CDC is obviously predicting a worse flu season than last year, but also 1 that’s worse than normal. That’s another part of the reason that the flu vaccine is so important. We’ve been putting the message out there that people die from the flu every year, but I don’t know how well that message has resonated with people. If we’re thinking that this flu season is more severe than normal, we’re looking at 70,000, 80,000, 100,000 people dying from the flu in 2021.

We think about dying from infectious disease, as a society, in a different way now. Having lived through the COVID-19 pandemic, we look at things differently, and we look at our vulnerable population differently. Some of the messages about COVID-19 are going to apply to our flu efforts. How do we protect those around us? How do we protect the people most vulnerable in our communities? This has to be part of our flu message, in a way that it hasn’t necessarily been. But first and foremost, our pharmacists have to get immunized with the flu vaccine in order to protect themselves. You can’t pour from an empty cup. Let’s protect ourselves first and make sure we’re protected but also do what we can, because we’re vaccinating people for the flu and COVID-19 at the same time. I know that workload, thinking about that volume of workload, probably gives some pharmacists heartburn, so we need the leaders of our chain pharmacies and folks to think about, “How do we manage that volume? How do we manage the workload?” I know folks, like Liz, already are, but that’s the other piece—we have to be cognizant of the workload that accompanies with the ability to fight a nasty flu season.

Jennifer Adams, PharmD, EdD, leads discussion on reasons for the mild flu season this previous year and share predictions for the upcoming flu season.

Reasons For the Mild Flu Season and Upcoming Predictions

Our patients have made a great leap of faith for the COVID-19 vaccine. How are going to engage with those same patients and say, “It’s time for your flu shot. There might not have been a flu last year”—we’ll get to that topic in a few minutes—“but we want you to protect yourself and your family.” We have some advice on how we can feel better behind the counter. How are we going to take that advice and muster up the confidence we need to give to our patients and get them to embrace the next level of service?

 It goes back to those conversations that I mentioned earlier. Even though I’m not practicing in a community pharmacy, I have in the past, so I understand how important those conversations can be and that sometimes, it’s not just 1 conversation. I might not practice all the time, but I’m still the pharmacist to all my friends and family. I’ll give the example of my best friend. She teaches middle school. She thinks she’s immune to probably everything because she’s been exposed to every possible germ out therebecause she teaches middle schoolers. She never gets the flu shot, she never gets the flu, she never gets sick, and she still hasn’t gotten her COVID-19 vaccine. We’re going to continue to have the conversation with her and talk about why it’s important. I’ve been able to debunk some of the myths…about the vaccine. It’s going to take time. The key piece that’s been the most important in conversations with her is, “I care about you. I love you. You’re my best friend, and I want you to be protected. I want you to be safe.”

Not every 1 of our patients is going to be our best friend, and we’re probably not going to love them all, but the message can still be there and can still be consistent. “I care about you. I care about your health, and that’s why I want to be able to share this information.” It’s listening to their concerns, helping them understand what’s real in their concerns and what’s not. Also, helping them see that the reason behind you wanting them to do this isn’t because you want to make money for your company but because you care about them as a person, as a member of your community, and that’s the only way we’ll get there together. As I said, there’s not an easy answer. Sometimes it’s not a single conversation. Sometimes it’s multiple conversations over time, that you have with the same patient, to address those hesitancies. You’re not failing if you don’t persuade them to get their vaccine on the first conversation. You’ll be persistent and continue because we care about our patients and our communities.

 I love that. Speaking to the patients, not just as a pharmacist with a white coat who knows everything and is trying to explain the need to get your immunization, we’re trying to relate as a mom, as a dad, or however you want to relate to that person. If you’re hesitant, because we have pharmacists who are hesitant to get the vaccine themselves, share the advice that helped you go through with getting it. It’s important to relate to the patients.

 I think too much about what we do for our communities. You might feel like you’re not going to get sick or get the flu, but you’re protecting your kids, your grandmother, your grandfather, your aunt, and the immunocompromised person you may be seeing in your pharmacy practice, for example. It’s a tough line to walk, but if you think outside self, what we do for our communities, and who we protect by getting vaccinated, sometimes it’s helpful reframing it to people to let them see who they’re going to be protecting. I talked about that a lot with COVID-19 vaccination and children. My children cannot get immunized yet. They’re not old enough. But obviously, 1 of the reasons I wanted to be immunized was to make sure that I could get everyone around them immunized, so I could protect them. People are much more willing to get vaccinated if they have a good reason, outside themselves, to make these choices that they may be on the fence about.

 Yes, I agree. One thing that’s come out of the pandemic is that people have started to look at helping one another more. When you frame the conversation—I like the word 

—you can’t come across as preachy. That’s not going to work. You have a conversation and capitalize on that trust factor. But when you frame it in the context of helping your community and helping others, in addition to yourself, that’s when people start to listen. The other thing I haven’t heard a lot about but is important is trying to improve compliance and adherence. People have to hear the same message from different sources, so maybe you involve other providers in helping you convey that message about why it’s important to get the vaccine.

Panelists provide tips on how pharmacists can encourage their patients to get their COVID-19 and influenza vaccines this year.

Encouraging Patients to Get COVID-19 And Influenza Vaccinations

 On the vaccine hesitancy topic, I’d like to break that down into 2 buckets. I’d like to talk about the vaccine hesitancy, some of the adverse effects of these immunizations on our staff internally, and then I’d like to turn to the second part of the conversation on how we overcome our burnout and hesitancy. We work to encourage our customers and our patients. I use both terms because some folks who are coming into the pharmacy aren’t patients, and we have to persuade them to return to the pharmacy for immunization services. Liz, start us off with a conversation about how we’re able to help our staff, behind the counter, to handle this volume of immunization services. Also, with the prospect that in a few short weeks the flu vaccine will hit our stores, overcome the burnout and the fatigue, get excited again, and create urgency for the next round of immunizations while we’re still deeply engaged in the current round of immunizations.

 It’s a very challenging situation. I feel for the pharmacists out there. They’re working tirelessly. Our clinical pharmacists, at least for my company, Albertsons, are working extreme hours, making sure that everything is coordinated, and that people are where they need to be. They continue to give pep talks and supportive commentary to our pharmacy teams, technicians, pharmacists, and everybody involved in this because not only are we doing these crazy number of immunizations, but our pharmacists still have their day jobs of filling prescriptions accurately and making sure our customers, and patients, are safe. Trying to get that balance has required a lot of learning for everybody as we’ve gone through this. The approach I always take is to understand why. Why are we asking you to continue to have these conversations? I know you’re tired. I know you haven’t had a vacation. I know you’re working tremendous hours, but why is this important?

Any 1 of us can look around at the world, at the United States, at our own states, our own towns, and see how it’s changed. We see the impact and difference that these vaccinations have made in terms of states that were absolutely shut down are wide open, and life is almost normal. I don’t have a lot of explaining to do to help people understand why. The proof is in the pudding. We can see how important immunizations are for people. They are hardworking. They keep plugging along, and they know we don’t want to have a terrible flu season. We used to always be afraid of flu season. Last year, flu season was mild for many reasons. This year, we want it to be just as mild by making sure we immunize our patient population and protect them. We continue to provide as much support as we can by understanding and explaining the business side, from our perspective. Most pharmacists want to keep driving it because we want life to be as we’ve always known it, except for the last year.

 Thank you. Susie, you have an environment where you’re able to glean the thoughts and feelings of the pharmacist moms group. I’m sure they’ve been vocal about a lot of different things with COVID-19, immunizations, and work especially. Maybe provide a few thoughts on what you’re seeing and some suggestions on how we can provide some additional support for our pharmacists and our technicians?

 There are a lot of comments and a lot of questions, but whether you’re a patient, you’re working in corporate, or you have a leadership position, just thinking of the pharmacists who are doing the work can go a long way in something they’re looking for. I also think different ideas. Liz talked about this earlier, but having best practices and being able to share those ideas with one another is critical, especially for some of the independent pharmacies—because they may not have leadership—and explaining to them what to do may be beneficial. It’s very important. But you can’t thank the pharmacist enough, who’s taking the time and who’s going to work every day. We saw pictures of pharmacists, in the group, taking off their masks and showing all the acne they might have and what to do with that. These are the things that they’re facing on a day-to-day basis that many of us take for granted when we’re working from home or if we’re not there. Talking about that, or maybe providing pharmacists a thank-you, such as cookies or cupcakes, would be appreciated. They’ve been getting a lot of things.

A discussion on the COVID-19 pandemic’s impact on pharmacy staff and solutions to help combat pharmacy staff fatigue, burnout, and vaccine hesitancy.

John O. Beckner, RPh

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