Community Pharmacy's Pandemic Capacity and Readiness Are Greater Than Ever
But will policy and program administrators make optimal use of existing primary care and pharmacy systems?
Back to school, up in the airplane, and off to the restaurant: The United States has chosen to move forward now that an effective vaccine has been available for more than 10 months. In the face of some of the worst outbreaks of the pandemic, we are forging ahead. Mask debates rage on and vaccine resistance continues, but in large part, behavior has changed and likely for the long term. With 72% of respondents to a survey supporting mask mandates and 61% supporting vaccine mandates, a majority of Americans have decided that life must go on but with evidence-based interventions and precautions.1 Most of us get tested when we need to, wash our hands a little longer than we did before, and wear masks when we should.
Pop-Up Providers, Shopping Malls, Sports Venues
When President Joseph R. Biden set a goal of more than 1 million vaccinations per day, one would have thought the United States was girding for a world war on 2 fronts, calling in the Federal Emergency Management Agency and the National Guard, sequestering space and tens of thousands of volunteers, and enticing many of them with early access to the vaccine. The media was fixated on the idea that there were not enough vaccination sites for such a lofty goal. Administrators and politicians often ended up ignoring an existing and well-scaled vaccine administration infrastructure, governors freaked out, and hospital lobbyists called in favors to receive their vaccine bounties. Makeshift vaccine providers, shopping malls, and sports venues, having never cared for patients before the pandemic, became primary venues for getting shots into arms. Never mind that more shots go into arms during school vaccinations and well-child efforts alongside influenza season and at a quicker pace than the COVID-19 rollout for many weeks during the vaccination push this past spring.
Let's Use the Current System and the Trust Built Over Many Decades
The vaccine supply is ample. So the country should focus on using the existing vaccine administration infrastructure of pharmacies and primary care providers, which together represent more than two-thirds of annual influenza vaccine administration, alongside the special role of health departments for assisting underserved populations and advising on policy. Why would a patient need, want, or be required to drive past tens, if not hundreds, of existing providers, some of whom already maintain their health records, to get a first, second, or third dose? Why should patients receive health care services from someone they have never met and will never meet again rather than highly trusted, locally based, frontline health care providers in their own neighborhoods? And we wonder why we have hesitancy and trust issues over the COVID-19 vaccinations.
The Next Wave(s): Multiple Tests and Vaccinations, OTC Counseling
Unlike the past fall, winter, and spring, during which a few thousand lab-confirmed positive tests countrywide defined a nearly absent influenza season, the upcoming seasons have many anticipating a trifecta of cold, COVID-19, and flu symptoms at pharmacies. We are launching a booster shot program, and testing and vaccination requirements will grow exponentially for patrons of concerts, gyms, institutions, and restaurants. Pharmacies will likely retain much- needed authority to test for infectious diseases, a capacity problem we have not solved in this country. If Delta leads to another variant that is better at getting around the complement of COVID-19 vaccines, we may have a crisis that exceeds or matches what we experienced in March 2020 and the months following with fear, a high demand for curbside and hand delivery services, and too few regularly scheduled physician visits not related to COVID-19. Pharmacies will be busy, regardless, as patients will continue to need medications.
Pop-Up Clinics Fill an Important Gap
Mass vaccination clinics did play an important role in filling the gap for those individuals who don’t usually access health care. The healthy and young, without an established connection to the health care provider community, often rely on events or work site drives for health care screenings and vaccinations. Individuals who are confined at home, marginalized, and/or very ill comprise the gap on the other side of the spectrum, with accessibility, cognition, and travel barriers. In both instances, pop-up clinics staffed by a known entity in the neighborhood or workplace can fill this gap without renting out the speedway 30 miles away.
Rolling Demand, Multiple Systems of Care, Plenty of Capacity
With a relatively steady half million newly vaccinated individuals per day, and rolling demand created by the 8-month federal guidance on “booster” shots, pharmacies should expect a very manageable but steady stream of residents accessing local vaccine providers over the next 6 months. Pharmacies and primary care providers should play a major role in vaccination administration. There is no need to disrupt the existing infrastructure by creating clinics that are unnecessary and have the potential to erode the already festering government and institutional mistrust simply to create “vaccine theater.” Hundreds of millions of tests and vaccines are carried out each year as part of the frontline health care infrastructure, and there is plenty of capacity, both at clinics and pharmacies.
Community-Based Pandemic Response Most Effective
Much like the lakes of Minnesota, which boast a longer shoreline than California, Florida, and Hawaii combined, smaller bodies of water (community-based providers) that are much more plentiful (10,000+ lakes) are superior to the flashy beaches of the Atlantic and Pacific oceans. Only in America would we spend trillions of dollars on a health care system and then create an alternative system of access when a pandemic ensues. By 2 to 1, patients prefer to use a pharmacy or primary care clinic as their main source of vaccination services.2 Many experts predict that COVID-19 will become endemic and that, like influenza, we will be chasing variants and similar pathogens indefinitely, perhaps seasonally. With many developing countries just now receiving their first sizable shipments of COVID-19 vaccinations, we can assume we will be in this for the long haul.
Countless Service Opportunities as Essential Community Providers
For pharmacies, the ongoing pandemic will offer continued opportunities to serve their communities, both as health care providers and leaders, in concert with the care team. Counseling and education opportunities, tests, and vaccinations will number in the billions over time, and pharmacists and primary care providers should prepare for and welcome this. Providing superior community-based care, they will demonstrate that the 60,000-plus pharmacy locations and nearly half a million primary care providers in the United States are part of the essential infrastructure.
Troy Trygstad, PharmD, PhD, MBA, is vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors of the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.
1. Page S, Hassanein N. No vaccination? Americans back tough rules and mask mandates to protect the common good. USA Today. August 22, 2021. Accessed August 25, 2021. https://www.usatoday.com/story/news/nation/2021/08/22/americans-back-mask-covid-vaccine-mandate-protectcommon-good/8134392002/
2. Allen Dobson L Jr, Trygstad T. We must use the vaccination infrastructure we already have. Pharmacy Times. April 1, 2021. Accessed August 25, 2021. https://www.pharmacytimes.com/view/we-must-use-the-vaccinationinfrastructure-we-already-have