Immunisations in pharmacies
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY
Controversy swirls around this topic. I sounded out several colleagues, including pharmacists.
An infectious disease physician: “(I see) no fundamental reason why not … under certain conditions: they keep recipients on site for 15 mins to make sure they do not suffer anaphylaxis; they [are] trained to resuscitate; they record the vaccination and report to the Immunisation Register and to the recipient’s GP and provide the recipient with an appropriate record. It might suit … families lacking access to bulk-billing GPs or who can’t organise appointments.”
An interested physician recognised this contentious issue, mainly because it disrupts GP-patient relationships.
“I’ve never been convinced (by the AMA), especially (regarding) flu vaccine – where adults >65 and parents of school-age children (need) GP appointments at convenient times. Pharmacists are well-equipped for following procedures, including cold-chain logging and record-keeping.”
Pharmacists recognised the risk of commercial pressures. Some saw pressure from the corporate chains which dominate retail pharmacy. They spoke of decreasing professional satisfaction, rather as can be heard said in general practice about corporatisation.
Westmead Hospital’s chief pharmacist, David Ng, helped set up the first pharmacy program in South Australia. He wrote: “There has been a pharmacy influenza immunisation program in several (American) states since the 1990s. South Australia and Queensland … introduce[d] enabling legislation and training programs several years ago, followed by NSW in 2015. Queensland has extended (these) programs to measles and pertussis.
“This service is underutilised because [there is no] MBS (rebate) and … the need for two pharmacists to be present for one to administer vaccine.
“Large chains … circumvent this by introducing contract GPs or nurse immunisers.
“… the system does not appear ready for a major influenza pandemic!”
An academic perspective
Professor Iqbal Ramzan, Dean of Pharmacy at the University of Sydney, commented: “Falling vaccination rates … pose a public health threat …all health professionals [must) maximise vaccine coverage.
“Most jurisdictions allow pharmacists (with) approved training to provide influenza vaccination. While there may be some disquiet within the medical fraternity, pharmacists have the requisite theoretical knowledge and, with training, the skills required to administer vaccines. Pharmacies offer easy access … this also provides GPs with valuable time to discuss complex issues with their patients.”
To their credit, pharmacists have established sophisticated training and operating procedures. Accreditation is recognised for best practice.
The facts of the matter
A recent paper, Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study,by H Laetitia Hattingh and colleaguesreported on 15,621 influenza vaccinations administered by pharmacists at 76 community pharmacies in 2015.
They found “no major adverse events; less than 1 per cent of consumers experienced minor events, which were appropriately managed. Between 12 per cent and 17 per cent eligible [for] free influenza vaccinations chose to have it at a pharmacy.
“A high percentage was delivered in rural and regional areas [where] pharmacist vaccination facilitated access. Immuniser pharmacists reported feeling confident … and [felt] that services should be expanded to other vaccinations.”
The authors concluded: “Vaccine delivery was safe. Convenience and accessibility were important. There is scope to expand to other vaccines and younger children; however, government funding needs to be considered.”
This is a work in progress. While risk is often part of treatment, its acceptability there is because we can see readily that the risk of doing nothing is greater. This is not as clear in relation to prevention where the risk of developing the condition is vague and located somewhere in the future. But discussions of this sort are an essential part of our national immunisation program’s public acceptability. Whoever does the immunising must be prepared to have it with those being immunised.