Local pharmacies can reduce the dual risks of COVID19 and influenza this fall

Local pharmacies can reduce the dual risks of COVID19 and influenza this fall
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At this moment, more than ever, convenient access to a clinician that provides immunization and testing is critical as COVID19 vaccines move closer to approval and rapid tests to detect SARS-CoV-2 increase in availability. Pharmacies can play a fundamental role in boosting vaccination rates and increasing testing to levels that will get the economy safely back on the sturdier footing and protecting loved ones at-risk. 

The pharmacist is often considered the most accessible health professional, and diagnostic testing in pharmacies is increasingly recognized as an effective mechanism to improve detection and treatment for contagious diseases, notably for streptococcal pharyngitis, influenza, HIV, and hepatitis C.

The Centers for Disease Control and Prevention (CDC) reported that more than 31 percent of people 65 years and older received their influenza vaccination at a community pharmacy or a pharmacy within a bricks-and-mortar store, and the numbers are growing. The CDC National Vaccine Advisory Committee points to the convenience, extended hours, possible reduced cost, and improvement in public understanding of immunizations as benefits of pharmacy-based vaccinations. Given that 90 percent of influenza-related deaths are in older adults, the outsized benefit to our seniors of community-based vaccination is clear. 

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Considering that older adults also endure disproportionate COVID19 harm, we must leverage that they are the most likely group to receive seasonal vaccinations at a pharmacy. Importantly, preventing influenza cases by vaccination would stem arrivals at hospitals by ill patients who were concerned, based on their symptoms, that they have COVID19. 

Prior studies demonstrated a boost in immunization rates in areas where pharmacists administer influenza shots. Johns Hopkins University researchers estimated that vaccination at pharmacies, in addition to traditional locations, in an influenza epidemic would raise vaccination coverage, mitigating up to 23.7 million symptomatic flu cases and providing cost-savings up to $2.8 billion to insurers and $99.8 billion to society.     

Another motivation for pharmacist-provided vaccinations was a successful effort to improve immunization rates in underserved areas. Given the disproportionate impact of COVID19 on minorities, pharmacy vaccination and testing is a route to improved and equitable access to care for underserved populations.  

More than 8 in 10 Americans live within 5 miles of a pharmacy and older adults visit their pharmacies more frequently than their primary care physicians. Shortened travel time, lowered SARS-CoV-2 exposure, and increased likelihood of vaccination series completion are three benefits of vaccination at your neighborhood pharmacy compared to a traditional medical office. Even amidst the pandemic, most pharmacies have remained open with normal or extended hours. Pharmacists are also considered by the public to be highly trusted health professionals that can help educate people in their communities to ease the very real threat of vaccine hesitancy that could prevent herd immunity. 

In April, the Office of the Assistant Secretary for Health released new guidance authorizing pharmacists to order and administer COVID-19 tests with the Assistant Secretary issuing the statement: "The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans. This will further expand testing for Americans, particularly our healthcare workers and first responders."  

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In late May, the Department of Health and Human Services affirmed authorization for pharmacists to order and administer FDA-authorized COVID-19 tests in all states, even in those that ostensibly prohibited it, under the Public Readiness and Emergency Preparedness (PREP) Act. However, authorization alone does not guarantee smooth and widespread implementation.

While the largest chain pharmacies are already involved in SARS-CoV-2 testing, to achieve the necessary response to cool COVID19 flare-ups and to achieve pandemic containment, community pharmacies must enhance readiness to administer diagnostic tests and vaccines at a level not before seen. Pharmacies offer potential to help flatten the curve; however, thoughtful planning must be performed on issues including medication storage, staff training, viable reimbursement, management of clinical laboratory agreements, health record access, health agency reporting, healthcare worker protection, and patient safety.   

A key first step is the addition of the SARS-CoV2 vaccines to the CDC Advisory Committee for Immunization Practice immunization schedule to grant authorization for pharmacists to administer these vaccines. Coordination between national and state health organizations, boards of pharmacy, large chains, independent community pharmacist associations, to name a few, will facilitate harmonization and scale-up as improved testing and SARS-CoV2 vaccination becomes available.  

The role of the neighborhood pharmacy in delivering the care that people in the U.S. deserve has never been more important. We must do the work now to prepare this critical resource for pandemic control. 

Jonathan H. Watanabe is associate dean of assessment and quality at the University of California Irvine School of Pharmacy and Pharmaceutical Sciences and a Scholar in the National Academy of Medicine (former Institute of Medicine) Emerging Leaders in Health and Medicine Jan D. Hirsch is the founding dean at the University of California Irvine School of Pharmacy and Pharmaceutical Sciences.