How Will We Massively Increase the Number of Vaccinations Given Each Year?

A Report on The New Partnership Between  Public Health and the Nation’s Pharmacies

By Todd Watkins, President, STChealth

How do we prepare to take on a huge increase in the number of vaccinations administered each year?

Average number of all vaccines shipped for use in U.S., per year (from 2006 to 2016): 281 million.

Number of covid-19 vaccinations that the HHS’s BARDA is preparing to have manufactured in the U.S., per year: 300 million.

Are we ready to take this opportunity to improve forever the capacity for eliminating vaccine–preventable diseases?

We are facing a huge opportunity. Sadly, it comes in on the back of a pandemic, but that is exactly the time when barriers come down.

Two recent examples:

• Hurricane Katrina dropped the barriers to state-to-state sharing of vaccine data, and
• It was during the H1N1 outbreak that the demand for vaccinations broke through the resistance to pharmacies administering vaccinations.

Now it’s time to use this crisis to make the next step forward in the availability of vaccinations and the data that magnifies their usefulness.

THE PHARMACY PUBLIC HEALTH COVID-19 COLLABORATION

That bring us to the Pharmacy-Public Health Covid-19 Collaboration. In April of this year, over sixty vaccine professionals found time to join a conference call to begin to figure out how to meet the crisis by breaking down barriers to new vaccination programs. From that larger group, we created a leadership team of four committed professionals, the “Navigators,” to guide our efforts.

One of the Navigators, Pamela Schweitzer (a retired Rear Admiral and former Assistant Surgeon General, who began her career as a pharmacist, same as her father and grandfather), said this:

“It would be crazy not to get together and drive change. The best thing about this group is that we get to hear from boots-on-the-ground pharmacists and public health advocates. We get to hear the issues each one is facing. Then we can start working on them. It takes energy – somebody has got to highlight what needs to be done.”

Rear Admiral (ret.) Pamela Schweitzer, speaking at a USPHS event

Why focus on pharmacists? Who has the bandwidth to handle all the millions of additional vaccinations? Only pharmacists. Schweitzer related her experience when she was working in the field during the H1N1 pandemic:

“I was deployed for H1N1, part of a team responsible for vaccinations in three states in the Southwest. We were being sent doses of the vaccine but we weren’t getting it out fast enough. We asked ourselves, who could do it quickest? The answer? The pharmacists. They can do the volume versus doctors’ offices. In many instances, pharmacists worked with the communities to help organize mass vaccination events. 

“So every day we had a standing call at 6AM. ‘We have this many doses. Where do they go?’ We’d get it to those who’d best get them out. And that was the pharmacists.”

Another of the Navigators, Jason Briscoe (Director of Pharmacy Operations for the Midwestern pharmacy chain, Discount Drug Mart) put it this way: “We [pharmacists] have been hungry for opportunities to provide care, and when we have had the chance, we’ve proven we can do the job.” He added, “Pharmacists are intensely trained clinicians uniquely accessible to our patients and communities. Rapport and relationship developed over time equate to trust, and trust leads to recommendations, such as a vaccine, being accepted.”

WHAT NEEDS TO CHANGE?

One of the questions we are putting to our group of Collaborators is this: If we are going to prepare for pharmacists to take on an even large role, with additional vaccinations in the tens of millions or even hundreds of millions, what needs to change?

Can we expect the Federal government to make the legislative changes?

We wondered how much to focus on change coming from Schweitzer’s previous employers at the Federal government. She replied, “I do not think we will see mandates coming down from the Federal level. But what can happen is this: HHS (including CDC, CMS, HRSA, ONC and FDA) can highlight best practices and publish guidance which states can consider as they make legislative changes. That is usually enough to start driving change.”

Schweitzer added, “What would really help at the national level is for the CDC and ONC to help the Information Technology to improve interoperability and functioning of the states’ IIS. Again, I don’t think it will be a mandate, but if a state wants to improve, I hope these agencies will be there to help.

“Further, we need to strengthen the IIS infrastructure, especially the bi-directional piece. When administering one vaccination, it makes sense to check and see if other vaccinations are due. We want to move toward a more national network so providers have access to data that can guide clinician decision support and states/counties can have accurate data that can help improve vaccine coverage in a community. We also want to make sure consumers have access to vaccination data on their mobile devices. We have some work to do to get that infrastructure in place.”

SO WHAT SHOULD STATES BE DOING NOW TO GET READY?

Here are some of the ways state health departments, departments of pharmacy and legislators can help get ready for the wave of vaccinations:

Break down the remaining barriers to pharmacists as vaccinators, including restrictions on the minimum age of patients. (This will give an option to parents who fear taking their children to doctors’ offices.)

Promote pharmacists, advocating for them as trusted medical advisors. As pharmacist Jason Briscoe said of this moment in history, “What is the mindset of patients? I sense the majority will be more open to vaccination, but I suspect some will have hesitancy around the how and the where. It is my belief community pharmacy will be a preferred destination with the safe, professional and very convenient environment we create.”

Break down the barriers to pharmacy staffing of vaccinators. Briscoe summed up this issue this way: “While every one of Discount Drug Mart’s pharmacists are trained, active immunizers, they rely heavily on pharmacy technicians with workflow.” (This, Briscoe pointed out is especially relevant for workplace vaccine clinics.) Some states, but not all, allow pharmacy technicians to administer vaccines (with appropriate training).

Jason Briscoe

Finally, Briscoe added this caution: “We have to be certain incentives built into reimbursement models drive positive outcomes and properly reward pharmacies that execute. We want to take the handcuffs off pharmacists to jump in and do more, but ‘doing more’ has to be sustainable. We need to build upon expanded scope of practice, not detract from or make more difficult the services pharmacies already provide.”

And Briscoe summed up his thoughts this way:

“Can we as pharmacists do more?

If our number is called, we’ll be ready.”

Jason Briscoe doing on-air flu shots with a news team

STChealth Offering MyIR to All States and Territories

At No Cost

STChealth’s consumer access solution, MyIR Mobile, is being offered to all state immunization programs at no cost. MyIR Mobile allows consumers to access a digital immunization record at no charge, providing quick access to important health records at a time when consumers need it most. Immunization programs in Arizona, Louisiana, Maryland, Mississippi, West Virginia, and Washington already use MyIR, with nearly 20,000 consumers checking their records in the last 60 days.

Through MyIR Mobile, consumers are able to check if their immunizations are up-to-date, add dependents, and schedule appointments for COVID-19 testing once available. FDA approved COVID-19 antibody test results will be captured in MyIR Mobile, and when a COVID-19 vaccine becomes available, MyIR Mobile will allow consumers to show proof of immunity or vaccination to assist with employer testing programs.

MyIR Mobile helps state immunization programs establish a touchpoint with consumers for ongoing education of COVID-19 as situations evolve. Additionally, state immunization programs will be provided with a consumer intelligence dashboard showing real-time visualizations of consumers connected, record requests, and match rates.

If your state immunization program is interested in learning more about MyIR Mobile, please contact us at clientpartners@stchome.com.

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Vax Stats of the Month

Teachable Moments in Public Health

by Bill Davenhall, Geomedicine Analyst, STC Health Analytics (Bill_Davenhall@stchome.com)

The Internet is overwhelmed with Covid-19 data visualizations. It appears that no nation is without a pandemic dashboard, complete with maps depicting cases, deaths, and recoveries. Seldom does public health have the full attention of the world, laser-focused around a single event. This should be a moment that Public Health professionals everywhere get accolades about their work. It is also one of the greatest opportunities for Public Health to communicate important messages about the value of its work (much hidden from plain sight) explaining the implications of a pandemic on human health, describing the nature of the virus’s ability to spread, and providing clear and concise information to the public, especially about surviving during the pandemic.

The challenges are great – but it is becoming obvious that the public wants and needs better explanations of what is happening, where and when. There remains a great need for public health officials to better explain why a pandemic is different than the seasonal flu. Visualizations can cut through all the “analytical noise” in order to deliver information that is vital for people to have. One excellent example: an insightful communication by a Public Health agency in Pima County, Arizona took Covid-19 case data and showed effectively where and when the virus overtook an entire community. Simple, effective and memorable, the keys to good communication. Seeing was believing. The Public Health Department of Pima County, Arizona, through this visualization, dispelled the notion that only parts of the community were more likely to be impacted.

Just imagine if more health data could be seen like this. Imagine if cancer deaths, drug overdoses, low-weight births, the top 10 leading causes of death, or the top five diagnoses in the community within the past 30 days were also seen this way? Perhaps we will begin to see information presented in more unique ways that increase everyone’s understanding of what they cannot see, and less time trying to figure out everything that’s in the vast oceans of TMI (too much information).

Second opinions always encouraged.