Torey Watson is trained as a pharmacist, but her goal is to do more than just fill prescriptions.
Pharmax Pharmacy (a small chain of pharmacies where Watson works as a clinical services coordinator, one hour and 30 minutes southwest of St. Louis) will soon allow it to offer childhood vaccines to patients without a prescription. This change came after the federal government expanded the ability of pharmacists to administer routine vaccinations to children as young as three years old.
As the father of two young children, Watson, 30, understands how difficult it can be to give a child a vaccine. Many pharmacists are used to administering vaccines to adults, he said. Doing the same with children requires extra skill.
“We’re going to have parents asking questions,” he commented.
Federal officials are confident pharmacists like Watson will undergo additional training and help reverse the drop in childhood immunization rates caused by the coronavirus pandemic. Fears about COVID-19 have led parents to avoid the doctor’s office and pediatricians to restrict face-to-face care. As a result, many children are missing routine immunizations.
Children who are late in vaccinations typically do not pose a health risk if the children around them are immunized, said Dr. Sean O’Leary, vice chairman of the committee on infectious diseases at the American Academy of Pediatrics. However, large groups of children are now behind, and the highly contagious vaccine-preventable diseases circulating in other parts of the world are only an airplane ride away, he noted.
“It’s a big problem,” he wrote in an email.
In August, the Department of Health and Human Services (HHS) took steps to lift restrictions in many states that prevented state-licensed pharmacists from vaccinating children.
“Today’s action means easier access to life-saving vaccines for our children as we seek to ensure that immunization rates remain high during the COVID-19 pandemic,” said HHS Secretary Alex Azar, when announcing the change.
However, immunization experts noted that difficulties remain in getting pharmacists fully integrated into the national childhood immunization framework.
A key issue is that few pharmacists participate in the Vaccines for Children (VFC) program, a federal initiative that purchases vaccines for the nation’s neediest children. Half of America’s children receive vaccines through the program, which purchases government-recommended vaccines for children ages 0 to 18 who are low-income, uninsured, or belong to an Indian group. Compared to last year, VFC-funded vaccine orders have decreased by 9.6 million doses as of November 9, a spokesman for the Centers for Disease Control and Prevention (CDC) stated. Vaccines containing measles have decreased by 1.3 million doses.
Weekly orders for influenza vaccines and measles vaccines have started to rebound to last year’s levels, although volume could be hit again if current increases in COVID have a daunting effect on doctor visits.
Without solving the problems that prevent pharmacists from participating in the VFC program, said Claire Hannan, executive director of the Association of Immunization Managers, steps to give parents more access to immunizations through pharmacies could ultimately help alone. Americans rich enough to use them.
“Yes, we have a situation with the pandemic that has caused a drop in routine vaccinations,” Hannan said. “But I don’t want to see us come up with a solution that only serves those who can afford it.”
Pharmacies serve as a convenient access point. Nearly 90 percent of Americans in 2018 lived within five miles of a community pharmacy. In contrast, about 5 percent of rural counties in 2019 did not have family doctors, according to a report by researchers from the University of Washington. 35 percent of rural counties had no pediatricians. In addition, KFF found that more than 51 percent of children in 2017 did not have a medical center, which means they do not have a primary care physician managing their consultations. (KHN is an editorially independent program from KFF).
“We need our pharmacists to be vaccinators” so we can get kids up to speed on their vaccinations, said LJ Tan, chief strategy officer for the Immunization Action Coalition, a national organization of physicians and health experts focused on vaccine education.
Congress established the VFC program to remedy immunization disparities discovered by a measles epidemic in the early 1990s that killed hundreds of people. Although physicians joined this program, the commitment of pharmacists lags far behind.
This pattern continues. As of October 6, of the nearly 38,000 participating providers, a CDC spokesperson stated that about two-thirds work in private practices. Seventy-one are pharmacies.
Stephanie Wasserman, CEO of Immunize Colorado, an Aurora-based nonprofit, added that increasing the number of pharmacists at VFC will be “a really critical piece” to the success of federal authorization. However, “the fact that they can participate does not necessarily mean that they will jump on the bandwagon,” unless pharmacists believe the program is well supported and will help their business, he said.
Registrants must adhere to strict storage and handling requirements that involve the use of expensive thermometers and refrigerators used only for products that are delivered under the government program, and if there is not enough demand, the vaccine experts said, the investment could not worth it.
In the case of rural pharmacies, says Michaela Newell, president of the Community Pharmacy Enhanced Services Network of Missouri, the cost of paying for the equipment and staff needed to handle the administrative work could increase in price before they are applied.
“I guess it wasn’t worth the pressure,” Hannan said.
Newell added: “I think the barriers right now are too high for pharmacists to join.”
On the other hand, state administrators also have trouble meeting the demands of the program. A 2019 study showed limited success in getting Michigan pharmacies to administer the human papillomavirus vaccine through the VFC program because the state health department did not have the staff to conduct on-site inspections.
The pressure on state resources has only worsened during the pandemic, Hannan says.
“You can’t get their attention for not giving the width,” said Rebecca Snead, executive vice president and CEO of the National Alliance of State Pharmacy Associations. “They have been compromised.”
The payment also poses a challenge in recruiting and keeping providers in the program, immunization experts said.
Medicaid, the government-sponsored health insurance program that provides health coverage for many of the children supported by the vaccine initiative, does not pay providers enough to cover costs. Participating physicians lose an average of $ 5 to $ 15 for each vaccine they administer through VFC, according to a report by Immunize Colorado.
Pharmacists cannot deny eligible children a vaccination if the family cannot afford it.
Some states run their Medicaid programs using a managed care model, which could make it difficult for pharmacists to pay, according to the report. Often times, children enrolled in these programs must obtain care from designated providers. If your local pharmacist is not on the approved provider list, you may not be paid.
The possibility of little or nothing being paid hasn’t stopped pharmacist and pharmacy owner Tim Mitchell from offering vaccines at his three pharmacies in Neosho, Missouri, about 30 minutes from the Oklahoma state line. He said he has been vaccinating patients since the late 1990s after he realized that children who walked into his pharmacies did not receive routine vaccinations.
“I saw it as a way to help my community,” he said, “but I also saw it as a business opportunity.”
Mitchell, 53, sees offering vaccines as a way to differentiate himself from his competitors and attract more customers to his pharmacies. He added that he presented the documents to register for the VFC.
While he welcomes the federal authorization, he acknowledged that not all of his peers can afford to offer the service.
“We can’t work for free,” Mitchell said.