‘Pharmacists can play key role in immunisation’

Pharmacists should have an increased role in advising on, and administering, vaccines for flu and other vaccine-preventable illnesses, according to Pharmaceutical Group of the European Union (PGEU).

John Chave, Secretary General of the PGEU, said pharmacists across Europe view advising patients on vaccination as part of their core activity but some are now moving into delivering immunisation services.

A number of countries, including Portugal, Ireland and the UK, have given pharmacists a hands-on role in administering vaccines – something which is already routine in the US and Australia. Chave said pharmacy vaccination has been a huge success in the US in particular, resulting in higher levels of vaccine coverage.

He said patients with chronic diseases are a key target group for influenza immunisation programmes and that these patients see their local pharmacist even more frequently than they are in contact with doctors.

According to the PGEU, involving pharmacists in vaccination is a win-win health policy as it increases overall immunisation rates without affecting the doctor-patient relationship.

“In fact, because of the increased awareness within communities, other providers are likely to see an increase in the number of vaccines they provide. Thus, when pharmacists provide vaccines, everybody benefits – the pharmacist, other healthcare providers and most of all, the patients and the community.”

98% of Portuguese patients who were vaccinated against seasonal flu in their local pharmacy were satisfied with the experience, said Chave, adding that convenience and costs are a factor for some patient groups.

He said training for pharmacists is an essential part of running a successful community-based immunisation scheme and noted that their involvement need not be limited to annual flu vaccination campaigns.

In the USA, where pharmacists have been vaccinating since the 1990s, pharmacists are involved in vaccination for influenza, pneumococcal disease, meningococcal disease, diphtheria, tetanus, pertussis, hepatitis A and B, human papillomavirus and travel vaccines.

“In some parts of the UK, pharmacists administer Hepatitis B vaccine to patients on methadone treatment. In Portugal, pharmacists are also involved in administering the cervical cancer vaccine.” Chave said.

The role of health professionals in immunisation is one of the central themes of European Immunization Week. To mark the occasion, WHO Europe has published a guide for doctors on how to discuss vaccination with parents.

Interview transcript

Vaccines Today: What role can pharmacists play in improving immunisation rates in Europe?

John Chave: In December 2009, the Council of the European Union recommended that Member States should vaccinate 75% of the older age groups against seasonal influenza by the 2014-15 winter season. This target of 75% should, if possible, be extended to the risk group of people with chronic conditions. Member States are also encouraged to improve vaccination coverage among healthcare workers. The World Health Organisation (WHO) has also set a target of 75% for influenza vaccine uptake in those aged 65 years and older, to be reached by 2010.

Pharmacists have always advised patients on the importance and/or appropriateness of immunisation, and of course dispensed and advised on vaccines. Getting vaccinated is the single most effective intervention to protect people from influenza. For example, among older people, influenza vaccination is thought to reduce influenza-related hospitalisation by 50-60% and influenza-related deaths by 70-80%. Most pharmacists in Europe would regard that as part of their core activity. But we are now seeing this going a stage further with pharmacists carrying out immunisation themselves. Good examples of this are to be found in Portugal, Ireland and the UK, for example. Elsewhere, anyone who visits the USA or Australia in the flu season will see pharmacists performing immunisation. In the USA in particular, pharmacy vaccination has been a huge success. 

VT: Are pharmacists in a position to discuss immunisation with patients?

John Chave: Absolutely. It is worth remembering that often the groups who may be most in need of vaccination services, the elderly and those with chronic diseases, are the ones who are more frequent visitors to pharmacies. And we know they visit the pharmacy more often than their local physician.

There is a very strong case for making even better use of this interface. Research in the USA has found that when pharmacists provide immunisations, they add to the overall number of patients being immunised, rather than take patients away from other immunisation channels. In fact, because of the increased awareness within communities, other providers are likely to see an increase in the number of vaccines they provide. Thus, when pharmacists provide vaccines, everybody benefits – the pharmacist, other healthcare providers and most of all, the patients and the community.

VT: Pharmacists in Portugal and, more recently, Ireland have played a strong role in administering flu vaccines. Can you tell us about their experiences?

John Chave: Pharmacy based immunisation services are a success story. In Portugal , 98% of patients report satisfaction with the service and a willingness to return. More importantly, nearly 14% of patients immunised at the pharmacy were patients who had never been immunised before, which suggests that the idea that pharmacy can reach patients others cannot quite reach is well founded.

In Ireland, legislation to facilitate pharmacists administering the seasonal influenza vaccine was introduced on 14 October 2011, well into the flu season. Over 1,400 pharmacists were trained to vaccinate and 550 pharmacies provided a vaccination service to over 9,000 patients. Pharmacists would anticipate having a larger portion of the market this year.  

VT: Could pharmacists play a role in delivering other vaccines?

John Chave: In the USA , where pharmacists have been vaccinating since the 1990s, pharmacists are involved in vaccination for influenza, pneumococcal disease, meningococcal disease, diphtheria, tetanus, pertussis, hepatitis A and B, human papillomavirus and travel vaccines. In some parts of the UK, pharmacists administer Hepatitis B vaccine to patients on methadone treatment. In Portugal, pharmacists are also involved in administering the cervical cancer vaccine.

VT: What additional training would be required if pharmacists across Europe were to play a more active and permanent role in immunisation programmes?

John Chave: Training is of course essential, and this was an important aspect of both the Portuguese and Irish experiences. Training courses in both jurisdictions covered basic life support, intramuscular injection techniques, recognising adverse reactions and dealing with anaphylaxis. In both countries there was strong willingness on the part of pharmacists to undergo the training.

VT: Can involving pharmacists in immunisation reduce demands on other parts of the healthcare system (such as GPs and paediatricians).

John Chave: Yes. It is worth noting that a significant proportion of those surveyed in Portugal pointed to convenience as a factor in their decision to get vaccinated in a pharmacy. And, depending how the health system is organised, pharmacy based vaccination can be cheaper for both patients and the health system itself. But I think we have to be honest here and say that in many EU countries, pharmacy based vaccination would require a legal change that would be strongly opposed by physicians. Not all pharmacists in Europe are enthusiastic about adopting the service, because understandably they don’t want to be drawn into a dispute with physicians. Yet, it is undeniable that the provision of influenza vaccination by pharmacists can reduce the demand in other frontline parts of the healthcare system which are often overburdened.

VT: Is it the case that some retail pharmacies sell homeopathic vaccines and do you think this should preclude these pharmacists from participation in national immunisation programmes?

John Chave: No, but I think pharmacists are under a duty to point out the difference between a vaccine with an active ingredient, and one without.