As the likelihood of a successful COVID-19 vaccine next year rises, there is increasing discussion about pharmacy’s role in their delivery. Anthony Tassone says we need to plan now
Optimism that the world is on the verge of a COVID-19 vaccine breakthrough is increasing almost daily and while many of the reports seem to be laced with a healthy dose of speculation, there is little doubt we are moving closer to achieving a solution.
This was reinforced during the week by Federal Health Minister Greg Hunt saying: “Our goal, our intention and our expectation is to ensure that every Australian who seeks to be vaccinated will be vaccinated during the course of 2021.”
That’s all well and good but what we must be doing now rather than later is planning the pathways to get the vaccine out to all Australians.
A lack of clarity
To date, it is unclear what the Government plans pharmacy’s role should be. There has been the release of the Australian Government’s ‘Australian COVID-19 vaccination policy’ which has been endorsed by National Cabinet. It only has a brief mention of community pharmacies under ‘Vaccination locations’ which reads:
‘Pharmacies. Pharmacists are licensed to varying degrees in each State and Territory to administer vaccines. They are likely to play a role in COVID-19 vaccination for some part of the population (e.g. healthy adults) at some stage, depending on the safety profile of the vaccines.’
But let’s be clear: pharmacy must have a key role. To overlook our network of 5,800 pharmacies across the country – with 97 per cent of consumers in capital cities no further than 2.5km from a pharmacy, and in regional areas, 65 per cent of people within 2.5km of a pharmacy – would be a failure of health policy of the highest magnitude.
But while the possibility of a vaccine draws ever closer, now is the time for the government to confirm primary care and as part of that, community pharmacy’s role – along with the authorisation of Medicare billing rights – noting there is an MBS review report soon to be released.
The Guild’s submission to this review last year made it clear pharmacies need access to the MBS when delivering services to consumers irrespective of where the pharmacist is practising. And never more so will this be the case than when we are trying to vaccinate the whole population – and likely need to deliver two doses to each person which appears to be a likely scenario to gain necessary immune response and protection against the virus.
“Pharmacists involved in the collaborative care of a patient as part of the health care team should not be excluded from the MBS due to their location. Pharmacists practising in community pharmacies are an integral member of a patient’s multidisciplinary healthcare team and should be involved in and remunerated for activities consistent with other members of the team, such as case conferencing.
“A patient accessing health services should not be disadvantaged by where they choose to access those services or by which health professional delivers them. Pharmacists currently have no option but to charge the patient a service fee for items that other health practitioners may be claim an MBS item for. The Guild supports the addition of pharmacists to the list of eligible health professions that can claim against specific items on the MBS, as set out in the Health Insurance Act 1973.
These statements are quite unequivocal but underpin the need and value of MBS access for pharmacists.
A successful example
With vaccinations, for instance we need only look at the availability of the influenza vaccinations through pharmacies which has risen from two million doses last year to three million this year and played an important role in a record number of Australians being vaccinated during 2020
The number of flu vaccines delivered also show the trust and confidence patients and consumers have in their community pharmacies. So how would they feel if they discover somewhere down the track that they can get a flu shot in a pharmacy, but not a COVID-19 vaccination? For one thing they would be confused and may well eschew following up where they can their COVID-19 shot and that is the last thing anyone wants.
Another aspect to take into account is that some reports indicate a possible vaccine may need robust cold chain protocols, but community pharmacy is adept at the management of medicines that need such treatment.
The Pfizer contender is reported to need such care, but Therapeutic Goods Administration head John Skerritt said cold chain logistics would be used to transport the vaccine.
“They’re very sophisticated eskies which require dry ice. They actually last for 14 days and they can be refilled twice,” he said.
The Government’s COVID-19 Vaccine and Treatment Strategy had now secured access to four COVID-19 vaccines and over 134 million doses.
This is great news and the Prime Minister Scott Morrison was quick to highlight that: “By securing multiple COVID-19 vaccines we are giving Australians the best shot at early access to a vaccine, should trials prove successful.”
“We aren’t putting all our eggs in one basket and we will continue to pursue further vaccines should our medical experts recommend them.
Don’t sit on the stockpile
But having invested heavily on securing the doses, the Government needs to make sure they don’t sit in a warehouse.
The Government is quick to point out it is consulting with the States and Territories, key medical experts and industry peak bodies on the framework for the initial roll-out of the COVID-19 vaccination program in early 2021.
It says key vaccination sites will initially include GPs, GP respiratory clinics, State and Territory vaccination sites and workplaces such as aged care facilities.
But where is the mention of pharmacy? The most accessible health professional locations, the ones that are open longer hours and on weekends seem to be forgotten
The Government admits: “The roll-out of a potential COVID-19 vaccine is a significant logistical challenge, suppliers that have a proven track record in vaccine logistics and distribution or booking systems, tracking and reporting of vaccines are being invited to participate in a limited tender process.”
Apart from Queensland, there has not been a confirmation at state and territory level that the COVID vaccine will be part of the scope of immunisations that suitably trained pharmacists can deliver. There’s clearly also still work to be done at this level – and the Guild is actively advocating for this to occur as a matter of high importance.
Clearing the pathway
A final point of note. If pharmacies are excluded and no MBS pricing mechanism access granted, all immunisation programs will be undermined, particularly if a chunk of the immuniser workforce is fully committed to vaccinating against COVID whilst a more than capable pharmacist immuniser workforce is either not included and/or not authorised to practise to their full scope to assist with the maintenance of delivery of other vaccinations for patients.
In other jurisdictions such as the UK, there are already concerns being raised by general practice of how realistic the timelines and deliverables are for the planned mass vaccination program against COVID-19. This is why we need all immuniser hands on deck including pharmacist immunisers.
There needs to be an immediate reappraisal of options for any COVID-19 vaccine and MBS access – with pharmacy considered for the frontline role it is so able – and willing – to fulfill. This way, we can truly make it ‘free for all Australians for those who choose to receive it’ as has been the government mantra in this unprecedented mass vaccination program.
Anthony Tassone is President, Pharmacy Guild of Australia (Victoria)