A leading GP has expressed concerns about expansion of pharmacist flu vaccination in WA, including that cold chain management could be less stringent
This week Western Australia’s Health Minister Roger Cook announced that, amidst a huge jump in flu cases in the state, the state Government would allow trained pharmacists to administer flu vaccines to children as young as 10, following in the footsteps of Tasmania.
The move was welcomed by both the Pharmacy Guild and PSA.
But RACGP WA Faculty Chair Dr Sean Stevens has told newsGP that he did not believe the move was warranted, and the safest place for a patient of any age to be vaccinated is “with a GP or in a medical facility where there is the ability to treat the complications that very rarely can arise”.
He told newsGP’s Matt Woodley that the potentially less strict cold chain management outside the GP setting could reduce the effectiveness of vaccines.
“The vast majority of general practices are accredited and one of the key standards … is close monitoring of cold chain,’ he said.
“Every general practice is aware of it, we have a program to monitor the cold chain and procedures to deal with any breach of the cold chain. It’s not as well monitored outside of a controlled medical setting.”
The comments come just days after the Sydney Local Health District announced that it was seeking to contact thousands of patients who received vaccinations at a Burwood general practice, encouraging them to seek re-vaccination.
This was because it was found vaccines were improperly stored in the practice refrigerator, exposing them to incorrect storage temperatures. Other vaccines were found to be expired.
PSA national president Dr Chris Freeman told the AJP that Dr Stevens’ comments about potentially looser cold chain management in pharmacy were “embarrassing to him and his colleagues”.
“The WA flu cases are of significance this year, and dwarf the figures from the previous year,” he said.
As at the beginning of 20 June, there have been 10,097 laboratory confirmed flu cases in WA since the beginning of this year.
The move to expand pharmacist vaccination in the state is a “serious piece of health policy, in that pharmacists can assist other health providers, such as GPs, nurses and even Indigenous health workers, to deliver immunisations to people who desperately need it.
“Lowering the age to 10 years allows us to better serve that community by increasing herd immunity. So PSA commends the Western Australian Government for making use of pharmacists’ expertise and training, to save the lives of Western Australians.
“But pharmacy has been the leader in cold chain storage for many decades, and has a very robust, accredited procedure for cold chain maintenance.”
This was why community pharmacy does not experience the same sort of issue recently seen in the Burwood surgery, and why patients could be assured that the vaccines administered in community pharmacy have been properly stored.
He stressed that general practice more widely should not at all be judged by the Burwood incident.
“The incident with those two GPs is actually really tragic, as it starts to undermine the public’s confidence in the delivery of health services,” he said.
“It is an isolated incident, and of course most GPs do comply with very stringent cold chain procedures.
“On the whole, most health providers who deliver vaccines to the public do so in a safe and effective way, and this does shine a light on why we need to be so careful with respect to storage and administration of those medicines.
“We as health professionals have a duty and responsibility to the public on this front, and I’m very proud of the pharmacy profession for upholding that.”
Dr Freeman said that the comment about the non-GP settings’ ability to manage complications was also problematic.
“The complications from delivery of vaccines are very, very rare and often involve reactions around phobias related to injection itself, and where that has occurred in pharmacy, it has been handled very appropriately,” he told the AJP.
“As part of our training to deliver vaccines, pharmacists are also trained to administer adrenaline to the patient on the very rare chance they do have an anaphylactic reaction.
“By restricting access to vaccines to just GPs would compromise the very principle of vaccination, and that is the herd immunity that can only be achieved through the vast majority of people receiving their vaccine.
“Access has absolutely a critical role in that by allowing pharmacists to deliver vaccines, we improve the herd immunity of the community.”
Several pharmacists took to social media, unimpressed by Dr Stevens’ comments.
Criticising the #pharmacy coldchain is out of line – over 92% of community pharmacies are accredited which includes best-practice cold-chain procedures. Vaccination by #pharmacists is safe – end of story. https://t.co/9MaRnO9xNV
— Shane Jackson (@ShaneJacks) June 20, 2019
Patients warned following vaccine bungle https://t.co/N29U0gfM15
— Anthony Tassone (@A_Tass1) June 20, 2019