Pharmacists couldn’t handle anaphylaxis, GP claims

pretty up-close snowflake

One pharmacy leader has asked GPs to act like a popular Disney character and “Let it go,” over COVID-19 vaccination

AMA national president Dr Omar Khorshid has appeared in mainstream media questioning the ability of pharmacists to handle an anaphylactic reaction to the COVID-19 vaccine, as well as the appropriateness of the pharmacy setting in the rollout.

Last week pharmacies were invited to express interest in participating in Phase 2A of the COVID-19 vaccination program rollout, via the Pharmacy Programs Administrator webste.

However Dr Khorshid told Sky News’ Ashleigh Gillon that the AMA has “significant reservations about the place of vaccination in pharmacy”.

“There’s a few reasons for that,” he said.

“One is about safety. In the very, very rare occurrence of a severe reaction, like anaphylaxis to a vaccine, it’s something that we really can’t expect a pharmacist to be able to manage.

“They would never have seen one before, and it’s outside the expertise of the average pharmacist. It just puts them under a huge amount of pressure.

“But actually, the main reason is that we think that the vaccination is part of a holistic primary care package, where people have a health care home: they know to go and see their local GP for their health care needs.

“And for young, healthy people, vaccination may be the only reason to actually get yourself in front of a doctor over a period of a few decades in the middle of life.”

When asked whether the AMA was recommending Australians go to the GP or a vaccination hub, and not a pharmacy, for the vaccine, he said that, “We’re still waiting to see exactly what this vaccination rollout will look like”.

“We hoped that it might be part of the usual GP interactions, and the patients would be able to go to their normal doctor for their vaccination as they do for their flu shot.

“But it does seem that the requirements of the program are pretty onerous, and there may not be very many practices that are approved, and it may be that in fact that this isn’t really a primary care rollout, and that this is a rollout which is about mass vaccination centres that just happen to be GP practices.

“If that’s the way it turns out then you won’t necessarily be going to your usual doctor, but at least when you go there you’ll know that it’s appropriately medically supervised, that if you have a minor reaction there’s people who know exactly what to do.

“If you have a severe reaction there’s resuscitation facilities and the ability to get you to hospital very quickly, and all those things are things I think Australians will expect to see when they’re going to get their vaccination done.”

Dr Khorshid also said that “if there are only going to be one or two thousand vaccination centres, we already know that there are… almost five and a half thousand GP practices that have put up their hands.

“So I guess it’d be a very strange message to both GPs and the community if there was a rollout in pharmacy and not in general practice.”

He said he had written to the Minister and had “multiple conversations with various people” at the Department to say that the rollout should be in the GP setting, “rather than undermining general practice or putting people’s safety at risk by having vaccinations in a non-medically supervised environment”.  

Anthony Tassone, Victorian branch president of the Pharmacy Guild, told the AJP that “if ever there was an encapsulation of the phrase, ‘flogging a dead horse,’ this is it”.

“Whether the AMA likes it or not – as we know patients do – community pharmacy and pharmacist immunisers will play a key role in the rollout of the Australian Government’s COVID-19 vaccination program.

“The AMA president may see value in drawing inspiration from the children’s hit movie Frozen, where Elsa sings, ‘Let it Go’,” Mr Tassone said.

The film, featuring Ice Queen Elsa, was a success for Disney in 2013.

“The AMA could reconsider that any opportunities they have on public comment and media representation regarding the COVID-19 vaccine would be best invested in promoting uptake of the vaccine itself amongst the public, as there may be some patients who are hesitant about receiving it.”

He said that GPs, pharmacists and other immunisers need to work together as “all hands on deck”.

“We are a team,” Mr Tassone said. “This is about patients.”

He also responded to the comments about anaphylaxis by pointing out that pharmacists do have significant expertise in this area.

“As a condition of delivering an immunisation service, pharmacist immunisers are required to maintain currency of training in first aid and CPR, and have the appropriate procedures in place to respond to an anaphylactic reaction.

“This has been the case ever since pharmacists have been given authorisation to deliver immunisations and continues to be the case with the upcoming rollout of the COVID-19 vaccine program.

“As with all health professionals who will be involved in the delivery of the COVID-19 vaccine, pharmacists will be required to undertake mandatory training – as will the doctors, as will the nurses who are involved in its administration.”

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  1. Anthony Zehetner

    All pharmacists have first aid training, access to calling 000 and Epipens!

    I should clarify that I am in support of pharmacists administering the COVID19 immunisation (in case readers interpret it differently!) Of course pharmacists have access to adrenaline ampoules, needles and syringes in the case of anaphylaxis, though a nearby Epipen (which GPs may not have in their rooms) is obviously very handy too for staff to grab! The average response time in suburbia is about six minutes (call for help is one of the first principles of first aid) so probably only one or two Epipens are needed if no adrenaline ampoules are handy or take time to draw up. There is too much animosity between doctors and pharmacists which is in no one’s interest, especially the patient who must always come first.

  2. Sahar Khalili

    Tassone eloquently and respectfully called the AMA out on their out-of-date attitudes about healthcare and their narrow mindedness in defending medical privilege at the cost of caring for the community, especially in these unique pandemic times for healthcare. Have a look outside your GP room – I’m not sure if you’re aware AMA – we all have the internet now, we know how to punch an EpiPen #firstaidcertificate

  3. Philip Smith

    I’m not sure of other state rules but an epipen is not in my vaccine anaphlysis kit. The 1 anaphlysis event I have had (non vaccine related with a staff memeber) I drew up adrenaline. The feedback from the hospital doctors was an epipen would not have been enough.

    But do I get a badge from the AMA for dealing with the situation and saving a life???

    Pity Tassone was not on Sky News at the same time with a great response.

  4. Kelly Lin

    This guy is out of touch but then again, he wouldn’t be doing his job if he wasn’t attacking pharmacists.

  5. James Ip

    In Victoria, pharmacist vaccinators need to keep adrenaline 1:1000 ampoules as part of the anaphylaxis kit as per the Australian Immunisation handbook. Most adults will need a dose of 500mcg whereas epipen only gives 300mcg. Stating pharmacists know how to use an epipens will only provide more ammunition for the AMA to say we don’t know how to treat anaphylaxis from a vaccine.

  6. Richard Teh

    I am a registered vaccinating pharmacist and am also currently completing my Medicine degree. From what I’ve seen on GP placement etc, pharmacists are AT LEAST just as equiped when it comes to administering vaccinations. The majority of GPs do not administer vaccines anyway, they allocate them to the practice nurse and take the billing’s for the 2 minute consult beforehand.
    In regards to anaphylaxis, I have had to administer an epipen twice in community pharmacy and on one occasion the GP in the clinic next door wouldn’t even step out of his clinic to help because it wasn’t his patient.
    Not trying to discredit general practice by any means as it’s an area of interest for me but come on guys how about we work together instead of against one another.

  7. Harriet Wright

    Think it would be worthwhile to point out to the AMA that young healthy people don’t go to GP for flu vaccinations. If they do, they end up with a private prescription which needs to be filled at a pharmacy. They then usually opt just to have vaccination in pharmacy rather than taking up another GP appointment (rare as hens teeth in rural areas anyway).

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