By: Chidinma Omereji
Many infectious diseases such as smallpox and measles have been well known since ancient times, and efforts made to prevent occurrence of these diseases gave rise to vaccines. Ever since Edward Jenner’s successful attempt to create immunity to smallpox in 1796, which eventually resulted in its eradication, global health has come a long way (CDC, n.d). Building on the success of the Global Immunization Vision and Strategy, the 64th World Health Assembly (WHA) welcomed discussions on the future of vaccines (WHO, 2012). During the 130th Executive Session held in January 2012, the WHA adopted a resolution that birthed World Immunization Week.
World Immunization Week, recognized annually during the last week of April, is an opportunity to underscore the importance of immunization in reducing mortality and to encourage families to vaccinate their children against deadly diseases. Immunization has contributed tremendously to global health and saves millions of lives every year. Furthermore, vaccines are widely recognized as one of the world’s most successful and cost-effective health solutions. Despite the huge benefits gained from immunization, it is quite paradoxical that this cost-effective yet highly successful tool suffers sluggish global coverage, misalignment of strategies and funding, and external threats to progress. Although immunization prevents between two and three million deaths every year, an estimated 20 million children still go without needed vaccines (WHO, 2019).
Throughout World Immunization Week, the World Health Organisation (WHO) aims to unite countries across the globe for a week of vaccination campaigns, public education, information sharing, and advocacy for governments to obtain the necessary guidance and technical support to implement high quality immunization programmes. The theme of this year’s campaign is #VaccinesWorkForAll, which urges improved global engagement for immunization and emphasizes the importance of vaccination in improving the health and wellbeing of everyone. As part of the 2020 campaign, WHO and partners aim to:
- Demonstrate the value of vaccines for the health of children, communities and the world;
- Depict how routine immunization serves as the foundation for strong, resilient health systems and universal health coverage; and
- Highlight the need to increase investment in vaccines and immunization while addressing gaps.
Under-utilization of vaccination programs remains a significant public health concern. It is of great importance to identify the determinants of noncompliance to vaccination schedules, such as access to healthcare facilities, availability of vaccines, awareness of the importance of vaccination, and acceptance of vaccination. Increased access to vaccines could save an estimated ten million lives per year, and more health professionals —particularly pharmacists — must be involved in vaccine delivery in order to reduce global mortality from vaccine-preventable diseases (FIP, 2016). Pharmacists are highly trusted health professionals and occupy a strong position to offer significant contributions to global immunization due to their accessibility and expertise. Because of their proximity and medication expertise, pharmacists also have the ability to provide public reassurance on vaccine products and their quality to large numbers of people.
The improved involvement of pharmacists in immunization has shown amazing results in enhancing vaccination coverage with evidence from various countries. In Canada, integration of pharmacists as immunizers within a publicly funded universal influenza vaccination yielded increased overall vaccination coverage and led to a higher coverage rate (Isenor et al, 2016). Additionally, a pharmacy vaccination clinic introduced in British Columbia was shown to increase the immunization rate among elderly people (Isenor et al, 2016). In other countries like South Africa, Argentina, Australia, Philippines, the practice of pharmacists as immunizers has been initiated, typically starting with pharmacy-based vaccination against influenza and then expanding to include other vaccines (FIP, 2016). It is estimated that pharmacist-administered vaccination services has the potential to reach a total global population of 655 million (FIP, 2016)
Pharmacists can play numerous roles in immunization as vaccine distributors, educators, facilitators and immunizers. Pharmacy-based vaccination delivery is a highly effective public health strategy for health systems and healthcare planners, complementing the existing service offerings for immunization. As medicines experts, pharmacists offer convenience, product safety information, patient advocacy/support, and an overall high-impact contribution to global vaccine issues. Most recently, the COVID-19 pandemic has thrown the world into panic, partly due to the lack of vaccines for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Fortunately, vaccine research and development for COVID-19 are already underway. Unexpected outbreaks of preventable communicable diseases like influenza and COVID-19 will happen again, somewhere, at some time, and pharmacists should be considered as invaluable contributors in the delivery, access and administration of vaccines in the following ways:
- Immunization Advocacy. Young pharmacists have the opportunity to support public health by promoting vaccination, increasing access to vaccines, and instilling confidence in local immunization programs. Many potential victims of vaccine-preventable diseases visit pharmacies daily and are often serviced by young pharmacists. This frequent interaction offers a good chance for pharmacists to promote disease prevention strategies. Pharmacists can ease patients’ fears by providing them with the facts and the risks associated with not being vaccinated. In these roles, pharmacists can further assist with debunking misinformation, myths, and pseudoscience about vaccination.
- Vaccine Pharmacovigilance and Safety. Although vaccines are generally very safe, there are still risks associated with vaccination. Many misconceptions about vaccines have misled populations about vaccine safety and, as a result, parents and guardians refuse vaccination, delay vaccines, or become vaccine-hesitant. In areas where pharmacists have legal backing to vaccinate, young pharmacists should screen for contraindications and precautions before vaccinating, ensure appropriate vaccine dosing and safe administration, and document any adverse effect that occurs following immunization. Young pharmacists who vaccinate should diligently maintain permanent vaccination records and report occurrences of adverse effects. Because pharmacists have knowledge and experience with adverse drug reaction management and reporting, they can take the lead in developing vaccine pharmacovigilance programs even if they are not actively vaccinating.
- Vaccine Logistics and Cold-Chain Storage. Vaccines are delicate biological substances that can become less effective or destroyed if they are exposed to either too high (>8°C) or too cold (<2°C) temperatures (Meyer J et al, 2018). Young pharmacists in logistics and supply chain management have the responsibility to ensure that vaccines are properly transported and stored. Young pharmacists in community pharmacies that offer vaccination services must also ensure that vaccines and their diluents maintain their appropriate stability and potency. This can be achieved by storing vaccinations in a dedicated vaccine fridge that is correctly packed to allow for cold air circulation, monitoring fridges daily, and recording temperatures at least twice-daily.
- Safe Vaccine Administration. Young pharmacists should acquire adequate skills and knowledge required for safe vaccine administration and maintain good vaccine and pharmacy practice. Young pharmacists with the ability to vaccinate must remain diligent in ensuring product safety, properly storing and transporting vaccines, recording inventory and temperatures, and maintaining patient confidentiality. Young pharmacists must also stay abreast of the guidelines on safe vaccination practices provided by their national authorities and governing bodies.
- Promotion of Routine Immunization. As part of pharmaceutical care services, young pharmacists should actively screen for routine immunization in their communities. Young pharmacists can readily fulfill this role, as they are often the first and most easily accessible health professional to patients. This unique position allows them to promote routine immunization and to identify patients who are part of the target groups for certain vaccinations. Promoting routine immunization will help prevent vaccine-preventable diseases, which will greatly reduce the need for antibiotic and antiviral drug use and ensuing resistance. Tasks which could be carried out by young pharmacists to support this objective include gathering immunization histories, encouraging use of vaccine profiles, issuing vaccination records to patients, preventing immunologic drug interactions, and screening patients for immunization needs.
- Formulary Management. Young pharmacists in organised healthcare settings can support in the development of formularies for their health facility and also advocate for the inclusion of vaccines, toxoids, and immune globulins in the formulary. This will serve to prevent vaccine-preventable diseases in both patients and in staff. Young pharmacists should utilize their training and expertise on pharmaceutics, pharmacology and disease epidemiology to provide information and recommendations for drug and vaccine decision-making. (Meyer J et al, 2018).
References
American Society of Health-System Pharmacists (ASHP). (2003). ASHP guidelines on the Pharmacists Role in Immunization. American Journal of Health-System Pharmacy, 60, 1371–7. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12901040
Centers for Disease Control and Prevention (CDC). (n.d). Retrieved from: https://www.cdc.gov/smallpox/history/history.html
Isenor, J. E., Killen, J. L., Billard, B. A., McNeil, S. A., MacDougall, D., Halperin, B. A., Slayter, K. L., & Bowles, S. K. (2016). Impact of pharmacists as immunizers on influenza vaccination coverage in the community-setting in Nova Scotia, Canada: 2013–2015. Journal of pharmaceutical policy and practice, 9, 32. https://doi.org/10.1186/s40545-016-0084-4
International Pharmaceutical Federation (2016). An overview of current pharmacy impact on immunisation; A global report. Retrieved from: https://www.fip.org/files/fip/publications/FIP_report_on_Immunisation.pdf
Meyer J., Khosa L., Nhira S., Chiloane L., Sibanda M., Schonfeldt M., Burnett R (2018). Childhood Vaccination and the Role of the Pharmacist. South African Pharmaceutical Journal, 85(4), 26–39. Retrieved from: http://www.sapj.co.za/index.php/SAPJ/article/view/2618
World Health Organisation. (2012). Draft Global Vaccine Action Plan. Sixty-Fifth World Health Assembly A65/22 Provisional agenda item 13.12. Retrieved from: https://apps.who.int/gb/DGNP/pdf_files/A65_REC1-en.pdf
World Health Organization. (2019). Immunization Coverage. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
