key: cord-0050344-33fvvvka
authors: Grabenstein, John D.
title: Pharmacists continue to protect communities during COVID-19
date: 2020-09-18
journal: J Am Pharm Assoc (2003)
DOI: 10.1016/j.japh.2020.08.008
sha: 540ae945f8f80e43cb5b0c3c6e32bdc355b2a69c
doc_id: 50344
cord_uid: 33fvvvka

nan

Most importantly, community pharmacists should remember they have often been trained in guiding patients through difficult conversations using tools such as the TTM as a guide. Many, perhaps most, pharmacists have hands-on experience with frameworks such as these.

The previous frameworks do not strongly address group identity, which may be a key component of COVID-19 mitigation behaviors in the United States. A more straightforward communication framework may be the Theory of Planned Behavior (TPB), which holds that an individual's intention to act is shaped by their attitudes toward the action, their perceived ability to act, and their perception of how others in their social group will perceive their actions (i.e., social norms). The TPB has been used to study pharmacist-patient interactions in opioid safety 11 and patients' medication adherence behaviors. 12 The value of consciously addressing social norms in the context of COVID-19 is underscored by a recent article by Bavel and 41 other authors. 13 This wide-scoping review contains many immediately actionable suggestions for anyone who wishes to communicate effectively regarding COVID-19 mitigation behaviors. The authors stated that one of the most effective ways to motivate behavior change is to showcase members of the patient's community engaging in the desired behavior and being rewarded for doing so. Thus, even when not directly engaged with patients, pharmacists should be aware that their actions will have an impact on how others may implement COVID-19 mitigation behaviors: every action by visible community members, such as pharmacists, reinforces the behavior of others.

Pharmacists may not always be accustomed to guiding patients toward healthier behaviors. However, COVID-19 is one of the most urgent health crises of the last century, and the next steps will likely be rooted in the preventive measures of public health rather than the curative measures of health care. Many community pharmacists may not feel comfortable acting as advocates for healthy, mitigationbased behaviors. The profession should take an interdisciplinary approach, using insights from community health and social pharmacy research for evidence-based ways to communicate effectively. Our profession should notdand indeed, cannotdback down from the challenge that comes with helping our patients remain healthy in the face of the greatest health care challenge of this generation. For years now, America's pharmacists have been administering more than 30 million vaccinations each year. Ten or 15 years ago, it may have been accurate to refer to pharmacists as nontraditional vaccinators. It has been many years now that pharmacists have stopped being "nontraditional."

Each vaccination by a pharmacist is a contribution to public health. These contributions accumulate, one by one, in many thousands of communities across the country. Amid our current pandemic, America is struggling to protect its people against multiple preventable infections. Pharmacists have been growing their vaccination skills for 25 years, since the mid-1990s. Now, more than ever, America needs pharmacists to pick up syringes, vaccinate, and add their talents to their local immunization coalition, 1 help their community catch up with vaccinations (across all age groups) that were postponed, 2-4 help their local influenza vaccination efforts to be the broadest yet, 5 and add to the general principles of vaccination they already know, so they are ready for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine(s).

Based on my experience in vaccine delivery since 1983, these can be accomplished by the following:

Be a vocal and active partner with your local health department and immunization coalition. 1 Help them understand how pharmacists can contribute to information sharing, education, identification of the vulnerable, vaccine delivery, documentation, and adverse event surveillance. 6, 7 Optimize your pharmacy's ability to communicate with your state or local immunization information system.

In May, the Centers for Disease Control and Prevention (CDC) reported drastic declines in routine vaccinations Grabenstein across the country and sounded urgent calls for catch-up. 2, 3 Coronavirus disease (COVID-19) precautions kept people of all ages away from routine sources of vaccination. In June, the CDC issued guidance to help vaccine providers across a variety of clinical settings plan for safe vaccination during the pandemic. 4 In August, the Department of Health & Human Services expanded authorities for properly prepared pharmacists to vaccinate children in all 50 states. 8 Additional suggestions have been compiled by the Immunization Action Coalition in its Repository of Resources for Maintaining Immunization during the COVID-19 pandemic. 9 Pharmacists and pharmacies should be familiar with the most recent guidance, act on it, and be back to vaccinating routinely. Be alert for subsets of people who may need extra advocacy or support among the people you serve: ethnic minorities, those in isolated communities, those in rural settings, and people who speak languages other than English. Reach out to all your patients. Pay special attention to the pneumococcal vaccination of those aged 65 years or older in addition to those with chronic underlying health conditions 10 to reduce the burden of this respiratory pathogen during the COVID-19 pandemic.

Influenza vaccination will be especially important in the 2020-2021 season for several reasons. 5 First, there is the usual value inherent in preventing influenza infection and complications in any year. Second, preventing influenza hospitalizations and outpatient visits will reduce the total burden on the health care system at a time when the care of patients with COVID-19 imposes extra stresses. Third, if there is any pathologic interaction associated with simultaneous infection with influenza virus and SARS-CoV-2 virus, influenza vaccination could ameliorate the problem. Partnering with your local immunization coalition on local influenza programs will bear fruit.

A remarkable variety of vaccine technologies is being tested in the search for safe and effective vaccines against the SARS-CoV-2 virus. A subunit vaccine would be similar in formulation to vaccines that pharmacists have administered for years. Pharmacists should become familiar with the immunology and pharmacology of mRNA and adenoviral-vector vaccine approaches. Be alert for information about products that need frozen storage or other special handling requirements. Relationships with local public health officials and community leaders will help strengthen the health of whole communities, including their most vulnerable members. The American Pharmacists Association (APhA) offers a wide range of support materials to all pharmacists on its COVID-19 website. 11 APhAeAcademy of Pharmacy Practice & Management members should take advantage of 2 relevant special interest groups (SIGs): the Immunizing Pharmacists SIG and the new Public Health SIG. 12 

Crucial to successful vaccination is the sociology of how people evaluate whether to accept or decline the offer of any vaccine, including the impending COVID-19 vaccines. It is possible that some locations or groups of people may be offered COVID-19 vaccination while the product is in the relatively unusual status of Emergency Use Authorization (EUA). The Food and Drug Administration (FDA) website explains in detail the criteria FDA considers before granting EUA status. 13 Explaining the level of evidence supporting a COVID-19 vaccine available under EUA, before phase 3 trial results are in hand, will take more time than usual.

In summary, help your patients "fill up their tanks" with all the vaccines they need to resolve their susceptibilities to preventable infections. Many of your patients have multiple such vulnerabilities, such as influenza, pneumococcal, zoster, and others. Pharmacists are not trained solely as influenza-injection-givers. Pharmacists are trained in the general principles that apply to all vaccines. Prepare now to step up and help protect your community.

Timeline of WHO's response to COVID-19

World Health Organization. WHO coronavirus disease (COVID-19) dashboard

Centers for Disease Control and Prevention. Cases in the U.S. Available at

COVID-19 pandemic planning scenarios

COVID-19: fighting panic with information

Pharmacy applications of the transtheoretical model in smoking cessation

The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program

Evaluation of a pharmacist-led naloxone coprescribing program in primary care

Community pharmacists and communication in the time of COVID-19: applying the health belief model

The transtheoretical model and stages of change

Theoretical exploration of Tennessee community pharmacists' perceptions regarding opioid pain reliever abuse communication

The relationship between the theory of planned behavior and medication adherence in patients with epilepsy

Using social and behavioural science to support COVID-19 pandemic response

References 1. National Network of Immunization Coalitions

Decline in child vaccination coverage during the COVID-19 pandemicdMichigan Care Improvement Registry

Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administratione United States

Centers for Disease Control & Prevention. Pandemic guidance: vaccination guidance during a pandemic

Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization PracticesdUnited States

Pharmacists and COVID-19

The legal extension of the role of pharmacists in light of the COVID-19 global pandemic

Department of Health & Human Services. Third Amendment to Declaration under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures against COVIDe19

Immunization Action Coalition. Repository of resources for maintaining immunization during the COVID-19 pandemic

Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged 65 years: updated recommendations of the Advisory Committee on Immunization Practices

Pharmacists' guide to coronavirus: information and resources on COVIDe19 for pharmacists and the communities they serve. Available at: www.pharmacist.com/coronavirus

APhA-APPM special interest groups (SIGs)

Emergency use authorization (EUA) information, and list of all current EUAs