key: cord-0899112-p2awfa3p authors: Dooley, Michael title: COVID‐19: Filling the Many Knowledge Gaps and Supporting Evidence‐Based Vaccination date: 2021-02-25 journal: J Pharm Pract Res DOI: 10.1002/jppr.1717 sha: 62cd40ea3f027b097d9dacb73c49eccb2ed31ef9 doc_id: 899112 cord_uid: p2awfa3p nan As we look into 2021, we inevitably reflect on the many challenges presented by COVID-19. We have needed to broaden our thinking and creativity to adapt to the many problems faced. As healthcare providers, it has been necessary to reform our own roles in care delivery while influencing change within our practice sphere and the policy that governs this work. We are still struggling with the crippling impacts of the pandemic, with many countries across the globe continuing to endure increasing infections and deaths. Closer to my home in Melbourne, the New Year has been welcomed across Australia with very few community-acquired cases across the nation, with much owed to the community for their stoic and spirited responses to long lockdowns, isolation and separation. During the last twelve months we have seen the profession respond and innovate. We have seen expanded roles for pharmacists on the frontline of healthcare delivery, providing essential services in all settings, from acute care hospitals and community pharmacies to aged care facilities and in patients' homes. This has encompassed a diverse range of initiatives and services focusing not only on therapeutics, but also educational strategies and public health interventions amongst others. 1,2 Yet there is still much to learn and implement. We are still learning about appropriate therapeutic interventions and the outcomes of our care, with local experiences of patients admitted to Australian intensive care units recently published in the literature, and their differences to international experiences being examined. 3, 4 We will continue to experience the significant impact of COVID-19 on the healthcare workforce; the burden of delivering care during this time remains a challenge with no end date. We know care is compromised when the healthcare workforce must deliver it in an unsafe environment. [5] [6] [7] The implementation of a global safe and effective vaccination program is the long-term solution for this pandemic, and is critical for all individuals, while including as a priority the protection of the healthcare workforce 8as per Australia's COVID-19 vaccine and treatment strategy, a common feature of such strategies around the world. 9, 10 The emergence of the plethora of potential vaccines is welcome, and with it comes the many challenges involved with providing timely, safe and effective programs across the globe. 10, 11 There will be a range of vaccinations adopted, with all countries working through the complexities associated with this at a time when urgency and lack of long-term data combine to make decisions much less clear than usual. In Australia, the Therapeutic Goods Administration (TGA) granted provisional approval on the 25 th January 2021 to Pfizer Australia Pty Ltd for its COVID-19 vaccine, making it the first COVID-19 vaccine to receive regulatory approval in Australia. We are expecting two other vaccines to be approved in Australia, with vaccinations commencing in March, if not earlier. This rapid implementation of vaccination programs is another demonstration of the importance of pharmacists' contributions to the healthcare team; pharmacists continue to be a critical pillar in providing appropriate and timely information and care to the community. This includes the care provided to individual patients, but also the broader levels of healthcare delivery relying on our practice, including public health, policy, surveillance, distribution and education. Evidence-based practice continues to be subject to tension during this pandemic, with evidence evolving month by month; decisions concerning medications for the treatment and prevention of infection have already been complicated by this tension. This complexity will be amplified during any vaccine rollout, as individuals will need to make decisions regarding vaccination based on information available to them at that time. It is imperative, then, that pharmacists are well placed and ready to support patients and practitioners to inform these decisions. This will be an expectation of the community. Evidence-based guidance regarding the efficacy and safety of vaccination, and the provision of this guidance, must include strategies to address misinformation circulating in the public. 12, 13 It continues to be critical that the workforce has access to timely and credible information to keep abreast of innovation in therapeuticsnot just to inform clinical decisions, but also to allow us to inform our community, with whom the decision to be vaccinated (or not) ultimately lies. We know there is still much to learn and many knowledge gaps to be filled. 14 This is compounded by the speed of implementation of different vaccines and vaccination programs in many countries, as well as the adoption of variable approaches to dosing schedules of the same vaccine. We have seen the reporting of deaths in Norway and the potential efficacy impacts associated with different vaccination schedules of the Pfizer BioNTech vaccine. 15, 16 The emergence of more transmissible variants and potential alterations on virus virulence and pathogenesis add further unknowns. 17 The need for systematic and evidence-based approaches to vaccination are crucial to enable healthcare practitioners to navigate at this time, with so many questions unanswered. 18 The role of pharmacists in the distribution, preparation and administration of vaccines has always been crucial, but with the additional constraints complicating these particular vaccinesrelating to cold chain and a lack of sufficient doses to vaccinatethis role is more compelling than ever. What's more, this historic effort must be undertaken while continuing to focus on strategies that stem transmission and continue to support our patients and colleagues during this time. The author has no conflicts of interest to declare. 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