On The Cover
Sonya Collins and Paria Sanaty Zadeh
Pharmacy teams once again are stepping up to fill gaps in care, address health equity, and ensure children and adolescents have access to COVID-19 vaccines as well as other vaccines. The Public Readiness and Emergency Preparedness Act amendments authorize pharmacists, student interns, and pharmacy technicians to vaccinate individuals 3 years and older against COVID-19, influenza, and other vaccine-preventable diseases. Additionally, depending upon the state, pharmacists may vaccinate children less than 3 years old. Pharmacists are using innovative approaches to make a difference in their communities.
Independent pharmacy runs festive vaccine clinics
Mayank Amin delivers vaccinations to the underserved in a Superman costume.
Nearly a year and a half after the first COVID-19 vaccine was administered in the United States, Mayank Amin, PharmD, owner of Skippack Pharmacy in Skippack, Pennsylvania, continues to see patients come in for their first dose.
“You can’t assume that just because someone hasn’t gotten a COVID-19 vaccine yet that they won’t ever get one,” said Amin.
Some patients wanted to ride out the first year of the COVID-19 vaccine rollout to see whether it caused any serious adverse effects, Amin explains. Others narrowly escaped a ventilator themselves before they decided to get the vaccine. And death of an unvaccinated family member caused some people to recognize the value of vaccination against COVID-19.
Eventually, people who had been holding out have found their way to Skippack Pharmacy—even those who’ve never previously used the independent pharmacy. That’s because, since his first COVID-19 vaccine clinic, Amin has aimed to make vaccination, whether at a public event for the community or a private area in his pharmacy (complete with aromatherapy, television, and a station to create thank you notes for health care workers), a memorable and positive experience.
When Amin received the unexpected gift of an ultra-low temperature freezer from a local long-term care facility, Skippack Pharmacy became a high-volume recipient of COVID-19 vaccine shipments. At one point, Amin had 16,000 doses of vaccine in the ultra-cold freezer required for proper storage.
In an effort to make sure every vaccine dose was used, Amin, his staff, and a team of volunteers spearheaded clinics that resembled street parties, where music played, free food and drink were offered, and Amin himself circulated the area while wearing a Superman costume.
The powerful freezer wasn’t the only unexpected and substantial donation that fueled these community events.
A local soft drink distributor heard about Skippack Pharmacy’s vaccination clinics and donated a full truckload of their sports drinks for the Sunday afternoon events. Local restaurants ensured volunteers and vaccinees were fed. Additionally, a local printer that does business with the Girl Scouts of America secured a donation of 10,000 boxes of the youth organization’s cookies to share with vaccine recipients.
The first clinic was conducted at the local firehouse. But, when that space proved too small, Amin set up shop at North Penn High School, his own alma mater. While the school certainly offered room for anyone who wanted to come—on a single day, 7,500 people moved through the gym for their COVID-19 vaccine—it didn’t allow Amin and his team of volunteers to reach everyone who needed to be immunized. Skippack Pharmacy’s Fight COVID Task Force and volunteers were the backbone of community efforts giving their personal time to make sure their community was protected.
The high school is in an affluent area with high vaccine confidence, and Amin was sure that his team could fill as many vaccination appointments in a day as they were able to offer with more than 300 volunteers per 4-hour shift, which included pharmacists, student pharmacists, nurse practitioners, nurses, physicians, other providers from across the health care professions, and employees of local pharmaceutical companies.
“There were areas around us with many lower-income families that didn’t have cars or other means to get to the high school, so we took the entire team as a mobile unit to areas where there was a need,” Amin said. State representatives and the state senator helped Skippack Pharmacy identify areas with high COVID-19 infection rates and few opportunities to get the vaccine. Amin and his crew then took their “street party”–styled clinics directly into these hotspots. As these were high-poverty areas, Amin also arranged for donations of food and household essentials. After patients received their vaccine, they could fill a shopping bag with the needed goods to take home.
Skippack Pharmacy’s vaccine clinics and accessible vaccinations continue to be important to the community. “Not that many people provide vaccines in a friendly, fun, educational environment like we do.” As of May 2022, Amin and his volunteers have provided more than 80,000 COVID-19 vaccinations. ■
Philadelphia area pharmacist goes extra mile to reach underserved community
Chichi Momah vaccinates a young patient.
Throughout the course of the vaccine rollout, Chichi Momah, PharmD, has hit every curveball thrown her way. Springfield Pharmacy’s initial COVID-19 vaccine allocation was a trifling 100 doses a week. Yet the pharmacy had already generated a waiting list of 50,000 people who were eager to be vaccinated. Momah tried every tactic she could dream up until she received a vaccine shipment better aligned with her community’s needs.
“I started talking to reporters. I emailed the health department every day. When I got the cell phone numbers of people who worked at the health department, I began sending text messages. Basically, I became a pain,” said Momah, who owns the pharmacy located in Springfield Township, Delaware County, a suburban area just outside Philadelphia.
Eventually, Momah received thousands of vaccine doses. She partnered with local high schools where she coordinated vaccine clinics that saw 1,200 people a day, twice a week. She brought together 36 volunteers for each event. Clinicians from the community, including pharmacists, primary care physicians, rheumatologists, and orthopedic surgeons pooled their efforts to get the job done.
“It was a beautiful thing,” Momah said.
The vaccination events reached a great many people; however, they weren’t reaching the most vulnerable members of Springfield Pharmacy’s community. “People were coming from all over to get the vaccine,” Momah said, “but 98% of them were nonminorities. And that’s not what Delaware County looks like.”
Momah realized it would take more than simply procuring the doses and hosting COVID-19 vaccination events in order to get uninsured, underinsured, and underserved people vaccinated.
Learning collaborative participants share diverse experiences in building vaccine confidence
Paria Sanaty Zadeh
Over the past year, a group of pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians engaged in monthly discussions on building vaccine confidence in their communities as part of the APhA COVID-19 Vaccine Confident Learning Collaborative. The 21 participants, some of whom are highlighted in these stories, represented various perspectives and diversities, including race, ethnicity, gender, geography across the country, patient population served, and practice setting.
Through the collaborative, funded in part by a cooperative agreement with CDC, participants shared challenges, barriers, and strategies for success in having conversations with patients—including adolescents and parents and caregivers of pediatric patients—to build vaccine confidence. The insights of the collaborative were used to enhance APhA’s Vaccine Confidence toolkit, Vaccine Confident webinars, advocacy efforts, commentary to regulatory agencies, and resources for pharmacy team members on COVID-19 vaccination, including primary series and booster doses, co-administration with other vaccines, pediatric vaccinations, and testing and treating COVID-19. ■
She began to visit churches and mosques to educate congregants about the vaccine. She also partnered with the local immigration coalition and community centers to get the word out and host events.
Through this targeted outreach, Momah learned about the different barriers that had kept many members of the community from presenting at vaccine clinics up to that point. Undocumented immigrants feared getting the vaccine may create a record of them that could lead to deportation. Some Black people worried that the vaccine was designed to hurt them, as in the Tuskegee Syphilis Study. Older adult residents of the community struggled to navigate online appointment platforms.
Momah and her clinical and community partners engaged translators from the immigrants’ own communities to dispel their fears about interacting with the health care system. They spoke frankly with Blacks about the scores of white patients who had traveled to Black communities and received the vaccine without harmful consequence. Additionally, they assisted by registering patients who were unable to navigate the online system themselves.
Soon after the adult vaccination clinics began to run smoothly, FDA approved the Pfizer-BioNTech COVID-19 vaccine for children, and Momah had to pivot.
“When we went back to the schools to vaccinate kids ages 5 to 11, we had to be a little bit more creative,” Momah said. She didn’t want the event to have the appearance of a clinical setting, so she and her colleagues removed their white coats and donned superhero t-shirts and costumes instead. Vaccinators applied bandages adorned with cartoon characters and sent children home with lollipops and balloon animals.
“We wanted it to feel more like a carnival,” Momah said. “Whatever it took to make it easier for the kids.”
Since the COVID-19 vaccine first became available, Momah and her band of volunteers have vaccinated patients of all ages in various settings, including nursing homes, health fairs, houses of worship, and every public, private, and charter school in the county. ■
Community pharmacist fosters next generation of vaccine confident West Virginians
Matt Rafa and his assistant teamed-up to help kids go from vaccine hesitant to vaccine confident.
When children ages 5 to 11 became eligible to receive COVID-19 vaccines, Matthew Rafa, PharmD, wanted to do more than just vaccinate the kids in his community.
“We have a real vaccine hesitancy issue in our state,” said Rafa, who practices at Kroger Pharmacy in Wheeling, West Virginia. “Wouldn’t it be great if we could turn some of those kids from vaccine hesitant into vaccine confident, rather than let them become adults who had one bad experience with a vaccine and then were unwilling to give it another try?”
Before he began to see patients in this age group, Rafa read all he could on best practices for vaccinating children, from distraction techniques to ways to reduce pain. Then he devised his own plan.
Rather than just hurry kids into the chair and hold them down, Rafa came right out and asked patients if they were scared and acknowledged that he understood their fear. He then explained that his main goal was to make sure the shot didn’t hurt and that he had several tools to help ensure that.
To reduce pain, Rafa used lidocaine gel as well as Buzzy, a small bumble-bee-shaped device placed directly on the arm that uses ice and intense vibration to distract the patient and disrupt pain transmission.
As he applied the lidocaine gel, he’d tell kids who liked superheroes that he was applying an Iron Man shield. For the Disney princess fans, Rafa would call the cooling gel “Frozen magic.”
“I’d ask them, ‘Do you feel it getting cold? Do you feel it getting tingly?’”
Training opportunities
This open forum covers what you need to know to increase vaccination rates in the pediatric age group, including practical strategies for success. Our expert speakers address common questions and concerns they are hearing about COVID-19 vaccines to provide you with messages you can use in your own practice to build vaccine confidence. (Video slides available at: www.youtube.com/watch?v=QpDP05SURY4)
Comfort and restraint technique (CDC)
This training demonstrates comfort and restraint techniques. Determine the best position for the patient based on comfort, age, activity level, administration site, and safety. Instruct the parent or caregiver on how to help the infant or child stay still so you can administer the vaccine(s) safely. (Video available at: www.youtube.com/watch?v=r1dGpTCgerE)
This training addresses how to select the equipment needed to prepare an intramuscular injection for children from birth through 18 years. A supply of needles of the appropriate lengths should be available. Aseptic technique must be used to protect supplies from microbial contamination. Safe injection practices minimize risk of injuries, infections, and noninfectious adverse events for both patients and providers. Health care providers are always advised to observe patients for 15 minutes after vaccination. (Video available at: www.youtube.com/watch?v=SsCxnccrsKM)
Rafa covered the walls of the counseling room in superhero and Disney princess posters. Just before he administered the vaccine, he’d say, “Can you name all the characters in 10 seconds? The record is 7. Can you beat that?”
“I can’t tell you how many times the kid didn’t even know I’d given them the shot,” Rafa said. “They were still talking and rattling off names, and I already had the needle in the sharps container and was putting the bandage on their arm.”
Rafa felt it was important to give children a sense of control over the situation. He did this in small ways, like allowing them to choose the color of their vaccine card and the theme of their bandage.
Rafa took his roadshow to schools and to weekly family dinners at a local soup kitchen to eliminate all the barriers. “They can’t tell you it’s not a good time when you are both right there.”
By the time children came back for their second dose they were already more vaccine confident.
“They’d come in, climb up in the chair, and say, ‘OK, I’m ready,’” said Rafa. He instilled confidence in older kids, too. He’d educate them on how to make sure future vaccines hurt less, no matter where they got them.
“Whenever you get another shot, make sure you keep that arm loose and relaxed, and then it won’t be as sore after,” he would tell them. “I wanted to educate them, so that even if they’re not coming to me regularly, wherever they are going, they’re going to feel more confident in getting any shot.”
Feedback from parents suggested to Rafa that his mission was accomplished. “One night, after I had given a vaccine to an especially frightened child, his mother texted me to let me know that the boy had asked if they could come back to me for all their shots.” ■
Family pharmacy vaccinates youngest members of the community
Pharmacists Jade and Henry Ranger helped relieve parent's vaccination fears.
As eligibility for COVID-19 vaccine was expanded to younger populations, Jade Ranger, PharmD, began to notice new reservations arising in parents of young children. While parents might have been enthusiastic about bringing in their adolescent and teenaged children for vaccination, some parents were less eager for their elementary school– and preschool-aged children to be first in line to receive a COVID-19 vaccine.
“With the younger ones, some of the parents seemed like they wanted to watch and wait for a little while and see how it played out before they brought their own small children in,” said Ranger, who co-owns and operates The Prescription Shoppe in Williamsburg, VA, with her husband Henry Ranger, PharmD.
Jade Ranger felt that her role as a community pharmacist was to lead by example. She and her pharmacist husband picked up their new shipment of vaccines the morning after it was approved for children ages 5 years and older.
That same morning, their 8-year-old son became their pharmacy’s youngest COVID-19 vaccination patient at that time.
The Rangers promptly shared the moment across The Prescription Shoppe’s social media accounts. Accompanying the photos of their grinning boy were the words, “As pharmacists, we advocate for vaccines. As parents, we’d be lying if we said we weren’t a little nervous. Bottom line: We believe that the benefits outweigh the risks, and we want to protect our children from the virus.”
It was important to Jade Ranger to acknowledge that she, too, felt a little nervous injecting the COVID-19 vaccine into her son. As a health care provider, she says that she can’t dismiss parents’ fears or any concerns that a potential patient may have. “You have to be very careful when you have these conversations. You don’t want to belittle anyone or make them feel stupid or as if they’ve been given bad advice.”
Jade Ranger believes her social media post helped change some minds. “After that, so many parents reached out with personal messages that said things like, ‘I was really nervous, but when I saw that you vaccinated your son, it put me at ease, and now I feel like we should get it done for our children,’” she said.
When children aged 6 months to 5 years became eligible for the COVID-19 vaccine, The Prescription Shoppe was among the first in town to offer it to this age group. Many pharmacists in the area, Jade Ranger says, aren’t comfortable administering the vaccine to such young children.
Through standing orders with a local physician, The Prescription Shoppe has offered pediatric vaccines for children ages 6 years and older since it opened in 2019. From then on, Jade Ranger says, patients have come to know the independent pharmacy as a “one-stop shot shop.” For the Rangers, it was an easy decision to extend their vaccine offerings to include the COVID-19 vaccine to young children once they were eligible.
When they started vaccinating young children, the pharmacists used an appointment-based schedule and allotted 20 minutes for this special population; their initial expectation was that these patient encounters would require more time. But now children can get vaccinated without an appointment, just like adults. As of August 2022, The Prescription Shoppe has administered COVID-19 vaccines to some 17,000 adults and children in their community. ■
Additional resources
A comparison chart about the requirements for pharmacists, technicians, and student pharmacists/interns to provide COVID-19, influenza, and childhood immunizations (apha.us/ImmunizationAuthority – Know the Facts).
A Task Force on Pharmacist Engagement in State-Based COVID-19 Vaccination developed 3 tools for use by pharmacists to satisfy the well-child visit requirement under the HHS Amendments authorizing pharmacists to administer childhood and COVID-19 vaccines.
CDC How to Recommend vaccination video series
The #HowIRecommend video series features short, informative videos from clinicians like you. These videos explain the importance of vaccination, how to effectively address questions from parents and caregivers about vaccine safety and effectiveness, and how clinicians routinely recommend same-day vaccination to their patients.
CDC and APhA resources
Community pharmacist registers dog as emotional support animal to soothe the needle-phobic
Brandy Willey helped her young patients by providing a registered emotional support dog.
“Do you want the dog?” Brandy Willey, PharmD, may ask patients who come in for a COVID-19 vaccine at Willey Pharmacy in Bear, DE.
If the answer is yes, Willey’s Yorkshire Terrier–Bichon Frisé mix, Charlie, runs in and hops up in the patient’s lap. While the patient gets lost in the little dog’s affection, Willey administers the vaccine, often completely undetected.
“I hear it all the time, ‘I didn’t even feel it. Are you sure you gave it to me?’” Willey said.
Charlie’s career as an emotional support animal (ESA) started before there were COVID-19 vaccines when Willey began bringing him to the store from time to time.
She found that some of her needle-phobic patients enjoyed holding the dog on their lap while they received a flu shot or shingles vaccine. Willey decided to get the dog officially certified as the pharmacy’s resident ESA.
“He’s a natural. Charlie knows how to read a room. He can read your energy. He knows if you want him on you or if you don’t want him on you. He’s a natural support animal,” Willey said.
During the COVID-19 vaccine rollout, Charlie has been working overtime. At the peak of vaccinations, when Willey pharmacists were administering up to 120 shots a day in the store, Charlie was on duty all day. These days, patients can call in to request him when they book their appointment.
Since Willey has begun administering pediatric COVID-19 vaccines, Charlie has been a boon. Willey recalls one little boy who was especially terrified. She could see the fear in his eyes as he sat in the waiting area with his mother before his appointment. Willey asked him if he wanted to play with the dog, and he said yes. Charlie jumped in the boy’s lap, and the boy immediately got excited—laughing and smiling. All the fear seemed to drain out of his body.
Willey decided that rather than take the young patient back to the vaccination room, she’d get the job done right there while he was so relaxed.
“After I verified all his information with his mom, I gave him the shot right there with the dog on his lap. It was perfect.”
On another day, a frightened little boy was disappointed to see that Charlie was not on duty that day. Willey told the boy and his mother that if they could wait 10 minutes, Charlie could come in. “My husband brought him right over,” Willey said.
Charlie has made the rounds at group homes for adults with intellectual disabilities and calms the nerves of many adult patients who come into the pharmacy, too. Local pediatricians, some of whom have heard about Charlie from their patients, refer their patients to Willey as well.
Charlie is just one of the tools in Willey’s toolkit that helps break down barriers between the vaccine hesitant and vaccines. In the last 18 months, her pharmacy has provided more than 14,000 vaccines.
“It’s about building trust with people, and there are many different ways to do that. But if you can gain their trust, then you can gently educate, and then they’ll come around. I see it all the time,” Willey explained. ■
Community pharmacy ensures kids are safe and comfortable
Trisha Winroth help make kids feel safe and comfortable while getting their vaccinations.
When children as young as 5 became eligible for COVID-19 vaccines, Trisha Winroth, PharmD, pharmacy manager at Walgreens in Lowell, MA, knew that many parents would be hesitant. Not only would they have concerns about putting a brand-new vaccine in their children’s arms, but they also wouldn’t be accustomed to taking their children to the pharmacy for immunizations.
“It’s certainly not normal to bring young kids to the pharmacy for vaccines. This was really new for us, so people were a little hesitant,” Winroth said.
Winroth wanted to come out ahead of the concerns and reservations that were sure to arise. The day pediatric vaccines became available in her pharmacy, the pharmacist brought her son in as their first patient.
That got the ball rolling for her friends’ and colleagues’ children to start coming in.
Because Winroth knew the parents of this first cohort of pediatric patients, she was able to follow up with parents the next day to find out whether the kids had experienced any adverse effects.
“We gave them the vaccine and they were playing soccer the next day. They weren’t even fazed,” Winroth said. Some parents were hesitant to have their children vaccinated because they had experienced unpleasant flu-like symptoms following the vaccination. They didn’t want to put their children through the same experience. When parents expressed this concern, Winroth was ready.
“As more and more of my friends’ and colleague’s children and got vaccinated, the more I could tell parents with confidence that these kids were totally fine.”
Winroth took to social media to spread the word about pediatric vaccines, too. First, she wanted parents to know that kids did not seem to be having bad reactions to the immunization. She also wanted to describe the measures she’d taken to ensure that pediatric patients would be safe and comfortable in her pharmacy.
As she developed and perfected new techniques for keeping kids safe and happy during immunizations, she passed the strategies along to other pharmacists in a “pharmacist moms” Facebook group.
“I just wanted to give other pharmacists a pat on the back and let them know that they could do this and that kids aren’t really that hard [to vaccinate],” she said.
She also filled bins with toys and prizes that children could play with as a distraction during the immunization and take home as rewards for being brave.
“Sometimes, just rummaging through the bucket of stuff was enough to distract them while I administered the vaccine,” Winroth said.
The pharmacist makes special accommodations for autistic and high-anxiety children. Her special knack with this patient population has brought many such children into her pharmacy. Knowing that it may take some time to get these patients comfortable, she schedules longer appointments for them. If a patient is claustrophobic and won’t enter the cubicle where immunizations typically take place, Winroth vaccinates the child in the waiting room.
“I will try anything they want to do as long as it’s safe.” ■
Community pharmacist gives nervous teens ample time to prepare for vaccination
George Zikry gave nervous teens ample time to prepare for vaccinations.
As soon as the Pfizer–BioNTech COVID-19 vaccine was approved for adolescents ages 12 to 15 years, George Zikry, PharmD, knew this group was going to have unique needs. Responsible for leading the vaccine initiative at Hendricks Pharmacy in Claremont, CA—first as a Chapman University School of Pharmacy resident and then as a staff pharmacist—Zikry anticipated those needs as he planned the pharmacy’s adolescent vaccination clinics.
Zikry scheduled special COVID-19 vaccination events at the pharmacy exclusively for this age group. While adult vaccination appointments took about 5 minutes, Zikry felt it was important to allow more time for the tweens and teens.
“We didn’t know how hesitant or scared [adolescent patients] were going to be—and we never wanted anyone to feel rushed—so we scheduled longer appointments for them,” Zikry said.
The pharmacy also provided goody bags to each young patient with the promise that the contents of their goody bag after the second dose would be even better. The mastermind behind the goody bags, Zikry said, was Hendricks Pharmacy owner, Brian Garner, PharmD.
“Dr. Garner has been very hands on with COVID-19 vaccine efforts. He created the COVID-19 vaccine appointment system, scheduled specialized clinics, and kept up with the literature,” Zikry shared.
Zikry’s hunch that immunizers should take their time with younger patients was spot on. One evening, a 14-year-old girl arrived at the pharmacy with her parents to get vaccinated. But when the time came, she was terrified and didn’t want the shot.
To help the teen overcome her fear, Zikry explained that the volume of the vaccine dose was so small that it called for the thinnest needle possible. He also noted that most people were surprised when the injection was completed because they hadn’t felt much of anything. Zikry told the young patient that he was certain she would feel the same way after being vaccinated. Still, she was unmoved. Next, the patient’s parents alternated between cajoling and pressing their daughter to get vaccinated. First, they’d listen and soothe. Then, frustrated, they’d say they were just going to hold her down. After this escalation, Zikry went in for another round of reasoning with and reassuring the patient.
“Whatever trauma she had around needles and vaccines, I didn’t want to add to that,” Zikry said.
Finally, in a lightbulb moment, Zikry grabbed roll-on lidocaine from the shelf and applied the numbing solution to her upper arm. The girl’s father pressed one of his car keys into the spot on her arm to show her that she couldn’t feel it. Skeptical, the patient took the key and pressed it into her arm harder.
“I let her know that the amount of pressure she was putting on her arm with the key was far more than I would apply with the needle,” Zikry said.
Finally, the young patient relented and Zikry administered the vaccine.
All told, Zikry spent well over 2 hours with the family that night, including 45 minutes after the pharmacy had closed and everyone else had gone home for the night.
“I knew she wasn’t going to feel it and that, when she realized that, I would have contributed to helping her get past her fear, and that really motivated me,” Zikry said.
The patient did get over her fear, and she gave all the credit to Zikry and the staff at Hendricks Pharmacy.
She thanked the pharmacy staff with a personal letter and a glowing Yelp review. And when she returned for her second dose, it took just 5 minutes.
Asked why he didn’t simply tell the family to come back when the young patient was ready, Zikry said, “We are trying to get everyone vaccinated. If they are taking that step to come in and get vaccinated, it’s my responsibility to help [the patient] get past her fears and make sure she does get vaccinated.” ■