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CEO Blog: Scott Knoer, MS, PharmD, FASHP

Scott Knoer is the 13th executive vice president and CEO of the American Pharmacists Association. Before joining APhA in 2020, Scott served as Chief Pharmacy Officer for the Cleveland Clinic. He also served in pharmacy leadership roles at the University of Minnesota Medical Center, Fairview, and the University of Texas Medical Branch at Galveston.

Read more about Scott

Published on Tuesday, January 5, 2021

How will we get America immunized? Here are a few hundred thousand suggestions

Operation Warp Speed leaders predicted that 20 million people, primarily frontline health care workers and residents of long-term care facilities, would receive the first dose of a COVID-19 vaccine in December. It’s now January, and media reports indicate that we’ve yet to break 5 million.

As with anything new, there will be bumps in the road as untested models are implemented. We are only in Phase 1a, and already we are seeing a need to refine the process. As more COVID-19 vaccines become available and more individuals become eligible to receive it, increased access points and optimal use of pharmacy teams will be critical to vaccinating more than 328 million Americans. We have got to kick this up a notch.

Pharmacy is ready

Here’s another number: more than 376,000. That’s how many pharmacists and student pharmacists have been trained to administer vaccines to patients across the lifespan. Their education and training have equipped them with the clinical and practical knowledge to vaccinate on a large scale. Pharmacists have been administering immunizations for more than a quarter of a century, and they know what it takes: who should or shouldn’t get a vaccine; appropriate storage, handling, and vaccine administration technique; important points to communicate to patients; how long patients should be monitored immediately post-vaccine and what to look out for; and how to handle vaccine reactions. They’re ready for this.

In addition, more than 10,000 pharmacy technicians have completed training programs like those offered by APhA to use the new vaccine administration authorities they’ve been granted under the PREP Act. Additional pharmacists, student pharmacists, and pharmacy technicians will continue to complete training over the next few weeks, increasing the size of the pharmacy workforce that is ready and able to address our communities’ COVID-19 vaccination needs.

A December 2020 APhA poll found that more than three-quarters of pharmacist respondents planned to get a COVID vaccine, and 60% said they’d be set up and ready to vaccinate patients as soon as the vaccine became available. That is a lot of immunizers.

Almost 90% of Americans live within 5 miles of a pharmacy. The pharmacist is often the most visited and trusted health care provider in communities across the country, particularly in rural and underserved communities. Pharmacists can answer questions about the vaccine, dispel myths, extend public health messaging, and help boost patient confidence and address any hesitation about getting the COVID-19 vaccine. The government can count on pharmacies to be not only key vaccination access points, but also sources of public education.

Health care experts are well aware of the potential impact pharmacies can have on nationwide vaccination efforts. On January 3, 2021, the Wall Street Journal published an op-ed from former FDA commissioner Scott Gottlieb touting pharmacies’ ability to get “shots in arms.”

The hundreds of thousands of pharmacists, student pharmacists, and pharmacy technicians who have immunization expertise are here, waiting. We cannot afford to squander such a large and capable workforce. Put us in, coach! A team without pharmacists cannot win.

Why wait?

Pharmacists are already involved to a certain extent, and the ultimate vision for our nation’s COVID vaccination program is to enlist all willing, ready, and able pharmacy providers. The federal government tapped two large pharmacy chains and other pharmacies to provide COVID-19 vaccines to residents of long-term care facilities. In health systems, pharmacists are immunizing their colleagues. And several local jurisdictions have engaged community pharmacies, some in underserved and rural areas, to kick off vaccination programs to Phase 1a and priority populations. But we need to speed up and optimize the use of pharmacy team members waiting in the wings.

The U.S. Department of Health and Human Services (HHS) and CDC established the Federal Pharmacy Partnership Program, which will give pharmacies a more active role beyond long-term care once more vaccine supply becomes available. Allocation and distribution for the Federal Pharmacy Partnership Program, according to the original plans, was not to begin until Phase 2. But as local jurisdictions begin to expand targeted populations prior to that time, they will need the help of all pharmacists to vaccinate essential workers, older adults, and those with chronic medical conditions.

The new administration and Congress must engage any willing, able, and ready pharmacies and pharmacy team members to administer authorized vaccines. We must also develop clear guidance and communications to providers and the public to help them more clearly identify who qualifies for Phase 1b and 1c vaccination. In addition, the system must get better at informing providers whether the vaccine will arrive at their sites, when it will arrive, and how much will arrive.

We need clarity now

Pharmacies can do even more once intolerable ambiguities are resolved.

The Federal Pharmacy Partnership Program includes national pharmacy chains and networks that represent independent pharmacies and regional chains—almost 70% of U.S. pharmacies—in efforts to mass immunize. The remaining 30% of pharmacies will get their vaccine allocations through state and local allocation channels, though many questions about the varying processes among states remain unanswered. Pharmacies are working their way through administrative procedures to gain access to vaccine so they can serve their communities.

States want autonomy in deciding who, how, and when their residents get the vaccine, but that’s led to concern among the health care workforce, namely pharmacists, who want to be prepared. These are pain points that the Biden administration should take care to address once it assumes power in a few weeks. We need transparency well in advance of the launch of phases Phases 1b and 1c, not to mention Phase 2, as well as simplified processes to enroll pharmacies in the state programs and make it easier for states to engage all willing, ready, and able pharmacists and pharmacies.

There’s no getting around payment

The vaccine itself will be provided at no cost by the government; however, payers are expected to reimburse providers for the administration of the vaccines to each patient. Pharmacy has worked with CMS to identify the payment pathway for Medicare patients. The Health Resources and Services Administration has identified a payment pathway for uninsured patients. Neither CMS nor other parts of the federal government controls payment policies for Medicaid or commercial plans, but the federal government can use its influence to encourage clear and consistent guidance. This will provide critical sustainability and access to community-based care providers during and after the pandemic. Pharmacies, physicians, clinics, and other community-based providers cannot continue to function without adequate reimbursement and a management and equitable billing process.

Getting it done

Pharmacies are often busy and strapped for time, and COVID-19 vaccination could be an extra stress—so now is the time to look for efficiencies and fold COVID-19 vaccination into their workflow. Still, pharmacists, student pharmacists, and pharmacy technicians have the bona fides, the willingness, and the passion to get us across the finish line. When so much remains uncertain and so many decisions must be made on the fly, that’s a guarantee. Pharmacies keep patients and communities educated, safe, and cared for. Their full participation in COVID-19 vaccination efforts could mean the difference between life and death for many Americans.

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Scott Knoer, MS, PharmD, FASHP
APhA Executive Vice President and CEO 

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