Expand Pharmacists’ Authority To Promote Access To Forthcoming COVID-19 Vaccine
Private pharmaceutical companies and the National Institutes of Health have outdone themselves.
Thanks to the funding provided by the NIH, a Phase 1 clinical trial for a COVID-19 vaccine is underway. In separate efforts, Inovio, Sanofi, Vaxart, GlaxoSmithKline, and Johnson & Johnson are all developing potential vaccines. In total, “about 35 companies and academic institutions are racing to create a vaccine, at least four of which already have candidates they have been testing in animals. The first of these – produced by Boston-based biotech firm Moderna – will enter human trials imminently.”
The speed with which the pharmaceutical industry and public health authorities have worked to develop a vaccine is truly remarkable. The dynamic response demonstrates how a vibrant pharmaceutical industry working in tandem with a focused public health authority can meet 21st Century pandemic threats.
Once developed and approved, it is imperative that patients have convenient and safe access to COVID-19 vaccines. Without widespread access, the benefits from the industry research efforts will be diminished. Unfortunately, many states impose excessive regulations on pharmacists that ultimately reduce vaccination rates and increase vaccination costs.
It is important to emphasize that, as part of their education, pharmacists are trained to administer vaccines. All accredited Doctor of Pharmacy programs require students to obtain an immunization certification, and all pharmacists that administer vaccines are trained on the CDC’s national immunization standards and recommendations.
Each state administers its own laws governing which vaccines pharmacists can administer and the regulatory burden that pharmacists must bear in order to provide these beneficial health care services to patients. While all 50 states permit pharmacists to administer flu vaccines, state regulations vary (sometimes widely) for others. They also vary regarding the protocol pharmacists must follow, and whether pharmacists need a prescription from a doctor before administering a vaccine.
Some states, such as California, empower pharmacists to administer all vaccines recommended by the CDC and therefore create fewer administrative obstructions. Other states, such as Ohio, require a prescriber-issued protocol before a pharmacist can administer a vaccine. Such protocols create additional barriers for patients, and can reduce the number of people who receive the vaccine.
These costs are disconcerting because, in practice, pharmacists are cost-effective providers of vaccines who are well positioned to expand access and vaccination rates.
According to a 2013 review of the evidence from a national pharmacy chain, 30.5% of the more than 6 million vaccine doses dispensed were administered during nights, weekends, and holidays. More than one million vaccinations (17.5% of all vaccinations) were administered during lunch hours (11 am-1 pm); and uninsured patients were more likely to be vaccinated during these off-clinic hours than individuals with insurance. A 2014 study showed that, compared to physician offices, the cost of vaccines at pharmacies were between 16% and 26% less.
Combined, these results demonstrate that pharmacists expand vaccine availability and affordability, which are particularly valuable to uninsured patients. The expected result is increased patient access to vital health care services.
Importantly, the evidence links the greater access to improvements in public health. According to a 2018 study conducted by researchers at Johns Hopkins School of Public Health,
adding pharmacies as locations that dispense flu vaccinations during a mild epidemic averted up to 17.1 million symptomatic cases, prevented up to 104,761 deaths and saved $1 billion in direct medical costs, $49.3 billion in productivity losses.
More relevant for a COVID-19 vaccine, the study’s simulation model found that the potential public health benefits are even greater during more severe pandemics. Specifically, the researchers found that “adding pharmacies averted up to 23.7 million symptomatic cases, prevented up to 210,228 deaths and saved $2.8 billion in direct medical costs, $97.1 billion in productivity losses and $99.8 billion in overall costs.”
Simply put, by expanding access to vaccines and lowering their costs, pharmacies improve societal vaccination rates, reduce the number of deaths, and generate health care savings.
Since current pharmacy regulations erect unnecessary barriers to vaccinations, the policy environment could inhibit the goal of making the COVID-19 vaccination widely available. For example, requiring patients to obtain a prescription for a COVID-19 vaccination from their doctor before a pharmacist can administer the vaccine, as is the case in too many states, creates additional costs and delays for patients that reduces the potential public health benefits.
Due to the large potential benefits from a COVID-19 vaccine, the policy solution is simple. Just like the flu vaccine, pharmacists should be empowered to administer the COVID-19 vaccine to patients in every state. States can make this a reality by ensuring that that pharmacists have the authority to administer all CDC recommended vaccines without a doctor’s prescription and without any undue protocol burdens.
If history is any guide, the result will be significantly higher vaccination rates, lower overall health care costs, and meaningful improvements in public health.
I am a Senior Fellow in Business and Economics at the Pacific Research Institute and the Director of PRI’s Center for Medical Economics and Innovation. My research explores the connection between macroeconomic policies and economic outcomes, with a focus on the health care and energy industries. I have over 25 years of experience advising Fortune 500 companies, medium and small businesses, and trade associations. I received my Ph.D. in economics from George Mason University.
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