Community Pharmacists can contribute through diverse ways to vaccination strategies, protecting public health and contributing to a robust and sustainable healthcare system. Pharmacists are ideally placed at the heart of communities to provide information, advice, referral, treatment, and preventative actions to reduce the burden of communicable and vaccine-preventable diseases. As part of their wider public health mission, community pharmacists and pharmacy organisations are also involved in public awareness campaigns on topics such as antimicrobial resistance and vaccine hesitancy.
PGEU members examples of the contribution of community pharmacists to vaccination strategies
During the COVID-19 pandemic, pharmacists played a crucial role that was even enhanced from the moment vaccines became available. A law was passed to allow the administration of COVID-19 vaccines by trained pharmacists, amongst a preventive strategy encompassing the administration and interpretation of rapid antigen tests. The law further involved pharmacists in the fight against the pandemic, in particular in the vaccination process, as recommended by the National Vaccination Taskforce. Pharmacists were allowed to prescribe and administer COVID-19 vaccines, following specific training. They were also mobilized, as pharmaceutical experts, to assist in the COVID-19 mass vaccination centers. In this role, pharmacists were responsible for the management of the supply and logistics within the center and assisted in the preparation of vaccines before administration. Until now, pharmacists are the only healthcare provider allowed to prepare and deliver COVID-19 vaccines to other caregivers such as GP’s and nurses. Moreover, pharmacists were responsible for the pharmacovigilance and monitoring/follow-up of risk minimisation measures in the centers.
In addition, community pharmacies have been equipped since April 2021 with an electronic system, so the COVID-19 vaccination status of the patient is shown to pharmacists as a pop-up in the dispensing software. This message is a trigger for pharmacists to start an awareness-raising discussion with their patients. Webinars were developed to train pharmacists on how to deal with possible vaccine hesitancy. The positive experience with COVID-19 vaccine prescription and administration in community pharmacy has resulted in the Belgian Health Minister proposing to expand vaccination services in pharmacies to influenza vaccination, resulting in a bill that was approved in October 2023.
Pharmacists and other healthcare professionals can currently administer vaccines in Danish pharmacies, following delegation by a physician. By 2017, approximately a third of Danish pharmacies had specially trained pharmacists providing seasonal influenza vaccinations under a defined protocol. The mandatory training that pharmacists need to follow includes specific requirements for the pharmacists to undertake relevant continuous professional development (CPD) and to keep confidential records for vaccinated patients. Such details are kept in electronic format in a national vaccination database. The flu vaccination service started in Copenhagen in 2014 and is currently a national service, as pharmacies offer this service in numerous locations around Denmark.
Pharmacists are also able to vaccinate against COVID-19 following delegation by a physician since December 2021.
In France, community pharmacists are allowed to vaccinate since March 2019. In 2016, only 46% of the at-risk population in France was vaccinated against influenza, which is below the WHO/European Commission recommendation of 75%. In 2017, the French government announced a pilot project aiming at improving the influenza immunization coverage of the adult population – by making this service available through community pharmacies. It built on existing evidence of improved vaccination coverage in other European countries where this service was available from pharmacies. Almost 60% of all pharmacies in the Nouvelle-Aquitaine and Auvergne-Rhône-Alpes regions took part in the pilot. Community pharmacists participating in the pilot followed relevant education and training courses and were supported by the French Chamber of Pharmacists via a dedicated online platform, which also served as data collection point.
In January 2022, around 60% of COVID-19 vaccines were administered by pharmacists, compared with 25% by doctors and 15% by nurses. The satisfaction rate of the service in pharmacies was ranked with 4.92/5.00. Subsequent laws expanded the list of vaccines that pharmacists are able to prescribe and administer to patients aged 11 and over to a wide array of vaccine-preventable diseases, effective in August 2023. More specifically, French community pharmacists may: (i) prescribe all vaccines in the vaccination schedule to people aged 11 and over (except live attenuated vaccines in immunocompromised patients); (ii) administer all vaccines in the vaccination schedule to people aged 11 and over; and (iii) prescribe and administer vaccines against seasonal influenza to people aged 11 and over, whether or not they are targeted by vaccination recommendations.
Pharmacist-led vaccination started in October 2020 with a flu vaccination pilot in 4 regions of Germany and was expanded over time to a total of 9 regions. In February 2022, pharmacists were included in the vaccination strategy against COVID-19. By the start of the season 2022/2023, flu vaccination by pharmacists was implemented as a service that could be offered in community pharmacies nationwide. In order to administer vaccines, pharmacists need to complete both theoretical and practical training. The curriculum for this training was developed by the Federal Chamber of Pharmacists (BAK) together with the German Medical Association (BÄK).
In recent years, community pharmacists in Greece have been empowered in their role to increase vaccination coverage. Since 2019, community pharmacists have been enabled to administer flu vaccinations in pharmacies as a complement to existing vaccination services, which have demonstrated very positive results.
Additionally, pharmacists have been involved in awareness and information campaigns on COVID-19 vaccination. Furthermore, pharmacies assisted citizens in scheduling their COVID-19 vaccination appointments. This remunerated service aimed at supporting people who had limited digital skills and were not able to book their appointments via the Greek’s government online appointment system. In 2023, upon consulting the patient record and following predetermined assessment criteria, pharmacists were authorized to dispense and administer the flu vaccine without the need of a medical prescription.
Community pharmacists in Ireland have been providing the seasonal influenza vaccination since 2011 and to date, more than a 1.5 million patients have received their flu vaccination in a pharmacy. Statistics show that provision via community pharmacies increases coverage for people who had never received the vaccination before (one in six), with 99% of patients indicating that they would return to the pharmacy for their next vaccination. Patient satisfaction with the service is very positive with 93% of patients rating the service either 9/10 or 10/10.
Since 2015 community pharmacists are also authorised to supply and administer shingles and pneumococcal vaccines without a prescription. In 2020, new legislation was passed allowing pharmacists to administer COVID-19 vaccines as well as to provide a flu and/or COVID-19 vaccination service outside of the pharmacy premises such as the patient’s home, nursing home, workplace premises, school/creche and sports center, among other sites.
Community pharmacy is an integral part of the national publicly funded seasonal influenza and COVID-19 vaccination programmes with community pharmacists having administered over 10% of all COVID-19 vaccines since the beginning of the pandemic as well as 29% of all flu vaccinations in the 2022/23 winter season. These programmes have now transitioned to an Autumn/Winter Vaccination Campaign which allows for the administration of both influenza and COVID-19 vaccines, as well as a Spring booster campaign for COVID-19 only, delivered in line with national guidance and predominantly through the community pharmacy and GP surgery network. Many pharmacies are also actively engaged in the vaccination of children in the primary school setting.
Community pharmacists are provided with free vaccines to administer to defined at-risk groups under the national programmes and are also remunerated for the administration of those vaccines. Details on vaccination for flu, COVID-19 and pneumococcal are entered into a pharmacy based digital immunisation record (HSE Pharmavax) which in turn is linked to the national immunisation database COVAX.
Italy became the third EU country in which community pharmacists could administer COVID-19 vaccines. Specific legislation was adopted in December 2020 and in March 2021, and an agreement between pharmacies/pharmacists’ Organizations and the Ministry of Health was signed, specifying standard procedures for COVID-19 vaccination. Since the end of March 2021, COVID-19 vaccinations could be administered directly by the pharmacist at the pharmacy.
The administration of COVID-19 vaccines takes place by licensed pharmacists on the basis of specific training programs and modules organized by the Higher Institute of Health. Informed consent and related medical history must be obtained before vaccination.
During the vaccination campaign 2021/2022, community pharmacists were able to vaccinate against influenza for the first time and are able to vaccinate both for influenza and COVID-19 in the 2023/2024 vaccination campaign.
From December 2023 onwards, community pharmacies in the Marche Region will also be able to administer free Herpes Zoster vaccines to the eligible population, i.e. people aged 65 years or older, without the need of a medical prescription. This is the first regional scheme that expands vaccination against other diseases, apart from the national plan covering seasonal influenza and COVID-19.
Since the beginning of 2022, pharmacists are legally allowed to vaccinate against COVID-19 in pharmacies. A pharmacist may vaccinate if their professional competence is evidenced by a course of study on vaccination at a higher education institution. Vaccination of persons aged 18 years and over is provided by pharmacies that have a contract with the National Health Service for vaccination against COVID-19. To ensure that vaccines are reported in the single electronic health information system, the pharmacy and the pharmacist must be registered with the Health Inspectorate. The pharmacy manager submits a completed form to the Health Inspectorate before vaccination in the pharmacy.
Since February 2022, citizens can be vaccinated against COVID-19 in pharmacies. People aged 12 and over can make an appointment for the COVID-19 vaccination at various participating pharmacies. The list of pharmacies is updated weekly, based on vaccine availability. Pharmacies offer both initial vaccinations and booster doses. Positive experiences with COVID-19 vaccine administration in community pharmacies have led to initial discussions with the Luxembourgish Health Ministry regarding a pilot project to offer influenza vaccinations in pharmacies.
As of 2023, pharmacists can prescribe vaccines against seasonal flu and COVID-19. Pharmacists, and other health personnel in pharmacies, can administer most vaccines on the market.
In order to be able to provide the vaccination service, pharmacists must complete a special training program. This mandatory training program has been developed jointly by the Pharmacy Association, the pharmacy chains and hospital pharmacies.
Most pharmacies offer flu vaccine services, and 25% of pharmacies offered the COVID-19 vaccination services during the pandemic. Approximately 30 different vaccines are administered in pharmacies according to a doctor’s prescription. One of the commonly administered vaccines in pharmacies, beyond the flu and COVID-19, is the tick-borne encephalitis (TBE) vaccine, which in the last few years has become widespread in use in southern Norway. All vaccination services are performed according to a set of national professional quality standards.
With the adoption on January 2021 of the Act amending the Act on special solutions related to the prevention, prevention and combating of COVID-19, other infectious diseases, pharmacists obtained the right to vaccinate against COVID-19. Pharmacists are trained with a COVID-19 vaccination course that consists of a theoretical and practical parts. After successfully completing the course, each pharmacist receives a certificate confirming that they have obtained qualifications in the scope of vaccination against COVID-19. Data from early January 2022 showed that since the launch of the vaccination service in July 2021, pharmacists in Poland had administered over 1 million COVID-19 vaccines in pharmacies.
On November 2021, community pharmacists were also allowed to administer flu vaccinations in pharmacies. During the 2022/2023 flu season over 127,000 flu vaccines were administrated in Polish pharmacies.
For the 2023/2024 flu vaccination season, trained pharmacists can vaccinate adult patients as a professional service and can issue pharmaceutical prescriptions for flu vaccines. According to the new reimbursement regulations, Polish patients can receive a flu vaccine free of charge for children up to 18 years of age, and adults over 65 years of age, based on a reimbursed prescription issued by a doctor. Currently, vaccination services at the pharmacy are subject to a fee.
In 2007 pharmacies’ role was expanded through the adoption of legislation allowing vaccination services. Since 2008, pharmacies have implemented influenza immunization campaigns on an annual basis. Furthermore, the list of vaccines has increased, and currently includes immunization against 15 different types of diseases, such as the flu, pneumococcal, hepatitis, HPV, among others. Community pharmacists are allowed to administer vaccines outside the National Vaccination Plan – defined by the Portuguese health authorities which includes vaccines that are administered by the National Health Service free of charge to the patients.
To provide this service, community pharmacists must obtain the Competency on “Administering vaccines and injectable medicines” which is certified by the Portuguese Pharmaceutical Society. This Competency is granted to pharmacists that complete mandatory training on vaccination and on basic life support. The Competency lasts 5 years – to maintain or renew it, community pharmacists must show evidence of continued activity and complete a refresher training. The Portuguese Pharmaceutical Society endorsed a training framework and guidelines establishing the minimum requirements for training accreditation. In addition, pharmacies must have a suitable room for vaccination equipped with the necessary equipment and materials to vaccinate and to deal with an anaphylactic event. Currently, more than 2500 pharmacies are providing vaccination services and more than 6000 pharmacists are enabled to vaccinate.
Since 2017, pharmacies are automatically integrating the vaccine administration record data from the pharmacy software system on the national e-Vaccination Bulletin. This was an important step that reinforced the integration of pharmacies in primary health care.
In 2023, recognizing the significant contribution of pharmacies to bolster the national vaccination strategy, the Portuguese Ministry of Health has decided to expand the National Vaccination Campaign in collaboration with the NHS against Influenza and COVID-19 to community pharmacies, significantly promoting the coadministration of these two vaccines to eligible patients in participating pharmacies. Additionally, for the first time, the vaccination service in pharmacies will be remunerated by the national health budget.
In October 2022, an Order of the Minister of Health approved the provision of the seasonal flu vaccination service by community pharmacies authorized for this activity. Since then, the vaccination service is carried out exclusively by pharmacists who have completed a postgraduate training program in vaccination against seasonal influenza. This service complies with the instructions contained in the Guide on vaccination in community pharmacies, annexed to the normative act issued by the Ministry of Health, that authorizes pharmacies to carry out vaccination services.
Upon completion of a training cycle and the awarding of the graduation certificate, the higher education institutions that organize training programs in seasonal influenza vaccination for pharmacists communicate to the Ministry of Health and the Romanian College of Pharmacists the list of pharmacists who obtained the graduation certificate of the training program to administer seasonal flu vaccines.
The vaccination is carried out in the pharmacy at the individual’s request, and in the case of minors, at the request of their legal representatives. People can be vaccinated if they have a medical recommendation or prescription, or if they have had at least one flu vaccination in the previous years. Pharmacists always conduct anamnesis for identification of possible contraindications or precautions for vaccination. Pharmacists can vaccinate after obtaining informed consent of the person/legal representative presenting for the vaccination service.
After the vaccine administration, pharmacists access the national electronic register of vaccinations and include the patient information in real time.
Vaccination services by pharmacists have been available since 2015 on a cantonal/regional basis. Each canton decides individually which vaccines are administered in pharmacies. Some cantons allow only the influenza vaccine, whereas in others all vaccines included in the national vaccination plan for adults are available. In order to provide this service, pharmacists must complete additional training including on injection techniques and theoretical aspects of vaccination and resuscitation (basic life support and use of an automated external defibrillator) and must obtain a vaccination certificate. As young pharmacists studying in Switzerland have this full training at university since 2022, they no longer need to have this additional certificate; their federal pharmacist diploma is enough for them to have the right to vaccinate.
Evidence shows that COVID-19 vaccination in public pharmacies reached a high level of satisfaction. This included the important elements of pre-vaccination discussion, pharmacies’ information level on COVID-19 vaccines, general comfort, injection technique, and premises used. Citizens actively chose pharmacies as a place of vaccination for their opening hours, ease of access, and trust, showcasing the pharmacies’ ability to cater for population needs.
In England, the seasonal influenza vaccination by pharmacists was first commissioned in 2010 at local level and since 2015 has been commissioned as a national service. Now, patients and the general public in England can receive their seasonal influenza vaccination in any pharmacy, without appointment.
Almost two thirds (62%) of those who received their flu jab from a community pharmacy are aged 65 or over, according to PSNC data. The second largest cohort is under-65s with chronic (long-term) respiratory disease (12%), followed by diabetic patients (8%).
Since January 2021, community pharmacists have gradually been enabled to administer COVID-19 vaccines in pharmacies in England to patients. Initially, only a couple of pharmacies were able to meet the government’s capacity criteria for the administration of COVID-19 vaccines. Due to the relaxation of the criteria, by the end of March 2021 over 400 pharmacies in England have been administering COVID-19 vaccines to patients. On 22 March 2021, NHS England confirmed that over 1,7 million vaccines had already been administered in community-pharmacy led sites. Also in Northern Ireland, Scotland and Wales, community pharmacies were structurally involved in the administration of COVID-19 vaccines to patients.
To vaccinate, pharmacists need to go through a training, and The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners sets the standards and lists the essential topics which should be incorporated into immunisation training for registered healthcare practitioners. Pharmacists who provide the COVID-19 Vaccination Service must have completed practical training in vaccination that meets these requirements.