Driving vaccination programs around COVID
The COVID-19 vaccination rollout enabled retail pharmacies to take a closer look at their immunization programs. To improve operations, many sought new certifications, updated technology and purchased equipment. Among the results were improved workflow, better customer service and, importantly, increased traffic and revenues. As the pandemic wanes and demand for vaccines decreases, retailers are leveraging what they learned to prepare for the future, which could present anything from another pandemic to a routine flu season.
Major retailers acknowledge that COVID-19 vaccines and testing drove traffic and sales. In March, Walgreens Boots Alliance reported that in the second quarter of fiscal 2022, U.S. retail comparable sales were up 14.7% compared with the year-ago period, led by COVID vaccinations and testing. The chain reported that it had administered 62.8 million vaccines to date. CVS announced that in fiscal 2021 it administered 59 million vaccines, and that fourth quarter revenues (ending Dec. 31, 2021) increased 10.1% compared with the prior year. In April, Kroger reported strong fiscal year 2021 sales, and that it had administered 11 million vaccines to date.
Now that pharmacies have moved beyond just trying to keep up with demand for COVID-19 vaccines, they are realizing that there are opportunities to help boost their immunization programs to help drive traffic and sales.
Gaining Trust
Consumers have been increasingly seeking vaccines from retail pharmacies. According to the Centers for Disease Control and Prevention’s 2020-2021 Flu Season Summary, 53.8% of people reported getting a flu vaccination at a store, which was significantly higher than the 34.9% for the 2019-2020 season. As retailers prepared to offer COVID-19 vaccines through the Federal Retail Pharmacy Program, many already had vaccination programs in place because they offered flu shots. One challenge was the increased volume.
“In a pandemic, when you go from several thousand vaccines to tens of thousands, you have to scale up,” said Sandra Canally, founder and CEO of The Compliance Team, which provides a variety of accreditation services. “That takes a lot of operational excellence to do that.”
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The Philadelphia-based organization added immunization certification, including COVID-19, to its offerings during the pandemic. “We created the certification program for those providers that really wanted to make sure their processes were where they needed to be,” Canally said. “It’s all about gaining the trust of the community.”
The program covers, among other topics, proper patient intake, safe vaccine storage and handling, and awareness of adverse events such as allergic reactions. “It’s not just ‘Did you have any adverse events and how is it documented?’” Canally said. “Was the handling of it the same across the board? Did Mary the pharmacist handle this the same as Joe the pharmacist?” She recommended having quality improvement meetings every quarter to discuss incidents and areas of improvement.
Many retailers looked at their flu vaccination program as a blueprint for their COVID-19 vaccine programs, said Dave Ross, vice president of North America commercial operations at Seqirus. “This includes their expertise in how to engage and educate their customers about the importance of immunization, how to manage vaccine inventories to ensure doses are where they are needed, and how to conduct effective and convenient mass-immunization clinics,” he said.
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The 2021-2022 season presented the influenza vaccine company’s retail partners with a unique challenge: the need to conduct two mass-immunization campaigns, flu and COVID-19, simultaneously. As retailers approach the upcoming flu season, they face vaccine apathy among consumers and hesitation to get flu and COVID-19 vaccines in the same visit, even though CDC guidance indicated that co-administration is safe and recommended. Also, retailers will have to contend with continued resource constraints.
The good news, Ross noted, is that this year retailers and manufacturers have more time to plan for concurrent immunization programs. There is also an opportunity to extend the time flu shots are available. “We should make sure immunization programs continue throughout the influenza season, which doesn’t typically peak until February or March,” he said. “Too often, we see flu immunization efforts come to an early end in November, which leads to millions of missed opportunities to protect the public from influenza and its complications.”
Leveraging Technology
Unlike flu shots, COVID-19 vaccines had eligibility requirements initially. “Not just anyone could walk in,” said David Kirkus, director of pharmacy consulting at Raleigh, N.C.-based EnlivenHealth. “You had to be 65 or older or have health conditions.” Then, when the COVID-19 vaccine became available to the general public, pharmacies had to handle the massive demand, and workflow and scheduling issues, while trying to fill prescriptions and counsel patients.
EnlivenHealth offers CareScheduler pharmacy scheduling and reporting software. “Most pharmacies prior to the pandemic were not scheduling appointments for services in general,” Kirkus said. “Most flu shots were walk-up.”
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Scheduling COVID-19 vaccines helped retailers not only with crowd control but with improving the customer experience. Scheduling appointments also changed the patient-pharmacist dynamic. People now see the pharmacy as a place to meet with a pharmacist for diabetes management, smoking cessation and other programs.
“If you can provide immunizations and more advanced clinical services in an accessible and convenient way, and make that an enjoyable experience for patients, that’s the framework the industry needs to move toward,” Kirkus said. “There is a lot to be said for what that type of interaction does for brand loyalty.”
In addition to online scheduling, pharmacies also implemented technology to report data to public health agencies. “One of the things this pandemic validated was the importance of data and technology,” said Michael Popovich, CEO of Phoenix-based STC Health. “The gap was how to make it smoother and capture it at the front end.”
The vaccine intelligence provider works with pharmacies to capture patient immunization data. When a patient gets an immunization, the pharmacy electronically sends the patient data directly to the state public health agency. The state collects and shares immunization records with federal agencies so that they could determine, among other details, where people were not getting the vaccine. “There was a lot of data floating around, and it wasn’t well used,” Popovich said. “On the federal level, they didn’t have systems that could answer the rapid fire questions that were coming from [the] government.”
As more chain and independent pharmacies adopt systems to make reporting easier, that will help health agencies make sense of the data and make rapid assessments of the situation, and answer questions from consumers, governments and others. “The government will always ask for information,” Popovich said. “Pharmacies now have networks in play.”
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Equipment
One of the details about the COVID-19 vaccines that captured media attention was that the vaccines had to be stored at extremely cold temperatures. “In the U.S., we didn’t see that many frozen vaccines before COVID-19,” said Joe LaPorte, director, products and projects at Wood Dale, Ill.-based PHC of North America. “That wasn’t something retail was set up for.”
PHC’s offerings included several ultra-low temperature freezers. Retailers are purchasing them and performing necessary tasks such as checking the temperature twice a day. Also, staff must be trained on how to handle the cold vaccines, as the Pfizer-BioNTech vaccine has to be stored at minus 90 degrees Celsius to below 60 degrees Celsius. “That is colder than anything on the planet,” LaPorte said.
If the vaccines are not properly stored, they could be less efficacious, which could raise the question of whether a breakthrough case of COVID-19 is due to a vaccine not being properly stored. LaPorte pointed to a 2012 study by the Department of Health and Human Services that found that among a sample of 45 of the CDC’s Vaccines For Children program providers, 76% had vaccines that were stored at inappropriate temperatures for five hours during a two-week sample period.
Going forward, proper refrigeration will be crucial. “If you are administering mRNA vaccines and therapeutics, you need to make sure your refrigerators are up to the challenge,” LaPorte said.
Just as refrigeration became an issue during the vaccine rollout, so did disposal of needles and syringes. While this was already a process, the added volume created a need for extra containers. “OSHA’s Bloodborne Pathogens Standard prohibits overfilling sharps containers,” said Kathryn Kane-Neilson, clinical specialist, regulatory compliance at Houston-based Sharps Compliance. “It’s generally recommended that providers have one container per person performing the vaccination to prevent any incidental needlesticks.”
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The medical waste disposal company’s retail pharmacy accounts secured large-scale orders of its FDA-cleared sharps disposal containers and sent a voluminous amount of sharps waste to Sharps Compliance’s treatment facilities. Now, as retailers plan for the future, they will determine their needs based on what public health surveillance experts say. “If boosters are warranted for the general population concurrently with the flu shot season, say in September and October, then that would present a different obstacle compared to a booster regimen spaced out during a different time of the year,” Kane-Neilson said.
For safety, pharmacies should have a backup supply of the appropriate disposal containers, and staff should be assigned to periodically check the fill level of the sharps containers. “Otherwise, overfilled containers can present an exposure risk due to protruding needles,” Kane-Neilson said. “The combination of these two simple strategies can be easily incorporated into their safety plan and thus be implemented as routine.”
Retail pharmacies are preparing for the next flu season, the expansion of COVID-19 vaccines for children and boosters for adults and for other consumer health needs. “You steadily move forward and make improvements,” STChealth’s Popovich said. “For pharmacy, there is a significant revenue upside.”