Pharmacists Move Into High Gear to Administer COVID-19 Vaccines

While some big chain pharmacies are busy administering vaccines to residents of long-term care facilities and hospital pharmacies are immunizing front line workers in the first phase of the COVID-19 vaccine rollout, community pharmacists are scrambling to make sure their facilities are ready for future phases involving many more eligible Americans. Here is some valuable information on how to do that.

ATLANTA – Pharmacists will be extremely busy responding to the COVID-19 pandemic this month, although not everyone will be doing the same thing, however.

Many will be getting vaccinated themselves, as frontline workers defined by the national Centers for Disease Control and Prevention. Those who work for large drugstore chains CVS and Walgreens will be visiting nursing homes to administer the vaccines to residents, well as healthcare workers. Those in hospitals will be making sure frontline staff is immunized and protected.

Pharmacists who work in the community, meanwhile, will be preparing to receive vaccine and answering questions about the products’ availability, effectiveness and safety. Mass vaccination for the general public is considered to still be months away.

Everything went into high gear after the Food and Drug Administration granted emergency use authorization for the Pfizer-BioNTech COVID‑19 Vaccine, and the CDC’s Advisory Committee on Immunization Practices signed off. According to the FDA approval, the vaccine is supplied as a frozen suspension in multiple dose vials; each vial must be diluted with 1.8 mL of sterile 0.9% Sodium Chloride Injection, USP prior to use to form the vaccine .After dilution, each vial contains 5 doses of 0.3 mL per dose.

The EUA announcement also points out that the vaccine does not contain a preservative. It does include 30 mcg of a nucleoside modified messenger RNA (modRNA) encoding the viral spike (S) glycoprotein of SARS-CoV-2. Other ingredients include lipids (0.43 mg (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 0.05 mg, according to the FDA.

One of the immediate challenges for pharmacists is making sure the vaccine is stored properly. In a fact sheet, Pfizer said most vaccine would be shipped from Kalamazoo, MI, although some will come from Pleasant Prairie, WI, by road or air. The pharmaceutical company is using specially designed, temperature-controlled thermal shippers utilizing dry ice to maintain recommended storage temperature conditions of -70°C±10°C for up to 10 days unopened. Shipments will be GPS tracked.

Once pharmacies or other vaccination providers receive a thermal shipper with our vaccine, they have three options for storage:

  • Ultra-low-temperature freezers, which are commercially available and can extend shelf life for up to six months.
  • The Pfizer thermal shippers, in which doses will arrive, that can be used as temporary storage units by refilling with dry ice every five days for up to 30 days of storage.
  • Refrigeration units that are commonly available in hospitals. The vaccine can be stored for five days at refrigerated 2-8°C conditions.

The company advises that, after storage for up to 30 days in the Pfizer thermal shipper, vaccination centers can transfer the vials to 2-8°C storage conditions for an additional five days, for a total of up to 35 days. Once thawed and stored under 2-8°C conditions, the vials cannot be re-frozen or stored under frozen conditions.

Moderna, Inc., which has a vaccine also being considered for emergency use authorization, says mRNA-1273, its COVID-19 vaccine candidate, remains stable at 2° to 8°C (36° to 46°F), the temperature of a standard home or medical refrigerator, for 30 days.

Walgreens says it will be collaborating with nearly 35,000 skilled nursing and assisted living facilities nationwide that have selected Walgreens as their vaccine provider, adding, “As states finalize their distribution plans, we believe we can begin administration in some long-term care facilities on the date of activation approved by the CDC to help ensure those most vulnerable are among the first to be protected against the virus.”

In a live discussion on the CVS Health website shortly before the EUA was granted, Garth Graham, MD, Vice President, Community Health & Chief Community Health Officer, notes that the company also was selected as one of the pharmacy partners to help provide vaccination services to long-term care facilities, with 45,000 long-term care facilities and skilled nursing facilities having chosen CVS as their preferred vaccine provider.

“So, we've now been in contact with those facilities,” Graham explained. “We're in the process of scheduling. And that scheduling is scheduling three visits and right before we have those visits, we have, essentially, a roster of individuals that we work with the facilities, to understand how many individuals would need to be vaccinated. And, based on those numbers, we would have the right number of vaccines that we would need to bring to the facility, as well as the right number of individuals that we would need to bring to the facility.”

Initially, COVID-19 vaccines rolled out to about 600 sites selected by the states and other entities, determined in direct proportion to the nation's adult population 18 years and older.

Initially, COVID-19 vaccines rolled out to about 600 sites selected by the states and other entities, determined in direct proportion to the nation's adult population 18 years and older.

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