America’s long-term care pharmacists are preparing to play a major role in the distribution and administration of a COVID-19 vaccine, from moving vials to facilities to educating providers on packaging and drug-specific conditions that will influence their inoculation efforts.
Chad Worz, executive director and CEO of the American Society of Consultant Pharmacists, said during a webinar Friday that pharmacy associations are working to convince the Centers for Disease Control and Prevention and other agencies that leaning on the existing LTC pharmacy infrastructure makes the most sense for skilled nursing and assisted living residents.
“This should be easy, as long as we can get the vaccine into our system,” Worz said. “It’s just a matter of knowing what goes where. It’s not difficult. We do it every day.”
Some of the emerging logistical challenges, Worz acknowledged, are the potential for ultra-cold storage requirements and packaging size. Moderna’s vaccine would need to be held at –94 degrees, with use required within 6 to 12 hours of thawing, Worz said.
Appearing in the same webinar, Kurt Proctor, Ph.D., senior vice president for the National Community Pharmacists Association, warned that a vaccine may come packaged by 1,000 doses — which could lead to waste without careful planning.
He, too, said that raising federal awareness of the role that multiple pharmacy services companies play in providing care to long-term care would help ensure that clients get the doses they need when they need them. He said a playbook from the CDC will be shared with all pharmacies expected to be involved in distribution.
Last month, T.J. Griffin, RPh, senior vice president of PharMerica’s LTC Pharmacy, was selected to represent LTC pharmacies on an Operation Warp Speed committee charged with implementing the federal COVID-19 vaccine acceleration program.
Plenty of key questions still remain in the development process, such as how many older adults are participating in ongoing clinical trials and what potential side effects might be.
“We’re going to have to make some very tough decisions in the coming months,” said Michael Wasserman, M.D., a geriatrician, medical director and member of the National Academies of Sciences, Engineering and Medicine committee developing a framework for vaccine distribution. “It’s bad enough there’s a lack of older adults in clinical trials … but when we get to nursing homes … we [may be] making decisions about folks who’ve never been tested.”
Wasserman said specialists who routinely work with older patients would play a key role in deciding whether the developed vaccines are safe and appropriate for the elderly. One key concern? A leading vaccine contender has been linked early in trials to fever in recipients, a factor that could create a “cascade” of other problems in patients with significant comorbidities such as cardiac conditions.
“It’s going to matter,” said Wasserman, president of the California Association for Long Term Care Medicine. “Those of us in the field of geriatrics are used to those complexities.”
Wasserman said recommendations on a distribution framework “with dates and locales” for use by the federal government should be available by month’s end.
Worz and Proctor acknowledged vaccine hesitancy both among the general public and in long-term care settings. Both underscored that pharmacy groups would be asking critical questions about whichever vaccine is selected to ensure quality and efficacy.
They also expect to offer consultants to promote “all hands on deck” strategies intended to ensure quick distribution, careful charting and follow-ups in the case of multiple-dose vaccines.
Vaccines are expected to be shipped with needed syringes and personal protective equipment such as gloves so as not to drive up additional demand for those products. And although vaccines will be free, Worz said providers and their pharmacy partners will have to work out reimbursement structures to pay for services related to drug administration.