The national seasonal flu vaccination campaign in France that runs from October 15th, 2019 to January 31st, 2020 is near to its close. The Social Security Funding Act in France for 2019 has included vaccination among the missions of pharmacists.
The previous 2018/2019 campaign reached a vaccination coverage of 47.2% for population at high risk of developing flu-related complications. A pilot program was successfully conducted in two regions, New Aquitaine and Auvergne-Rhône-Alpes with 3,000 community pharmacists participating in the flu immunization. For the 2019/2020 flu campaign, all pharmacists in France will have the opportunity to enroll in this program. As of October 2019, and in just one month, the one million thresholds for patients vaccinated against flu in pharmacies has been reached, according to Féderation des Syndicats des Pharmaceutiques de France (FSPF).
The target population for this healthcare intervention is adults (at least 18 years of age) belonging to one of the following categories:
- People aged 65 years and over
- People with certain chronic conditions
- Pregnant women, regardless of the trimester of pregnancy
- Obese people with a BMI 40 kg/m2
- People living with infants under 6 months with risk factors for severe influenza: premature babies, children with congenital heart disease, congenital immune disease, pulmonary, neurological or neuromuscular disease
- People living with immunosuppressed patients
- Patients staying in a follow-up care facility as well as in a healthcare institution
- Health professionals and any professional in regular and prolonged contact with
- People at risk of severe influenza
- Personnel navigating cruise ships and planes
- Travel industry staff accompanying travel groups
Apart from meeting the mentioned criteria, there is also a requirement for pharmacist to check for a history of severe allergic reaction to ovalbumin (the main protein found in egg whites) or a previous vaccination and to confirm no vaccine contraindication (i.e. hypersensitivity to any of the components, febrile disease or ongoing acute infection). Compensation is set at 4.50 euros for a prescription vaccination (otherwise it is 6.30 euros) and it is not perceived as a barrier for vaccination.
The possibility of getting the flu shot in pharmacies could, in fact, improve vaccination coverage, especially among this part of the population who does not see a doctor regularly. There are advantages of pharmacy setting (accessibility, longer opening hours, no need for appointments, etc.) that make this option very attractive. The goal is certainly not to replace the doctor or nurse, but to examine the extent to which the pharmacist’s intervention would facilitate and expand access to this vaccination and thus improve flu immunization coverage. The role of the pharmacist in educational activities is key for the implementation of any health program because they are trusted agents working closely in local communities. Besides, most of these immunization programs only require a minor change in local regulation and a training and accreditation procedure for the participant pharmacies to follow.
Experience in other countries varies from vaccination in pharmacies in 7 countries: France, Ireland, Portugal, Switzerland, UK, Malta and Denmark. And in other countries, like Finland, The Netherlands, Italy, Spain (in a recent pilot program), Norway and Sweden, the pharmacist intervention is restricted to providing the Community Pharmacy and materials for the vaccination, being a nurse the person in charge of the administration.
In Ireland, community pharmacists have been providing a flu vaccination service since 2011. Research carried out showed a high level of satisfaction with the service, with statistics showing that provision via Irish Community Pharmacies increases coverage for people who had never received the vaccination before (one in six) and with 99% of patients indicating that they would return to the pharmacy for their next vaccination.
The number of people receiving the flu vaccination in pharmacies is continuously growing each year, with 78,935 people flu vaccinations in Community Pharmacies in 2016/2017. Pharmacist participation in vaccination services has significantly improved access to this vital healthcare intervention and accounts for around 10% of total flu vaccinations in Ireland.
In Switzerland, in most cantons, pharmacists can now vaccinate healthy adults. Pregnant women and patients undergoing regular medical treatment should be vaccinated by their GP. Vaccination in pharmacies in this country is generally not covered by basic health insurance, unless a doctor’s prescription is available. In Ticino, vaccination is still done after a medical prescription for the vaccine.
Portugal has more experience, as pharmacists have been vaccinating in Community Pharmacies for 10 years. Patients must have a medical prescription and the vaccine is not reimbursed. However, a new initiative, carried out in the northern region of Lisbon since 2018, allowed people aged 65 and over to be vaccinated against influenza under the same conditions as in the primary care units of the Portuguese National Health Service, i.e. without a prescription and free of charge. In this setting, the result was clear, this six-week pilot project in pharmacies increased the influenza vaccination rate by 32%.
The success of these programs in Europe is yet another step towards the WHO goal of achieving 75% influenza vaccination in the elderly. Current low uptake of seasonal influenza vaccination in Europe jeopardizes the prevention of the 34,000 of the deaths associated with seasonal influenza in Europe, over 75% of which are among people aged 65 years or above.