We’re relying on the wrong pharmacies for vaccinations

Focus should be on small organizations – not chains

ACCORDING TO THE US Centers for Disease Control and Prevention,  Massachusetts has administered about 50 percent of the vaccine distributed.  This is about average when compared to other states, but when one considers the resources available to develop the vaccination plan, the number of large healthcare systems, the population density, and the number of pharmacies located here the results are more disappointing.

Massachusetts seems to have little or no understanding of the differences between the larger chain pharmacies and smaller pharmacies, including independent pharmacies and grocery store pharmacies, despite the critical need to utilize these organizations to vaccinate citizens across the state.

This lack of understanding, combined with no requests for feedback when the plan was developed, has resulted in over-reliance on chain pharmacies and under-utilization of smaller pharmacies instead of leveraging the unique strengths of each.  During the first two phases, when demand is greater than supply, a changing eligible population, and inevitable changes based upon experience with this new vaccine, the most effective pharmacies are the smaller pharmacies that are nimble, can adjust on the fly, and can facilitate communication directly to the people administering the vaccine. In short, there’s no middle management.

Instead, the state is relying on larger chain pharmacies with multiple layers of management and slower reaction to changes.  The result is a disappointing slow vaccine administration rate.  Contrast this situation with West Virginia, a state that leveraged local providers and engaged them in the development of the vaccination plan and has administered about 80 percent of the vaccines distributed. One reason for this higher percentage is the use of independent pharmacies.

The disappointing results in Massachusetts are likely to continue during Phase 2 with the focus on disadvantaged populations.  These populations are hesitant to take the vaccine. An effective strategy, one that has been used by the CDC for other vaccines, (and recently supported in a commentary in “NEJM Catalyst,”) is having the patient’s local healthcare provider give a strong recommendation for vaccination.

Publicly available data indicate that the average independent pharmacy provides more prescriptions to our disadvantaged population compared to the average chain pharmacy in Massachusetts.  The independent community pharmacist is often the first, and sometimes the only, healthcare provider these patients have contact with.

To maintain these services in our population we should support these pharmacies where possible. Independent pharmacies will be more effective at getting disadvantaged populations to consider vaccination because they are the most available healthcare provider, have a close relationship with their patients due to stable staff (they do not move from pharmacy to pharmacy), they are trusted, and offer a higher level of service.

If independent pharmacies were leveraged earlier in the vaccination plan, available vaccines would have been administered more quickly resulting in fewer cases and deaths.  The optimal time to leverage the large number of chain pharmacies is when vaccines are readily available, the supply exceeds the ability of smaller pharmacies to vaccinate, the population needing vaccination is large and stable, and the process has been tested and standardized.

Meet the Author

Todd Brown

Executive director, Massachusetts Independent Pharmacists Association
Finally, utilizing smaller pharmacies located in the state as opposed to large chain pharmacies with headquarters located elsewhere, would stimulate our economy by supporting small businesses. It is not too late. Massachusetts should engage these pharmacies as soon as possible to leverage the economic impact and have the best chance at reaching the most people.

Todd Brown is an instructor and vice chair at Northeastern University School of Pharmacy and executive director of the Massachusetts Independent Pharmacists Association.