The irritation of people booking then not turning up, clotting concerns, missing patients, bribery…Terry Maguire thought he had seen it all…  
 

In hindsight it was a blessing. What was I thinking? How on earth did I ever imagine, when I submitted my application, that I could run a mass vaccination centre that opened seven days a week, 12 hours a day, for five gruelling months?

It was simply insane. So when I was turned down and I had soothed my damaged ego, I quickly realised how lucky I was. Horses for courses! I am more suited to the leisurely trot of the AstraZeneca vaccination schedule where, if I want, eight vaccines over six hours in a working day can be as hectic as it gets.

Not for me the aggressive gallop, the never-ending queues, managing multiple vaccinators and the toxic time schedules of the Pfizer shot. I might eventually stretch my pace to three vials a day, but 1,200 shots in four days? This is certainly for better pharmacists than me, and they have my sincere admiration for what they do.

The AZ community pharmacy vaccine service, launched by CPO Cathy Harrison in mid-March, offers maximum utility from the Northern Ireland pharmacy network. Some 350 pharmacies signed up in February, top-up training was completed, PGDs signed off. Vaccinations started in my pharmacy, on 31 March and by 15 April I had completed my first batch of 80 doses and was keen to do more.

Initially there was huge public demand. The Vaccine Management System (VMS) allows access to a central database which verifies patients and gives permission to vaccinate. The system also creates payments.

We quickly got to grips with this system which massively reduces administration. Conservatively, the pharmacy service adds 40,000 vaccinations a month for the health service in Northern Ireland and that makes me very proud indeed.

And then news of the rare blood-clotting risk associated with the AZ vaccine hit the headlines. The media could not get enough of it and the public understandably struggled to put this risk into perspective.

Some good work was done by commentators giving comparisons with risks people might understand, like the risk of being killed in a car accident or being struck by lightning. But unfortunately editorial decisions to run the news as a headline story severely damaged public confidence in AZ’s vaccine and we got lots of queries and more than a few cancellations.

The age under which use of the vaccine was not recommended was dropped from 45 years to 40 ahead of other UK regions but still fewer people than expected were coming forward. In late March Belfast opened a huge vaccination centre but staff at that site were under-utilised so, without warning, PHA announced that 35-to-40-year-olds could access the vaccination service.

The media failed to clarify that this was for the mass vaccination centre only and it was merely to give nursing staff employed there something to do while it used up its AZ vaccine. Anecdotally people were preferring to attend the vaccination centres in hospitals so they could get the Pfizer vaccine.

We were inundated with 35-to-40-year-olds booking onto our site and we had to cancel each one, knowing that in just over a week this cohort would be included. Thankfully the same mistake was not made at end of May when the age was dropped to allow vaccinations for all over 30 years.

Bit what irritates me most is when clients book and then just don’t turn up. Avoiding vaccine wastage is important but is beyond my control when five out of a clinic of 16 simply do not attend.

On one Saturday I could not locate two patients on the VMS. Numerous attempts, using various iterations and spellings of their names all failed. I went ahead and vaccinated them anyway; they were bona fide. I made an ethical decision and notified the Health Board asking for help to locate them. I got wrapped across the knuckles and told strictly I should not have done this, and I needed to rectify it.

In late March I had a phone call from a man who told me he was 79 years old and urgently needed vaccines for himself and his wife. I offered to book him in, but he then confessed he was living in Dublin but was willing to pay, generously. He understood that each vial had at least an extra dose, perhaps two. He was right about the additional dose, but bribery? Perhaps he was from one of those media outlets so keen on big Covid-related headlines…

It is an honour to be part of this service and I hear this sentiment reflected by many colleagues across the UK. It marks, I believe, a milestone in the development of community pharmacy practice and we are embracing this clinical development with gusto.

The bumps in the road are irritating but minor; merely obstacles by which we will more quickly learn about this new terrain. 
 

Terry Maguire is a leading community pharmacist in Northern Ireland.