Community pharmacies in Northern Ireland must build on the work they have done during the pandemic, especially the Covid vaccination programme which has added greatly to their credibility, says Terry Maguire…
 

The roll-out of the Moderna Covid vaccine across the pharmacy network began at the end of July. It was a modest introduction, with only 16 contractors being supplied with vaccine in the first week.

Moderna, compared with the AZ vaccine, presents significant cold-chain challenges. But our success with the AZ vaccine - pharmacies have administered over 133,000 first and second doses since March - convinced the department of Health of the merit of involving community pharmacies. It seems the DHSS is delighted with our performance.

For licensing reasons, Moderna arrives in the pharmacy frozen in a specialist container and a separate fridge is required to receive the vaccine where it thaws out overnight. When at fridge temperature it is effective for 28 days and has the same restrictions as the AZ vaccine, for example, when taken out of the fridge and from time of first vial puncture.

When the JCVI announced restrictions to mRNA vaccines for those aged under 40 years, the numbers coming forward for vaccination in community pharmacy fell off. By mid-summer the under 40s was the key age group still to be vaccinated. They were also hesitant to come forward and we could only offer the AZ vaccine.

The Moderna vaccine allowed community pharmacies to remain relevant in the vaccination programme. During August, even with few pharmacies involved, there were just over 5,000 Moderna vaccinations and this will expand greatly as more pharmacies come on-line. From 6 September the  roll-out will become easier as vaccine, due to licence modifications, can arrive defrosted and no longer require a separate fridge.

What seems certain is community pharmacy will be involved in any winter Covid-19 booster campaign and the expanded flu vaccination programme. We are being rewarded for stepping up during the pandemic on numerous fronts and we are now seeing a recognition and endorsement of the value of community pharmacy.

Yet Northern Ireland still struggles to improve vaccination rates in the 18-40 age-groups. My brief conversations with people when they telephone to ask about bookings provide genuine insights into the challenges for the vaccination programme.

Many who initially avoided vaccination when called and who are now coming forward mainly reflect mainly three things: a morbid fear of needles, an irrational worry about vaccine safety, and a staggering complacency about the dangers Covid-19 infection.

These concerns remain the major barriers to ensuring high vaccination rates and they need to be addressed more assertively. We try to be as supportive as possible in all our contacts and often this just means empathically listening and factually talking.

Some millennials are perniciously self-obsessed while being delightfully eccentric. One girl bought a tube of Emla cream when she arrived for her appointment, applied it across her deltoid muscle and sat for an hour before coming into the vaccination room. During her wait a friend regularly probed her deltoid with a ball-point pen to identify the time of complete anaesthesia. When I vaccinated her she promptly fainted, falling off the chair onto the floor and blocking the room for 30 minutes.

More seriously, anti-vaxxers have impressively demonised vaccines, falsely over-stating the significance of blood clots for all vaccines and blatantly lying about fertility issues and future genetic diseases, all the while being in complete denial of the clear data on Covid-19 morbidity and mortality.
A consultant obstetrician came to a Wednesday clinic. She expressed embarrassment at coming forward only in August 2021.

In her late 30s, she was unhappy to about getting vaccinated back in January, but now felt it unethical to work while still unvaccinated. Initially she did not perceive any personal risk to her or her patients in the early days of Covid-19. Indeed, back then, there was minimum impact on expectant and new mums and their babies.

In the first wave there was a reassuring collapse in the number of premature births from March to June 2020, noted first in the Republic of Ireland and then confirmed internationally. This has not been explained, but it is now recognised that suffering from Covid-19 in the third trimester risks severe breathing problems and real trauma for mother and baby.

The tragic and high-profile death of a Derry mother as her child was delivered and later baptised during her funeral provided a powerfully emotional drive for many expectant mums to come to our clinics, many in tears as they received their first vaccination.

Community pharmacy in Northern Ireland has impressed with all that we have done during the pandemic and particularly through our involvement in the on-going vaccination programme which has added greatly to our value and credibility.

We must now build on this.

Terry Maguire is a leading community pharmacist in Northern Ireland.