- In the U.S., many non-physician medical professionals, including nurses, medical students, pharmacists and dentists have the authority to administer vaccines.
- Dentists can give a flu vaccine with as little as three hours of training, while pharmacists can give many types of vaccines to both adults and adolescents with online training course
- Pharmacists can give many types of vaccines to both adults and adolescents following completion of 12-hour online training courses of self-study, one live seminar and an injection technique check.
In 2009, public health officials in the United States responded to a predicted “heavy flu season” by passing a regulation allowing dentists, pharmacists, paramedics, nursing students and medical students to administer the annual influenza vaccine.1 Since then, it has become commonplace to see invitations to “get your flu shot” at the grocery store pharmacy, in drug stores, and anywhere any level of medical care is offered.
Gone are the days when we could assume that the person administering vaccinations by injection has been thoroughly trained—both in how to safely administer them and understand how the ingredients in the vaccines might interact with each other, as well as how to treat any potential adverse reactions.
Now there are multiple online courses for training medical professionals of all kinds to become “vaccine certified.” These courses are generally offered to anyone in a medical field of study, from pharmacists and nurses to medical students and dentists.
The Road to Vaccine Certification Status
In a 10-hour, self-paced, online course offered by the University of Minnesota, dentists are promised that at the end of this comprehensive course, they will be able to:
- Recognize the public health impact of vaccine-preventable disease in the US.
- Identify the levels at which a dentist can undertake vaccine advocacy.
- Appreciate dentists’ unique opportunities to contribute to disease prevention in the US.
- Obtain an in-depth understanding of immunology as it relates to vaccines.
- Identify patients who have contraindications to vaccine administration.
- Describe the vaccine-preventable disease influenza.
- Recognize populations at risk for influenza.
- Explain societal impact of influenza.
- Describe CDC recommendations on who should receive the influenza vaccine.
- Identify contraindications and limitations for each influenza vaccine.
- Describe common and uncommon adverse reactions associated with the types of influenza vaccine.
- Describe proper intramuscular injection influenza vaccine administration.
- Detail treatment procedures for patients experiencing local and systemic adverse effects secondary to vaccine administration.
- Describe requirements for proper vaccine storage and handling.
- Detail the necessary steps to set up a vaccine practice.2
In a three-hour online course, the University of Minnesota claims to be able to teach a more basic version that would still allow dentists to attain the degree of expertise to administer flu shots to their patients.
For pharmacists, the online training is broader, but then it also qualifies pharmacists to administer more than just the flu vaccine. The American Pharmacists Association (APhA) offers a three-part model comprising 12 hours of self-study in modules focusing on various aspects of vaccination including case studies and an assessment exam, an eight-hour live seminar including a final exam, and a final in-person assessment of intramuscular and subcutaneous injection techniques.”3
One of the five self-study modules making up that first 12-hour study section explains how the immune system works, covering both active and passive immunity and explaining how vaccines were developed and how they cause an immune system reaction. That same single module also goes into the various types of vaccines as well as timing of vaccinations and a discussion of the concept of herd immunity.
The other four modules cover such subjects as the characteristics and dangers of reportedly vaccine-preventable diseases, the role of the pharmacist in improving vaccine uptake, identifying target groups for vaccination according to the Advisory Committee on Immunization Practices, recognizing contraindications and adverse reactions to vaccines. This module also provides information on how to educate consumers and combat the “common myths about vaccines.”
There is a separate module dedicated to the nuts and bolts of managing a pharmacy-based vaccination program, including marketing strategies, reimbursement concerns and information on liability issues and how the Vaccine Injury Compensation Program works.
The live seminar reinforces the self-taught section of the course and covers strategies for dealing with patient concerns about vaccines and how to discuss “current evidence that explores the relationship between autism and vaccines.”4 It also covers information so that certificate holders will be able to recognize emergency reactions to vaccines and know how to manage them when they occur.
Safety Not Listed in Top Concerns of Pharmacists
The focus on pharmacy-based administration of vaccines tends to be on the perceived benefits, such as more flexible hours of operation (evenings and weekends), ease of scheduling (walk-in appointments are common in pharmacies), convenience (number of locations), and high traffic volume.5
As reported in a survey study of pharmacists from states with differing policies about pharmacy-based vaccine administration,6 the primary drawbacks to such programs relate to cost issues, vaccine storage and administration concerns, and patient education.7 In that study, 57 percent of the pharmacists surveyed reported that insurance coverage did not adequately cover the costs for their time, administration costs, or vaccine storage.
Not all insurance carriers cover vaccinations given in pharmacies. The challenges of communicating vaccine status also was mentioned as an issue, both in terms of making sure that schools, parents and physicians were aware that pharmacists could give vaccines and in ensuring access to electronic databases so vaccine status could be tracked and shared.
The minimal training called for to prepare pharmacists—and other health professionals such as dentists—for administering potentially dangerous medical interventions does not seem to be raising many alarms among the public. Perhaps it should.
1 Pfieffer S. Dentists, Paramedics Can Now Administer Flu Vaccines. WBUR Boston Aug. 12, 2009.
2 Immunization Delivery for Dentists: An On-Line Course. University of Minnesota, Continuing Dental Education 2017.
3 Pharmacy-Based Immunization Delivery. American Pharmacists Association Dec. 1, 2016.
5 Haggan M. Barriers to Pharmacist Vaccination. The AJP Online June 9, 2017.
6 Islam J, et al. Opportunities and Challenges of Adolescent and Adult Vaccination Administration Within Pharmacies in the United States. Biomedical Informatics Insights Feb. 16, 2017.
7 Zimlich R. Cost, Perception Remain Barriers in Pharmacy-Based Vaccination. Medical Economics June 19, 2017.