South Africa has started the second phase of its COVID-19 vaccine rollout. The aim is to vaccinate essential workers, people in congregate settings such as nursing homes, those over 60 years of age and other vulnerable groups.
The overall target of the phased rollout is to vaccinate 67% of the population (approximately 40 million people) by the end of the year.
But targets are unlikely to be met. The first round went slowly, and while the second has picked up pace, vaccination numbers remain low. Hold-ups have included procurement and delivery of vaccines, the emergence of new variants, as well as the suspension of the use of some vaccines owing to safety concerns.
In the first phase of the rollout, aimed at healthcare workers and other frontline staff, only a few points of delivery were set up. These have been expanded significantly for the second phase and are meant to include both public sector healthcare institutions such as primary healthcare clinics and hospitals and private healthcare sector settings such as doctors and pharmacies.
At present there are 3 481 community pharmacies, 613 institutional public, and 306 institutional private pharmacies in the country. This means a very extensive network that is also rural and urban.
But a successful rollout isn't just about the physical points where people can get the vaccinations. It's also about having a trained workforce to administer them. Currently, healthcare professionals who are allowed to vaccinate are predominantly doctors and nurses trained to do so in line with the country's regulations.
Pharmacists do not qualify to issue the jabs under the country's vaccination regulations without appropriate certification. This means that most of the 17 000 pharmacists in the country can't be vaccinators unless trained appropriately. The vaccine administration technique is a skill that isn't uniformly taught as part of the country's undergraduate pharmacy degree.
Some pharmacies will nevertheless be part of the rollout plan - those that have clinics on their premises that are run by nurses. And possibly those that have pharmacists who have completed the additional training to qualify them to administer vaccines.
South Africa needs to bring all pharmacists into the net. As I set out in my paper, this is achievable. It requires a change in how pharmacists are trained. In other countries such as the USA, UK and Australia, pharmacists have been providing vaccination services for years.
The gap and how to fix it
The curriculum for South Africa's current Bachelor of Pharmacy (BPharm) degree is offered by nine universities in the country. It is designed to train pharmacists as generalists. To qualify to give vaccinations, South African pharmacists have to do post-qualification training and certification. This is offered as a part-time course.
The system should be redesigned to overcome this. The changes would include:
Changing the undergraduate pharmacy degree curriculum to incorporate adequate training on injection techniques to administer vaccines to meet current pharmacy rules. These require pharmacists performing immunisation services to be familiar with handling of syringes and administration devices.
Amending legislation that governs the practice of pharmacy.
Pharmacists already learn a great deal about vaccinations in the undergraduate curriculum. Subjects covered include vaccine-preventable diseases, vaccines for routine and travel immunisation, immunisation concepts, and logistics of vaccine transport and cold chain management.
The International Pharmaceutical Federation, a non-governmental organisation and global body representing pharmacy, strongly promotes pharmacists as vaccinators. It is encouraging countries to update regulations on vaccine administration by pharmacists to improve vaccine coverage globally.
The COVID-19 pandemic has highlighted the importance for countries that haven't developed pharmacists in vaccine administration in their basic training to make the necessary changes.
Pharmacists have an important role to play in immunisation. Under the current scope of practice in South Africa, pharmacists are involved in the provision of healthcare education, patient counselling, and health promotion related to vaccines, immunisation and vaccine-preventable diseases. This role should be expanded to include management of patients' immunisation schedules and keeping track of adverse events following immunisation.
This aspect of pharmacovigilance is vital to monitoring the potential successes and adverse effects of vaccines and positive health outcomes for patients post-immunisation.
Changes to the curriculum would need to be implemented immediately and uniformly across all universities that offer the Bachelor of Pharmacy degree in South Africa.
If the changes were made South Africa could look forward to a large number of adequately trained pharmacist vaccinators entering the healthcare system as interns going forward. This would strengthen the country's healthcare workforce by expanding the number of vaccinators available for COVID-19 vaccination and for long-term routine immunisation services.
The greater the number of pharmacists who are trained and able to administer vaccines, the stronger the vaccinator workforce will be - and the greater the vaccine coverage will be.