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Boosters for Teens Threaten to Worsen Pharmacy Staffing Strains

Jan. 10, 2022, 10:35 AM

People could face delays in getting Covid-19 boosters after federal agencies cleared additional doses for younger Americans, as the move threatens to overwhelm a pharmacy system that’s already struggling with vaccine appointments and staffing shortages.

The Centers for Disease Control and Prevention’s recommendation that adolescents ages 12 to 17 get booster shots at least five months after their second dose aims to provide additional protection against the highly transmissible Covid-19 variant that’s now dominating in the U.S. It also makes boosters available for the first time for children ages 12 to 15.

But expanded eligibility puts further stress on pharmacies that are trying to keep up with routine vaccinations, Covid-19 testing, and maintaining continuity of care, pharmacists and industry groups say. Staffing woes, fueled in part by pharmacy workers quitting en masse due to overwhelming workloads, are already making it difficult to get boosters in states like Maine.

“Even though we are excited, we are humbled to accept a call to vaccinate the country, it is definitely going to be adding more and more strain,” said Bled Tanoe, an Oklahoma-based pharmacist who worked for a major pharmacy chain until last August and now works for a private company. “Unfortunately, we’re going to see more people leaving the profession, which would delay access to vaccines altogether.”

According to the CDC, about 5 million 12- to 15-year-olds are now eligible for a third dose of Pfizer-BioNTech’s vaccine—the only option for minors in the U.S. The Food and Drug Administration and CDC have also reduced the time frame for adults to get Pfizer Inc.‘s and Moderna Inc.‘s boosters to five months after the second dose, instead of six.

Pharmacy ‘Burnout’

Pharmacists already are going to “pretty extraordinary lengths to meet the demand of their community” amid limited resources, Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacists Association, said.

A community pharmacist in Milwaukee has worked a couple days of 24-hour testing shifts, while another one rented a U-Haul to pick up an order of over-the-counter tests that hadn’t yet been delivered, said Proctor, whose group represents more than 21,000 independent pharmacies across the country. “Pharmacies are definitely very busy.”

Tanoe founded a movement called #PizzaIsNotWorking and is asking for government intervention to provide better working conditions for pharmacists and technicians, who she says are often simply offered pizza, gift cards, or other rewards for their extra work. Strained resources can threaten patient safety or care if pharmacists have less time to cross reference medications or follow up with patients, she said.

“They’re not able to see why Mrs. Jones has not been back in three months for her insulin. Is something wrong? They don’t have time to do that, right, because they have all those other things to do,” Tanoe said.

Michael Hogue, immediate past president of the American Pharmacists Association, suggested during the Jan. 5 meeting of CDC’s outside experts that the agency could stop short of saying everyone 12 and up “should” get a booster, and recommend that they “may” get one instead. He cited lower hospitalization rates among adolescents, and the “increasing severe shortage of staff personnel in pharmacies, both of pharmacists and of pharmacy technicians, and the amount of burnout that’s happening in those practice sites.”

Based on the “stress on the existing system, the small numbers of people who we are seeing in these age groups that are hospitalized or dying from COVID—I think it’s premature to go into a ‘should’ statement at this point,” Hogue said before the advisory committee vote.

Mitchel Rothholz, chief of governance and state affiliates at the APhA, said in an interview after the meeting that although the CDC panel recommended adolescents should get the booster because of waning protection, it’s important to note that making more people eligible for a booster dose “does put a strain on the health-care system.”

“In my own community, we’ve got volunteers who are helping the community pharmacies, and those are other health care professionals or non-medical professionals, who are helping the process,” Rothholz said.

The limited supply of Covid-19 treatment pills may be an even greater concern, especially in rural areas where health-care delivery may not be readily available, Melissa Johnson, an infectious disease pharmacist at Duke University, said.

“Pharmacies may be the only place that these folks have,” said Johnson, who’s also president-elect of the Society of Infectious Diseases Pharmacists. “Not only do we know that people are stretched thin, but that may be the only access for those patients in those rural areas. We really do have to work to make it available as much as possible to everyone all across the spectrum here.“

Easing the Strain

Pharmacy groups overall say vaccinations are one of the main tools to turn the tide in the fight against Covid-19 and its ever-emerging variants. Support from the federal government could come in the form of more National Guard members helping dispense Covid-19 vaccines and better-coordinated messaging on the safety and efficacy of shots, they say.

“I think the bottom line of what we’re we’re facing is we’ve got to get the unvaccinated vaccinated,” Rothholz said.

Proctor said it “might be appropriate” for health departments to communicate the level of demand pharmacies are experiencing when parents are considering when and where to make appointments for their child’s booster shot. The National Association of Chain Drug Stores encourages people to get an appointment instead of walking in.

People on the hunt for a Covid-19 test should also evaluate whether they need it to be safe before lining up at the pharmacy, Proctor said. “There’s a lot of people that are putting stress on testing infrastructure that are not necessarily needing to be tested,” he said, adding that people who suspect they have Covid-19 and have symptoms should quarantine.

Proctor is also calling on the Centers for Medicare & Medicaid Services to release additional information on how to reimburse pharmacies for testing and other work done to order Covid-19 antiviral treatments.

Several pharmacy trade groups urged CMS to “require pharmacists to be compensated for testing, patient assessment, and ordering/prescribing and dispensing for oral COVID-19 antiviral drugs” in a statement in November. Their call for action followed a CMS decision to encourage, but not mandate, payments to pharmacies for these services.

Despite the burnout, Proctor said staffing issues shouldn’t impact clinical recommendations on the safety and effectiveness of a Covid-19 booster shot.

“I’m not sure it’s appropriate to say well, ‘We’re not going to recommend this because providers are too busy,’” he said.

To contact the reporters on this story: Celine Castronuovo at ccastronuovo@bloombergindustry.com; Jeannie Baumann in Washington at jbaumann@bloombergindustry.com

To contact the editor responsible for this story: Alexis Kramer at akramer@bloomberglaw.com

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