Accredited GP clinics and community pharmacies can register to administer COVID-19 vaccines when the mass rollout kicks off next month. But doling out doses isn’t as easy as it sounds.
Patients must be observed for 30 minutes after the injection — double the time for a normal flu injection — and there’s a lot of paperwork and follow-up required to ensure doses are administered on time and logged correctly.
Experts and industry bodies are concerned about pharmacies’ and clinics’ ability to do so and some say the government payment doesn’t cover the high administrative costs.
Vaccines are poorly recorded by pharmacists
Most Australians will receive the AstraZeneca or Pfizer vaccine. Both require two doses administered 28 and 21 days apart respectively. The shots are legally required to be logged with the Australian Immunisation Register and this record will be made available on the MyGov website or the Express Plus Medicare app which people can access on their smartphone.
Doctors will be paid $30.75 for the first injection and $24.45 for the second, with an additional $10 incentive for practices to ensure both shots are delivered at the one surgery.
Metropolitan pharmacies will be paid $16 for each dose plus the $10 incentive, and those in rural areas will get $19 a dose, again with the $10 incentive.
Proof of inoculation could be needed for international travel and workplaces and could even become a condition of entry to public spaces or events.
But pharmacists are notoriously bad at logging jabs with the register, a report from the National Centre for Immunisation Research and Surveillance shows.
In 2018 they reported administering more than a million influenza vaccinations but logged just one-tenth of them. It got a little better in 2019 with 2 million vaccinations reported and half a million logged.
That’s not to say doctors are much better: while vaccines given to children are generally well reported, another study found only half of all shingles vaccines administered were recorded with the register.
GPs are better-placed
Royal Australian College of General Practitioners president Dr Karen Price tells Crikey GPs should be the first port of call for the vaccine.
“Patients Australia-wide are used to going to their GP for vaccinations,” she said. “We have the appropriate medical training and setting for vaccinations, as well as existing links to the [Australian Immunisation Register].
“GPs are also experienced in talking to our patients if they have concerns, ensuring consent and building vaccine confidence.”
Price says clinics already have automated text messaging systems to remind people to get their second dose and are prepared for a “surge” coming forward to get the vaccine.
To make sure things run smoothly and vaccines are available in rural clinics and centres in diverse communities, more funding was needed.
“From the outset we have argued that this is not a standard vaccination program given all of the clinical, logistical and administrative costs associated,” Price said.
“The government’s current funding model is primarily suitable for mass vaccination clinics and may not be suitable for smaller clinics in both metro and rural areas who are already running at capacity.”
Incentives needed for pharmacists
National Centre for Immunisation Research and Surveillance epidemiologist Kaitlyn Vette tells Crikey more needed to be done to encourage Immunisation Register records. Providing funding was a start.
“[Pharmacies] haven’t been eligible to receive payments for reporting,” she said.
Funding was provided when vaccines are rolled out through national immunisation programs but these are generally for vaccines given to children, which pharmacists usually can’t administer.
Promoting the use of software which can automatically log vaccines was a good next step, she says.
“The majority of pharmacy vaccinations are still being reported manually, or they were in 2019,” she said.
“An obvious step in increasing reporting would be enabling or facilitating the automation of [Australian Immunisation Register] reporting through any software used to record vaccination … [and] making sure that reporting is as fast and simple as possible.”
Vette says pharmacists had to undergo accredited immunisation provider training, which includes addressing patients’ concerns and vaccine hesitancies.
“Pharmacists are well-qualified health professionals in their own right and I think there are good prerequisites in all jurisdictions for pharmacy immunisation providers, including CPR, first aid anaphylaxis management,” she said.
Pharmaceutical Society of Australia’s national president Associate Professor Chris Freeman has advocated for pharmacists to administer the vaccine.
“Pharmacists are more than capable, qualified and willing to provide this service to ensure the large-scale rollout of the COVID-19 vaccine,” he said.
The Pharmacy Guild of Australia tells Crikey it was still assessing the training for delivering the vaccinations and gauging its members’ response.
What about nurses?
It will mostly be practice nurses in GP clinics that are vaccinating patients in that setting.
My sentiments exactly! In my near 50 year nursing.
career, I’m sure I gave more injections…including multi-dose ones…than ANY doctor or pharmacist. There must be a multitude of retired nurses who could be called upon to administer the vaccine, We’re not all demented!!!
Never met a Doctor yet who could give a good injection. Nurses do it all the time (same with IV’s) . Nurses give the flu shots in most pharmacies and surgeries so what’s the problem?
Nurses are qualified to give injections and I don’t see it as a problem as long as there is a decent resuscitation trolley and a doctor on site to lead a resuscitation if needed.
Anaphylactic reactions are rare, very rare!
If one happens this is not the situation to have to send someone next door or across the street to get a doctor who may or may not be current in tubing an airways.
In this situation, time means the difference between life and death.
Absolutely, Eva, I’d have thought that nurses would be the obvious choice. Nurses give far more injections than either doctors or pharmacists on a daily basis.
Fairly simple solution to the failure of pharmacies and medical practices to record vaccinations on the Australian Immunisation Register is to make payment conditional on the immunisation being recorded, which as the story notes is legally required anyway.
In NSW 11 hospitals have been announced as the first vaccination sites and expressions of interest sought from GP practices and pharmacies. Seems to me it will take some sites which only do vaccinations to get the number of people done. And some of them will have to be open nights and weekends. GPs and pharmacies have lots to do as it is – having them do it at lots is sites will help but can they achieve the volumes needed?
Publicly employed nurses should be given the main task – they’ll do it better, without fuss, document correctly, and they’ll be cheaper and unlike many, they’re not out to make a quid at every opportunity. Immunisation nurses often vaccinate in teams, vaccinating hundreds of people a day for a fraction of the cost of GPs and Pharmacists. It’s just more of the LNP government donating to the wealthy.
And besides, why are the feds failing to take responsibility for our first line of defence – border control and quarantine, leaving that to everyone else whilst they rely on the fantasy that we’ll all be saved by vaccines. Not everyone intends to be immunised, and as we’ve seen, the current vaccines may well be ineffective against emerging, and recently emerged, strains.
Keeping it out of the country in the first place would be the most intelligent plan.
Sustainable Oz, could you explain how publicly funded nurses are going to do the vaccination?
On publicly paid time as normal duties or on overtime after their shifts are over?
I find that their is still a serious misconception floating about and that is the current vaccines will make you “Immune”.
The current vaccines are meant to mitigate the infection that you get from Covid19, that means you still get the infection, mostly you will not end up in the ICU and we are not sure about the chances of transmission that the vaccinated infected person has.
All in all the current vaccinations are not a silver bullet.
Amber – what happened? You were doing so well and now this predictive programming article which suggests the vaccine up-take is fait accompli. It is not. The official vaccine up-take statistics in the USA is surprisingly 50/50. When it is all said and done about Americans, at least they can show some level of resistance to tyranny. And amazingly, those at the fore-front of vaccine hesitance are the American health workers. They are even being bribed with financial incentives to take the vaccine but they are refusing. They are being threatened with termination of employment but still they refuse. These are doctors, nurses, paramedics, and even age care workers and front-line medical staff who are being termed “vaccine hesitant”. This information is coming from pro vax sites with no chance of alleged misinformation. I would put up the links but the mod will not allow a bonafide discussion. Why don’t you do an over-due article on this particular seriously current issue?.. Or is it not pro vax enough for your editors? Lift your game Cky.
There so many, many, many things where we should not take the US lead. This is one of them.
I would say people in the US are much closer to the Vacine coal face than Australains. That’s why the health workers know. They are in constant communication with experts in their field They are close to it. Under these circumstances can learn a lot by their civil disobedience.
The coal face health workers in the US have been dying like flies.
I seriously doubt that other than the god/ shaman influenced benightedly desperate deniers there are many people in the US refusing a free vaccine.
You read too much main stream news. Do you always believe what you read in the daily cerebral cortex broad-sheets?
Well Craig, mostly I read medical journals which have research which is peer reviewed.
I sometimes am asked to comment upon someone’s research plan to ensure rigor in the manner.
I tend to steer clear of conspiracy theories and have a passing sympathy for anyone who has distorted their intelligence sufficiently to actually believe the nonsense peddled by the “Alternate facts factories”.
Tyranny- being offered a free vaccine, under no compulsion.
Yeah, for sure.
Said the spider to the fly.
I would never compare health outcomes or population responses with the US.
Their health system is something that has no equivalency anywhere else in the world.
Their outcome data is given in socio-economic strata and race, which would cause a riot in Australia.
The anti-VAXes in the US have a number of drivers one of which is religious fervour and another is conspiracy theories including Bill Gates and 5G.
There are a small number of these social media influenced alternate thinkers in Australia and I usually don’t give them much attention because that actually gives their parallel theories credence,credibility and oxygen.
At risk of being deemed hard hearted, I think that the Dunning Kruger effect is being displayed and the Darwin awards may have some contenders in this very vocal minority.
Darwin? I don’t think you are hard hearted. Just ideologically unsound.
I mentioned Darwin because the Darwin awards are the ones where people either cause their own death by their own stupidity thus removing themselves from the gene pool.
For the highest level of Darwin award, you must have removed yourself from the gene pool before having bred or alternately taking your progeny with you in death and thus taking out your contribution to the shallow end of the pool.
I don’t see that as an ideologically unsound comment on the Dunning Kruger effect.