Samrat Baral

The COVID-19 pandemic has claimed the lives of hundreds of thousands of people globally, with healthcare system cracking under its pressure. But the scientific world has guided the development of vaccines at a record pace, which would normally take years. Nepal has been scrambling to test, trace, isolate and treat the persons suspected of virus infection from the outset of the contagion outbreak. It had become a mere spectator of what unfolds around the world in terms of vaccine efficacy and its rollouts.
The vaccines produced by Pfizer and BioNTech, Moderna, AstraZenca, Oxford University, Bharat Biotech Sputnik V of Russia and Sinopharm are touted as the frontrunners in global rollout along with other around 60 vaccine candidates. Prevention of further humanitarian loss and the revival of world economy from the deep recession caused by COVID-19 now largely rests on how these vaccines work effectively. US regulator Food and Drug Administration (FDA) has recently approved the vaccines produced by Pfizer, BionNTech and Moderna in the US. Only recently, Indian regulators also approved AstraZeneca- and Oxford University- made and the one by Bharat Biotech.

Vaccine approval
World Health Organisation (WHO) has also validated the use of Pfizer and BioNTech vaccine for emergency use of late. In line with the global rush of vaccine approval for the disease, Department of Drug Administration (DDA), medicine regulatory agency of Nepal, has also only just approved the one manufactured by Oxford/AstraZeneca. Nepal is eyeing on the possible vaccines that can be secured at the earliest for its needy citizens. It has targeted to vaccinate those above the age of 15 that makes up 72 per cent of the population. While 20 per cent of the total vaccine required is expected to be acquired through COVAX facility, a vaccine alliance co-led by WHO and Gavi, the rest of the requirement has to be borne out from the state coffers.
With the rhetoric of “nobody is safe until everyone is safe” made by WHO Director General Dr. Tedros Adhanom Ghebreyesus in his regular press briefings, Nepal will definitely get a share of vaccine needed for its people sooner or later. So, it’s high time that we took the stock of the preparations the concerned agencies have taken. Legal hurdle has already been cleared by a third amendment to Drug Act-2035 through ordinance to pave the way for the vaccine rollout anytime soon. There have also been talks of preparing cold chain in each state throughout the country for safe delivery of vaccines. The public and private hospitals will likely be allocated as vaccination centres along with camps run similar to during national vaccination programmes.
But there is one aspect of health care facility little talked about which can add significantly to the mass vaccination drive - the community pharmacies. In the vaccine rollout plan envisioned by the Centre for Disease Control and Prevention (CDC) of the US, the pharmacies are at the heart of vaccine distribution throughout the US. As per DDA, there are twenty two thousand odds of pharmacies operating in the country. While some of these pharmacies are operating as an integral unit in hospital or clinic settings, majority are offering their services by remaining in the communities. The community pharmacies are often the first point of contact the patients make. These pharmacies contributed significantly for the health care during the months long lockdown.
These pharmacies kept open when some major hospitals shut their doors fearing COVID-19 contagion. Community pharmacies are so close to the community that they could hardly afford to close. They provided the most essentials like face masks and sanitizers to daily essential pharmaceuticals and seasonal flu vaccines, among others. The government should consider the community pharmacies as one of the vaccination centres as private partners to administer the vaccines. These pharmacies have their robust supply chain that can be relied on for the delivery and administration of the vaccines once they become available. Vaccines such as seasonal flu vaccine and phenumococcal vaccines that require storage and shipment under cool refrigerator condition follow the route from wholesalers to the retail pharmacies.
A roadmap has to be prepared in advance that includes the priority groups to get the inoculation since we are unlikely to have sufficient shots in one go enough for all the target population. Once that is prepared, the community pharmacies can have time to upgrade themselves with additional manpower, storage facilities, ancillary supplies like needles, personal protective equipment (PPE), and documentation for the preparation of database. The early guidance will help establish pharmacies in advance at all local unit levels, as more aspirants will join to assure equitable distribution drive within the country, and this will lay a foundation for future health care services throughout the county.
More than 10,000 odds of pharmacists can push this drive. The aspiring pharmacies shall be made to apply to get the authorisation to work as a vaccination centres, be audited and reviewed by a DDA team. DDA can thus authorise them to work as a vaccination centres upon assurance that they indeed have the facilities and manpower to handle the vaccination. Upon getting authorization, these pharmacies can work in liaison with the local government entities to list the probable vaccine recipients by categorising them into priority basis based on government guidelines. There should be recording and follow ups to assess the efficacy and adverse effects, if any, of the vaccine.

Record keeping
This record keeping will help trace the accurate outcome of the vaccination. Since the vaccination is essentially a phase 4 of the clinical trial, thorough record keeping is a must, and the community pharmacists owing to their knowledge in the field can do so efficiently. The government agencies can get the unbiased outcome of the vaccination from the community pharmacists in years to come. Since the jab may need to be administered twice in the gap of two-three weeks, arrangements shall be made in advance so that all get the proper dosing within the time frame prescribed.
When community pharmacies commit to providing vaccination services, the hospitals can concentrate more on providing in-patient and out-patient services so that those needing health services other than vaccination won’t be left to suffer for the want of care. To avoid the last ditch hustle and bustle, an arrangement and action plan in advance will be crucial and the community pharmacists’ role shall pay dividend in our fight against COVID-19 with the rollout of vaccine shots.

(Baral did his Masters in Pharmaceutical Sciences)