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privacy protections provided when dispensing a prescription should also be provided when giving a vaccine. Additional privacy may be required for patients who need to partially dis- robe to allow for visualization of the entire vaccine target area. VAERS The Vaccine Adverse Event Reporting System (VAERS) is a program co-managed by the CDC and the United States Food and Drug Administration (FDA). This program monitors adverse events that occur after a vaccination. It is important to note that not all adverse events that happen after a vacci - nation is due to the vaccination itself, but this program can determine if further research is needed. For example, con- sider two patients who each receive an influenza vaccine. The first patient has a sore arm at the site of injection. The second patient had a heart attack while shoveling snow. Both adverse events are reported to VAERS. The report of a sore arm is something that the system expects, but the heart attack would be uncommon. The CDC and FDA would look for other reports of cardiac issues following influenza vaccinations to determine if the heart attack were related to the vaccina - tion or was merely a tragic event that would have occurred with a vaccine or not. Researchers often refer to these events as the difference between causation and coincidence. For very rare side effects (those effects caused by the vaccina- tion), it may take millions of vaccinations to find a pattern. The VAERS program can find these patterns and alert health care providers to cautions and contraindications to vaccination. A federal requirement states that some adverse events must be reported if the person administering the vaccine is aware that
they occurred. Some of these reportable events include ana- phylaxis, encephalitis following a pertussis containing vaccine, chronic arthritis following a rubella containing vaccine, intus- susception following a rotavirus vaccine, or SIRVA following an intramuscular deltoid injection. A full listing of reportable events may be found at https://vaers.hhs.gov/resources/VAERS_ Table_of_Reportable_Events_Fol lowing_Vaccinat ion.pdf Work-Place Safety Several work-place safety issues will impact the safety or risk management for the business. Is there sufficient lighting to guarantee that the vaccine administration process is safe and can follow the 5 Rights? Have all vaccine administrators been trained about blood borne pathogens? After all, Blood Borne Pathogen training is an annual requirement. Does the workplace have a coordinated method for tracking this annual training? Have all people with a reasonable expectation of expo- sure to human blood—the administering members of the health care team and perhaps staff who are responsible for sanitizing the vaccination areas--been offered the Hepatitis B vaccine? If the vaccine was requested, has the series been completed BEFORE the member of the health care team has an expo- sure to human blood? Facilities using needles for injection are required to have needle stick policies, including a needle stick log and an evaluation of any needle sticks. Additionally, facilities are required to use safety needles for all human injections and to have a committee that determines which safety devices will be used. This committee must include professionals who are using the devices. Pharmacy technicians who administer vaccines by injection are eligible to serve on this decision-making body.
P O P U L A T I O N & P U B L I C H E A L T H S A F E T Y
Herd Immunity Recently, media reports have used the term “herd immunity” in relation to people getting an infection and recovering. The assumption is that those who recover will be immune from the condition. That may, in fact, have been the original Darwin-like description of those animals that survived a variety of dis- eases. Today, however, scientists use the term “herd immunity” to describe the protection that is offered to people who cannot be vaccinated. Science uses the agri-business description of protecting the “herd” by vaccinating a critical number of the members of that herd. Let’s say that there are 100 head of cattle in a herd. They are roaming freely across grasslands and only 93 are located and vaccinated. The remaining seven are protected because the 93 that were vaccinated cannot carry or transmit the disease. When describing herd immunity in relation- ship to vaccine preventable diseases, the goal is to vaccinate a large enough percentage of the population to protect those who cannot be vaccinated. There are a variety of reasons why someone cannot be vaccinated: no vaccine available, allergic reaction, current contradictory drug therapy, too young to be vac- cinated, existing disease, or pregnancy. In order to protect these vulnerable patients, those who are eligible to be vaccinated
need to be vaccinated to protect the entire “herd” or community. Herd immunity can only be attained by vaccinating a suf- ficient number of people. For some diseases, the percent of the population who need to be vaccinated to achieve herd immunity for the rest has been calculated. For exam- ple, 95% of the population must be vaccinated against measles to protect the remaining 5% against this deadly disease. Diphtheria requires approximately 85% of the popu- lation to be vaccinated to prevent the spread of this disease. However, science has not yet calculated the vaccination rate needed to provide herd immunity against SARS-CoV-2. As rates of childhood vaccinations drop, the potential for a community, a state, or the country to lose herd immunity becomes a very real possibility. Pharmacies, pharmacists, and pharmacy technicians can help protect the public by advo- cating for vaccinations and being trained to provide them. Table 2 demonstrates that the United States is perilously close to losing herd immunity for a number of infectious dis- eases currently controlled with vaccines and herd immunity. Vaccination rates for measles and pertussis have fallen below optimal for protection of those who cannot receive vaccines.
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