AVAILABILITY AND STORAGE OF VACCINES IN COMMUNITY PHARMACIES

AVAILABILITY AND STORAGE OF VACCINES IN COMMUNITY PHARMACIES

CHAPITRE ONE

INTRODUCTION

1.0 The Study’s Background

Immunization is the process of fortifying an individual’s immune system against an agent (known as the immunogen). When this system is exposed to molecules that are foreign to the body, known as non-self, it will organize an immune response and, as a result of immunological memory, it will gain the ability to promptly respond to a repeat encounter. This is an adaptive immune system function. As a result, by deliberately exposing an animal to an immunogen, its body can learn to protect itself; this is known as active immunization (Okwor et al., 2012).

T cells, B cells, and the antibodies produced by B cells are the most essential components of the immune system that are improved by immunization. Memory B and memory T cells are in charge of responding quickly to a second interaction with a foreign chemical. Passive immunization is the direct delivery of these materials into the body rather than the body producing these elements. Immunization is accomplished through a variety of methods, the most frequent of which is vaccination. Vaccines against pathogenic microorganisms can assist to prepare the body’s immune system, allowing it to fight or prevent an infection. The idea that mutations can cause cancer cells to produce proteins or other compounds recognized by the body serves as the theoretical foundation for therapeutic cancer vaccinations. Other compounds can also be utilized for vaccination, such as nicotine in experimental vaccines (NicVAX) or the hormone ghrelin in studies to develop an obesity vaccine. Immunizations are unquestionably a less hazardous and easier technique to develop immunity to a specific disease by risking a milder form of the disease itself. They are essential for both adults and children since they can protect us from the many diseases that exist.

Some infections and diseases have been nearly eradicated throughout the United States and the world thanks to the use of immunizations. Polio is one such example. Polio has been eradicated in the United States since 1979, thanks to dedicated health care workers and parents who vaccinated their children on time (American Pharmaceutical Association [Apha], 2013). Polio is still present in other regions of the world, therefore some people are still at risk of contracting it. This includes persons who have never had the vaccine, those who have not received all doses of the vaccine, and those traveling to countries where polio is still widespread.

Immunization is the greatest valuable gift a health care provider can offer a kid, and it is still the most cost-effective preventative health measure currently available (South Africa, 2003; Cameroon, 2009). Vaccines are delicate biological chemicals that lose effectiveness over time (World Health Organization [WHO], 1998), and this loss of potency can be increased when stored outside of the recommended temperature range (WHO, 2004). Any reduction of vaccination potency is permanent and irrevocable. As a result, appropriate vaccine storage at the recommended temperature settings is critical to preserving vaccination potency until the time of administration (WHO, 1998).

Prior to the introduction and widespread use of human immunizations, few children survived childhood without contracting a slew of illnesses such as measles, mumps, rubella, chickenpox, whooping cough, and rotavirus diarrhea. In addition to these common childhood diseases, thousands of children each year suffer or die from paralytic poliomyelitis, diphtheria, or bacterial meningitis caused by Haemophilus influenza type b (Hib) or Streptococcus pneumonia (Sutter et al., 1999).

Vaccines are widely regarded as one of the most cost-effective preventive measures against certain diseases, and the Centers for Disease Control and Prevention (CDC) named vaccinations one of the top ten public health achievements of the twentieth century (WHO, 1998), with vaccinations saving millions of lives since their introduction more than 200 years ago (WHO, 2004).

In comparison to other health care professionals, community pharmacists are uniquely placed to provide support and advice to the general public. Most customers have ready access to a pharmacy where health expert assistance is available on demand due to the combination of location and accessibility (Bradshaw et al., 1998). Community pharmacists enjoy a high level of public trust and confidence in their abilities to provide non-prescription medication advice (Pharmacy Research UK., 2009). Despite a global trend toward liberalization of non-prescription markets, pharmacies remain the primary suppliers of non-prescription pharmaceuticals in many countries (Tisman, 2010). Pharmacists are thus in a position to facilitate customer self-care and self-medication, which should be capitalized on.

According to a recent poll of public health officials (Rambhia et al., 2009), pharmacists play an important role in vaccination administration and pandemic planning. According to evidence in the medical literature, pharmacists are particularly positioned to impact previously difficult-to-reach populations (Crawford et al., 2011; Westrick, 2010). According to a review of pharmacy-led vaccination programs (Francis and Hinchliffe, 2011), pharmacies may be more effective in immunizing high-risk, older persons who are more likely to use prescription drugs and hence use pharmacy services. Pharmacist interventions have been found to promote medication adherence (Jiang et al., 2010), provide access to health care expertise and advice, and provide a range of primary care services (Taitel et al., 2011).

In his statement, Rutter (2015) stated that the pharmacy has a long history of facilitating self-care; but, more than ever before, pharmacists and their staffs are being given chances to broaden their contributions, which include participation in routine immunization. Although significant barriers remain, if the community pharmacy is to maximize its potential, it is critical to inquire about pharmacists’ ability and readiness to embrace change, particularly as it relates to vaccine storage (Rutter, 2015).

1.1 Vaccine Types

Vaccines are inactivated or dead organisms, or refined compounds derived from them. Vaccines come in a variety of forms (National Institute of Allergy and Infectious Diseases, 2012). These are various strategies used to try to reduce the risk of illness while still being able to induce a beneficial immune response.

Vaccines that have been inactivated

Some vaccines contain previously virulent microorganisms that have been rendered inactive by chemicals, heat, radiation, or antibiotics. Vaccines for influenza, cholera, bubonic plague, polio, hepatitis A, and rabies are examples.

Vaccines that have been attenuated

Live, attenuated microorganisms are used in several vaccines. Many of these are live viruses that have been cultivated in conditions that have rendered their virulent properties inactive, or that use closely related but less dangerous organisms to elicit a broad immune response. Although most attenuated vaccines are viral in nature, some are bacterial. Yellow fever, measles, rubella, and mumps are viral infections, while typhoid is a bacterial disease. Calmette and Guérin’s live Mycobacterium tuberculosis vaccine does not contain a contagious strain, but rather a virulently modified strain called “BCG” that is used to stimulate an immunological response to the vaccination. For plague immunization, a live attenuated vaccine containing the strain Yersinia pestis EV is utilized. There are various advantages and disadvantages of using attenuated vaccinations. They typically elicit longer-lasting immunological responses and are the preferred type in healthy adults. However, they may not be safe for use in immunocompromised people and may occasionally mutate into a virulent form and cause disease.

Toxoid

Toxoid vaccines are manufactured from inactivated poisonous chemicals that, rather than the microorganism, cause sickness. Tetanus and diphtheria vaccines are two examples of toxoid-based vaccinations. Toxoid vaccinations are well-known for their effectiveness. Not all toxoids are used to kill microorganisms; for example, Crotalus atrox toxoid is used to protect dogs from rattlesnake attacks.

Vaccines for Subunits

Rather than exposing an inactivated or attenuated microorganism to an immune system (as in a “whole-agent” vaccine), a fragment of it can elicit an immunological response. The virus-like particle (VLP) vaccine against human papillomavirus (HPV) is composed of the viral major capsid protein, as well as the hemagglutinin and neuraminidase subunits of the influenza virus. For plague immunization, subunit vaccine is utilized.

Vaccines with Conjugates

Certain bacteria have poorly immunogenic polysaccharide outer coats. By attaching these outer coats to proteins (e.g., toxins), the immune system can be induced to detect the polysaccharide as a protein antigen. This method is employed in the Haemophilus influenzae type B vaccine.

Vaccines in Development

A variety of novel vaccinations are also being developed and used, including;

Vaccines against dendritic cells

They mix dendritic cells with antigens to present the antigens to the body’s white blood cells, triggering an immunological response. These vaccines have showed some promising preliminary results in the treatment of brain tumors (Kim and Liau, 2010) and are also being studied in the treatment of malignant melanoma (Anguille et al., 2014).

Vector Recombinant

Immunity to diseases with complex infection pathways can be produced by combining the physiology of one microorganism and the DNA of another.

Vaccination with DNA

DNA vaccination, which is made from the DNA of an infectious agent, is an experimental technique to vaccination. The postulated method is viral or bacterial DNA insertion (and expression, aided by electroporation, prompting immune system recognition) into human or animal cells. Some immune system cells that recognize the proteins expressed will launch an attack against these proteins and the cells that express them. Because these cells live for a very long time, if the pathogen that normally expresses these proteins is encountered later, the immune system will attack them immediately. One possible advantage of DNA vaccines is their ease of production and storage. DNA vaccination is still experimental and has not been licensed for human usage as of 2015 (Arce-Fonseca et al., 2015).

Vaccines against T-cell receptor peptides

These are being developed for a variety of diseases, including valley fever, stomatitis, and atopic dermatitis. These peptides have been found to improve cell-mediated immunity by modulating cytokine production.

Identification and targeting of bacterial proteins

The suppression of complement by discovered bacterial proteins would counteract the major bacterial virulence mechanism (Meri et al., 2008).

While most vaccines are made from inactivated or attenuated microorganism compounds, synthetic vaccines are made entirely or mostly of synthetic peptides, carbohydrates, or antigens.

Valence

Vaccines can be either monovalent (also known as univalent) or multivalent (also known as polyvalent). A monovalent vaccine is intended to protect against a single antigen or pathogen (Scot, 2004). Sutter et al. (1999) defined a multivalent or polyvalent vaccine as one that immunizes against two or more strains of the same pathogen or against two or more microorganisms. A multivalent vaccine’s valency can be specified by a Greek or Latin prefix (e.g., tetravalent or quadrivalent). In some situations, a monovalent vaccine may be preferred for eliciting a high immunological response quickly (Neighmond, 2010).

Heterotypic

These vaccinations, often known as Heterologous or “Jennerian” vaccines, include pathogens from other animals that either do not cause disease or produce minor disease in the creature being treated. Jenner’s use of cowpox to defend against smallpox is a typical example. The use of BCG vaccine produced from Mycobacterium bovis to protect against human tuberculosis is a recent example (Scot, 2004).

1.2 Obstacles to Vaccine Use in Nigeria

According to recent WHO estimates, nearly to a million children (868,000 children) under the age of five die in Nigeria each year, putting Nigeria second only to India in terms of global yearly childhood fatalities (Ayene, 2014). The persistent low rate of vaccine uptake jeopardizes Nigeria’s efforts to reach MDG 4, which aims to drastically reduce child mortality. Vaccine-preventable fatalities account for approximately 20% of all pediatric deaths (FBA Systems Analyst, 2005). There is little doubt that religion, politics, and a lack of storage facilities are among the biggest hurdles to effective vaccine usage or routine immunization in Nigeria, as stated below.

Politics

Politics is most typically associated with the art and actions used to rule a country or civilization, but it may also be expanded to the practice and philosophy of influencing other people on a civic or individual level with justification (Abdulraheem et al., 2011). Governance include the processes of developing policies to solve many problems, including health issues that arise within a state. Politics is important in the development of the health system in the context of routine immunization. Questions about what policies to implement on health issues like routine immunization have a political undertone (Anyene, 2014). In Nigeria, policies governing the primary health care system, under which routine immunization is carried out, are related to politics. Political concerns such as Local Government Area (LGA) leadership, allocation to LGAs, and so on eventually affect primary health care because that level of government is primarily accountable for it. It is also worth noting that in Nigeria, the politics of routine immunization start at the top, with the Federal Executive Council, the Legislature (NASS), the Minister of Health and the Federal Ministry of Health, the Governors, the Commissioners, and the State Ministries of Health, all the way down to the Local Government Chairmen and all 774 local governments.

Refusal of Routine Immunization

Another issue and obstacle confronting Nigerian immunization programs is the rejection of specific vaccines/vaccination by parents or religious bodies, particularly in the country’s north (Jegede, 2007; Ankarah, 2005). The following are the reasons for such rejection:

Fear and Perplexity

Due to rumors, erroneous information, and fear, many decision-makers and caregivers oppose routine immunization. Attempts to increase coverage must include an understanding of people’s attitudes and their impact on behavior. Many people in Nigeria are concerned about routine immunization. Fathers of partially immunized children in Muslim rural communities in Lagos State see hidden motives linked to nongovernmental organizations (NGOs) sponsored by unknown enemies in developed countries to reduce the local population and increase mortality rates among Nigerians. Belief in a hidden immunization agenda is widespread in Jigawa, Kano, and Yobe States, where many people believe activities are being funded by Western countries seeking to impose population control on local Muslim communities (Feildein, 2005; Yola, 2003).

Low self-esteem and distrust

In many parts of Nigeria, there appears to be a lack of confidence and trust in routine immunization as an effective health intervention (Babalola, 2005). According to a 2003 study in Kano State, 9.2% of respondents (mothers aged 15-49) had “no faith in immunization,” while 6.7% had “fear of side effects.” For many, immunization provides only partial immunity, as seen in Kano and Enugu (Brieger, 2004; Fieldein, 2005). The widespread belief that immunization can prevent all childhood illnesses undermines trust because, when immunization fails to provide such protection, faith in immunization as an intervention for any and all diseases is lost.

Religious Aspects

Nigeria is a deeply religious country, where religion and spirituality pervade all aspects of life. This infiltration does not exclude health-related issues, such as immunization (Anyene, 2009). Some of the ways religion has influenced routine immunization uptake are described below. Religious leaders have propounded and promoted conspiracy theories linking vaccination and fertility control and/or sterilization, particularly in the North, including in states with the lowest immunization coverage rates. According to one idea, polio immunization and other vaccines are part of a Western scheme to sterilize young females and exterminate the Muslim population (Jegede, 2007). In general, the Muslim north has the lowest immunization coverage, with 6% (northwest) and 44.6% (southeast). For example, in Ekiti state (southwest), the northeast and west of Ekiti, which have a higher Islamic influence, have low immunization coverage and low educational attainment (Ophori et al., 2014). Christians have 24.2% vaccine coverage as compared to only 8.8% for Muslims (Ankrah, et al., 2005).

Cultural Practices

Cultural traditions, like religion and politics, play a major role in uptake of routine immunization. Immunization immediately affects the subject of childrearing and child care and these are concerns that have a cultural background. Certain cultural practices though acceptable for many years, have however, been found to be detrimental to immunization uptake, child survival and development. While this has been recognized and efforts to counter detrimental cultural practices are undertaken in different parts of the country, they have not always been successful, partly because these cultural practices are sometimes deeply entrenched and other times because there is insufficient engagement with the community and therefore inadequate sensitivity to the issues and education on their harms.

One such cultural practice which happens in Yobe State is that a lady should remain indoors for 40 days after giving birth. This precludes her from receiving both postnatal-care for herself and immunization services for her newborn (Rafau, 2004). In certain cultures, bearing babies at home is still the norm. In such situations, the opportunities for immunization, especially the early ones such as BCG and OPV1, given right after birth and six weeks after respectively, may be missed (Ubajaka, et al., 2012).

In some cultures, a husband’s consent is required in order for a woman, often the primary caregiver, to leave the house as well as to offer any sort of medical treatment or receive any health services for the child (Mongono, 2013). Cultural practices and beliefs may be responsible for some of the inequalities in vaccine uptake. For instance, males are more likely to obtain full immunization compared to girls, stressing cultural attitudes regarding gender, where male offspring are frequently more highly respected and wanted than females. However, it has been stated that the disparity is generally not significant. These gender discrepancies also affect schooling. Males are more likely than females in some locations to have had access to schooling. According to studies, the more educated a mother is, the more likely her children will be inoculated (Babaloloa, 2006). Concerns about the need for immunization remain widespread in Katsina and other Northern states. There is some debate about why an otherwise healthy infant should be given an injection. This raises skepticism and blinds minds to the true benefits of immunization. The same care and consistency that was used to address the impact of religion on vaccine-related issues should be used to address cultural difficulties. It is critical to understand cultural ideas and practices in order to develop and implement appropriate engagement, education, and other strategies.

Poverty

The poorer the parents, the more probable it is that they will fail to immunize their children (FBA, Systems Analyst, 2005), increasing morbidity and death while further impoverishing the families and creating a vicious circle. Even though immunization is free, some people still pay for things like transportation for health workers who visit patients in remote areas. This receipt must be presented before immunization may take place. Many parents are unable to pay these fees and hence do not bring their children for immunization (Oluwadare, 2012). The failure of governments to address poverty issues and implement effective poverty alleviation programs has a negative impact on routine immunization rates in Nigeria.

1.3 Vaccination and the Pharmacist

One major reason of vaccine failure is the use of weak or impotent vaccine, which is usually due to inappropriate storage (Rathore, 1987). All vaccines must be kept in a cold chain network, according to the Canadian National Vaccine Storage and Handling Guidelines for Immunization Providers, 2007. The Cold Chain refers to preserving a vaccine’s effectiveness and integrity by providing optimal conditions during storage, handling, and shipping. From manufacturing to administration, this process involves stakeholders, equipment, and facilities and is meant to ensure that adequate storage temperatures and light protection are maintained at all times.

According to a 2013 report by the American Pharmaceutical Association, all 50 states in the United States have approved the engagement of pharmacists in routine vaccines. Similarly, as stated by Wei et al., (2016), the involvement of pharmacists in Manitoba Canada contributed to the efficacy of routine influenza virus vaccine.

In a country like Nigeria, where electricity or power supply is scarce and vaccines are also handled by untrained staff who are unaware of the importance of a cold chain system in vaccine storage, difficulties must undoubtedly exist (Okwor et al., 2009). Excessive cold, heat, or light will cause a cumulative and irreversible loss of efficacy. The Cold Chain requires that refrigerated vaccines be kept at a temperature between +2°C and +8°C, and frozen vaccines be kept at -15°C or lower. Light protection is required for light sensitive vaccinations. The pharmacist’s role in the Cold Chain is to keep it intact by receiving, handling, and transporting vaccines properly, including the proper use and management of equipment, refrigerators, thermometers, temperature monitoring devices, transport coolers, insulation supplies, and ice packs (Public Health Agency of Canada [PHAC], 2007).

1.4 General Recommendations for Safe Vaccine Storage and Handling in a Pharmacy (PHAC, 2007)

Temperature

Thermostats should never be used to monitor temperature since they may not accurately measure the temperature at which vaccinations are stored. It is advised that extra thermometers be placed within the unit next to the vaccines on the storage shelf and utilized for monitoring purposes. Every refrigerator reading should also include a check of the room temperature. The refrigerator compartment should be set at +5°C, which is mid-range and allows for adequate temperature changes, to provide the best safety margin for temperature swings within the +2°C to +8°C range. The freezer temperature should be set at -15°C or lower. Each compartment’s temperature must be checked at least twice a day, once in the morning when the door is opened for the first time and once at the end of the day immediately before the door is closed for the last time. The thermometer should be placed so that it does not need opening the fridge to read the temperature (CDC, 2015).

Vaccines, both refrigerated and frozen

Heat sensitive vaccines suffer an irreversible and cumulative loss of potency when the cold chain is broken, whereas cold sensitive vaccines suffer an immediate loss of efficacy when frozen. Vaccines should never be stored on the side of the door or in the vegetable crisper bins, but always on the middle rack in the center of the refrigerator or freezer.

How to Change the Temperature

The temperature should be modified if it is already outside the recommended range or if temperature trends show that it is approaching the higher or lower temperature limit. Only the designated vaccination coordinator should modify the temperature, and any additional staff who observes the unit needs to be adjusted should notify the vaccine coordinator. When adjusting the freezer temperature, keep in mind that the temperature of the air venting into the fridge compartment may change. A warning sign should be placed on the appliance that says, “DO NOT adjust refrigerator or freezer temperature controls.”

Determine whether it is required to remove all vaccines and store them properly when adjusting the temperature. Check the temperatures in the refrigerator and freezer and make minor adjustments to the thermostat. Adjustments should be made gradually, taking care not to exceed the prescribed temperature range. The temperature within the unit may take about a half hour to settle before being rechecked. Continue to adjust the thermostat every half hour as needed, but make sure the temperature within the device has stabilized before reintroducing the immunizations.

Temperature Variation Influencing Factors

Many factors can affect the temperature of vaccines inside a refrigerator or freezer. The only approach to ensure temperature stability is to test twice daily and record the results. Temperatures in the storage container can vary depending on the contents or load, the seasonal temperature, how frequently the door is opened or left ajar, and power outages. It is advised not to open the door more than four times each day because this exposes the immunizations to temperature changes.

Maintenance and Equipment

a. Thermometers

Because thermometer calibrations and accuracies differ, ask the manufacturer for the accuracy of your specific thermometer, ensuring it has a calibration accurate within +/- 1°C. The only thermometers approved for household vaccine storage units are adequately monitored min/max thermometers. These thermometers constantly monitor the temperature and can tell you how long the item has been operating outside of the recommended temperature range. Min/max thermometers must still be checked twice daily. Keep track of the current temperature as well as the minimum and maximum temperatures since the last reset. To clear the min/max temperatures, the thermometer must be reset after each reading. Regardless of whether you store a large or small supply of vaccines in your unit, you may wish to use an alerted min/max thermometer to guarantee there are no after-hours breaches in the cold chain that go unreported until the next day. Always record and save daily thermometer readings and keep them on hand in case of a cold chain incident. Keep the temperature logs for two years in case of a review.

The positioning of the thermometer is also critical! They should be placed in the unit’s center, away from the walls, door, or fan, and next to the vaccines in the vaccine box on the middle shelf.

Backup Resources

Always assume that vaccine storage equipment will fail. Make arrangements for a backup generator or another location with appropriate equipment where the vaccines can be temporarily housed.

Tasks for daily, weekly, quarterly, and annual equipment maintenance

Regular maintenance of all equipment is needed to ensure optimal performance and prevent equipment faults. It is just as crucial to keep track of whether or not maintenance chores have been accomplished. Always keep track of when the equipment was installed, when repairs and routine cleaning activities were completed, the manufacturer’s recommendations for routine maintenance, and the service provider’s contact information.

1.5 Pharmacists’ Role in Vaccine Adoption

Various factors can help or hinder the process of effective utilization and successful routine immunization. One of these factors is the potential role of community pharmacists. These functions are multifaceted and will be described further below.

Vaccine educators: pharmacists

Patients can get vital information from community pharmacists. As vaccine educators, pharmacists educate and advise patients on the importance and necessity of receiving immunizations. Physician perspectives on the community pharmacist’s role in patient advocacy include assisting physicians in monitoring pharmacotherapy and providing patient counseling and medical information (Bradshaw and Doucette, 1998; Owens et al., 2009). This view of community pharmacists as information sources includes the coordination and education regarding the importance of receiving routine and recommended vaccinations, as well as the vaccine product itself. As previously noted, pharmacists have been trained in clinical services and patient communication; it is only natural that they use this training to advocate for immunizations. Patient vaccine information, screening, and recommendations offered by pharmacists have been demonstrated to boost immunization rates (Fuchs, 2006).

Pharmacists have been effective vaccination instructors, assessing patients and making recommendations to patients and providers. Community pharmacists, as providers of pharmaceutical therapy management and a source of patient medication records, can identify individuals at risk for vaccine-preventable diseases using pharmacy data and patient interviews (Kassam et al., 2001). Community pharmacists also educate the community through public awareness campaigns and the distribution of material on the importance of vaccination and where to obtain it. Community pharmacists on the Isle of Wight, England, vaccinated 9.7% of all patients who received influenza vaccine on the island during the 2010-2011 influenza seasons by scanning pharmacy records, distributing vaccine material, and promoting vaccination. They also discovered that two-thirds of these immunizations were initiated as a result of a pharmacy staff reminder (Warner et al., 2013). Similar findings have been reported for pharmacist-led initiatives for the zoster vaccine. When compared to when there was no pharmacist intervention, pharmacists and pharmacy staff who promoted the zoster vaccine and provided personal selling and patient education were able to increase the number of zoster vaccinations (Teetre et al., 2014; Wang et al., 2013).

Vaccine Facilitators: Pharmacists

Initially, pharmacists’ involvement in immunizations was limited to the distribution of vaccine products and the hosting of immunization providers in their pharmacy. Community pharmacists enabled immunizations administered by other health care providers, such as physicians and nurses, by making their pharmacies available as locations to administer vaccines. Hosting other providers was often limited to 2-3 days throughout the fall and for a few hours at each event. The revenue earned by such events was likewise retained by the vaccine providers, and the pharmacy benefited from goodwill and collateral sales (Grabenstein, 1998). With all states now enabling pharmacists to immunize, modern community pharmacists are now using their pharmacies to host their own immunization clinics all year. This shift from distributors or facilitators to complete providers of immunizations may explain the paucity of literature on pharmacists’ roles as vaccine facilitators and distributors.

Pharmacies, as vaccine distributors, help other providers give immunizations by ordering and distributing vaccine goods to physicians and medical clinics. A random sampling of community pharmacies from 17 states revealed that approximately one in every five pharmacies engaged in vaccine distribution by reselling or distributing vaccinations to local physicians and/or clinics (Hung et al., 2007).

The pharmacist’s function as a facilitator increases immunization rates by increasing access to vaccine supplies and the areas where these providers can administer immunization services. Pharmacists in this role also assist other providers in increasing their vaccine options and rates of immunization. While community pharmacists no longer serve in the original defined role of facilitators (hosting other providers of immunizations), serving as facilitators was critical in the progression of community pharmacists to immunizers by introducing the public to the concept of vaccination delivery in the pharmacy setting. It is advised that pharmacists serve as vaccine facilitators to trial immunization services in the pharmacy and expose the public and health system to vaccine delivery occurring in the community pharmacy for countries wanting to introduce pharmacy-based immunization delivery services.

Immunizers: Pharmacists

According to the APhA Annual Pharmacy-Based Influenza and Adult Immunization Survey 2013, 86% of community pharmacy settings administer immunizations. With pharmacists permitted to administer vaccinations in all 50 states, the most effective and efficient pharmacist position for providing vaccination services is to function as an immunizer (AphA, 2013). Pharmacists who are active immunizers analyze patients for indications and contraindications and give vaccines directly to the people they serve. Immunizing pharmacists adhere to the recommendations and immunization schedules established by the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention (CDC, 2015). In a review of interventions to increase influenza and pneumococcal vaccination rates among community-dwelling adults, results revealed that pharmacist interventions were ineffective when pharmacists only provided reminders to physicians and did not administer the vaccine themselves. By merging the responsibilities of vaccine educator and immunizer, pharmacists are able to provide comprehensive and successful vaccination services.

There is a wealth of material supporting the function and impact of community pharmacists as immunizers. Community pharmacy-based immunization services are a low-cost, convenient, and easily accessible option for the general people to acquire immunizations (Levi et al., 2010). As previously indicated, one of the most significant impediments to immunization is access. Pharmacists can quickly act on their suggestions (administer the vaccine to the patient) without referring the patient elsewhere, where the patient may not follow through or forget. With increased access, pharmacists have helped to improve immunization rates, bring patients up to date on vaccinations, and reach those who might not otherwise be vaccinated (Goad, 2013; Warner et al., 2013; Hung et al., 2007).

1.6 Statement of the Problem

More than 40,000 to 50,000 adult and child deaths in Nigeria may have been avoided if routine immunization for certain avoidable diseases such as measles, herpes zoster, tetanus, and a variety of others had been successful (Abdhuraheem et al., 2011). The federal government and donor agencies invest nearly $50 billion annually in the vaccine supply chain, but when these funds are spent and the purpose for which they are spent is not met due to decreased potency of such vaccines or insufficient manpower for vaccine delivery to the target population, it can be considered an investment in futility. Because these widely available vaccines are underutilized, pharmacists have an opportunity to help improve immunization rates and thus advance public health. Community pharmacy-based vaccination programs will help to increase the number of immunization providers and locations where patients can receive vaccines. It is thus critical to comprehend the current role of community pharmacy-based immunization in Delta state, as well as to assess the level of availability of such vaccines in community pharmacies, as well as the storage mechanisms and facilities available to them in order to maintain the cold chain vaccine delivery process.

1.7 Study Justification

The study’s premise stems from the fact that, due to Nigeria’s inconsistent power supply, vaccines have a high risk of losing their efficacy before being delivered to the target population. To keep immunization relevant, immunization providers must devise ways to keep vaccines in the proper storage conditions from transit to storage and eventual distribution to patients. This study is still relevant since vaccine storage is a key aspect that can affect vaccine potency as well as the success of any immunization program. In addition, vaccination availability in community pharmacies is critical in situations of envenomation by rodents, snakes, and other dangerous species. It is also crucial in increasing vaccination uptake among individuals who may be susceptible to vaccine-preventable diseases. As a result, it is critical to ascertain the current state of vaccination availability and storage facilities. Keeping this in mind, a thorough search of the literature reveals a high level of involvement of community pharmacists in routine immunizations in developed countries such as the United States, Canada, the United Kingdom, and Australia. However, there is limited literature on vaccine storage practices as well as the involvement of community pharmacists in immunization programs in Nigeria, which this study hopes to fill.

1.8 Goals of Research

The goal of this study is to determine the availability and storage of vaccines in Delta state community pharmacies.

Particular Goals

The following are the study’s particular objectives:

To find out if kid immunizations are available in community pharmacies.

To find out if adult immunizations are available in community pharmacies.

To evaluate the availability and sufficiency of vaccine storage facilities in community pharmacies.

To investigate the factors that influence vaccination availability and storage in Delta state.

To investigate the factors that influence community pharmacists’ participation in regular immunization in Delta State.